-
Drug and Therapeutics Bulletin Aug 1983
Topics: Agoraphobia; Behavior Therapy; Humans; Phobic Disorders
PubMed: 6617496
DOI: No ID Found -
Journal of the American Psychoanalytic... 1998Psychoanalysis as a profession is in difficulty because changes in the mental health field have exposed vulnerabilities inherent in psychoanalytic traditions. In this... (Review)
Review
Psychoanalysis as a profession is in difficulty because changes in the mental health field have exposed vulnerabilities inherent in psychoanalytic traditions. In this setting, scientific outcome studies of psychoanalytic treatment are a necessity. To enable such studies, certain preliminary research is required. In particular, a set of reliable diagnoses that recognize psychodynamic factors, in addition to "descriptive" criteria, must be developed. This paper outlines the rationale, significance, and design of a pilot study in the area of anxiety disorders, agoraphobia in particular, intended to provide a basis for recategorization of the currently predominant DSM system.
Topics: Agoraphobia; Anxiety Disorders; Humans; Panic Disorder; Pilot Projects; Psychiatric Status Rating Scales; Psychoanalytic Theory; Psychoanalytic Therapy; Thinking
PubMed: 9795888
DOI: 10.1177/00030651980460030401 -
L' Infirmiere Canadienne Jun 1985
Topics: Adult; Agoraphobia; Antidepressive Agents; Behavior Therapy; Female; Humans; Phobic Disorders; Psychotherapy
PubMed: 3846579
DOI: No ID Found -
The Cochrane Database of Systematic... Apr 2016Panic disorder is characterised by the presence of recurrent unexpected panic attacks, discrete periods of fear or anxiety that have a rapid onset and include symptoms... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Panic disorder is characterised by the presence of recurrent unexpected panic attacks, discrete periods of fear or anxiety that have a rapid onset and include symptoms such as racing heart, chest pain, sweating and shaking. Panic disorder is common in the general population, with a lifetime prevalence of 1% to 4%. A previous Cochrane meta-analysis suggested that psychological therapy (either alone or combined with pharmacotherapy) can be chosen as a first-line treatment for panic disorder with or without agoraphobia. However, it is not yet clear whether certain psychological therapies can be considered superior to others. In order to answer this question, in this review we performed a network meta-analysis (NMA), in which we compared eight different forms of psychological therapy and three forms of a control condition.
OBJECTIVES
To assess the comparative efficacy and acceptability of different psychological therapies and different control conditions for panic disorder, with or without agoraphobia, in adults.
SEARCH METHODS
We conducted the main searches in the CCDANCTR electronic databases (studies and references registers), all years to 16 March 2015. We conducted complementary searches in PubMed and trials registries. Supplementary searches included reference lists of included studies, citation indexes, personal communication to the authors of all included studies and grey literature searches in OpenSIGLE. We applied no restrictions on date, language or publication status.
SELECTION CRITERIA
We included all relevant randomised controlled trials (RCTs) focusing on adults with a formal diagnosis of panic disorder with or without agoraphobia. We considered the following psychological therapies: psychoeducation (PE), supportive psychotherapy (SP), physiological therapies (PT), behaviour therapy (BT), cognitive therapy (CT), cognitive behaviour therapy (CBT), third-wave CBT (3W) and psychodynamic therapies (PD). We included both individual and group formats. Therapies had to be administered face-to-face. The comparator interventions considered for this review were: no treatment (NT), wait list (WL) and attention/psychological placebo (APP). For this review we considered four short-term (ST) outcomes (ST-remission, ST-response, ST-dropouts, ST-improvement on a continuous scale) and one long-term (LT) outcome (LT-remission/response).
DATA COLLECTION AND ANALYSIS
As a first step, we conducted a systematic search of all relevant papers according to the inclusion criteria. For each outcome, we then constructed a treatment network in order to clarify the extent to which each type of therapy and each comparison had been investigated in the available literature. Then, for each available comparison, we conducted a random-effects meta-analysis. Subsequently, we performed a network meta-analysis in order to synthesise the available direct evidence with indirect evidence, and to obtain an overall effect size estimate for each possible pair of therapies in the network. Finally, we calculated a probabilistic ranking of the different psychological therapies and control conditions for each outcome.
MAIN RESULTS
We identified 1432 references; after screening, we included 60 studies in the final qualitative analyses. Among these, 54 (including 3021 patients) were also included in the quantitative analyses. With respect to the analyses for the first of our primary outcomes, (short-term remission), the most studied of the included psychological therapies was CBT (32 studies), followed by BT (12 studies), PT (10 studies), CT (three studies), SP (three studies) and PD (two studies).The quality of the evidence for the entire network was found to be low for all outcomes. The quality of the evidence for CBT vs NT, CBT vs SP and CBT vs PD was low to very low, depending on the outcome. The majority of the included studies were at unclear risk of bias with regard to the randomisation process. We found almost half of the included studies to be at high risk of attrition bias and detection bias. We also found selective outcome reporting bias to be present and we strongly suspected publication bias. Finally, we found almost half of the included studies to be at high risk of researcher allegiance bias.Overall the networks appeared to be well connected, but were generally underpowered to detect any important disagreement between direct and indirect evidence. The results showed the superiority of psychological therapies over the WL condition, although this finding was amplified by evident small study effects (SSE). The NMAs for ST-remission, ST-response and ST-improvement on a continuous scale showed well-replicated evidence in favour of CBT, as well as some sparse but relevant evidence in favour of PD and SP, over other therapies. In terms of ST-dropouts, PD and 3W showed better tolerability over other psychological therapies in the short term. In the long term, CBT and PD showed the highest level of remission/response, suggesting that the effects of these two treatments may be more stable with respect to other psychological therapies. However, all the mentioned differences among active treatments must be interpreted while taking into account that in most cases the effect sizes were small and/or results were imprecise.
AUTHORS' CONCLUSIONS
There is no high-quality, unequivocal evidence to support one psychological therapy over the others for the treatment of panic disorder with or without agoraphobia in adults. However, the results show that CBT - the most extensively studied among the included psychological therapies - was often superior to other therapies, although the effect size was small and the level of precision was often insufficient or clinically irrelevant. In the only two studies available that explored PD, this treatment showed promising results, although further research is needed in order to better explore the relative efficacy of PD with respect to CBT. Furthermore, PD appeared to be the best tolerated (in terms of ST-dropouts) among psychological treatments. Unexpectedly, we found some evidence in support of the possible viability of non-specific supportive psychotherapy for the treatment of panic disorder; however, the results concerning SP should be interpreted cautiously because of the sparsity of evidence regarding this treatment and, as in the case of PD, further research is needed to explore this issue. Behaviour therapy did not appear to be a valid alternative to CBT as a first-line treatment for patients with panic disorder with or without agoraphobia.
Topics: Adult; Agoraphobia; Humans; Panic Disorder; Psychotherapy; Randomized Controlled Trials as Topic
PubMed: 27071857
DOI: 10.1002/14651858.CD011004.pub2 -
The International Journal of Clinical... Apr 2007There are a number of clinical reports and a body of research on the effectiveness of hypnotherapy in the treatment of irritable bowel syndrome (IBS). Likewise, there... (Review)
Review
There are a number of clinical reports and a body of research on the effectiveness of hypnotherapy in the treatment of irritable bowel syndrome (IBS). Likewise, there exists research demonstrating the efficacy of cognitive-behavioral therapy (CBT) in the treatment of IBS. However, there is little written about the integration of CBT and hypnotherapy in the treatment of IBS and a lack of clinical information about IBS-induced agoraphobia. This paper describes the etiology and treatment of IBS-induced agoraphobia. Cognitive, behavioral, and hypnotherapeutic techniques are integrated to provide an effective cognitive-behavioral hypnotherapy (CBH) treatment for IBS-induced agoraphobia. This CBH approach for treating IBS-induced agoraphobia is described and clinical data are reported.
Topics: Agoraphobia; Cognitive Behavioral Therapy; Humans; Hypnosis; Irritable Bowel Syndrome; Relaxation Therapy
PubMed: 17365071
DOI: 10.1080/00207140601177889 -
The Journal of Nervous and Mental... Oct 1978Agoraphobia is the commonest and most severe form of phobic disorder. Techniques presently available for its treatment fall into the broad categories of behavior...
Agoraphobia is the commonest and most severe form of phobic disorder. Techniques presently available for its treatment fall into the broad categories of behavior therapy, pharmacotherapy, and psychotherapy. Of the behavioral approaches in current use flooding is probably most effective. Group exposure methods are valuable and have the advantage of conserving therapist time. Pharmacological agents of demonstrated value include monoamine oxidase inhibitors (phenelzine) and tricyclic antidepressants (imipramine). These drugs are capable of preventing the spontaneous panic attacks observed in agoraphobic patients. Psychotherapy, once the mainstay of treatment, has largely become an adjunctive procedure.
Topics: Agoraphobia; Behavior Therapy; Follow-Up Studies; Humans; Monoamine Oxidase Inhibitors; Panic; Phobic Disorders; Psychotherapy
PubMed: 702127
DOI: 10.1097/00005053-197810000-00003 -
The Journal of Nervous and Mental... Feb 2016The aim of the current study was to compare the 20-year outcome in panic disorder with agoraphobia (PD with AG) and agoraphobia without panic disorder (AG without PD)...
The aim of the current study was to compare the 20-year outcome in panic disorder with agoraphobia (PD with AG) and agoraphobia without panic disorder (AG without PD) patients after inpatient psychological treatment. Of 53 eligible patients having completed a medication-free integrated exposure and psychodynamic treatment, 38 (71.7%)-25 PD with AG and 13 AG without PD patients-attended 20-year follow-up. AG without PD patients improved less than PD with AG patients did on primary outcome measures. In the PD with AG group, there were large uncontrolled effect sizes (<-2.30). More of the AG without PD patients had avoidant personality disorder at pretreatment, but the presence of this disorder did not predict outcome. The follow-up results support that PD with AG and AG without PD are two different disorders. The results also suggest that the very long-term outcome in PD with AG patients is excellent for this integrated treatment.
Topics: Adult; Agoraphobia; Female; Follow-Up Studies; Humans; Implosive Therapy; Male; Panic Disorder; Psychotherapy, Psychodynamic; Treatment Outcome
PubMed: 26588081
DOI: 10.1097/NMD.0000000000000419 -
Clinical Psychology Review Apr 1998The cognitive models of panic disorder with (PDA) or without (PD) agoraphobia are now widely recognised. These models propose that patients misinterpret external or... (Review)
Review
The cognitive models of panic disorder with (PDA) or without (PD) agoraphobia are now widely recognised. These models propose that patients misinterpret external or internal cues in a catastrophic manner and as a result of these catastrophic cognitions the symptoms are maintained. There is now a large body of empirical evidence for this proposal and the aim of this paper is to systematically review the literature to evaluate whether the empirical evidence supports the contribution of catastrophic cognitions to PD and PDA. Empirical studies using different methodologies, such as interview, questionnaire, self-monitoring, and in vivo techniques are reviewed. The results indicate there is substantial empirical evidence in support of the central role of catastrophic cognition in cognitive models. Different methodologies provided convergent support for the importance of catastrophic cognitions in the maintenance of panic disorder and agoraphobia. Limitations in the interpretation of the existing research are highlighted and future research directions are proposed.
Topics: Agoraphobia; Arousal; Attention; Humans; Internal-External Control; Mental Recall; Neurobehavioral Manifestations; Panic Disorder; Social Perception
PubMed: 9564584
DOI: 10.1016/s0272-7358(97)00088-3 -
Psychiatria Danubina Feb 2021
Topics: Agoraphobia; Eye Movement Desensitization Reprocessing; Humans; Panic Disorder; Psychiatric Status Rating Scales
PubMed: 33638960
DOI: No ID Found -
Behavioural and Cognitive Psychotherapy May 2013Agoraphobia is disabling and clients find it hard to access effective treatment.
BACKGROUND
Agoraphobia is disabling and clients find it hard to access effective treatment.
AIMS
This paper describes the development of an inexpensive service, delivered by trained volunteers in or near the client's own home.
METHOD
We describe the development of the service, including selection, training and supervision. Outcomes were evaluated over 5 years, and compared with those available from the local psychology service.
RESULTS
Effect sizes on all measures were high. Benchmarking indicated that results on comparable measures were not significantly different from the local psychology service. As in many previous studies drop-out rate was fairly high.
CONCLUSIONS
This model worked well, and was inexpensive and effective. Further research on long term outcome and methods of enhancing engagement is needed.
Topics: Adult; Agoraphobia; Chronic Disease; Cognitive Behavioral Therapy; Community-Institutional Relations; Comorbidity; Female; Follow-Up Studies; Health Services Accessibility; Humans; Inservice Training; Male; Middle Aged; Outcome and Process Assessment, Health Care; Panic Disorder; Surveys and Questionnaires; Volunteers
PubMed: 23017813
DOI: 10.1017/S135246581200077X