Occupational functioning, sickness absence and medication utilization before and after cognitive-behaviour therapy for generalized anxiety disorders

2010 ◽  
Vol 18 (3) ◽  
pp. 218-224 ◽  
Author(s):  
Michael Linden ◽  
Doris Zubrägel ◽  
Thomas Bär
2004 ◽  
Vol 74 (1) ◽  
pp. 36-42 ◽  
Author(s):  
M. Linden ◽  
D. Zubraegel ◽  
T. Baer ◽  
U. Franke ◽  
P. Schlattmann

2014 ◽  
Vol 4 (9) ◽  
pp. e444-e444 ◽  
Author(s):  
S Roberts ◽  
K J Lester ◽  
J L Hudson ◽  
R M Rapee ◽  
C Creswell ◽  
...  

Abstract Anxiety disorders that are the most commonly occurring psychiatric disorders in childhood, are associated with a range of social and educational impairments and often continue into adulthood. Cognitive behaviour therapy (CBT) is an effective treatment option for the majority of cases, although up to 35–45% of children do not achieve remission. Recent research suggests that some genetic variants may be associated with a more beneficial response to psychological therapy. Epigenetic mechanisms such as DNA methylation work at the interface between genetic and environmental influences. Furthermore, epigenetic alterations at the serotonin transporter (SERT) promoter region have been associated with environmental influences such as stressful life experiences. In this study, we measured DNA methylation upstream of SERT in 116 children with an anxiety disorder, before and after receiving CBT. Change during treatment in percentage DNA methylation was significantly different in treatment responders vs nonresponders. This effect was driven by one CpG site in particular, at which responders increased in methylation, whereas nonresponders showed a decrease in DNA methylation. This is the first study to demonstrate differences in SERT methylation change in association with response to a purely psychological therapy. These findings confirm that biological changes occur alongside changes in symptomatology following a psychological therapy such as CBT.


2015 ◽  
Vol 9 (1) ◽  
pp. 11-21 ◽  
Author(s):  
Bo Karlsson ◽  
Gunilla Burell ◽  
Ulla-Maria Anderberg ◽  
Kurt Svärdsudd

AbstractBackground and aimsStress has been pointed out as an important influential factor in the development and maintaining of the fibromyalgia syndrome (FMS) . Since stress may worsen the pain experience, the development of individual strategies for coping with stress is essential to reduce the impact of FMS on daily life. The aim of the study was to investigate whether a group based stress management cognitive behaviour therapy (CBT) programme could influence self-reported stress, wellbeing and life control, as well as self-reported pain behaviour in female FMS patients.Methods48 female FMS patient were randomized into a cognitive behaviour therapy treatment group (n = 24) and a waitlist control group (n = 24) . When the 6 months waitlist period was over the control group received the same CBT programme. This allowed two analytical approaches, one based on the randomized controlled trial design and one based on a before-and-after design to improve the statistical power of the study. Four psychometric instruments were used: The West Haven-Yale Multidimensional Pain Inventory (three parts, MPI-1 to MPI-3), the Maastricht Questionnaire, the Everyday Life Stress, and the Montgomery-Åsberg Depression rating scale – self-reported. Primary outcome was the MPI-1 dimension ‘life control’, secondary outcomes were the MPI-1 dimensions ‘interference’, ‘affective distress’ and ‘support from spouses or significant others’, the various MPI-2 dimensions, the ‘general activity level’ in the MPI-3 dimension, and ‘vital exhaustion’, ‘stress behaviour’, and ‘depression’. The only tertiary outcome was the MPI-1 dimension ‘pain severity’.ResultsIn the RCT design the West Haven-Yale Multidimensional Pain Inventory dimensions ‘life control’, ‘interference from pain’, ‘affective distress’, ‘support from spouses or significant others’, and ‘distracting responses’ and ratings for depression improved in the treatment group as compared with the control group. In the before-and after design these improvements were maintained and enhanced during 1-year follow-up, and so was the ‘vital exhaustion’ and ‘stress behaviour’. ‘Pain severity’ was rated higher after the intervention.ConclusionsCognitive behaviour therapy improved the life control in a female population with FMS. Coping behaviour in response to chronic pain was improved at the same time and in spite of higher subjective ratings of pain. Positive effects were seen on depression, vital exhaustion and stress behaviour. The effects of therapy were maintained and enhanced during the follow up period. It appears that women with FMS after the CBT treatment, according to this protocol obtained tools leading to better acceptance of their disorder.ImplicationsFMS is a disorder with great therapeutic challenges. Total abolishment of pain symptoms is extremely difficult or impossible to achieve. Thus, the development of individual strategies for coping with pain is essential to reduce its impact on daily life. Since stress may worsen the pain experience, coping with stress might be a promising route to accomplishing that goal. In evaluations of interventions for pain it is important to monitor the effect on behaviour responses to pain and not only ratings of pain itself.


1989 ◽  
Vol 17 (1) ◽  
pp. 1-14 ◽  
Author(s):  
K. G. Power ◽  
D. W. A. Jerrom ◽  
R. J. Simpson ◽  
M. J. Mitchell ◽  
V. Swanson

Generalized anxiety patients were randomly allocated to Cognitive-Behaviour Therapy, Diazepam or Placebo and managed in a primary care setting. Treatments were balanced for degree of psychologist/patient contact. A range of outcome measures, including patient self report, psychologist assessor and general practitioner ratings were used. Large variations within group response to treatment emerged. At the end of active treatment the superiority of Cognitive-Behaviour Therapy was suggested. Post-study psychotropic prescription and psychological treatment was assessed at a 12-month follow-up. The Cognitive-Behaviour group revealed the lowest incidence of subsequent treatment interventions.


2012 ◽  
Vol 41 (3) ◽  
pp. 280-289 ◽  
Author(s):  
Björn Paxling ◽  
Susanne Lundgren ◽  
Anita Norman ◽  
Jonas Almlöv ◽  
Per Carlbring ◽  
...  

Background: Internet-delivered cognitive behaviour therapy (iCBT) has been found to be an effective way to disseminate psychological treatment, and support given by a therapist seems to be important in order to achieve good outcomes. Little is known about what the therapists actually do when they provide support in iCBT and whether their behaviour influences treatment outcome. Aims: This study addressed the content of therapist e-mails in guided iCBT for generalized anxiety disorder. Method: We examined 490 e-mails from three therapists providing support to 44 patients who participated in a controlled trial on iCBT for generalized anxiety disorder. Results: Through content analysis of the written correspondence, eight distinguishable therapist behaviours were derived: deadline flexibility, task reinforcement, alliance bolstering, task prompting, psychoeducation, self-disclosure, self-efficacy shaping, and empathetic utterances. We found that task reinforcement, task prompting, self-efficacy shaping and empathetic utterances correlated with module completion. Deadline flexibility was negatively associated with outcome and task reinforcement positively correlated with changes on the Penn State Worry Questionnaire. Conclusions: Different types of therapist behaviours can be identified in iCBT, and though many of these behaviours are correlated to each other, different behaviours have an impact on change in symptoms and module completion.


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