Melinda A. Stanley

Treatment of generalized anxiety in older adults: A preliminary comparison of cognitive-behavioral and supportive approaches

Generalized Anxiety Disorder (GAD) in older adults has received little attention from researchers, despite evidence that anxiety disorders are a significant mental health problem in this population. This study compared the efficacy of cognitive behavior therapy (CBT) and nondirective, supportive psychotherapy (SP) for 48 older adults, ages 55 and up, with well-diagnosed GAD. Treatments were administered in small groups that met for 14 weekly 1 1/2 hour sessions. Treatment effects were assessed at posttreatment and over a 6-month follow-up period. Primary outcome variables targeted anxiety and worry, and transfer effects were assessed with measures of depression and associated fears. Two composite indexes of treatment response were derived to identify treatment responder status and high endstate functioning. Two participants declined participation prior to randomization; 15 others were classified as drop-outs. Results for the remaining 31 participants (CBT: n = 18; SP: n = 13) demonstrated significant improvements on primary outcome and transfer effect variables in both treatment conditions. Effect sizes generally were large, and treatment gains were maintained or improved over the 6-month follow-up phase. Examination of treatment responder status and endstate functioning revealed no significant differences between groups. The data support the potential efficacy of psychosocial group treatment for GAD in older adults, although limitations of the work and suggestions for future research are discussed.

Are obsessional thoughts and worry different cognitive phenomena

Abstract Worry and obsessional thoughts are cognitive activities that can be found in the general population as well as among various psychopathological states. In addition, these two types of cognitive phenomena are among the defining characteristics of two distinct anxiety disorders: generalized anxiety disorder (worry) and obsessive-compulsive disorder (obsessions). Through a review of the literature, the core features of these cognitive phenomena were compared and contrasted in an effort to determine areas of similarities and differences. The conclusion indicates that although there are areas of overlap, obsessions can be differentiated from worry along several important dimensions. Also, adverse mood state appears to play a critical role when both worry and obsessional thoughts are pathological.

Characteristics of Generalized Anxiety Disorder in older adults: A descriptive study

Despite the prevalence of Generalized Anxiety Disorder (GAD) in older adults, little is known about psychopathological features of excessive worry in the elderly. This investigation compared 44 GAD patients (mean age 67.6), diagnosed using structured interview, with a matched sample free of psychiatric disorders on self-report and clinician measures. Results indicated that GAD in the elderly is associated with elevated anxiety, worry, social fears, and depression. Using self-report measures alone, near-perfect classification of Ss into groups was achieved with four measures (PSWQ, WS-Soc, FQ-Soc, and BDI). Using clinician ratings, near-perfect classification was achieved with Hamilton anxiety ratings. Comparison of GAD patients whose symptoms began in childhood vs middle adulthood revealed few differences on these dimensions. Results are discussed in light of features of GAD in the elderly, highlighting implications for further study.

Comparison of cognitive therapy and relaxation training for panic disorder.

Current approaches to the treatment of panic disorder (PD) include a treatment package consisting of relaxation training (RT), cognitive therapy (CT), and exposure-based components. In an examination of the separate effects of RT and CT without formally taught exposure of any form, 64 PD patients were assigned randomly to one of these treatment protocols or to a minimal-contact control (MCC) condition. Both RT and CT were superior to the MCC condition on a variety of measures pertaining to panic, global psychological functioning, agoraphobic fear, and other associated fears. A significantly greater percentage of patients were classified as treatment responders (based on a composite index) after CT (82%) and RT (68%), compared with the control group (36%). On measures of agoraphobic fear, CT patients fared slightly better than RT patients. Some support was demonstrated for specific cognitive changes after CT, although treatment specificity was not strongly supported overall. These results are discussed in light of current theories of PD and the presumed importance of exposure in its treatment.

A comparison of clinical features in Trichotillomania and obsessive-compulsive disorder

Trichotillomania (TM) recently has been conceptualized as a variant of obsessive-compulsive disorder (OCD). However, no systematic data have compared the clinical features of these two disorders. Here we report data from 8 TM and 13 OCD patients which suggest important clinical differences between groups. First, TM patients reported a significantly greater degree of pleasure during hair-pulling than OCD patients reported during performance of ritualistic behaviors. Second, TM was accompanied by significantly fewer associated obsessive-compulsive symptoms. Third, the groups differed with regard to other clinical features including anxiety, depression, and personality characteristics. We conclude that TM is not conceptualized best as a variant of OCD.

The social phobia and anxiety inventory: Construct validity

The Social Phobia and Anxiety Inventory (SPAI) is a new instrument composed of social phobia and agoraphobia subscales. The latter scale is used to detect social anxiety that may result from agoraphobia. The SPAIs construct validity was assessed through several procedures. First, confirmatory factor analyses were conducted to validate the existence of the two subscales. Second, exploratory factor analyses examined the underlying structure of the social phobia subscale. Third, a Q factor procedure determined if different anxiety diagnostic groups could be differentiated by their SPAI response pattern. The results confirmed the utility of the two SPAI subscales and identified a number of dimensions contained within the social phobia subscale which differed depending upon the specific subject sample. In addition, the complaints of social phobies appeared more homogeneous than those of an agoraphobic comparison group. The results are discussed in terms of construct validity and the sensitivity of the SPAI to various dimensions of social phobia fears.

Schizotypal features in obsessive-compulsive disorder

This study examined the prevalence and nature of schizotypal features in obsessive-compulsive disorder (OCD). Although this symptom pattern has been related retrospectively to treatment resistance, no prospective data have addressed such an hypothesis. This study sets the stage for further work in this arena by prospectively identifying and characterizing a schizotypal subset of OCD patients. Twenty-eight percent of the sample had schizotypal features, although only 8% met criteria for schizotypal personality disorder. Social-evaluative concerns and psychotic-like symptoms characterized this subgroup. Schizotypal patients did not differ from nonschizotypes with regard to anxiety, depressive, or obsessive-compulsive symptoms.

Attention and memory for threat in panic disorder

Recently, information processing paradigms have been utilized to explore the role of attentional and memory processes in the maintenance of clinical anxiety disorders. The present study extended these data using a dual-task paradigm to assess attentional vigilance and a cued recognition task to evaluate short-term memory effects in Panic Disorder (PD). Twenty PD patients and 20 normal controls completed a computerized task wherein they read aloud one of a pair of rapidly presented words (primary task) while simultaneously attempting to detect a small probe that appeared adjacent to one of the words (secondary task). Eighty stimulus words were chosen to represent four categories: physical panic-related threat, social threat, positive-emotional, and neutral. Reaction time and accuracy in detecting the probe were assessed, as well as psychophysiological responding (heart rate, skin conductance, EMG). Following task completion, a cued recognition task was administered to examine short-term memory of task stimuli. Results indicated that PD patients exhibited slower reaction times relative to normal controls during presentation of physical panic-related threat and positive-emotional stimuli. A similar trend emerged for social threat stimuli, although the PD and control samples responded similarly to neutral stimuli. No group differences were found on the cued recognition measure or psychophysiological responding during task performance. The data are discussed in terms of possible implications for cognitive models of PD.

Anxiety disorders in the elderly: The emerging role of behavior therapy

In recent years, behavior therapists have made a deliberate effort to expand their horizons to include underserved populations. The application of behavioral and cognitive behavioral procedures to anxiety disorders in the elderly represents one such beginning effort. In this review, we will present an overview of available literature concerning the psychopathology, assessment, and behavioral treatment of the anxiety disorders in later life. As will be noted, research is beginning to elucidate specific features and treatment of anxiety in the elderly, although the majority of this attention has been directed at Generalized Anxiety Disorder, specific phobias, and non-clinical anxiety complaints. Areas for future research are highlighted throughout this review, in the hopes of stimulating increased attention in these areas.

Can the Yale-Brown Obsessive Compulsive Scale be used to assess trichotillomania? A preliminary report.

Given recent conceptualizations of trichotillomania (TM) as a variant of obsessive compulsive disorder (OCD), clinician-rated measures of obsessive compulsive symptoms have been adapted for use in the assessment of TM. Although the reliability and validity of these instruments have been well-documented in patients with OCD, psychometric properties have not been examined systematically in patients with TM. Here, we evaluate the reliability and validity of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) in a sample of 11 patients with a primary diagnosis of TM. Data addressed the utility of the Y-BOCS for evaluating symptoms of TM, and provided information regarding the proposed overlap between OCD and TM. Initial analyses suggested that interrater reliability, internal consistency, and test-retest reliability for the total score were adequate. However, the range of scores was somewhat restricted, and suggested in particular that interference in daily functioning from TM symptoms is quite low. Both internal consistency and test-retest reliability for the Target Behaviors subscale were inadequate, suggesting that this combined score is inappropriate for use with TM patients. Concurrent validity data using the total score were mixed, although the Y-BOCS did appear to be sensitive to change in TM symptoms over treatment. Implications for the use of the Y-BOCS with TM patients and hypothesized phenomenological differences between TM and OCD are discussed.