Jim White

Attentional bias for emotional faces in generalized anxiety disorder

OBJECTIVES Recent cognitive theories propose that attentional biases cause or maintain anxiety disorders. This study had several aims: (i) to investigate such biases in generalized anxiety disorder (GAD) using naturalistic, ecologically valid stimuli, namely, emotional facial expressions; (ii) to test the emotionality hypothesis by examining biases for happy as well as threat faces; and (iii) to assess the time course of the attentional bias. DESIGN The dependent variable was an index of attentional bias derived from manual RTs to probe stimuli. There were four independent variables: one between-subjects variable of group (2: GAD, control), and three within-subjects variables: Type of emotional face (2: threat, happy), Stimulus duration (2: 500 ms, 1250 ms) and Half of task (2: first, second). METHOD Attentional bias was assessed with a dot probe task. The stimuli comprised photographs of threatening, happy and neutral faces, presented using two exposure durations: 500 ms and 1250 ms. RESULTS Anxious patients showed greater vigilance for threatening faces relative to neutral faces, compared with normal controls. This effect did not significantly vary as a function of stimulus duration. Anxious patients also showed enhanced vigilance for happy faces, but this was only significant in the second half of the task. CONCLUSIONS The study confirmed not only that GAD patients show a bias in selective attention to threat, relative to controls, but also that this bias operates for naturalistic, non-verbal stimuli. As the attentional biases for threat and happy faces appeared to develop over a different time frame, different underlying mechanisms may be responsible.

Selective processing of negative information: effects of clinical anxiety, concurrent depression, and awareness.

Anxious patients (n = 20) and normal controls (n = 20) carried out a modified Stroop color-naming task with anxiety- and depression-related words in supraliminal and subliminal exposure conditions. Within the anxious group, patients with generalized anxiety disorder (GAD) without concurrent depression (n = 11) showed more color-naming interference for anxiety words than neutral words in comparison with patients with a combined diagnosis of GAD and depression (n = 9). Compared with controls, the GAD subgroup without concurrent depression showed slower color naming for negative than neutral words, in both supraliminal and subliminal conditions, replicating K. Mogg, B. P. Bradley, R. Williams, and A. Mathewss (1993) results. These findings provide further evidence of an anxiety-related bias for negative information in preconscious processes and highlight the importance of assessing concurrent depression.

A phase I trial of the selective oral cyclin-dependent kinase inhibitor seliciclib (CYC202; R -Roscovitine), administered twice daily for 7 days every 21 days

Seliciclib (CYC202; R-roscovitine) is the first selective, orally bioavailable inhibitor of cyclin-dependent kinases 1, 2, 7 and 9 to enter clinical trial. Preclinical studies showed antitumour activity in a broad range of human tumour xenografts. A phase I trial was performed with a 7-day b.i.d. p.o. schedule. Twenty-one patients (median age 62 years, range: 39–73 years) were treated with doses of 100, 200 and 800 b.i.d. Dose-limiting toxicities were seen at 800 mg b.i.d.; grade 3 fatigue, grade 3 skin rash, grade 3 hyponatraemia and grade 4 hypokalaemia. Other toxicities included reversible raised creatinine (grade 2), reversible grade 3 abnormal liver function and grade 2 emesis. An 800 mg portion was investigated further in 12 patients, three of whom had MAG3 renograms. One patient with a rapid increase in creatinine on day 3 had a reversible fall in renal perfusion, with full recovery by day 14, and no changes suggestive of renal tubular damage. Further dose escalation was precluded by hypokalaemia. Seliciclib reached peak plasma concentrations between 1 and 4 h and elimination half-life was 2–5 h. Inhibition of retinoblastoma protein phosphorylation was not demonstrated in peripheral blood mononuclear cells. No objective tumour responses were noted, but disease stabilisation was recorded in eight patients; this lasted for a total of six courses (18 weeks) in a patient with ovarian cancer.

A follow-up study of cognitive bias in generalized anxiety disorder

Patients with generalized anxiety disorder (GAD) without concurrent depression (n = 11) and normal controls (n = 17) were tested twice, about 2 months apart, on a modified Stroop colour-naming task, which presented anxiety-related, depression-related and neutral words in masked and unmasked exposure conditions. GAD patients received cognitive behaviour therapy in the test-retest interval, and were also retested at follow-up, about 20 months after initial testing. GAD patients showed interference in colour-naming negative words across both masked and unmasked conditions before treatment, but not post-treatment, compared with controls. Reduced interference effects of masked threat words over time correlated with reduced ratings of anxious thoughts at post-treatment, and at follow-up, in GAD patients. Thus, the preconscious bias for threat information in GAD appears to vary over time in association with changes in anxious thoughts and worries.

Attention Training: Effects on Anxiety and Beliefs in Panic and Social Phobia

This study tested the effectiveness of a new cognitive technique involving attention training. A single case systematic replication series (Sidman, 1960) was used to replicate and extend previous findings. In particular the effects of attention training on panic frequency, general anxiety, and beliefs was investigated across two panic disorder cases and one social phobia case, and across different therapists, and settings. A true reversal design was used in one of the cases. In this case attention training was followed by an attentional manipulation incompatible with the hypothesized effects of attention training so that the effects of attention training on target problems could be clearly evaluated on its re-introduction. The results are consistent with those of a previous study (Wells, 1990) and provide preliminary evidence that panic attacks, anxiety and beliefs can be effectively and lastingly reduced by cognitive techniques which do not directly target the content of negative appraisal.

Stress Control: A Controlled Comparative Investigation of Large Group Therapy for Generalized Anxiety Disorder

One hundred and nine patients with a primary diagnosis of GAD were allocated to either cognitive, behavioural, cognitive-behavioural or placebo versions of “Stress Control” large group didactic therapy or to a waiting list condition. Each group was run by two therapists and, with the exception of the placebo, contained between 20 and 24 patients. A wide range of measures were administered at pre-, mid- and post-therapy and at six month follow-up. At post-therapy, all therapy conditions showed highly significant change on almost all measures, with the active therapies, and to a slightly lesser degree, the placebo, being significantly different to the waiting list on most measures. At follow-up, the active treatment conditions enhanced post-therapy improvements, while the placebo condition maintained progress. No significant differences existed between the four treatment conditions at post-therapy and, with the exception of one measure, at follow-up. However, a trend at both points favours the cognitive and behavioural conditions.

Stresspac: A Controlled Trial of a Self-Help Package for the Anxiety Disorders

In order to test the efficacy of a self-help anxiety management package, sixty-two individuals meeting DSM-III-R criteria for an anxiety disorder were randomly allocated to one of three conditions: Stresspac patients were given a self-help/information package. Advice only patients were offered verbal advice on ways of coping with anxiety. Patients in both conditions were seen on one occasion shortly after referral for assessment and management advice. They were then placed back on the waiting list for a three month period. Patients in the No intervention condition also completed measures during this time. They were not seen until the end of this period when formal assessment took place. All patients were then followed through individual therapy and to 12 month follow-up. Results clearly support the superiority of the Stresspac condition after the waiting period, at post therapy and at follow-up on a range of measures. Possible explanations for the results are discussed.

Stress control : a pilot study of large group therapy for generalized anxiety disorder

A pilot study is reported on a six session didactic large group treatment package for Generalized Anxiety Disorder (GAD) patients referred to a primary care service. Thirty patients underwent the course. By combining a didactic therapy element with workshops, the therapy package allowed a much larger number of individuals to attend the group than could be dealt with in “traditional” group therapy. Two psychologists ran the course. There were few practical difficulties involved in running the course and the range of self-report outcome measures suggest that large group didactic therapy may be a clinically and cost-effective treatment for GAD.

Rationale and design of a UK database for a rare cancer type: the GEM Registry for gastrointestinal stromal tumours

Background:Despite advances in the management of and changes in clinical practice, little is known about the epidemiology, patterns of care and outcomes of gastrointestinal stromal tumour (GIST) patients in the UK. Patient registries are receiving increasing attention as they can provide important information on clinical practice and patient outcomes. The rationale and study design of the GIST Epidemiology and Management (GEM) Registry, which forms part of the routine clinical practice for GISTs in several UK centres, are described.Methods:The GEM Registry is a secure web-based registry system designed around a Microsoft Access core using SQL interface. Demographic, surgical, histopathological and clinical data will be captured including treatment outcomes and survival. The registry was piloted in six centres and following further fine tuning of the data sets, ethical committee submission and approval was completed.Results:The GEM National Registry is the first of its kind to be implemented in rare cancers in UK. The registry is being rolled out initially in selected centres with the aim to expand to other centres. The first publication reporting analyses of the central data set is anticipated for the summer of 2013.Conclusion:GEM Registry will enable us to obtain a clear picture of incidence/prevalence of GISTS in UK. Clinicians will be able to review the prognostic and predictive value of variables in a large prospective data set. The data can be used for planning the delivery and improving the quality of care. This information is likely to inform clinical practice and, in years to come, guide the development and implementation of clinical trials for novel tyrosine kinase inhibitors. The results will not only benefit the GIST community, but also serve as a basis for the study of other rare tumour types.

“Subconscious Retraining”: A Placebo Strategy for Generalized Anxiety Disorder

This report describes a placebo strategy which engendered a reasonable degree of positive expectation in 10 Generalized Anxiety Disorder patients and was perceived by them as being credible, sensible and appropriate at pre- and post-therapy and at six month follow-up. The significant improvement noted on a range of measures suggests that the strategy is not inert.