Disorders - Anxiety Disorders
Parker, B., Turner, W.
Background: The sexual abuse of children and adolescents is a significant worldwide problem. It is associated with a wide variety of negative psychological, social and physical consequences for the victims. These effects can often be seen immediately following sexual abuse, but they may manifest later on and sometimes only in adult life. There are a number of different interventions aimed at helping children and adolescents who have been sexually abused, and psychoanalytic/psychodynamic psychotherapy has a long-established tradition of being used for such victims. In this review, we set out to find the evidence for its effectiveness specifically in children and adolescents who have been sexually abused. Objectives: To assess the effectiveness of psychoanalytic/psychodynamic psychotherapy for children and adolescents who have been sexually abused. Search methods: We searched the following databases in May 2013: CENTRAL, Ovid MEDLINE, Embase, PsycINFO, CINAHL, Sociological Abstracts, Social Science Citation Index, Conference Proceedings Citation Index - Social Science and Humanities, LILACS and WorldCat. We also searched three trials registers, checked the reference lists of relevant studies and contacted known experts. Selection criteria: Randomised and quasi-randomised trials comparing psychoanalytic/psychodynamic psychotherapy with treatment as usual or no treatment/waiting list control for children and adolescents up to age of 18 who had experienced sexual abuse at any time prior to the intervention. Data collection and analysis: The review authors (BP and WT) independently screened search results to identify studies that met eligibility criteria. Main results: No studies were identified that met the inclusion criteria for this review. Authors' conclusions: There are no randomised and quasi-randomised trials that compare psychoanalytic/psychodynamic therapy with treatment as usual, no treatment or waiting list control for children and adolescents who have been sexually abused. As a result, we cannot draw any conclusions as to the effectiveness of psychoanalytic/psychodynamic psychotherapy for this population. This important gap emphasises the need for further research into the effectiveness of psychoanalytic/psychodynamic psychotherapy in this population. Such research should ideally be in the form of methodologically high-quality, large-scale randomised controlled trials. If these are not conducted, future systematic reviews on this subject may need to consider including other lower quality evidence in order to avoid overlooking important research. Copyright © 2013 The Cochrane Collaboration.
Cochrane Database of Systematic Reviews, 2013 (7) (no pagination)(CD008162) :
- Year: 2013
- Problem: Anxiety Disorders (any), Post Traumatic Stress Disorder, Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Psychodynamic/Psychoanalysis
Bennett, Kathryn, Manassis, Katharina, Walter, Stephen D, Cheung, Amy, Duda, Stephanie, Rice, Maureen, Baer, Susan, Barrett, Paula, Bodden, Denise, Cobham, Vanessa E., Dadds, Mark R., Ginsburg, Golda, Heyne, David, Hudson, Jennifer L., Kendall, Philip C., Liber, Juliette, Warner, Carrie Masia, Mendlowitz, Sandra, Nauta, Maaike H., Rapee, Ronald M., Silverman, Wendy, Siqueland, Lynne, Spence, Susan H, Utens, Elisabeth, Wood, Jeffrey J.
Background: Investigations of age effects on youth anxiety outcomes in randomized trials (RCTs) of cognitive behavior therapy (CBT) have failed to yield a clear result due to inadequate statistical power and methodologic weaknesses. We conducted an individual patient data metaanalysis to address this gap. Question: Does age moderate CBT effect size, measured by a clinically and statistically significant interaction between age and CBT exposure? Methods: All English language RCTs of CBT for anxiety in 6 - 19 year olds were identified using systematic review methods. Investigators of eligible trials were invited to submit their individual patient data. The anxiety disorder interview schedule (ADIS) primary diagnosis severity score was the primary outcome. Age effects were investigated using multilevel modeling to account for study level data clustering and random effects. Results: Data from 17 of 23 eligible trials were obtained (74%); 16 studies and 1,171 (78%) cases were available for the analysis. No interaction between age and CBT exposure was found in a model containing age, sex, ADIS baseline severity score, and comorbid depression diagnosis (power ≥ 80%). Sensitivity analyses, including modeling age as both a categorical and continuous variable, revealed this result was robust. Conclusions: Adolescents who receive CBT in efficacy research studies show benefits comparable to younger children. However, CBT protocol modifications routinely carried out by expert trial therapists may explain these findings. Adolescent CBT protocols are needed to facilitate the transportability of efficacy research effects to usual care settings where therapists may have less opportunity for CBT training and expertise development. (PsycINFO Database Record (c) 2013 APA, all rights reserved). (journal abstract)
Depression & Anxiety, 30(9) : 829-841
- Year: 2013
- Problem: Anxiety Disorders (any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Bussell, J.
Objective: The purpose of this study was to investigate whether acupuncture can improve memory and reduce anxiety.; Design, Setting and Subjects: A two-group, randomized, single-blind study involving 90 undergraduate university students was conducted from January to December of 2011.; Interventions: Subjects completed the State-Trait Anxiety Inventory (STAI) form Y-1 (State Anxiety, SA) and Y-2 (Trait Anxiety, TA). Then, each subject lay on a treatment table for 20 minutes. The acupuncture group had needles inserted into select acupoints; control subjects did not. Subjects then completed the STAI form Y-1 again, after which they completed the Automated Operation Span Task (AOSPAN) - a computerized test of working memory.; Main Outcome Measures: Performance on the AOSPAN and the STAI scores were the main measures of the outcomes.; Results: The acupuncture group scored 9.5% higher than the control group on the AOSPAN Total Correct Score (65.39 vs. 59.9, p=0.0134), and committed 36% fewer math errors (2.68 vs. 4.22, p=0.0153). Acupuncture subjects also reported lower SA after intervention than control subjects (26.14 vs. 29.63, p=0.0146).; Copyright © 2013. Published by Elsevier B.V.
Journal of Acupuncture & Meridian Studies, 6(5) : 241-246
- Year: 2013
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Acupuncture, acupressure
Cavanagh, K., Strauss, C., Cicconi, F., Griffiths, N., Wyper, A., Jones, F.
Objectives: There is growing evidence that mindfulness has positive consequences for both psychological and physical health in both clinical and non-clinical populations. The potential benefits of mindfulness underpin a range of therapeutic intervention approaches designed to increase mindfulness in both clinical and community contexts. Self-guided mindfulness-based interventions may be a way to increase access to the benefits of mindfulness. This study explored whether a brief, online, mindfulness-based intervention can increase mindfulness and reduce perceived stress and anxiety/depression symptoms within a student population. Method: One hundred and four students were randomly allocated to either immediately start a two-week, self-guided, online, mindfulness-based intervention or a wait-list control. Measures of mindfulness, perceived stress and anxiety/depression were administered before and after the intervention period. Results: Intention to treat analysis identified significant group by time interactions for mindfulness skills, perceived stress and anxiety/depression symptoms. Participation in the intervention was associated with significant improvements in all measured domains, where no significant changes on these measures were found for the control group. Conclusions: This provides evidence in support of the feasibility and effectiveness of shorter self-guided mindfulness-based interventions. The limitations and implications of this study for clinical practice are discussed. (copyright) 2013 Elsevier Ltd.
Behaviour Research & Therapy, 51(9) : 573-578
- Year: 2013
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Mindfulness based therapy, Technology, interventions delivered using technology (e.g. online, SMS)
Chan, Ee Suen, Koh, David, Teo, Yan Choo, Hj-Tamin, Rozita, Lim, Alice, Fredericks, Salim.
Background: Qigong, a traditional Chinese exercise, has a potential role in the management of stress.; Objective: To examine the influence of Qigong training on depression, anxiety and stress.; Design: A randomised control trial among first year student participants.; Methods: Qigong was practised twice a week by the study group (n = 18) while a control group (n = 16) had no intervention. The Depression, Anxiety and Stress (DASS-21) and Patient Health Questionnaires (PHQ) were administered. Salivary biomarkers were also measured over a 10-week period.; Results: After 10 weeks, only the Qigong group showed a statistically significant improvement in their depression, anxiety and stress scores. Similarly, increases in secretion rates of salivary immunoglobulin-A, and decreases in salivary cortisol concentrations were seen only in the Qigong group.; Conclusions: The practice of Qigong improves psychological states and mucosal immunity; as indicated by psychometric tests and biochemical markers of stress.; Copyright © 2013 Elsevier Ltd. All rights reserved.
Complementary Therapies in Clinical Practice, 19(4) : 179-183
- Year: 2013
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Mind-body exercises (e.g. yoga, tai chi, qigong)
Chandla, S. S., Sood, S., Dogra, R., Das, S., Shukla, S. K., Gupta, Sanjay
There has been an increasing interest in pranayamic breathing exercises which have been known to improve the quality of life. Present study was conducted to find out the effect of Bhastrika and Anulom Vilom Pranayam and yogasana on heart rate variability, general well being, cognition and anxiety levels of the medical students. Ninety-six medical students were randomly divided into two groups. One group performed Bhastrika and Anulom Vilom Pranayam and the second Suryanamaskar for six weeks. The subjects were made to fill in PGI memory scale, Hamilton- anxiety scale and psychological general well being schedule and recording of heart rate variability parameters was done, before and after six weeks of pranayam practice. The results showed highly significant increase in high frequency (HF) components of heart rate variability and decrease in low frequency (LF) components and LF/HF inthe group practising pranayam. There was also highly significant improvement of cognition, general well being and anxiety as shown by the PGI memory scale, Hamilton- anxiety scale and psychological general well being schedule scores in this group. In the yogasana group no significant changes were observed in the heart rate variability, cognition and anxiety although psychological general well being schedule scores significantly improved after six weeks practice of yogasana. The study shows that practice of slow breathing type of pranayam for six weeks improves cognition, anxiety and general well being and Increases the parasympathetic activity. Whereas there was no effect of the yogasana on the above parameters except improvements in the general well being.;
Journal of the Indian Medical Association, 111(10) : 662-665
- Year: 2013
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Mind-body exercises (e.g. yoga, tai chi, qigong)
Britton, Jennifer C., Bar-Haim, Yair, Clementi, Michelle A., Sankin, Lindsey S., Chen, Gang, Shechner, Tomer, Norcross, Maxine A., Spiro, Carolyn N., Lindstrom, Kara M., Pine, Daniel S.
Attention Bias Modification Treatment (ABMT), an emerging treatment for anxiety disorders, is thought to modify underlying, stable patterns of attention. Therefore, ABMT research should take into account the impact of attention bias stability on attention training response, especially in pediatric populations. ABMT research typically relies on the dot-probe task, where individuals detect a probe following an emotional-neutral stimulus pair. The current research presents two dot-probe experiments relevant to ABMT and attention-bias stability. In Experiment 1, anxious youth receiving 8-weeks of cognitive-behavioral therapy (CBT) were randomly assigned to ABMT that trains attention towards happy faces (n=18) or placebo (n=18). Two additional comparison groups, anxious youth receiving only CBT (n=17) and healthy comparison youth (n=16), were studied. Active attention training towards happy faces did not augment clinician-rated response to CBT; however, individuals receiving training exhibited reductions on self-report measures of anxiety earlier than individuals receiving CBT only. In Experiment 2, healthy youth (n=12) completed a dot-probe task twice while undergoing functional magnetic resonance imaging. Intra-class correlation demonstrated stability of neural activation in response to attention bias in the ventrolateral prefrontal cortex and amygdala. Together, these two studies investigate the ways in which attention-bias stability may impact future work on ABMT.; Copyright © 2012 Elsevier Ltd. All rights reserved.
Developmental Cognitive Neuroscience, 4 : 52-64
- Year: 2013
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Attention/cognitive bias modification
Blanco, Carlos, Bragdon, Laura B., Schneier, Franklin R., Liebowitz, Michael R.
Social anxiety disorder (SAD) is a highly prevalent and often disabling disorder. This paper reviews the pharmacological treatment of SAD based on published placebo-controlled studies and published meta-analyses. It addresses three specific questions: What is the first-line pharmacological treatment of SAD? How long should treatment last? What should be the management of treatment-resistant cases? Based on their efficacy for SAD and common co-morbid disorders, tolerability and safety, selective serotonin reuptake inhibitors (SSRIs) and venlafaxine should be considered the first-line treatment for most patients. Less information is available regarding the optimal length of treatment, although individuals who discontinue treatment after 12-20 wk appear more likely to relapse than those who continue on medication. Even less empirical evidence is available to support strategies for treatment-resistant cases. Clinical experience suggests that SSRI non-responders may benefit from augmentation with benzodiazepines or gabapentin or from switching to monoamine oxidase inhibitors, reversible inhibitors of monoamine oxidase A, benzodiazepines or gabapentin. Cognitive-behavioural is a well-established alternative first line therapy that may also be a helpful adjunct in non-responders to pharmacological treatment of SAD.;
International Journal of Neuropsychopharmacology, 16(1) : 235-249
- Year: 2013
- Problem: Anxiety Disorders (any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Anxiolytics including benzodiazepines
Dundas, Ingrid, Hagtvet, Knut A., Wormnes, Bjorn, Hauge, Helge
This study examined whether self-hypnosis could enhance a cognitive-behavioral (CB) intervention against test anxiety. Students seeking help for test anxiety at the student welfare service (mean age = 24.7 years) received one group session of a CB intervention and were then randomized to either two sessions of the same CB intervention (CB only, N = 39) or two sessions of self-hypnosis training designed to enhance the CB intervention (CB with self-hypnosis, N = 34). Anxiety and self-confidence measures were administered at recruitment and 3 days prior to the student's exam, subsequent to the intervention. A comparison group of students who had not sought help completed the same questionnaires at the same time points relative to their exams (non-help-seeking group, N = 85). Self-hypnosis training did not add to the effectiveness of the CB intervention. On the contrary, the CB intervention was more effective without self-hypnosis on three measures: test anxiety, state anxiety and self-esteem. We suggest that self-hypnosis for test anxiety might be better reserved for students not responding to a CB-only intervention, or who clearly prefer a self-hypnosis intervention. (PsycINFO Database Record (c) 2013 APA, all rights reserved). (journal abstract)
Nordic Psychology, 65(3) : 224-241
- Year: 2013
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other Psychological Interventions
Farrer, L., Gulliver, A., Chan, J. K., Batterham, P. J., Reynolds, J., Calear, A., Tait, R., Bennett, K., Griffiths, K. M.
Mental disorders are responsible for a high level of disability burden in students attending university. However, many universities have limited resources available to support student mental health. Technology-based interventions may be highly relevant to university populations. Previous reviews have targeted substance use and eating disorders in tertiary students. However, the effectiveness of technology-based interventions for other mental disorders and related issues has not been reviewed. To systematically review published randomized trials of technology-based interventions evaluated in a university setting for disorders other than substance use and eating disorders. The PubMed, PsycInfo, and Cochrane Central Register of Controlled Trials databases were searched using keywords, phrases, and MeSH terms. Retrieved abstracts (n=1618) were double screened and coded. Included studies met the following criteria: (1) the study was a randomized trial or a randomized controlled trial, (2) the sample was composed of students attending a tertiary institution, (3) the intervention was delivered by or accessed using a technological device or process, (4) the age range of the sample was between 18 and 25 years, and (5) the intervention was designed to improve, reduce, or change symptoms relating to a mental disorder. A total of 27 studies met inclusion criteria for the present review. Most of the studies (24/27, 89%) employed interventions targeting anxiety symptoms or disorders or stress, although almost one-third (7/24, 29%) targeted both depression and anxiety. There were a total of 51 technology-based interventions employed across the 27 studies. Overall, approximately half (24/51, 47%) were associated with at least 1 significant positive outcome compared with the control at postintervention. However, 29% (15/51) failed to find a significant effect. Effect sizes were calculated for the 18 of 51 interventions that provided sufficient data. Median effect size was 0.54 (range -0.07 to 3.04) for 8 interventions targeting depression and anxiety symptoms and 0.84 (range -0.07 to 2.66) for 10 interventions targeting anxiety symptoms and disorders. Internet-based technology (typically involving cognitive behavioral therapy) was the most commonly employed medium, being employed in 16 of 27 studies and approximately half of the 51 technology-based interventions (25/51, 49%). Distal and universal preventive interventions were the most common type of intervention. Some methodological problems were evident in the studies, with randomization methods either inadequate or inadequately described, few studies specifying a primary outcome, and most of the studies failing to undertake or report appropriate intent-to-treat analyses. The findings of this review indicate that although technological interventions targeting certain mental health and related problems offer promise for students in university settings, more high quality trials that fully report randomization methods, outcome data, and data analysis methods are needed.
Journal of Medical Internet Research, 15(5) : e101
- Year: 2013
- Problem: Anxiety Disorders (any)
- Type: Systematic reviews
-
Stage: Universal prevention
, At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Technology, interventions delivered using technology (e.g. online, SMS)
Horigian, Viviana E., Weems, Carl F., Robbins, Michael S., Feaster, Daniel J., Ucha, Jessica, Miller, Michael, Werstlein, Robert
Background and Objectives: Research shows that interventions for substance use disorders may be helpful in reducing internalizing disorders in adolescents. This paper examines the prevalence and reductions of anxiety and depression symptoms among youth receiving substance use treatment.; Methods: Four hundred eighty adolescents ages 12-17 who received treatment for substance abuse as part of the Brief Strategic Family Therapy effectiveness trial were screened for anxiety and depression using the Diagnostic Interview Schedule for Children-Predictive Scales (DISC-PS). Twelve-month post-randomization assessments were completed by 327 parents and 315 youth. Sixty-five percent of the sample was found to have probability of at least one anxiety disorder or depression diagnosis.; Results: Significant reduction of anxiety and depressive symptoms and significant reductions in probable anxiety and depression diagnoses were observed at follow-up. Few differences by treatment type and by ethnic group were noticed.; Conclusions and Scientific Significance: Findings indicate that substance use interventions might help reduce the prevalence of anxiety and depressive symptoms and the probability of these disorders.; Copyright © American Academy of Addiction Psychiatry.
American Journal on Addictions, 22(4) : 329-337
- Year: 2013
- Problem: Anxiety Disorders (any), Depressive Disorders, Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Family therapy
Hilton, Robert C., Rengasamy, Manivel, Mansoor, Brandon, He, Jiayan, Mayes, Taryn, Emslie, Graham J., Porta, Giovanna, Clarke, Greg N., Wagner, Karen Dineen, Birmaher, Boris, Keller, Martin B., Ryan, Neal, Shamseddeen, Wael, Asarnow, Joan Rosenbaum, Brent, David A.
Objective: To assess the relative efficacy of antidepressant medication, alone and in combination with cognitive behavioral therapy (CBT), on comorbid symptoms of anxiety, attention, and disruptive behavior disorders in participants in the Treatment of Resistant Depression in Adolescents (TORDIA) trial.; Method: Adolescents with selective serotonin reuptake inhibitor (SSRI)-resistant depression (N = 334) were randomly assigned to a medication switch alone (to another SSRI or to venlafaxine) or to a medication switch plus CBT. Anxiety, attention-deficit/hyperactivity disorder (ADHD), and disruptive behavior disorder (DBD) symptoms were assessed by psychiatric interview and self-report at regular intervals between baseline and 24 weeks. The differential effects of medication and of CBT, and the impact of remission on the course of comorbid symptoms and diagnoses, were assessed using generalized linear mixed models.; Results: Remission was associated with a greater reduction in scalar measures of anxiety, ADHD, and DBDs, and a greater decrease in the rate of diagnosed anxiety disorders. The correlations between the changes in symptoms of depression on the CDRS-R and anxiety, ADHD, and oppositional symptoms were modest, ranging from r = 0.12 to r = 0.28. There were no significant differential treatment effects on diagnoses, or corresponding symptoms.; Conclusion: The achievement of remission had a beneficial effect on anxiety, ADHD, and DBD symptoms, regardless of the type of treatment received. There were no differential effects of medication or CBT on outcome, except for a nonsignificant trend that those adolescents treated with SSRIs showed a greater decrease in rates of comorbid DBDs relative to those treated with venlafaxine. Clinical trial registration information-Treatment of SSRI-Resistant Depression In Adolescents (TORDIA); http://clinicaltrials.gov/; NCT00018902.; Copyright © 2013. Published by Elsevier Inc.
Journal of the American Academy of Child & Adolescent Psychiatry, 52(5) : 482-492
- Year: 2013
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Serotonin-norepinephrine reuptake inhibitors (SNRIs), Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)