Patrick Gosselin

Experimental manipulation of intolerance of uncertainty: a study of a theoretical model of worry.

Intolerance of uncertainty has been identified as an important variable related to worry and Generalized Anxiety Disorder (GAD) [Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: a preliminary test of a conceptual model. Behaviour Research and Therapy, 36, 215-226; Ladouceur, R., Dugas, M. J., Freeston, M. H., Rhéaume, J., Blais, F., Boisvert, J.-M., Gagnon, F., & Thibodeau, N. (1999). Specificity of Generalized Anxiety Disorder symptoms and processes. Behavior Therapy, 30, 197-207]. The goal of the present study was to clarify the relationship between this cognitive process and worry by experimentally manipulating intolerance of uncertainty. A gambling procedure was used to increase intolerance of uncertainty in one group (N = 21) and to decrease intolerance of uncertainty in another group (N = 21). The results indicate that participants whose level of intolerance of uncertainty was increased showed a higher level of worry, compared to participants whose level of intolerance of uncertainty was decreased. These results provide some initial clarifications as to the causal nature of the link between intolerance of uncertainty and worry. These results are coherent with our theoretical model of worry and GAD (Dugas et al., 1998), which stipulates that intolerance of uncertainty plays a key role in the acquisition and maintenance of excessive worry.

Intolerance of Uncertainty and Worry: Investigating Specificity in a Nonclinical Sample

The goal of this study was to explore the specificity of the relationship between intolerance of uncertainty and worry in a nonclinical sample. Three hundred and forty-seven university students completed measures of worry, obsessions/compulsions, and panic sensations. They also completed measures of process variables known to be associated with worry (intolerance of uncertainty), obsessions/compulsions (responsibility), and panic sensations (anxiety sensitivity). The results show that intolerance of uncertainty was highly related to worry, moderately related to obsessions/compulsions, and weakly related to panic sensations. Further, the relationship between intolerance of uncertainty and worry remained strong after shared variance with other study variables was removed. The findings are discussed in terms of their implications for understanding worry and preventing generalized anxiety disorder.

Benzodiazepine Discontinuation among Adults with GAD: A Randomized Trial of Cognitive-Behavioral Therapy.

This study evaluated the specific effectiveness of cognitive-behavior therapy (CBT) combined with medication tapering for benzodiazepine discontinuation among generalized anxiety disorder (GAD) patients by using a nonspecific therapy control group. Sixty-one patients who had used benzodiazepines for more than 12 months were randomly assigned to the experimental conditions. Nearly 75% of patients in the CBT condition completely ceased benzodiazepine intake, as compared with 37% in the control condition. Results of the 3-, 6-, and 12-month follow-ups confirmed the maintenance of complete cessation. Discontinuation rates remained twice as high in the CBT condition. The number of patients who no longer met GAD criteria was also greater in the CBT condition. The addition of specific CBT components thus seemed to facilitate benzodiazepine tapering among patients with GAD.

Evaluation of intolerance of uncertainty: Development and validation of a new self-report measure

Intolerance of uncertainty represents an important risk factor for development of anxiety disorders. However, few measures have been developed in order to evaluate this construct. Four studies were conducted in order to validate a new instrument evaluating intolerance of uncertainty: the Intolerance of Uncertainty Inventory (IUI). The first study described the questionnaires development and evaluated the psychometric properties of its preliminary version. Study 2 examined the reliability and the factorial validity of the final version of the questionnaire, while Study 3 mainly addressed its convergent validity. Finally, Study 4 examined the questionnaires temporal stability. Factorial analyses confirmed the IUIs validity. Results also supported the IUIs reliability, convergent validity, and temporal stability. The IUI is the first instrument that offers the possibility of measuring intolerance of uncertainty as a tendency to consider uncertainties to be unacceptable, as well as in terms of cognitive and behavioral manifestations.

The Intolerance of Uncertainty Index: Replication and Extension with an English Sample.

Intolerance of uncertainty (IU) is related to anxiety, depression, worry, and anxiety sensitivity. Precedent IU measures were criticized for psychometric instability and redundancy; alternative measures include the novel 45-item measure (Intolerance of Uncertainty Index; IUI). The IUI was developed in French with 2 parts, assessing general unacceptability of uncertainty (15 items, Part A) and manifestations of uncertainty approximating more common anxiety disorder symptoms (30 items, Part B). The psychometric stability of the back-translated English items of the IUI as well as the incremental variance of Parts A and B remain to be assessed. The current study involved 2 samples of English-speaking community participants (n = 437 and n = 309; 73% women and 27% men) who completed the IUI and several related measures. Exploratory and confirmatory factor analyses suggested a refinement of IUI items as well as a unitary structure for Part A and a 3-factor structure for Part B. Regression results suggested Parts A and B each provide incremental validity in measures of worry, generalized anxiety disorder symptoms, negative problem orientation, and depression. Comprehensive results, implications, and future research directions are discussed.

Évaluation de l'attitude d'un individu face aux différents problèmes de vie : Le questionnaire d'attitude face aux problèmes (QAP)

Resume L’attitude negative par rapport aux problemes constitue une predisposition cognitive non fonctionnelle lorsqu’un individu tente de resoudre les problemes de la vie de tous les jours. Des etudes recentes suggerent notamment que les deficits de resolution de problemes observes aupres de patients souffrant de certaines psychopathologies (e.g. anxiete generalisee, depression majeure) seraient principalement occasionnes par cette variable cognitive. Jusqu’a maintenant, aucun instrument n’avait encore ete developpe afin d’evaluer specifiquement l’attitude negative face aux problemes. Le present article rapporte les etapes de developpement et de validation d’un questionnaire construit afin d’evaluer specifiquement et ce, de facon rapide et efficace, l’attitude negative face aux problemes. La premiere etude rapporte les etapes de developpement et de validation initiale du Questionnaire d’Attitude face aux Problemes (QAP) aupres de 301 participants universitaires francophones. La deuxieme evalue les proprietes psychometriques de la version finale de l’instrument, soit sa structure factorielle, sa validite et sa fidelite aupres d’un deuxieme echantillon de la population non clinique (N = 344). Finalement, la troisieme etude evalue la stabilite temporelle de l’instrument a l’aide d’une passation test-retest effectuee avec un intervalle de 4 semaines (N = 75). Les resultats obtenus appuient la validite et la fidelite de l’instrument. Le QAP est donc un instrument utile tant aux cliniciens qu’aux chercheurs interesses a evaluer l’attitude negative face aux problemes des gens.

Évaluation de la peur de l’accouchement. Validation et adaptation française d’une échelle mesurant la peur de l’accouchement

OBJECTIVES The fear of childbirth, a central aspect of tokophobia, recently started to capture the attention of the scientific community as a potential determinant of obstetric and post-natal complications. However, studies on this subject are still few and this can be partly explained by the lack of validated instruments, especially in French. This paper presents the results from two studies designed to develop and evaluate the psychometric properties of a French version of the Traumatic Event Scale (TES), adapted to assess fear of childbirth (Söderquist et al., 2004 [21]). METHOD The first study presents details regarding the development of this scale and checks the quality of the resulting items as well as their internal consistency, convergent validity and factorial validity. This study relied on a sample of 65 mothers with at least one child under the age of 36 months. In the second study, the psychometric properties of the instrument developed in Study 1 were tested more systematically on a sample of 204 women who were at the time experiencing their first pregnancy. RESULTS AND CONCLUSION The results from the first study show adequate psychometric properties, strong correlations with measurements assessing worry, and support a five factor model. Results from this second study replicated the results from the first one on the basis of confirmatory factor analyses. Findings presented in these studies confirm that this instrument presents very good psychometric properties as a measurement of the fear of childbirth in pregnant women.

Guided self-help for generalized anxiety disorder in older adults

Objective: The main objective of this study was to examine the efficacy of a guided self-help treatment based on cognitive behavioral principles (CBT-GSH) for generalized anxiety disorder (GAD) in older adults. Methods: Three older adults aged from 66 to 70 and diagnosed with GAD were included in a single-case experimental multiple-baseline protocol. Data were collected using daily self-monitoring, standardized clinician ratings, and self-report questionnaires at pretest, posttest, and 6-month and 12-month follow-ups. Treatment consisted of awareness training, worry interventions, relaxation training, pleasant activities scheduling, and relapse prevention. Participants used a manual presenting weekly readings and at-home practice exercises. They also received weekly supportive phone calls from a therapist. Results: At posttest, participants showed improvement on worries and GAD severity, on psychological process variables targeted by treatment (intolerance of uncertainty, negative problem orientation, cognitive avoidance, and perceived usefulness of worry), and on secondary variables associated with GAD (anxiety, depression, sleep difficulties, cognitive functioning, and disability). These results were generally maintained at 12 months after the end of treatment. Participants had favorable opinions toward the treatment. Conclusion: The results of this study suggest that CBT-GSH is both feasible and effective for the treatment of GAD in older adults.

ÉVALUATION DU TROUBLE D'ANXIÉTÉ GÉNÉRALISÉE ET DES INQUIÉTUDES CHEZ LES ENFANTS ET LES ADOLESCENTS REVUE CRITIQUE DES INSTRUMENTS RAPPORTÉS DANS LA LITTÉRATURE

Resume Les inquietudes excessives, caracteristiques centrales du Trouble d’anxiete generalisee (TAG), entrainent des consequences majeures dans le fonctionnement academique, sociale et personnel des enfants et des adolescents (Albano & Hack, 2004). Malgre leur frequence elevee et les consequences nefastes qui leur sont associes, les inquietudes et l’anxiete generalisee sont encore peu etudiees aupres de ces groupes d’âges. Par ailleurs, les cliniciens ont souvent de la difficulte a les evaluer puisque la plupart des instruments disponibles et frequemment utilises dans la litterature s’en tiennent a l’evaluation des symptomes physiques de l’anxiete et permettent peu d’evaluer les inquietudes ou les criteres de l’anxiete generalisee. Des outils de mesures specifiques ont toutefois recemment ete developpes, notamment aupres des adultes, pour evaluer ces construits. L’objectif de la zzzpresente etude consiste a realiser une revue critique des instruments presentes dans la litterature pour evaluer le TAG et les inquietudes des enfants et des adolescents. Les entrevues diagnostics, les questionnaires auto-rapportes et les grilles d’observation furent selectionnes a partir des banques de donnees MEDLINE (1986-2006/12) et PsycINFO (1983-2006/12). Les avantages, inconvenients ainsi que les qualites psychometriques des instruments sont discutes. Par ailleurs, lorsque des informations normatives etaient disponibles celles-ci ont ete rapportees. Des recommandations sont formulees quant aux recherches futures a effectuer dans le domaine de l’evaluation du Trouble d’anxiete generalisee et des inquietudes excessives chez les enfants et les adolescents.

Insomnia Symptoms Following Treatment for Comorbid Panic Disorder With Agoraphobia and Generalized Anxiety Disorder.

Abstract Patients with panic disorder with agoraphobia (PDA) or generalized anxiety disorder (GAD) frequently also suffer from insomnia. However, the impact of cognitive-behavioral therapy (CBT) for anxiety disorders on insomnia has been understudied. Furthermore, comorbidity between anxiety disorders is common. Our main objective was to assess the impact of CBT for PDA or GAD on insomnia. In a quasi-experimental design, 86 participants with PDA and GAD received conventional CBT for their primary disorder or combined CBT for both disorders. Overall, CBTs had a significant impact on reducing insomnia symptoms (&eegr;2 = 0.58). However, among people with insomnia at pretest (67%), 33% still had an insomnia diagnosis, and the majority (63%) had clinically significant residual insomnia following treatment. In conclusion, the CBTs had a positive effect on the reduction of insomnia, but a significant proportion of participants still had insomnia problems following treatment. Clinicians should address insomnia during CBT for PDA and GAD.