Claude Bélanger

Marital relationship and the treatment of panic disorder with agoraphobia: a critical review

The purpose of this paper is (1) to specify, among studies on the links between marital relationship and cognitive-behavioral treatment of panic disorder with agoraphobia (PDA), the conceptual and methodological limitations that may have produced inconsistent results in this field so far; and (2) to propose avenues of research that will help in remedying current weaknesses and answering important questions in this area. Following definition of PDA and a survey of its socioeconomic consequences, the authors examine results of the various ways research has tried to specify the links between marital relationship and the development, maintenance, and treatment of this disorder: the study of major life events before and after the onset of PDA, interpersonal problems and quality of marital relationship in the presence of PDA, the links between marital relationship and PDA treatment outcome, variability of experimental outcomes according to types of measure used to study these links, the effect of the spouse as co-therapist in PDA treatment, and the impact of a PDA treatment based on marital communication and problem-solving. Research hypotheses and methodological procedures are proposed to improve understanding of PDA and its treatment outcome.

Cardiovascular, Neuroendocrine, and Monoaminergic Responses to Psychological Stressors: Possible Differences between Remitted Panic Disorder Patients and Healthy Controls

Both clinical symptomatology and stress research suggest that panic attacks might be partially attributable to exaggerated psychophysiological responses to environmental stressors. In the present study, we aimed to explicitly test this idea by measuring the physiological responses to a mild psychological stressor in both healthy controls (n = 8) and fully remitted, medication-free panic disorder patients (n = 8). One hour before the stressor, former patients, compared to healthy controls, exhibited higher diastolic blood pressure. From a blood sample taken 30 min before the stressor, patients, compared to controls, had lower paroxetine platelet binding site densities. During the stressor, patients, compared to controls, had greater increases in plasma levels of cortisol. These preliminary findings suggest that remitted panic disorder patients might have disturbed physiological responses to mild psychological stressors. These disturbances might be related to the development of future episodes.

Belief in the obsessional doubt as a real probability and its relation to other obsessive‐compulsive beliefs and to the severity of symptomatology

OBJECTIVES Despite the important role of doubt in understanding obsessive-compulsive disorder (OCD), current cognitive models of OCD usually do not separate this initial doubt from the anticipated consequence of not ritualizing. The current study evaluates belief in the obsessional doubt as a real probability as an additional cognitive dimension of obsessive-compulsive (OC) beliefs. METHODS One hundred and fifteen participants with OCD completed four clinical scales measuring different OC beliefs in: (a) the real probability of obsessional doubt; (b) the realism of anticipated consequences; (c) the degree of conviction in the need to perform rituals; and (d) the perceived ability to resist rituals. The severity of symptomatology was also evaluated. DESIGN Using cross-sectional and longitudinal data, correlational analyses were performed to determine the relationship between OC beliefs as well as to observe how these beliefs may be related to the severity of symptomatology and how they fluctuated over time. Regression analyses were also employed to verify which OC beliefs better predicted the perceived ability to resist rituals. RESULTS Belief in the obsessional doubt as a real probability was significantly related to other OC beliefs. Also, levels of belief for the same doubt remained stable for a period of two weeks, but different levels of belief were observed for distinct obsessional doubts measured at the same time. Finally, belief in the obsessional doubt as a real probability better predicted the perceived ability to resist rituals than other OC beliefs. CONCLUSIONS Belief in the obsessional doubt as a real probability may be an important dimension to consider when evaluating OC beliefs in treatment resistant OCD, particularly in people who have low perceived ability to resist rituals.

Predictors of Comorbid Eating Disorders and Diabetes in People with Type 1 and Type 2 Diabetes

OBJECTIVES The objective of this study was to identify psychosocial predictors of comorbid eating disorders (EDs) in individuals with type 1 and type 2 diabetes. METHODS In this cross-sectional study, 140 people with diabetes answered an online survey covering sociodemographic information, body esteem, restrictive eating, medication omission, coping styles and depressive symptoms. Participants were recruited through advertisements on more than 100 websites, including forums, community organizations and Facebook groups focusing on either diabetes or EDs. Recruitment took place in Canada, Europe, Australia and the United States. RESULTS On average, EDs developed after diabetes diagnoses in participants with type 1 diabetes but prior to diabetes diagnosis in participants with type 2 diabetes. In type 1 diabetes, avoidance coping styles and depressive symptoms predicted an additional diagnosis of EDs. Co-occurring EDs and type 2 diabetes were predicted by body mass indexes and task-oriented coping strategies. CONCLUSIONS Variables potentially influencing the development of EDs in people with diabetes differ according to the type of diabetes, body mass indexes, coping styles and depressive symptoms; they should be more systematically evaluated and closely monitored. In the context of diabetes management, prevention strategies for ED onset based on increased knowledge of the risk factors associated with EDs are necessary and could help decrease the risk for the health complications of diabetes.

Fall-Related Psychological Concerns and Anxiety among Community-Dwelling Older Adults: Systematic Review and Meta-Analysis.

Fear of falling and other fall-related psychological concerns (FRPCs), such as falls-efficacy and balance confidence, are highly prevalent among community-dwelling older adults. Anxiety and FRPCs have frequently, but inconsistently, been found to be associated in the literature. The purpose of this study is to clarify those inconsistencies with a systematic review and meta-analysis and to evaluate if the strength of this relationship varies based on the different FRPC constructs used (e.g., fear of falling, falls-efficacy or balance confidence). A systematic review was conducted through multiple databases (e.g., MEDLINE, PsycINFO) to include all articles published before June 10th 2015 that measured anxiety and FRPCs in community-dwelling older adults. Active researchers in the field were also contacted in an effort to include unpublished studies. The systematic review led to the inclusion of twenty relevant articles (n = 4738). A random-effect meta-analysis revealed that the mean effect size for fear of falling and anxiety is r = 0.32 (95% CI: 0.22–0.40), Z = 6.49, p < 0.001 and the mean effect size for falls-efficacy or balance confidence and anxiety is r = 0.31 (95% CI: 0.23–0.40), Z = 6.72, p < 0.001. A Q-test for heterogeneity revealed that the two effect sizes are not significantly different (Q(19) = 0.13, p = n.s.). This study is the first meta-analysis on the relationship between anxiety and FRPCs among community-dwelling older adults. It demonstrates the importance of considering anxiety when treating older adults with FRPCs.

The Effect of Cognitive-Behavioral Group Marital Therapy on Marital Happiness and Problem Solving Self-Appraisal

Problem solving self-appraisal affects problem solving performance and marital adjustment. This study investigated the effects of cognitive-behavioral group marital therapy on couples’ adjustment and their self-appraisal of problem solving activities. Sixty-six couples participated in group couples therapy. Subjects were randomly assigned to an experimental or a waiting list control group. They completed the Problem Solving Inventory and the Marital Happiness Scale. Therapy was effective in improving global couple adjustment and problem solving self-appraisal. The program had a differential effect on the improvement of self-perceived problem solving abilities depending on the spouses’ initial self-appraised problem solving ability level.

Predictors of Dropout From Cognitive-Behavioral Group Treatment for Panic Disorder With Agoraphobia An Exploratory Study

Panic disorder and agoraphobia are both characterized by avoidance behaviors, which are known correlates of treatment discontinuation. The aim of this exploratory study is to distinguish the profile of participants suffering from panic disorder with agoraphobia that complete treatment from those who discontinue therapy by assessing four categories of predictor variables: the severity of the disorder, sociodemographic variables, participants’ expectations, and dyadic adjustment. The sample included 77 individuals diagnosed with panic disorder with agoraphobia who completed a series of questionnaires and participated in a cognitive-behavioral group therapy consisting of 14 weekly sessions. Hierarchical linear regression analyses revealed the importance of anxiety, prognosis, and role expectations as well as some individual variables as predictors of therapeutic dropout, either before or during treatment. Among the most common reasons given by the 29 participants who discontinued therapy were scheduling conflicts, dissatisfaction with treatment, and conflicts with their marital partner. These results suggest that expectations and dyadic relationships have an impact on therapeutic discontinuation. The clinical implications of these findings are discussed.

Understanding and Treating Anxiety Disorders in Presence of Personality Disorder Diagnosis

The prevalence of personality disorders varies between 0.5% and 2.5% in the general popu‐ lation and it increases drastically in the clinical population [1, 2]. In a psychiatric population, about one half of all patients have pathological personality [3]. Following the multiaxial classification of the Diagnostic Manual of the American Psychiatric Association (DSM-IVTR; [1]), Axis II personality disorders are defined as being stable, inflexible, and pervasive patterns of psychological experiences and behaviors that differ prominently from cultural expectations, and that lead to clinically significant distress or impairment in important areas of functioning. In the DSM-IV-TR, there are 10 distinct personality disorders organized into three clusters. Cluster ′′A′′ includes three personality disorders considered as odd or eccen‐ tric: paranoid, schizoid and schizotypal. Antisocial, borderline, narcissistic and histrionic personality disorders are grouped under Cluster ′′B′′, which is considered as the dramatic, emotional or erratic cluster. Finally, Cluster ′′C′′ comprises three anxious or fearful person‐ ality disorders: the avoidant personality disorder, the dependent personality disorder and the obsessive-compulsive personality disorder. In the next version of the DSM (DSM-V), the task force is proposing some major changes for Axis II and as per the may 1st 2012 online revision[4], the DSM-V will retain six personality disorder types : schizotypal, antisocial, borderline, narcissistic, avoidant and obsessive-compulsive.

L’expérience de la douleur et de la souffrance chez les musiciens d’orchestre

Dans le cadre de cette etude, quatre musiciens d’orchestre professionnels se sont pretes a des entretiens semi-directifs afin de rendre compte de leurs experiences de la douleur dans le contexte du travail d’orchestre. Nous avons procede a une analyse a la fois descriptive et interpretative du materiel recueilli. Les resultats revelent que chez les musiciens rencontres, la quete d’ideal est au cœur de leur activite musicale. Ils demontrent au sein de cette activite un investissement massif qui comporte des gratifications et des souffrances sur le plan identitaire, modulant le sens attribue a la douleur. Dans cet article, nous discutons des resultats selon la theorie de la psychodynamique du travail (Dejours, 1980).

The Role of Expectations in Treatment Outcome and Symptom Development in Anxiety Disorders

For more than 60 years, researchers have been interested in determining the impact of expectations on treatment outcome. Earlier studies mostly focused on two types of expectations: prognostic and process expectations. Aims: To review how four different types of expectations (prognostic, process, anxiety expectancy and anxiety sensitivity) contribute to psychotherapy outcome, and to the development of clinical disorders, especially anxiety. Conclusions: First, the role of process and prognostic expectancies in clinical disorders and psychotherapy outcome should be clarified by addressing the methodological flaws of the earlier expectancy studies. Second, studies, especially those on anxiety disorders, may benefit from evaluating the four different types of expectations to determine their relative impact on outcome, and on the development and maintenance of these disorders. Third, possible links with other clinical disorders should be further explored. Finally, expectancies should be assessed prior to treatment and after several sessions to determine the extent to which the treatments failure in modifying initial low expectancies contribute to a poor outcome.