Martin D. Provencher

Worry themes in primary GAD, secondary GAD, and other anxiety disorders

This study examines worry themes among 87 anxiety disorder patients divided into three groups: (a) 24 primary generalized anxiety disorder (GAD) patients, (b) 25 secondary GAD patients, and (c) 38 other anxiety disorder patients (primarily obsessive-compulsive disorder, social phobia and panic disorder with agoraphobia). Structured and free-recall measures were used to measure five worry themes: relationships, work, finances, physical threat, and the future. Both types of measures revealed that GAD patients worry more about the future than non-GAD patients. Further, post hoc analyses testing for linear relationships indicated that primary GAD patients worry more about the future than secondary GAD patients who in turn worry more about the future than other anxiety disorder patients. The results suggest that although worry about immediate problems may not differentiate GAD patients from other anxiety disorder patients, high levels of worry about future events may be a distinguishing feature of GAD.

Schema Theory and Schema Therapy in Mood and Anxiety Disorders: A Review

Schema theory was developed for patients with chronic psychological problems who fail to make significant gains in cognitive therapy. Although the theory has been applied most frequently to personality disorders, mood and anxiety disorders may also be a relevant application. This article reviews the literature applying schema theory to mood and anxiety disorders. The literature suggests that people with mood and anxiety disorders present high levels of early maladaptive schemas, some of which would appear to reflect the characteristics of the individual disorders. Preliminary research suggests that schema therapy may be successfully extended to mood and anxiety disorders. Further research is necessary to examine the utility of schema therapy for these clienteles and to identify the individuals who stand to benefit most.

Strategies used with intrusive thoughts: Context, appraisal, mood, and efficacy☆

Abstract Neutralization and avoidance play a key role in current models of OCD and GAD. This study examines strategies used when intrusive thoughts occur as a function of potential discriminative stimuli (sequences, context, thought appraisal), mood state, and efficacy. Structured interviews identified strategies used by 53 normal subjects when the most frequent intrusive thought occurred. The seven major strategies used to cope with the thoughts were physical action, thought replacement, analyzing the thought, talking to others, thought stopping, attempts to convince that the thought has no importance, and doing nothing. Results suggest that the choice of a strategy is not random; some strategies were used in particular situations, in specific sequences, and according to the intensity and appraisal of the intrusive thought. All strategies were equally efficient (or inefficient) and efficacy was not associated with thought characteristics. Thought appraisal was related to mood intensity, whereas depressed mood was associated with lower efficacy of strategies. The specific and differential effects of mood intensity and type need to be integrated into current models of intrusive cognition and OCD.

Sleep disturbances in bipolar disorder during remission

BACKGROUND While sleep disturbances associated with bipolar disorders depression and mania phases are well documented, the literature regarding sleep during remission phases is less consistent. The present studys aim was to describe the nature and severity of sleep difficulties in individuals with bipolar disorder (BD) during remission phases. METHODS Fourteen participants with BD were compared to 13 participants with primary insomnia and 13 without mental health disorders or insomnia on different sleep and daytime functioning parameters using actigraphy, sleep diaries and self-report measures. RESULTS Results suggest that sleep of individuals with BD was similar to that of individuals without mental health disorders or insomnia, but differed from that of individuals with insomnia. Nevertheless, participants with BD still presented sleep complaints and, like individuals with insomnia, were less active in the daytime, carried on their daily activities at more variable times from day to day, and reported more daytime sleepiness. LIMITATIONS Patients were taking medications and the limited sample size did not permit comparison of sleep parameters between bipolar I and bipolar II patients. CONCLUSIONS Psychological interventions aimed at encouraging the adoption of more stable sleep and daily routines might be helpful in helping individuals with BD cope more efficiently with some of these complaints.

Psychotherapies for comorbid anxiety in bipolar spectrum disorders

BACKGROUND Comorbid anxiety disorders are highly prevalent in bipolar disorder and have been shown to have serious negative impacts on the course of illness. The pharmacological treatment of anxiety can interact with the bipolar disorder and has not been proven effective. As such, many have recommended the psychological treatment of anxiety. This paper reviews the literature on psychological treatments for anxiety comorbid to bipolar disorder. METHOD The Medline, PsychInfo and Web of Science databases were thoroughly examined for relevant treatment studies. RESULTS Despite frequent recommendations in the literature, surprisingly few have studied the psychological treatment of comorbid anxiety in bipolar disorders. Nevertheless, preliminary results suggest that comorbid anxiety disorders can be effectively treated in a bipolar clientele using cognitive-behavioral therapy, mindfulness-based cognitive-behavioral therapy or relaxation training. In contrast, interpersonal, family therapy and psychoeducation alone would not seem to be beneficial treatment alternatives for anxiety. Cognitive-behavioral therapy appears to reduce the symptoms of obsessive-compulsive disorder, generalized anxiety disorder, panic disorder, post-traumatic stress disorder and general symptoms of anxiety among patients with bipolar disorder. However, the long-term maintenance of anxiety treatment effects may be somewhat reduced and adaptations may be called for to augment and sustain benefits. CONCLUSIONS There is an urgent need for randomized controlled trials of different forms of psychotherapy for anxiety disorders comorbid to bipolar disorder. Until such trials are available, the most promising approach would appear to be the sequential or modular CBT-based treatment of the anxiety disorder.

Awareness promotion about excessive gambling among video lottery retailers.

This paper describes and evaluates “As luck would have it,” an awareness program completed by retailers in Quebec Province. This program, which is presented as a two-hour awareness promotion workshop, aimed to inform retailers about excessive gambling. More specifically, it provided answers to the following questions: (1) What is chance and randomness? (2) Is there a link between misunderstanding the concept of chance and excessive gambling? (3) How does one recognise the symptoms of this disorder? (4) How should retailers intervene if they decide to do so? Results showed that retailers developed a better understanding of problem gambling, could recognise its main symptoms, felt more capable of coping with excessive gamblers, and of choosing the most appropriate moment to do so. In the follow-up phase, retailers who had attended the workshop reported that they approached a problem gambler significantly more often than the retailers who had not attended the workshop, and had discussed how to help problem gamblers significantly more often. The practical implications of these results are briefly discussed.

Behavioural activation for depression: Efficacy, effectiveness and dissemination

BACKGROUND Depression being a prevalent psychobiological disorder across the world, there is a need to identify effective, evidence-based treatments that are time and cost-effective in an effort to increase the populations accessibility to treatments. Low-intensity interventions, such as guided self-help treatments, hold promise for the dissemination of evidence-based treatments. Behavioural activation, a component of cognitive-behavioural therapy, is receiving increasing attention and empirical support as a stand-alone psychological treatment for depression. This article reviews behavioural activations theoretical foundations and efficacy in light of determining its potential as a low-intensity intervention. METHOD A systematic review of articles on low-intensity behavioural activation interventions for depression was conducted using the PsychInfo, Medline and Embase databases. Behavioural activations potential for dissemination as a guided self-help treatment is discussed and future avenues of research are stressed. LIMITATIONS Studies on the efficacy of behavioural activation as a guided self-help treatment are very limited to date and there are significant variations among existing studies. CONCLUSIONS Based on the research literature, it can be concluded that behavioural activation could be a viable option as a low-intensity guided self-help psychological treatment for mild to moderate depression. Further research is required to better understand the optimal parameters and client-therapist characteristics of this form of low-intensity intervention.

Comorbid anxiety in bipolar spectrum disorders: A neglected research and treatment issue?

BACKGROUND Anxiety disorders are highly prevalent among patients with bipolar disorder and have a substantial impact on the course of illness and response to treatment. Despite the substantial impact that comorbid anxiety disorders have on the prognosis of individuals with bipolar disorder, many aspects of this comorbidity have received little attention from researchers. This study aims to document the current state of the literature on the comorbidity between anxiety and bipolar disorders by analyzing publication trends on the subject. METHOD This study is a quantitative and qualitative review of articles on the comorbidity between anxiety disorders and bipolar disorder published between 1990 and 2010 in the ISI Web of Science, Medline and PsycINFO databases. The number of articles published each year on this comorbidity was calculated and compared to the literature published on bipolar disorder as a whole. Articles were classified into five categories and 13 subcategories to identify the main focuses of the literature and current gaps in the knowledge on the subject. RESULTS Interest in the comorbidity between anxiety disorders and bipolar disorder grew continually since 1990, but seems to have reached a plateau. The majority of articles addressing this comorbidity are descriptive in nature, with very few concrete studies examining the mechanisms and treatment approaches that might lead to positive advancements in the field. LIMITATIONS Articles written in languages other than English or French were not reviewed. CONCLUSIONS It is time to step up research efforts to better understand and manage this under-studied combination of disorders.

Early Maladaptive Schemas in the risk for bipolar spectrum disorders

BACKGROUND The hypomanic personality style is a risk factor for bipolar spectrum disorders and shares many cognitive and affective features with the bipolar spectrum. Schema theory may serve as a unifying theory that would explain many of these features. This study is an exploratory investigation of Early Maladaptive Schemas (EMSs) in association with the hypomanic personality and bipolar spectrum risk. METHODS A sample of 966 participants completed the Young Schema Questionnaire, the Hypomanic Personality Scale and the Patient Health Questionnaire. Associations were investigated using univariate and multivariate analyses. Participants deemed at risk of developing a bipolar disorder (N=107) were compared to low-risk controls (N=681). RESULTS The Entitlement/Grandiosity and Insufficient Self-Control/Self-Discipline positively predicted the risk of developing a bipolar disorder, while Emotional Inhibition negatively predicted risk. High-risk participants demonstrated higher mean scores on all EMSs except Emotional Inhibition. These three EMSs, combined with Vulnerability to Harm or Illness, significantly predicted group membership. CONCLUSIONS A bipolar spectrum EMS profile was identified, consisting of Entitlement/Grandiosity, Insufficient Self-Control/Self-Discipline and the absence of Emotional Inhibition. These EMSs are highly consistent with characteristics of the bipolar spectrum. This study supports the application of schema theory to the hypomanic personality and bipolar spectrum. Future research should explore the possible interaction between EMSs, life events and affective symptoms and the applicability of schema therapy to the bipolar spectrum.

Early Maladaptive Schemas among patients diagnosed with bipolar disorder

BACKGROUND Bipolar disorder is associated with a variety of cognitive features that seem to play a role in affective symptoms. Schema theory may serve as a unifying theory that would explain many of these features. This study is an exploratory investigation of schema theorys Early Maladaptive Schemas (EMSs) among individuals diagnosed with bipolar disorder. METHODS A sample of 74 participants with bipolar disorder and 99 mixed clinical controls (46 with unipolar depression and 53 with anxiety disorders) completed the Young Schema Questionnaire and comparison measures. Associations were investigated using univariate and multivariate analyses. Mean scores were compared with previously established benchmarks. RESULTS Participants with bipolar disorder demonstrate elevated scores on most EMSs, many at an intermediate position between nonclinical and mixed clinical control groups. When controlling for depression, participants with bipolar disorder exceed those with unipolar depression on Approval-Seeking/Recognition-Seeking and Entitlement/Grandiosity. Bipolar group membership is predicted by high scores on Approval-Seeking/Recognition-Seeking and low scores on Emotional Inhibition and Abandonment. LIMITATIONS Women were overrepresented. Axis II traits were not assessed, nor were manic symptoms in the mixed clinical sample. CONCLUSIONS Bipolar disorder is associated with a general activation of the EMSs. Approval-Seeking/Recognition-Seeking and Entitlement/Grandiosity seem to be particularly high, while Emotional Inhibition and Abandonment seem to be typically low. These EMS are highly consistent with characteristics of the bipolar spectrum. By demonstrating the activation of the EMSs, this study suggests that the EMS component of schema theory may be applied to bipolar disorder. Future research should explore how EMSs might interact with life events to trigger affective symptoms and, ultimately, the applicability of schema therapy to bipolar disorder.