Ignacio Fernández-Arias

Treatment of Anxiety Disorders in a Psychology Clinic.

People with anxiety disorders demand psychological attention most often. Therefore, it seems important to identify both the characteristics of the patients who demand help and the clinical variables related to that demand and its treatment. A cohort of 292 patients who requested help at a university clinical facility was studied. The typical profile of the patient was: being female, young, unmarried, with some college education, and having previously received treatment, especially pharmacological one. The three most frequent diagnoses of anxiety, which include 50% of the cases, were: Anxiety Disorder not otherwise specified, Social Phobia, and Panic Disorder with Agoraphobia. Regarding the characteristics of the intervention, the average duration of the assessment was 3.5 sessions (SD = 1.2), and the duration of the treatment was 14 sessions (SD = 11.2). The percentage of discharges was 70.2%. The average cost of treatment was around €840. The results are discussed, underlining the value of empirically supported treatments for anxiety disorders.

Does adding pharmaceutical medication contribute to empirically supported psychological treatment for anxiety disorders

BACKGROUND The goal of this work is to determine whether the combined use of empirically supported psychological treatments (ESTs) and pharmacological therapy (PT) achieves better results than the isolated use of ESTs in the treatment of Anxiety Disorders (AD) in a welfare clinical setting. METHOD A quasi-experimental study was designed, with a sample of 287 patients with primary diagnosis of AD. Of the patients, 25.1% (n = 72) received ESTs+PT and 74.9% (n = 216), only ESTs. At pretreatment, no intergroup differences were observed in anxiety and depressive symptoms, duration of the problem and comorbidity, but there were differences for previous treatments (they were fewer in the EST group). RESULTS After the intervention, both groups showed similar degree of completion, compliance with treatment, task performance and similar effectiveness at post treatment but EST+PT was significantly longer (16.58 sessions vs. 13.04 sessions). CONCLUSIONS It is concluded that adding PT to EST does not improve the results but it does increase the cost and duration of treatment, thereby reducing the efficiency of the intervention.

Premature termination of psychological treatment for anxiety disorders in a clinical setting.

BACKGROUND Empirically supported psychological treatments (ESTs) have demonstrated their effectiveness and clinical utility for the treatment of anxiety disorders (AD) but few studies have assessed the factors associated with premature termination in ESTs for AD. METHOD The goals of this study, which involved 291 patients with a diagnosis of anxiety who had received outpatient psychological care, consisted of examining premature termination of treatment (PTT), comparing the individual characteristics of the patients who successfully completed treatment with those who terminate it prematurely, and analyzing the predictors of PTT. RESULTS Of the sample, 8.2% refused to start treatment, 28.5% dropped out before completing it, and 63.2% successfully completed treatment. In 50% of the cases, PTT occurred during the first 7 sessions, and in 80%, before the 15th session. Alternatively, 76.4% of the patients who complete treatment successfully do so before session 20. We found that patients with PTT attended a significantly lower number of treatment sessions and attended the sessions more irregularly and unpunctually. Presenting a generalized anxiety disorder (GAD), problems with punctuality and with task performance were predictors of failure to complete treatment. CONCLUSIONS These findings suggest the need to reinforce early adherence to treatments to help patients remain in treatment.

Factors associated with prolonging psychological treatment for anxiety disorders

BACKGROUND Anxiety disorders are one of the disorders most frequently requested for psychological attention. The purpose of this study is to identify the factors that can explain a longer duration of psychological treatment for anxiety disorders. METHOD 202 patients from the University Psychology Clinic of the Complutense University of Madrid were analyzed. RESULTS Multivariate regression analysis showed that the presence of obsessive-compulsive disorder and the application of arousal control techniques followed by modeling and other specific techniques were the best predictors of treatment duration. CONCLUSION Reducing as much as possible the number of techniques applied without reducing intervention efficacy is suggested. In some disorders that produce a greater life disorganization, it may be useful to try to organize the patient´s life either as a first goal or at the same time as the intervention program, so as to increase its effectiveness and reduce the number of sessions.