Hanne Nørr Fentz

Mechanisms of change in cognitive behaviour therapy for panic disorder: The role of panic self-efficacy and catastrophic misinterpretations

The efficacy of cognitive behavioural therapy (CBT) for panic disorder with or without agoraphobia (PD) is well-established; however, little is known about the underlying change processes of clinical improvement during therapy. According to cognitive theories, CBT for PD primarily works by changing catastrophic misinterpretations of bodily symptoms and panic attacks. However, panic self-efficacy, i.e. the perceived ability to cope with panic attacks, has also been suggested as an important change mechanism in CBT for PD. The aim of the study was to investigate if change in catastrophic misinterpretations and panic self-efficacy mediated change in the level of anxiety during the course of thirteen sessions of group CBT for PD. Forty-five participants completed weekly self-report measures of the possible cognitive mediators and the level of anxiety throughout therapy. The results indicated that within-person change in panic self-efficacy in one session, but not in catastrophic misinterpretations, predicted within-person level of anxiety symptoms the following week. However, in a reversed analysis, prior change in level of anxiety symptoms also predicted change in panic self-efficacy the following session. These results support panic self-efficacy as a mediator of change in CBT for PD, although a reciprocal causal relationship between panic self-efficacy and level of anxiety seems to be implied.

Emotion Differentiation and Emotion Regulation in High and Low Socially Anxious Individuals: An Experience-Sampling Study

AbstractThe present study explored when and how emotional difficulties and poor quality of life arise in the everyday lives of socially anxious individuals. 264 freshmen-year college students completed an online survey for 11 consecutive days. Comparing individuals high (HSA) and low in social anxiety, results revealed that irrespective of daily positive emotion differentiation ability, HSAs engaged daily emotion suppression strategies, pointing to inflexible emotion regulation. Furthermore, HSAs with poor daily negative emotion differentiation used the least daily cognitive reappraisal. Finally, both expressive suppression and cognitive reappraisal showed group-specific effects on daily positive affect. Daily expressive suppression was more strongly associated with diminished daily positive affect in HSAs, and HSAs benefited less in terms of daily positive affect from daily use of cognitive reappraisal. Based on these findings, emotion differentiation ability and emotion regulation appear relevant clinical targets for individuals with social anxiety disorder.

The role of depression in perceived parenting style among patients with anxiety disorders.

Despite a long tradition of research on the relationship between parenting style and anxiety disorders, few studies have taken the effect of comorbid depression into account. This study investigated perceived parenting in 504 outpatients with panic disorder/agoraphobia, social phobia or obsessive-compulsive disorder, and in 210 psychology students. The anxiety group reported both parents as less caring and their fathers as more controlling than did the student group. However, these between-group differences disappeared when taking self-reported depressive symptoms into consideration. Also no differences in parental style were found between the three diagnostic anxiety groups, when depressive symptoms were taken into account. Self-reported depressive symptoms were more consistently associated with negatively perceived parenting style than with self-reported anxiety symptoms in both the anxiety group and the student group. Results do not support theories of parental control as a specific risk factor for anxiety disorders, but they are in accordance with prior findings showing an association between depression and perceived lack of parental care.

The mediational role of panic self-efficacy in cognitive behavioral therapy for panic disorder: a systematic review and meta-analysis.

Cognitive models of panic disorder (PD) with or without agoraphobia have stressed the role of catastrophic beliefs of bodily symptoms as a central mediating variable of the efficacy of cognitive behavioral therapy (CBT). Perceived ability to cope with or control panic attacks, panic self-efficacy, has also been proposed to play a key role in therapeutic change; however, this cognitive factor has received much less attention in research. The aim of the present review is to evaluate panic self-efficacy as a mediator of therapeutic outcome in CBT for PD using descriptive and meta-analytic procedures. We performed systematic literature searches, and included and evaluated 33 studies according to four criteria for establishing mediation. Twenty-eight studies, including nine randomized waitlist-controlled studies, showed strong support for CBT improving panic self-efficacy (criterion 1); ten showed an association between change in panic self-efficacy and change in outcome during therapy (criterion 2); three tested, and one established formal statistical mediation of panic self-efficacy (criterion 3); while four tested and three found change in panic self-efficacy occurring before the reduction of panic severity (criterion 4). Although none of the studies fulfilled all of the four criteria, results provide some support for panic self-efficacy as a mediator of outcome in CBT for PD, generally on par with catastrophic beliefs in the reviewed studies.

Perceived stress, disturbed sleep, and cognitive impairments in patients with work-related stress complaints: a longitudinal study

Abstract Patients on sick leave due to work-related stress often present with cognitive impairments as well as sleep disturbances. The aim of this longitudinal study was to examine the role of perceived stress and sleep disturbances in the longitudinal development in cognitive impairments in a group of patients with prolonged work-related stress (N = 60) during a period of 12 months following initial professional care-seeking. Objective cognitive impairments (neuropsychological tests) were measured on two occasions – at initial professional care-seeking and at 12-month follow-up. Questionnaires on perceived stress, sleep disturbances, and cognitive complaints were completed seven times during the 12 months which facilitated multilevel analysis with segregation of within-person (change) and between-person (baseline level) components of the time-varying predictors (perceived stress and sleep disturbances). Change in perceived stress was associated with concurrent and subsequent change in self-reported cognitive complaints over the period of 12 months and to a lesser extent the change in performance on neuropsychological tests of processing speed from baseline to 12-month follow-up. Change in sleep disturbances was also associated with concurrent and subsequent change in self-reported cognitive complaints over the 12 months but not with change on neuropsychological test performance. Although the mechanism behind the improvement in cognitive impairments in patients with work-related stress should be further explored in future studies, the results could suggest that improvement in cognitive impairments is partly mediated by decreasing levels of perceived stress and, to a lesser extent, decreasing levels of sleep disturbances. Lay summary This study examines the role of perceived stress and sleep disturbances in respect to the development of cognitive impairments (e.g. memory and concentration) in a group of patients with work-related stress. We found that change in cognitive impairments seems to be partly explained by change in perceived stress and, to a lesser extent, sleep disturbances over time. This could suggest that cognitive impairments can be reduced by stress management interventions which aim to reduce perceived stress and sleep disturbances but future studies are needed to confirm this interpretation.

Relationship Help-Seeking in a Danish Population Sample

Empirically supported couple interventions often transfer from the US to several other parts of the world yet we have little data on their final reach. This study investigated relationship help-seeking in a random population sample of 1,371 individuals living with a partner in Denmark, a European high income - high divorce country. Only a small fraction of respondents had ever sought couple education (3%) or counseling/therapy (7%) with their partner. Among respondents experiencing a severe relationship crisis, individual types of help-seeking were the most prevalent. Both women (38.9%) and men (27.8%) with a recent relationship crisis sought information online, and mostly women (19.4%) also sought individual therapy. Findings can inform strategies for increasing the reach of couples in new cultural contexts.