Douglas M. McNair

Simulated public speaking as a model of clinical anxiety.

Normal male volunteers took single acute doses of either diazepam or placebo under double-blind conditions in three simulated public speaking experiments. Measures of palmar sweating and subjective anxiety showed that anticipation of speaking in public increased anxiety relative to baseline and prestress conditions, and performance of public speaking further increased anxiety. A dose-related anxiolytic effect of diazepam on subjective anxiety supported the models clinical relevance. Moreover, the intensity of the subjects public speaking phobia predicted both degree of prestress anxiety relief from 10 mg diazepam and overall anxiety level, regardless of medication, throughout the experimental session. A measure of traditionalism predicted placebo and 5 mg diazepam response during prestress: As in previous clinical trials, high traditionalism scorers reported more relief from placebo, whereas low scorers showed more relief from diazepam.

Symptomatic volunteers in multicenter drug trials.

1. Symptomatic volunteers were recruited at two collaborating institutions for anti-anxiety and antidepressant drug trials. Advertisements were placed for volunteers with significant symptoms of anxiety, depression, or both, and who were not currently in treatment. 2. It was possible to recruit adequate numbers of volunteers who met the numerous criteria for severity of distress; and who were not ruled out by various exclusion criteria, such as medical contraindications, etc. 3. Acceptable homogeneity across the samples at the collaborating institutions was found for demographic characteristics, level of distress, duration of symptoms, etc. 4. Attrition rates for these volunteers were lower than for the typical anxiolytic and antidepressant trials using outpatients. 5. Symptomatic volunteers appear to present a feasible alternative to the increasingly diminishing pool of outpatients.

Self-evaluations of antidepressants

Antidepressant clinical drug trials conducted from 1955–1972 are analyzed to determine the most frequently used patient self-rating scales and to estimate their relative sensitivities (validities). Other analyses suggest how the methodology of the trials may have influenced measurement sensitivity. Interpretive problems are discussed, and some tentative recommendations are presented.

Differential changes in areas of social adjustment from depressive episodes through recovery

The findings of the present short-term prospective study of 99 depressed outpatients further support previous cross-sectional observations to the effect that the course of depressive illness is often complicated by fluctuating social disturbances manifested by uneasiness in the work area, by disagreements with colleagues, and by difficulty in maintaining conflict-free relationships with significant others. By contrast, the incapacity to enjoy and use leisure time appeared less related to the symptomatologic variation in depression. Although we favor the hypothesis that impairment in leisure activity may represent a trait marker of depression, the hypothesis of it being a residual complication of repeated depressive episodes cannot be ruled out in view of short follow-up.

Methods relating to evaluation of therapeutic outcome

The purpose of this chapter is to present brief descriptions of the development and application of a set of procedures useful in the evaluation of therapeutic outcome. Initially attention will be focused on patient self-reports. These are designed to measure the patient’s moods and attitudes and his perception of his therapist. An instrument to describe characteristic patient interpersonal interactions and relationships is next discussed. Since individual psychotherapy is a dyadic relationship it is necessary to account for the therapist as well as his client. Procedures developed for assessing the therapist’s techniques and his goals for the patient are, accordingly, described. Finally, a scale devised to assess therapist attributes that contribute to successful treatment is presented.

Does marijuana enhance experimentally induced anxiety

Two experiments tested whether laboratory stressors induce greater or more variable anxiety in marijuana-intoxicated subjects. In experiment 1, marijuana and placebo subjects were shown a motion picture film depicting dental procedures. In experiment 2, they were subjected to the stress of giving a short videotaped speach. We found no significant difference between marijuana and placebo subjects in anxiety response to these two stressors, as measured by a mood adjective rating scale.

Tricyclic antidepressants and peripheral anticholinergic activity

Peripheral anticholinergic activity of single acute doses of three tricyclic antidepressants (amitriptyline 50 mg, desipramine 50 mg, doxepin 100 mg) and placebo was assessed by several physiologic measures in normal male volunteers. Amitriptyline and doxepin produced similar significant depressions in salivary flow and finger sweating compared to placebo, while desipramine produced no change. Supine and standing blood pressures and standing pulse yielded significant differences among the drugs. Measures in at least three areas (salivation, perspiration, and pulse-blood pressure) offer a simple and reliable battery of tests for the peripheral autonomic effects of tricyclic antidepressants.

Placebo response, placebo effect, and two attributes

Two putative predictors of placebo response were studied in three samples of psychiatric outpatients. Two groups, 73 university medical center patients and 56 college health service patients, underwent 1 week of placebo treatment. A quasi-control group of 112 patients receiving no medication waited about 1 week before beginning psychotherapy. One attribute, acquiescence or traditionalism, predicted placebo response, thereby replicating prior findings. Acquiescence was unrelated to change in controls indicating that it may represent a correlate of true placebo effect under some conditions. Additonal findings suggested qualifications as to the generality of the relationship. The second attribute, autonomic awareness, was associated with change in all three samples. It appeared to predict nonspecific improvement unrelated to placebo probably due to its relationship to intensity of somatization.

Tricyclic treatment of generalized anxiety disorder

While tricyclic antidepressants (TCAs) have now long been used in treatment for depressive and panic-phobic disorders, we reviewed and reported on their efficacy in generalized anxiety states. These ill-defined states usually have admixtures of anxiety and depression. While there is no neat diagnostic categorization to fit this wasteland of yet-to-be-defined disorders, they show surprising responsiveness to imipramine. The onset of efficacy appears to begin at about 2 weeks or later and is probably superior to at least one well-known benzodiazepine, chlordiazepoxide, well beyond that time. It is not possible to dismiss these observed antianxiety effects as secondary to antidepressant effects or as attributable to the unintended inclusion of a peculiarly sensitive subset of individuals such as panic-phobic patients. These findings indicate that affect regulation by TCAs applies to so-called generalized anxiety as well as to depression and panic-phobic disorder. Brief reminders and guidelines are outlined for the possible clinical use of TCAs in anxiety disorders, but there remain more questions than answers. Several replication studies concerning the results reviewed here are now under way.

Persistence of a drug-personality interaction in psychiatric outpatients

CLINICAL drug trials with psychiatric outpatients usually span brief time periods. Investigators rarely follow up such trials. Apparently only one previous study reported an objective and comprehensive follow-up of a clinical trial of mild tranquilizers.1 Unfortunately it used different measures during the clinical trial and at follow-up, and psychiatric status for the two periods could not be compared. This paper reports a follow-up four months after the end of a double-blind trial of diazepam (Valium).a-4-t The 2-week trial indicated that a personality characteristic (Acquiescence) and medication had significant joint, or interactive, effects upon outcome. Patients had been classified as High or Low Acquiescers by their frequency of agreement with 35 glib generalizations from the Bass Social Acquiescence Scale.5