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Frontiers in Psychology 2019Convincing evidence on Virtual Reality (VR) exposure for phobic anxiety disorders has been reported, however, the benchmark and golden standard for phobia treatment is...
Inferiority or Even Superiority of Virtual Reality Exposure Therapy in Phobias?-A Systematic Review and Quantitative Meta-Analysis on Randomized Controlled Trials Specifically Comparing the Efficacy of Virtual Reality Exposure to Gold Standard Exposure in Agoraphobia, Specific Phobia, and Social...
Convincing evidence on Virtual Reality (VR) exposure for phobic anxiety disorders has been reported, however, the benchmark and golden standard for phobia treatment is exposure. For direct treatment comparisons, the control of confounding variables is essential. Therefore, the comparison of VR and exposure in studies applying an equivalent amount of exposure in both treatments is necessary. We conducted a systematic search of reports published until June 2019. Inclusion criteria covered the diagnosis of Specific Phobia, Social Phobia, or Agoraphobia, and a randomized-controlled design with an equivalent amount of exposure in VR and . We qualitatively reviewed participants' characteristics, materials, and the treatment procedures of all included studies. For quantitative synthesis, we calculated Hedges' effect sizes for the treatment effects of VR exposure, exposure, and the comparison of VR to exposure in all studies and separately for studies on each diagnosis. Nine studies ( = 371) were included, four on Specific Phobia, three on Social Phobia, and two on Agoraphobia. VR and exposure both showed large, significant effect sizes. The comparison of VR to exposure revealed a small, but non-significant effect size favoring ( = -0.20). Specifically, effect sizes for Specific Phobia ( = -0.15) and Agoraphobia ( = -0.01) were non-significant, only for Social Phobia we found a significant effect size favoring ( -). Except for Agoraphobia, effect sizes varied across studies from favoring VR to favoring exposure. We found no evidence that VR exposure is significantly less efficacious than exposure in Specific Phobia and Agoraphobia. The wide range of study specific effect sizes, especially in Social Phobia, indicates a high potential of VR, but also points to the need for a deeper investigation and empirical examination of relevant working mechanisms. In Social Phobia, a combination of VR exposure with cognitive interventions and the realization of virtual social interactions targeting central fears might be advantageous. Considering the advantages of VR exposure, its dissemination should be emphasized. Improvements in technology and procedures might even yield superior effects in the future.
PubMed: 31551840
DOI: 10.3389/fpsyg.2019.01758 -
Journal of Affective Disorders Mar 2024Anxiety-related disorders feature elevated negative affect (NA), and in some cases, diminished positive affect (PA). It remains unclear how well extant psychotherapies... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Anxiety-related disorders feature elevated negative affect (NA), and in some cases, diminished positive affect (PA). It remains unclear how well extant psychotherapies for anxiety-related disorders improve PA versus NA.
METHODS
We systematically searched the Cochrane Central Register of Controlled Trials, PubMed, PsychInfo, and Web of Science databases. Records included studies involving (1) patients with a principal or co-principal diagnosis of at least one anxiety-related disorder (i.e., generalized anxiety, social anxiety, panic, agoraphobia, health anxiety, specific phobia, obsessive-compulsive disorder, or posttraumatic stress disorder), and (2) pre- and post-treatment PA and NA scores or a change index between pre- and post-treatment PA and NA scores. Effect sizes were calculated for meta-analyses.
RESULTS
Fourteen studies with 1001 adults with an anxiety-related disorder were included. Psychotherapeutic interventions included cognitive behavioral, present-centered, and imagery-based approaches. Treatments reduced NA (g = -0.90; 95%CI [-1.19, -0.61]) to a greater extent than they improved PA (g = 0.27; 95%CI [0.05, 0.59]), Z = -5.26, p < .001. The limited number of studies available precluded analyses of the relationship between changes in affect and symptoms.
LIMITATIONS
Results should be considered with caution given the small number and heterogeneity of included studies.
CONCLUSIONS
Current psychotherapeutic interventions for anxiety-related disorders may not improve PA and NA to comparable levels.
Topics: Adult; Humans; Anxiety Disorders; Phobic Disorders; Psychotherapy; Agoraphobia; Anxiety; Psychotropic Drugs
PubMed: 38211753
DOI: 10.1016/j.jad.2024.01.086 -
Rheumatology (Oxford, England) Jan 2014This study examines the reported evidence of an association between benign joint hypermobility syndrome (BJHS) and psychological symptoms. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This study examines the reported evidence of an association between benign joint hypermobility syndrome (BJHS) and psychological symptoms.
METHODS
A systematic review of published (AMED, CINAHL, MEDLINE, EMBASE, PubMed, Cochrane Library) and unpublished research databases (OpenGrey, the World Health Organization (WHO) International Clinical Trials Registry Platform, Current Controlled Trials, the UK National Research Register Archive) was performed from their inception to January 2013. Studies assessing the prevalence and incidence of psychological conditions for people diagnosed with BJHS were included. Meta-analysis assessing the odds ratio (OR) and standardized mean difference in severity of psychological conditions was performed. Methodological quality was assessed using the Critical Appraisal Skills Programme (CASP) appraisal tools.
RESULTS
Fourteen papers including 3957 participants, 1006 people with and 2951 controls without BJHS were eligible. The overall methodological quality was moderate. The results indicated that people with BJHS experience significantly greater perceptions of fear and more intense fear (P < 0.05) and have a higher probability of demonstrating agoraphobia (P < 0.05), anxiety (OR 4.39, 95% CI 1.92, 10.40), depression (OR 4.10, 95% CI 1.79, 9.41) and panic disorders (OR 6.72, 95% CI 2.22, 20.35) than those without BJHS (P ≤ 0.005). Neither anxiety nor depression have been assessed in childhood populations.
CONCLUSION
People with BJHS commonly exhibit a range of symptoms related to anxiety and depression. Considerable emotional symptoms accompany BJHS. Further study is warranted to explore how these results relate to non-Mediterranean populations and children. However, the data suggest that targeting psychological symptoms could be an important approach to managing the range of symptoms reported in these patients.
Topics: Depressive Disorder; Global Health; Humans; Joint Instability; Mental Health; Prevalence; Risk Assessment; Syndrome
PubMed: 24080253
DOI: 10.1093/rheumatology/ket317 -
Depression and Anxiety Aug 2016A systematic review and meta-analysis was conducted to explore the efficacy of medication augmentation strategies compared to control treatments in patients who have had... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
A systematic review and meta-analysis was conducted to explore the efficacy of medication augmentation strategies compared to control treatments in patients who have had a partial or no response to initial treatment for generalized anxiety disorder, social anxiety disorder, and panic disorder.
METHODS
Double-blind controlled trials of medication augmentation in adult treatment-resistant anxiety disorders conducted between January 1990 and January 2015 were systematically reviewed and evaluated by two independent raters. The search identified 625 articles; 610 were excluded following abstract review and 15 had full-text screening. Studies had to include a definition of treatment resistance, exclude concomitant medications, and have a parallel or crossover design. Data extraction forms were completed in duplicate.
RESULTS
Six studies were included in the meta-analysis. Effect estimates were calculated using random effects modeling; heterogeneity was assessed and subgroup and sensitivity analyses were completed. Primary outcome was response, defined by Clinical Global Impression-Improvement score of ≤2. Augmentation was not associated with an increased risk of response, as compared with placebo (RR = 1.08, 95% CI = 0.94-1.24). A small significant effect was found in reduction in symptom severity: standard mean difference = -0.32, 95% CI = -0.56 to -0.08. No significant differences between augmentation with medication versus placebo were found in ratings of functional impairment and dropouts due to adverse events.
CONCLUSIONS
Augmentation does not appear to be beneficial in treatment-resistant anxiety disorders. These results may be limited by small study samples, and a small number of overall studies in the analysis.
Topics: Anxiety Disorders; Drug Synergism; Humans
PubMed: 27175543
DOI: 10.1002/da.22525 -
Behaviour Research and Therapy Sep 2019Both dysfunctional and self-efficacy-related cognitions are theorized as etiological and maintaining factors in agoraphobia. Exposure therapy is an effective treatment... (Meta-Analysis)
Meta-Analysis
Both dysfunctional and self-efficacy-related cognitions are theorized as etiological and maintaining factors in agoraphobia. Exposure therapy is an effective treatment and central component of CBT for agoraphobia, but the role of changes in these cognitions as a mechanism of action has not been established. The present review aims to evaluate (a) whether exposure without cognitive interventions elicits changes in cognitive variables and (b) whether cognitive changes mediate outcomes in exposure-based treatments. We searched PsycInfo and PubMed for studies on agoraphobia (with or without panic disorder) and exposure as a treatment component. Fifteen articles with 29 relevant study arms (N = 921) were identified for a meta-analysis of cognitive changes after exposure. Seventeen articles (N = 1881) were included in a systematic narrative review of cognitive mediation. A random effects model revealed a large effect of cognitive improvement after pure exposure treatments, d = 1.02 (95% CI 0.81-1.23). The systematic review mostly supported changes in cognition as mediators of symptom change. Improved study designs and statistical methods in future mediation studies are needed to strengthen causal interpretation. Cognitive change is a probable mechanism of action in exposure therapy, especially change in self-efficacy. The present review suggests novel ways in which cognitive interventions can augment exposure therapy.
Topics: Agoraphobia; Cognition; Humans; Implosive Therapy; Prognosis; Self Efficacy
PubMed: 31374484
DOI: 10.1016/j.brat.2019.103443 -
JAMA Psychiatry May 2017Whether and under which conditions D-cycloserine (DCS) augments the effects of exposure-based cognitive behavior therapy for anxiety, obsessive-compulsive, and... (Meta-Analysis)
Meta-Analysis Review
D-Cycloserine Augmentation of Exposure-Based Cognitive Behavior Therapy for Anxiety, Obsessive-Compulsive, and Posttraumatic Stress Disorders: A Systematic Review and Meta-analysis of Individual Participant Data.
IMPORTANCE
Whether and under which conditions D-cycloserine (DCS) augments the effects of exposure-based cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders is unclear.
OBJECTIVE
To clarify whether DCS is superior to placebo in augmenting the effects of cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders and to evaluate whether antidepressants interact with DCS and the effect of potential moderating variables.
DATA SOURCES
PubMed, EMBASE, and PsycINFO were searched from inception to February 10, 2016. Reference lists of previous reviews and meta-analyses and reports of randomized clinical trials were also checked.
STUDY SELECTION
Studies were eligible for inclusion if they were (1) double-blind randomized clinical trials of DCS as an augmentation strategy for exposure-based cognitive behavior therapy and (2) conducted in humans diagnosed as having specific phobia, social anxiety disorder, panic disorder with or without agoraphobia, obsessive-compulsive disorder, or posttraumatic stress disorder.
DATA EXTRACTION AND SYNTHESIS
Raw data were obtained from the authors and quality controlled. Data were ranked to ensure a consistent metric across studies (score range, 0-100). We used a 3-level multilevel model nesting repeated measures of outcomes within participants, who were nested within studies.
RESULTS
Individual participant data were obtained for 21 of 22 eligible trials, representing 1047 of 1073 eligible participants. When controlling for antidepressant use, participants receiving DCS showed greater improvement from pretreatment to posttreatment (mean difference, -3.62; 95% CI, -0.81 to -6.43; P = .01; d = -0.25) but not from pretreatment to midtreatment (mean difference, -1.66; 95% CI, -4.92 to 1.60; P = .32; d = -0.14) or from pretreatment to follow-up (mean difference, -2.98, 95% CI, -5.99 to 0.03; P = .05; d = -0.19). Additional analyses showed that participants assigned to DCS were associated with lower symptom severity than those assigned to placebo at posttreatment and at follow-up. Antidepressants did not moderate the effects of DCS. None of the prespecified patient-level or study-level moderators was associated with outcomes.
CONCLUSIONS AND RELEVANCE
D-cycloserine is associated with a small augmentation effect on exposure-based therapy. This effect is not moderated by the concurrent use of antidepressants. Further research is needed to identify patient and/or therapy characteristics associated with DCS response.
Topics: Antidepressive Agents; Anxiety Disorders; Combined Modality Therapy; Cycloserine; Drug Synergism; Excitatory Amino Acid Agonists; Humans; Implosive Therapy; N-Methylaspartate; Obsessive-Compulsive Disorder; Outcome Assessment, Health Care; Stress Disorders, Post-Traumatic
PubMed: 28122091
DOI: 10.1001/jamapsychiatry.2016.3955 -
Family Practice Jan 2019The growing worldwide prevalence of individuals with anxiety disorders has increased needs for mental health services. Due to limited number of mental health providers...
BACKGROUND
The growing worldwide prevalence of individuals with anxiety disorders has increased needs for mental health services. Due to limited number of mental health providers and community resources, especially in low-income countries, individuals often seek services from primary care settings. Through collaborative care models, services via telemedicine address the mental health provider shortage. While previous reviews show telemedicine effectively treats mental illness, a gap exists for reviews on videoconferencing psychological therapy for anxiety treatment.
OBJECTIVE
This systematic review aims to summarize videoconferencing psychological therapy for anxiety disorder treatment.
METHODS
Database searches were performed with PubMed, PsychINFO and Embase. Inclusion criteria identified controlled and uncontrolled studies evaluating videoconferencing psychological therapy. Studies were appraised using the Effective Public Health Practice Project Quality Assessment tool. Data collected included research design, sample size, intervention details, outcome results, intervention effect size and differences between videoconferencing psychological therapy and face-to-face therapy.
RESULTS
The search revealed 1253 articles, with 21 meeting inclusion criteria. Sample sizes ranged from 1 to 121 participants; cognitive-behavioral therapy was most commonly evaluated. Participants' diagnoses included panic disorder with and without agoraphobia, generalized anxiety disorder, social anxiety disorder, social phobia and hypochondriasis. Three studies occurred in outpatient health care settings. Fourteen studies reported statistically significant improvement on anxiety measures; 11 reported clinically significant improvements. Effect sizes ranged from small to very large, and all controlled studies found no differences between videoconferencing and face-to face groups.
CONCLUSION
Results provide promise for evidence-based interventions delivered via videoconferencing psychological therapy. More rigorous research is needed in various settings and populations.
Topics: Anxiety Disorders; Behavioral Medicine; Cognitive Behavioral Therapy; Humans; Videoconferencing
PubMed: 30188992
DOI: 10.1093/fampra/cmy072 -
Asian Journal of Psychiatry Dec 2016Anxiety disorders are common mental health disorders with significant impact on the individual as well as burden on the country as a whole. (Review)
Review
BACKGROUND
Anxiety disorders are common mental health disorders with significant impact on the individual as well as burden on the country as a whole.
METHODS
A systematic review of databases, reference lists, internet sources, and input from content experts revealed 42 studies that documented the prevalence of anxiety symptoms or disorders. 12 of these studies specifically evaluated anxiety disorders.
RESULTS
4 studies looked at the prevalence of anxiety disorders in the general population, whilst the remainder focused on selected population groups: university students (4 studies); substance abuse (3 studies); and victims of abuse (1 study). Studies in the general population showed that the prevalence of generalised anxiety disorder was 0.4-5.6%, mixed anxiety and depression were 3-5%, panic without agoraphobia 0.4%, phobia unspecified 0.5-%, and anxiety not-otherwise-specified 0.3-6.5%. We found significant variability in anxiety disorders in the studies in selected population groups. The variability could also have been affected by methodological factors within each study.
CONCLUSION
This study provides a broad overview of the prevalence of anxiety disorders in Malaysia. More research is required to develop diagnostic instruments that are validated for local use and comparable with international standards. Reliable prevalence estimates are lacking within certain groups, e.g. those in rural, indigenous, migrant population groups and those exposed to natural disasters.
Topics: Anxiety Disorders; Community Mental Health Services; Malaysia; Prevalence; Primary Health Care
PubMed: 27931891
DOI: 10.1016/j.ajp.2016.08.020 -
Journal of Anxiety Disorders Mar 2022Panic disorder is a common and disabling psychiatric condition marked by sudden onset of physiological sensations that are appraised as dangerous. A number of studies...
BACKGROUND
Panic disorder is a common and disabling psychiatric condition marked by sudden onset of physiological sensations that are appraised as dangerous. A number of studies and reviews have examined the efficacy of psychosocial treatments for PD; however, there is a lack of overarching reports that discuss the strength of evidence for the different psychosocial treatments for PD. This umbrella review provides an overview of systematic reviews and meta-analyses on psychosocial treatments for PD.
METHODS
A systematic search and review of the literature was conducted according to PRISMA guidelines.
RESULTS
A total of 38 reviews (31 meta-analyses and 7 systematic reviews) were included in the umbrella review. Most of the 38 reviews were focused on the use of CBT, both in-person and internet-based, to treat PD among adults, generally finding it to be an efficacious treatment compared to control conditions. A limited number of the 38 reviews included other age ranges or examined other forms of psychosocial treatments. The methodological quality of most included reviews was rated as critically low according to the AMSTAR-2 rating system.
CONCLUSIONS
Future reviews should focus on improving their methodological quality. Although the included reviews supported CBT as an efficacious treatment for reducing panic symptoms among adults, future research could focus on how CBT compares to other psychosocial treatments and the efficacy of CBT for PD among other populations (e.g., children and adolescents) and among diverse cultural groups.
Topics: Adolescent; Adult; Child; Humans; Meta-Analysis as Topic; Panic Disorder
PubMed: 35063924
DOI: 10.1016/j.janxdis.2022.102528 -
Expert Opinion on Pharmacotherapy 2016The prevalence of panic disorder (PD) in the population is high and these patients have work impairment, high unemployment rates, seek medical treatment more frequently... (Review)
Review
INTRODUCTION
The prevalence of panic disorder (PD) in the population is high and these patients have work impairment, high unemployment rates, seek medical treatment more frequently and have more hospitalizations than people without panic symptoms. Despite the availability of pharmacological, psychological and combined treatments, approximately one-third of all PD patients have persistent panic attacks and other PD symptoms after treatment.
AREAS COVERED
MEDLINE/Pubmed, CENTRAL, PsycINFO and Web of Science databases were searched for clinical trials in treatment-resistant PD. Only studies published between 1980 and 2015, in English, with human subjects, considered "journal articles" and clinical trial were included. We included trials recruiting only adult subjects with treatment-resistant PD, consistent with criteria from DSM-III to DSM5. We included all prospective experimental studies. Case, case series, retrospective studies or studies with <10 PD subjects were not included.
EXPERT OPINION
Only 11 articles were included in this review. There were few quality studies, only two were randomized, controlled and double blind. Augmentation of the pharmacological treatment with cognitive-behavioral therapy demonstrated some short-term efficacy in treatment-resistant PD. There were also preliminary evidences of efficacy for monotherapy with reboxetine and olanzapine, and augmentation with pindolol, divalproex sodium, aripiprazole and olanzapine in short-term treatment.
Topics: Antidepressive Agents; Antipsychotic Agents; Cognitive Behavioral Therapy; Combined Modality Therapy; Humans; Panic Disorder; Prospective Studies; Randomized Controlled Trials as Topic; Treatment Failure
PubMed: 26635099
DOI: 10.1517/14656566.2016.1109628