Mariângela Gentil Savoia

Adverse life events and coping skills in panic disorder

UNLABELLED Research literature and clinical experience shows that panic patients are often able to identify stressors that preceded the onset of their first attacks. In this study we investigated the relation between life events, coping skills, and panic disorder. METHODS Forty-tree panic patients were compared with 29 control subjects regarding the occurrence and the impact of stressful life events in a 1-year period preceding the onset of panic attacks using the Social Readjustment Rating Scale and London Life Event and Difficulty Schedule. Coping skills were measured using the Ways of Coping Questionnaire. RESULTS No differences were observed between panic patients and controls regarding the number of reported stressful life events in the previous year. Panic patients compared to controls reported loss of social support as the most meaningful class of events significantly more often. In response to stressful situations, panic patients more often used coping skills judged as ineffective. CONCLUSIONS The present study suggests that the type of life event and the coping skills used in response to them, more than the occurrence of stressful events itself, may be associated with the onset of panic disorder.

Choking phobia: full remission following behavior therapy

OBJECTIVE A phobic behavior pattern is learned by classical and operant conditioning mechanisms. The present article reviews the main determinants of choking phobia etiology and describes the behavior therapy of an adult patient. METHOD Psychoeducation, functional analysis, and graded exposure to aversive stimuli were used to treat the patient, after extensive psychiatric and psychological assessment. Ingesta and anxiety levels were measured along treatment and at follow-up. RESULTS A multiple assessment baseline design was used to demonstrate the complete remission of symptoms after seven sessions, each of them exposing the patient to a different group of foods. CONCLUSION Psychoeducation and exposure were critical components of a successful choking phobia treatment.

Avaliação de traços de personalidade em pacientes com fobia social

CONTEXTO: Os sintomas de transtornos de personalidade (Eixo II) comumente encontrados em pacientes com fobia social se sobrepoem com os sintomas que descrevem o transtorno pelo Eixo I. OBJETIVO: O presente estudo teve por objetivo avaliar tracos de personalidade em pacientes com diagnostico de fobia social. METODO: Cento e oito sujeitos com idade entre 18 e 65 anos foram avaliados pelo Inventario de Temperamento e Carater de Cloninger. RESULTADO: Os pacientes com fobia social diferiram dos dados normativos nos seguintes tracos de personalidade: Busca a Novidade, Fuga de Danos, Persistencia, Autodirecionamento e Autotranscendencia. CONCLUSAO: Esses achados apontam para uma sobreposicao entre a descricao dos tracos de personalidade citados por Cloninger e a descricao dos sintomas de fobia social do DSM-IV, Eixo I.

Fobia de deglutição: discussão analítico-comportamental de seus determinantes e da amplitude da mudança

The behavior-analytic therapy of choking phobia in a 35 yrs-old woman, a case previously published focusing strictly on its psychiatric aspects, is now presented concerning specific life history determinants of both choking phobia and other responses of the same functional class, all of them involving experiential avoidance. Psychoeducation included detailed functional analysis of choking phobia and relationship problems, correlating both set of phenomena under a single perspective. By means of therapist-assisted graded exposure sessions to different sets of foods, according to a multiple baseline design, the fear subsided and ingesta returned to normal levels. In parallel, significant changes occurred in relationship patterns. Relational frame theory provides a possible explanation to the fact that the client promoted extensive and progressive changes in her eating pattern and relationship with significant others.