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Journal of the Formosan Medical... Dec 2023Cognitive-behavioral therapy (CBT) and biofeedback therapy are commonly regarded as effective treatment modalities for panic disorder. The aim of this study was to... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Cognitive-behavioral therapy (CBT) and biofeedback therapy are commonly regarded as effective treatment modalities for panic disorder. The aim of this study was to establish a Taiwanese version of an integrated cognitive-behavioral and biofeedback therapy (ICB) and examine its effects on panic disorder using psychological and physiological indicators.
METHODS
Thirty patients with panic disorder were enrolled in this study. They were randomly assigned to either the ICB group (n = 15) or the treatment as usual (TAU) group (n = 15). The intervention consisted of six sessions, conducted once a week. Psychological indicators were measured at baseline (prior to intervention), week 3, and week 6, while physiological indicators were measured at baseline and week 6. The psychological indicators included five scales, with the Panic Disorder Severity Scale (PDSS) being the primary measure. The physiological indicators included respiratory sinus arrhythmia (RSA) and skin conductance, which respectively represent parasympathetic and sympathetic activity.
RESULTS
Considering all participants, PDSS scores significantly decreased over time, but the difference between the ICB and TAU groups did not reach statistical significance. Among the physiological indicators, resting-state RSA and RSA under relaxation showed significant between-group differences over time, with the ICB group demonstrating a more pronounced improvement in RSA.
CONCLUSION
In the context of existing pharmacological treatments, the benefits of ICB for panic disorder may not be observable through psychological indicators. However, it can lead to enhancement of parasympathetic activity as evidenced by the physiological indicators.
Topics: Humans; Panic Disorder; Treatment Outcome; Biofeedback, Psychology; Combined Modality Therapy; Cognition
PubMed: 37453901
DOI: 10.1016/j.jfma.2023.07.007 -
Frontiers in Psychiatry 2023We aimed to explore the predictive role of serum BDNF and anxiety-related variables in changes in somatic symptoms post-escitalopram treatment in panic disorder (PD)...
BACKGROUND
We aimed to explore the predictive role of serum BDNF and anxiety-related variables in changes in somatic symptoms post-escitalopram treatment in panic disorder (PD) patients.
METHODS
Ninety PD patients and 99 healthy controls (HCs) were enrolled. PD patients received an 8-week escitalopram treatment. All patients were administered the Panic Disorder Severity Scale-Chinese Version (PDSS-CV) and State-Trait Anxiety Inventory (STAI) to assess panic and anxiety-related symptoms, respectively. Patient Health Questionnaire 15-item scale (PHQ-15) was performed to measure somatic symptoms, and the blood sample was collected to detect serum BDNF levels in all participants. We performed partial correlation analysis and multiple linear regression to explore correlates of PHQ-15 and predictors of PHQ-15 changes post-escitalopram treatment after controlling for age, gender, education levels (set as a dummy variable), the current duration, comorbid AP, and/or GAD.
RESULTS
Compared to HCs, PD patients had lower serum BDNF levels and higher PHQ-15 scores that could be improved post-escitalopram treatment. Lower baseline STAI state ( = -0.07, = 0.004), and PDSS-CV scores ( = -0.25, = 0.007), but higher baseline serum BDNF levels ( = 0.35, = 0.007) contributed to the prediction of PHQ-15 changes post-escitalopram treatment.
CONCLUSION
State anxiety, serum BDNF levels, and panic severity could predict changes in somatic symptoms post-escitalopram treatment, our results highlighted that serum BDNF could serve as a biological indicator for improving somatic symptoms in PD patients.
PubMed: 37533888
DOI: 10.3389/fpsyt.2023.1168771 -
Psychiatria Danubina 2023This study aimed to analyze the concepts of experiential avoidance, anxiety sensitivity and behavioral inhibition system through healthy volunteers and patients...
PURPOSE
This study aimed to analyze the concepts of experiential avoidance, anxiety sensitivity and behavioral inhibition system through healthy volunteers and patients diagnosed with anxiety disorder. It was planned to analyze and evaluate the correlation among the levels of experiential avoidance, anxiety sensitivity and behavioral inhibition system in various anxiety groups.
METHOD
Within the scope of this study, clinical interviews were carried out with patients who sought treatment at the Psychiatry Department of the Hospital of Balıkesir University Medical Faculty. The study included 50 Generalized Anxiety Disorder (GAD) patients and 50 Panic Disorder (PD) patients who fulfilled the study criteria and accepted to participate in the study. A voluntary control group of 50 individuals with similar age and gender with the patients was formed. The participants were evaluated through the Acceptance and Action Questionnaire-II (AAQ-II), Behavioral Inhibition System/Behavioral Approach System Scale (BIS/BAS Scale), and Anxiety Sensitivity Index-3 (ASI-3).
RESULTS
In this study, the anxiety sensitivity, behavioral inhibition system sensitivity and experiential avoidance levels were all found to be higher in both the GAD and PD patients than the controls. On the other hand, the scale scores did not significantly differ between the GAD patients and PD patients. Positive correlations were determined among anxiety sensitivity, experiential avoidance and behavioral inhibition system. Our data provided findings supporting that the development of anxiety disorders entails increased anxiety sensitivity, behavioral inhibition system sensitivity and experiential avoidance levels.
DISCUSSION
The literature has shown, through separate studies, a correlation among experiential avoidance, anxiety sensitivity and behavioral inhibition system as well as a correlation between these concepts and anxiety disorders, and this study handled them altogether to reveal their correlation with anxiety in a clinical environment.
Topics: Humans; Panic Disorder; Anxiety; Anxiety Disorders; Inhibition, Psychological; Surveys and Questionnaires
PubMed: 37917840
DOI: 10.24869/psyd.2023.344 -
Der Nervenarzt Sep 2023Cognitive behavioral therapy (CBT) and pharmacotherapy with antidepressants are both a highly effective treatment for agoraphobia and/or panic disorder; however,...
BACKGROUND
Cognitive behavioral therapy (CBT) and pharmacotherapy with antidepressants are both a highly effective treatment for agoraphobia and/or panic disorder; however, a combination of CBT and antidepressants is under debate due to potentially unfavorable interference effects. The associations of existing antidepressant medication with panic and agoraphobia symptom burden and their change in the context of a structured 5‑week day hospital and exposure-focused treatment in a naturalistic setting were investigated.
METHODS
Out of a total of n = 488 patients medication use during treatment was retrospectively determined for n = 380: n = 100 (26.3%) were taking antidepressants of different drug classes. Calculations were performed using multiple linear regression analysis, t‑tests, response analyses, and χ-tests.
RESULTS
Patients with existing antidepressant medication more often met the criteria for comorbid depressive disorder (p < 0.001). The measure of symptom change and treatment response rates did not differ between patients with and without antidepressants with respect to anxiety symptoms.
DISCUSSION
In the context studied, patients with and without existing antidepressant medication benefited equally from CBT with respect to anxiety symptoms.
Topics: Humans; Panic Disorder; Agoraphobia; Implosive Therapy; Retrospective Studies; Antidepressive Agents
PubMed: 37640865
DOI: 10.1007/s00115-023-01535-y -
BMJ Paediatrics Open Mar 2024The reported prevalence rate of anxiety disorder in the paediatric population varies widely between different counties. Currently, there is no national epidemiological...
BACKGROUND
The reported prevalence rate of anxiety disorder in the paediatric population varies widely between different counties. Currently, there is no national epidemiological survey anxiety disorder in China. This study aims to investigate the national prevalence of anxiety disorder, the distribution profiles of different subtypes and its comorbidity rates among school students.
METHODS
A nationwide epidemiological survey of mental disorders in school students aged 6-16 years was conducted. Participants were randomly recruited from five provinces in China. The Child Behavior Checklist was used to screen students at high risk for mental disorders. The final diagnosis was made based on the Diagnostic and Statistical Manual-IV. The point prevalence and comorbidity rate of anxiety disorder were calculated, and the difference between age, sex and socioeconomic status groups was also compared.
RESULTS
Generalised anxiety disorder (GAD) was the most common anxiety disorder in school-attending children and adolescents, with a prevalence rate of 1.3% (95% CI: 1.2 to 1.3). Separation anxiety and specific phobia were more common in children than in adolescents. Girls had a higher prevalence of panic disorder (0.3% vs 0.2%, χ=14.6, p<0.001) and agoraphobia (0.9% vs 0.8%, χ=4.3, p=0.03) than that of boys. We found no significant difference between developed and less developed areas. Girls were more likely to have panic disorder and GAD than boys, with ratios of 2.13:1 and 1.01:1, respectively. The co-occurrence of anxiety disorder and attention-deficit and disruptive behaviour disorder was very common, ranging from 40% to 85%.
CONCLUSIONS
Anxiety disorder was prevalent among school students in China, and comorbidity with attention-deficit and disruptive disorder was very common. The data imply that screening for anxiety disorder is needed in school settings. Policies should be adapted to provide psychological services to children and adolescents. A comprehensive assessment is recommended in clinical practice.
Topics: Male; Female; Child; Humans; Adolescent; Prevalence; Phobic Disorders; Anxiety Disorders; Attention Deficit Disorder with Hyperactivity; Comorbidity
PubMed: 38538104
DOI: 10.1136/bmjpo-2023-001967 -
Frontiers in Psychiatry 2023Individuals with panic disorder frequently face ongoing symptoms, suboptimal treatment adherence, and increased relapse rates. Although mobile health interventions have...
BACKGROUND
Individuals with panic disorder frequently face ongoing symptoms, suboptimal treatment adherence, and increased relapse rates. Although mobile health interventions have shown promise in improving treatment outcomes for numerous mental health conditions, their effectiveness, specifically for panic disorder, has yet to be determined.
OBJECTIVE
This study investigates the effects of a mobile-aided case management program on symptom reduction and quality of care among individuals with panic disorder.
METHODS
This 3-year cohort study enrolled 138 participants diagnosed with panic disorder. One hundred and eight participants joined the mobile-aided case management group and 30 in the treatment-as-usual group. Data were collected at baseline, 3-month, 6-month, and 12-month treatment checkpoints using self-report questionnaires, in-depth interviews, direct observation, and medical record analysis.
RESULTS
During the maintenance treatment phase, the mobile-assisted case management group decreased both panic severity ( = 0.008) and state anxiety ( = 0.016) more than the control group at 6 months. Participants who underwent case management experienced enhanced control over panic symptoms, heightened self-awareness, and elevated interpersonal support.
CONCLUSION
The mobile-aided case management is beneficial in managing panic disorder, especially maintenance treatment.
PubMed: 37928915
DOI: 10.3389/fpsyt.2023.1203194 -
Journal of Behavior Therapy and... Dec 2023Anxiety disorders are the most prevalent mental disorders worldwide. Virtual reality (VR) treatment approaches have increasingly been studied. Before clinical... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND OBJECTIVES
Anxiety disorders are the most prevalent mental disorders worldwide. Virtual reality (VR) treatment approaches have increasingly been studied. Before clinical implementation, it is necessary to evaluate the treatment effect of VR applications. The objective is to evaluate the treatment effect of virtual reality applications in the treatment of anxiety disorders compared to conventional therapy.
METHODS
A systematic literature review with meta-analysis was conducted. Four databases were used to identify randomized controlled trials published between April 2011 and April 2021 which compare VR applications with non-VR interventions or waiting lists. Study characteristics, pre- and post-treatment data were extracted. Hedges g was calculated as effect size. Primary outcome was anxiety symptoms.
RESULTS
Data from 17 studies from 827 participants was extracted. The studies examined specific phobia (n = 9), social anxiety disorder (n = 4), agoraphobia (n = 2) and panic disorder (n = 2). 16 out of 17 studies used head-mounted displays as VR application. A non-significant effect size with significant heterogeneity was observed in favor of the use of VR applications in anxiety symptoms (g, 0.33; 95%-CI, -0.20-0.87). Compared to passive control groups, VR applications are associated significant with lower anxiety symptoms (g, 1.29; 95%-CI, 0.68-1.90).
LIMITATIONS
The study and patient characteristics varied between the individual studies which is reflected in a high statistical heterogeneity of the effect sizes.
CONCLUSIONS
The added value of VR applications over waiting-list or psychoeducation only control groups is obvious. VR applications can be used as part of the treatment of anxiety disorders, especially when conventional therapy is unavailable.
Topics: Humans; Anxiety Disorders; Phobic Disorders; Phobia, Social; Anxiety; Virtual Reality; Virtual Reality Exposure Therapy; Randomized Controlled Trials as Topic
PubMed: 37453405
DOI: 10.1016/j.jbtep.2023.101893 -
BMC Complementary Medicine and Therapies Nov 2023Anxiety disorder is the most prevalent psychiatric disorder. Benzodiazepines, which are often used for anxiety in patients with anxiety disorder, have various side...
BACKGROUND
Anxiety disorder is the most prevalent psychiatric disorder. Benzodiazepines, which are often used for anxiety in patients with anxiety disorder, have various side effects. Lavender, one of the most commonly used essential oils in aromatherapy, has the potential to reduce benzodiazepine use for anxiety disorders.
METHODS
This study is a multicenter, double-masked, randomized, placebo-controlled clinical trial. The study will recruit patients aged 20-59 years old with generalized anxiety disorder and panic disorder among anxiety disorders. The bottle containing the test solution (lavender aroma essential oil or distilled water) will be given to the patients. Patients will carry the bottles with them in their daily life and use the drops on tissue paper when anxious. The primary endpoint is the number of times anxiolytics used in 28 days.
DISCUSSION
If the use of benzodiazepines could be reduced by sniffing lavender aroma, which is inexpensive and safe, it would contribute not only to the risks associated with benzodiazepine use but also to the health care economy and could even be added as a standard treatment.
TRIAL REGISTRATION
University hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), ID: UMIN000034422 Registered 17 January 2019.
Topics: Humans; Young Adult; Adult; Middle Aged; Odorants; Lavandula; Aromatherapy; Anxiety Disorders; Benzodiazepines; Randomized Controlled Trials as Topic; Multicenter Studies as Topic
PubMed: 37932761
DOI: 10.1186/s12906-023-04231-1 -
Trials Aug 2023Due to several treatment barriers, many individuals with panic disorder do not receive evidence-based treatment. One promising option to narrow this treatment gap is...
Efficacy of an Internet-based intervention with self-applied exposure therapy in virtual reality for people with panic disorder: study protocol for a randomized controlled trial.
BACKGROUND
Due to several treatment barriers, many individuals with panic disorder do not receive evidence-based treatment. One promising option to narrow this treatment gap is Internet-based psychotherapy, which has been shown particularly effective in guided formats. Still, there remains room for improvement to make these digital therapies more accessible, cost-efficient, and aligned with best practices for in-person interventions (e.g., exposure). The smartphone app "Invirto - Treatment for Anxiety" offers digitally guided, evidence-based treatment of panic disorders including virtual reality (VR) for exposure therapy. The aim present study is to investigate the efficacy, safety, and acceptance of Invirto in comparison to a care-as-usual (CAU) control group.
METHODS
We plan to conduct a randomized controlled trial with two conditions (intervention vs. CAU), three assessment times via online surveys (t0: baseline; t1: 3 months after baseline; t2: follow-up assessment 6 months after baseline), and a total of 128 participants with a clinical diagnosis of panic disorder (symptoms must be experienced ≥ 1 year). Recruitment will take place via email, phone, and the study website. The primary outcome will be the change in anxiety symptoms as measured by Beck's Anxiety Inventory from t0 to t1. Secondary outcomes will be the change in anxiety symptoms (measured by the Panic and Agoraphobia Scale, PAS; Questionnaire on panic-related Anxieties, Cognitions and Avoidance, ACA), depressive symptoms (measured by the Beck-Depression-Inventory, BDI-II), treatment satisfaction (measured by the Client Satisfaction Questionnaire, CSQ-8; Treatment Adherence Perception Questionnaire, TAPQ-adapt; Positive and Negative Effects of Psychotherapy Scale, PANEPS-I), psychological flexibility (measured by the Acceptance and Action Questionnaire-II, AAQ-II), and dissociation during VR exposure (measured by an adapted version of the Peritraumatic Dissociative Experiences Questionnaire, PDEQ-adapt). Participants in the intervention group will receive access to the intervention (Invirto) right after t0, while the CAU group will receive access to Invirto after t1. We expect a larger change in both the primary and secondary outcomes from t0 to t1 in the intervention group in comparison to the CAU group.
DISCUSSION
This study is one of the first to evaluate an Internet-based intervention for people with panic disorder that includes self-application of VR exposure therapy. The findings are expected to extend the body of knowledge about effective Internet-based treatment options for people with panic disorder. The empirical and clinical implications and the limitations of the study are discussed.
TRIAL REGISTRATION
DRKS00027585 ( www.drks.de/drks_web/ ), date of registration: 13 January 2022.
Topics: Humans; Panic Disorder; Internet-Based Intervention; Implosive Therapy; Cognitive Behavioral Therapy; Anxiety Disorders; Treatment Outcome; Internet; Randomized Controlled Trials as Topic
PubMed: 37573377
DOI: 10.1186/s13063-023-07536-1 -
Frontiers in Physiology 2024
PubMed: 38645691
DOI: 10.3389/fphys.2024.1403768