Amparo Belloch

Determinants of Dyspnea in Patients with Different Grades of Stable Asthma

Dyspnea is a main feature of symptomatology in asthma, and its perception does not necessarily correlates well with airway obstruction. The aim of this study was twofold: 1 to identify factors determining the subjective degree of dyspnea in patients with different grades of stable bronchial asthma and 2 to compare various clinical methods existing for grading dyspnea. The investigation comprised 153 outpatients with stable asthma. The parameters studied were the following: demographic characteristic of subjects, baseline dyspnea score by means of three clinical instruments (baseline dyspnea index [BDI], Medical Research Council [MRC] scale, and modified Borg scale), asthma severity, standard measures of physiologic lung function, anxiety, depression, subconscious illness attention, and asthma-related quality of life (HRQOL). The dyspnea scores were all significantly interrelated (r = 0.77–0.85, p<0.001). The three clinical scales for grading dyspnea were significantly correlated with the same parameters: airflow obstruction, lung hyperinflation, emotional factors, HRQOL, age, age at asthma onset, asthma duration, female gender, clinical severity, and lower economical, and educational levels. Multiple regression analysis showed that independent factors determining clinical dyspnea scores were: age, airway obstruction, and emotional status. Moreover, in patients with severe asthma, lung hyperinflation helped to explain the individual dyspnea score. These data suggest that clinical methods are appropriate for evaluating the impact of dyspnea on daily activities of asthmatic patients. BDI, MRC, and Borg clinical dyspnea scales showed similarly information in subjects with asthma. Independently of asthma severity, older age, airway obstruction, and psychological disturbance were associated with higher degree of dyspnea. However, if subjects had severe airway obstruction, lung hyperinflation was a major determinant of baseline dyspnea score.

Gender Differences in Health‐Related Quality of Life Among Patients with Asthma

This study has a twofold objective: 1) to explore to what extent suffering from asthma affects the HRQL of men and women differently at several stages of disease severity and 2) to analyze whether the informed poorer HRQL of asthmatic women is related to their higher scores on instruments measuring emotionally disordered symptoms. One hundred fifty‐one outpatient asthmatics (84 women and 67 men) completed the Spanish versions of the Asthma Quality of Life questionnaire (AQL), as well as anxiety and depression inventories. A full history, physical examination, and pulmonary function test were performed on all subjects. Patients were classified into one of four asthma severity categories following the criteria of the Global Initiative on Asthma (GINA). There were no gender differences in sociodemographic variables, asthma duration, GINA, FEV1 or dyspnea. However, women showed a poorer HRQL than men, as well as high degrees of anxiety and depression. When these data were reanalyzed taking into account the four groups of asthma severity, women only reported a poorer HRQL than men at the intermittent asthma level. The gender differences on depression and anxiety scores were maintained at the three lower severity levels, but not at the most severe asthma degree. When depression and anxiety scores were partialed out, the AQL scores maintained significant relationships with asthma severity, dyspnea, and FEV1, both in women and men. Therefore, only in men were there also relationships among AQL and sociodemographic data. The best predictor of the womens HRQL was the dyspnea score, whereas in men it was the asthma severity (GINA).

Symptom dimensions in obsessive–compulsive disorder: From normal cognitive intrusions to clinical obsessions

Cognitive behavioral models of obsessive-compulsive disorder (OCD) assume continuity between normal obsessional intrusive thoughts (OITs) and obsessions. However, this assumption has recently been criticized. This article examines this issue using a new instrument (the Obsessional Intrusive Thoughts Inventory, INPIOS) specifically designed to assess the frequency and content of 48 OITs, which was completed by 734 community subjects and 55 OCD patients. Confirmatory factor analysis suggests six first-order factors included in two second-order factors, one containing aggressive, sexual, religious, immoral and repugnant OITs, and the other containing contamination, doubts and checking, symmetry and order, and superstition OITs. This structure integrates the research on OC symptoms and OITs. The INPIOS showed excellent known-groups validity, and it adequately represented obsessions as well as OITs. OCD and community subjects experience OITs representative of all types of obsessional contents. The dimensional structure is discussed in terms of OIT/obsessive-compulsive symptom structures currently proposed.

Confirmatory Factor Analysis of the White Bear Suppression Inventory and the Thought Control Questionnaire

The White Bear Suppression Inventory (WBSI) was developed to assess chronic thought suppression, whereas the Thought Control Questionnaire (TCQ) measures different strategies to suppress unpleasant intrusive thoughts. The present study examines the latent factor structure of these instruments in a sample of 540 normal subjects using confirmatory factor analyses (CFA). Regarding the WBSI, the CFAs indicated that the tested models did not provide a good fit for the data. Data analysis showed that the TCQ with five factors and 30 items did not reach a reasonable fit. Therefore, in order to present a five-factor structure with an adequate fit, those items with problematic factor loadings were eliminated. Correlational analyses indicated that the WBSI had a significant association with depression, obsessive-compulsive symptoms, and pathological worry, whereas only two TCQ subscales, punishment and worry, were related to these psychopathological symptoms.

Dysfunctional Belief Domains Related to Obsessive-Compulsive Disorder: A Further Examination of their Dimensionality and Specificity

International consensus has been achieved on the existence of several dysfunctional beliefs underlying the development and/ or maintenance of the Obsessive-Compulsive Disorder (OCD). Nevertheless, questions such as the dimensionality of the belief domains and the existence of OCD-specific dysfunctional beliefs still remain inconclusive. The present paper addresses these topics through two different studies. Study 1: A series of confirmatory factor analyses (N = 573 non-clinical subjects) were carried out on the Obsessive Beliefs Spanish Inventory-Revised (OBSI-R), designed to assess dysfunctional beliefs hypothetically related to OCD. An eight-factor model emerged as the best factorial solution: responsibility, over-importance of thoughts, thought-action fusion-likelihood, thought action fusion-morality, importance of thought control, overestimation of threat, intolerance of uncertainty and perfectionism. Study 2: The OBSI-R and other symptom measures were administered to 75 OCD patients, 22 depressed patients, and 25 non-OCD anxious patients. Results indicated that, although OCD patients differed from their non-clinical counterparts on all of the OBSI-R subscales, no evidence of OCD-specificity emerged for any of the belief domains measured, as the OCD subjects did not differ from the other two clinical groups of patients.

Strategies to Control Unwanted Intrusive Thoughts: Which are Relevant and Specific in Obsessive- Compulsive Disorder?

Current cognitive-behavioral approaches to Obsessive-Compulsive Disorder (OCD) propose that chronic thought suppression and other dysfunctional strategies to control negative unwanted intrusions play an important role in the genesis and/or maintenance of the disorder. However, little empirical research has been devoted to investigating which control and/or suppression methods are used most often by OCD patients, and which could be considered specific to OCD. The purpose of the present study was to provide evidence with regard to these issues. With this end, 39 clinical OCD patients, 23 depressed patients, 25 non-obsessive anxious patients, and 30 community adults completed two measures of thought control/suppression strategies: the reduced Spanish version of the Thought Control Questionnaire (TCQ-r) and the White Bear Suppression Inventory (WBSI). Participants also completed measures of OCD, depressive and anxious symptoms. The results indicated that, in OCD patients, the chronic tendency to suppress negative unwanted thoughts (WBSI) was associated with Punishment (TCQ) and, to a lesser extent, with Worry and Reappraisal. When examining between-group differences, punishment for having negative intrusions proved to be OCD-relevant and OCD-specific, since OCDs were distinguishable from the other three groups on this measure. However, Distraction, Social control, Reappraisal, and Worry strategies were shown to be control strategies that were not specifically used by OCD participants or by those with anxiety and depressive disorders.

Dimensions of the self-consciousness scale and their relationship with psychopathological indicators

The current study has two specific aims: one is to examine the levels of self-consciousness in patients with different mental disorders (social phobia, panic disorder, major depression, dysthymia and generalized anxiety) as well as in a group with no mental disorder; another aim is to provide data for external validation of the different components of the self-consciousness scale using anxiety and depression measures. To do this, we considered the Fenigstein, Scheier, and Buss (1975) dimensions of self-consciousness (public self-consciousness, private self-consciousness and social anxiety), the private sub-scales proposed by Burnkrant and Page (1984) (Self-reflectiveness and Internal State Awareness), and the public self-consciousness sub-scales presented by Mittal and Balasubramaniam (1987) (Style Consciousness and Appearance Consciousness). Our results show that the original dimensions of the scale (private and public self-consciousness) do not support the existence of differential profiles among the groups studied. However, using the Mittal and Balasubramanian (1987) subdimensions for both public and private self-consciousness, we found different profiles regarding self-reflectiveness, style consciousness and appearance consciousness in some groups.

Bronchial Asthma and Personality Dimensions: A Multifaceted Association

Personality dimensions seem to play an important role in chronic diseases by maintaining or increasing the patients physical complaints. This study examines in bronchial asthma: (a) the relationships among clinical data, baseline lung function, and personality traits; and (b) the patients characteristics related to the physicians judgement about his or her asthma severity. Five questionnaires measuring anxiety, depression, self-consciousness, and subjective symptoms were completed by 51 asthmatic patients. Responses to questionnaires and clinical and demographic data were factor-analyzed. Factor analysis revealed that the physicians severity judgement is based on elderly age, high scores on depression, and longer duration of asthma.

Cognitive therapy for autogenous and reactive obsessions: Clinical and cognitive outcomes at post-treatment and 1-year follow-up

This study provides data about the differential effectiveness of cognitive therapy (CT) for obsessive-compulsive disorder (OCD) symptom presentation. Two OCD manifestations, autogenous and reactive, are considered. Seventy OCD patients started CT; 81.40% completed it and 72.85% were available 1 year later. Fifteen of the 57 treatment completers had autogenous obsessions, whereas 33 had reactive obsessions. Nine patients had both obsession modalities. Reactive patients were more severe, as they scored higher on thought suppression and on the dysfunctional beliefs of intolerance to uncertainty and perfectionism. Autogenous patients scored higher on the over-importance of thoughts beliefs. Although CT was effective in reducing OCD severity and the ascription to dysfunctional beliefs and neutralizing strategies in both the autogenous and the reactive patients, a significantly better outcome was observed for the autogenous patients, both at post-treatment (with 73.33% recovering versus 33.33% for reactives) and 1 year later.

Empirically Grounded Clinical Interventions: Cognitive Versus Behaviour Therapy in the Individual Treatment of Obsessive-Compulsive Disorder: Changes in Cognitions and Clinically Significant Outcomes at Post-Treatment and One-Year Follow-Up

Clinical significance analyses of controlled studies comparing Exposure and Response Prevention (ERP) and Cognitive Therapy (CT) in the treatment of Obsessive-Compulsive Disorder (OCD) are scarce. The objective of this study is to compare the clinical efficacy of ERP and CT for OCD patients, and the usefulness of each in changing dysfunctional beliefs and thought control strategies at post-treatment and at a one-year follow-up. The two treatments were delivered on the basis of a routine clinical practice in a public-mental health service. Thirty-three OCD patients were randomly assigned to ERP or CT, and 29 completed the treatments (13 in ERP and 16 in CT). The ERP applied was in vivo, gradual and therapist-guided. The CT was designed to challenge all the cognitive domains considered relevant for OCD, using cognitive techniques. The improvement and recovery rates (YBOCS) were slightly superior for CT than for ERP (ERP: 69.23% and 61.53%, respectively; CT: 81.25% and 68.75%, respectively). These therapeutic outcomes were maintained after the two treatments: at the one-year follow-up, 53.85% of the treated patients remained free of symptoms in ERP, and 65.5% in CT. Finally, the two treatments were equally effective in modifying dysfunctional beliefs, and the outcomes at the end of the treatments were maintained, or even increased, one year later.