Exposure in vivo of agoraphobics: contributions of diazepam, group exposure, and anxiety evocation

1976 ◽  
Vol 6 (1) ◽  
pp. 71-88 ◽  
Author(s):  
Julian Hafner ◽  
Isaac Marks
Keyword(s):  
Treatment Group ◽  
Psychological Treatment ◽  
Group Versus ◽  
Parallel Design ◽  
Individual Exposure ◽  
Treatment Conditions ◽  
Exposure In Vivo ◽  
Anxiety Arousal

SynopsisFifty-seven chronic agoraphobic outpatients were treated by 12 hours of exposure in vivo on four days over two weeks to check the effects of oral diazepam versus placebo during group exposure, group versus individual exposure, and high versus medium anxiety arousal during individual exposure. The controlled parallel design allowed comparative evaluation of each treatment condition to six months follow-up. Assessment was blind with respect to drug and psychological treatment. Patients in all treatment conditions improved significantly in phobias and in related life areas.Outcome to group exposure on phobias and other measures was similar in all three drug conditions (placebo, waning diazepam, peak diazepam) with no significant differences between them. Diazepam patients had significantly less discomfort than placebo patients during group exposure treatment. Group exposure patients improved slightly but significantly more than individual exposure patients on non-phobic measures, though group exposure was accompanied by more panics during treatment yet was easier to run by the therapist. Individual exposure under high anxiety arousal was no more therapeutic than with lower anxiety. Diazepam is a mild palliative during group exposure but does not facilitate outcome to treatment. Group exposure in vivo is mildly facilitatory for outcome compared with individual exposure. Anxiety evocation during treatment was not therapeutically helpful.

Regression of cardiac amyloid deposits with novel therapeutics: reaching new frontiers in cardiac ATTR amyloidosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Chacko ◽  
A Martinez-Naharro ◽  
T Kotecha ◽  
R Martone ◽  
D Hutt ◽  
...  
Keyword(s):  
Treatment Group ◽  
Cardiac Amyloidosis ◽  
T1 Mapping ◽  
Group Versus ◽  
Control Group ◽  
Cardiac Amyloid ◽  
Attr Amyloidosis ◽  
Amyloid Load ◽  
The Impact

Abstract Background Cardiac involvement is the main driver of outcome in ATTR amyloidosis. Advances in therapeutics hold potential in transforming the course of the disease but the impact on cardiac amyloid load is unknown. The aim of this study was to evaluate the impact of patisiran, a new double stranded RNA based gene silencing therapy and a stabilizer, diflunisal, on cardiac amyloid load as measured by CMR and T1 mapping, in patients with ATTR amyloidosis. Methods and results Thirty-two patients with hereditary cardiac amyloidosis were studied. Sixteen patients received treatment with patisiran, and sixteen control subjects did not receive any disease modifying treatment. Patients were assessed with echocardiogram, CMR, NT-proBNP and six-minute walk time measurements at baseline and at 1 year (Mean interval 11.45±3.08 months in treatment group, mean interval 12.82±5.06 months in the control group). CMR analysis comprised LV volumes, T1 mapping to measure the extracellular volume (ECV) occupied by amyloid, T2 mapping and late gadolinium enhancement imaging. At 1-year follow-up, there was a substantial reduction in cardiac amyloid burden, in keeping with cardiac amyloid regression in 45% of patients on treatment. Overall the treatment group showed a reduction in ECV at 1 year follow up compared to an increase in ECV at 1 year in the control group (−1.37%, 95% CI: −3.43 to 0.68% versus 5.02%, 95% CI: 2.86% to 7.18% respectively, p<0.001). The treatment group also showed an improvement in change in 6MWT at 1 year follow up compared to 6MWT at 1 year in the control group (−8.12 meters, 95% CI: −50.8 to 34.6 meters in the treatment group versus −132.27 meters, 95% CI: −216 to −48.6 meters in the control group, p=0.002). The treatment group showed a reduction in BNP at 1 year follow up compared to an increase in the control group (−567.87, 95% CI: −1288.90 to 153.15 in the treatment group versus 2004, 95% CI: 12.82 to 3995.45 in the control group, p<0.001). There was no significant difference from baseline and 1-year data between the control and treatment groups for the difference in echocardiographic parameters, native T1, T2. There was a significant reduction in the percentage of injected dose by 99Tc-DPD scintigraphy in treated patients at 1 year compared to baseline. Conclusions These findings provide the first compelling evidence of substantial cardiac amyloid regression in ATTR amyloidosis, as well as the potential for CMR to be used to track response in treated patients with ATTR cardiac amyloidosis. Combination therapy with transthyretin knock down and stabilizing agents may well be synergistic given enhanced stoichiometry of stabilizers in the face of much reduced plasma transthyretin concentration. Funding Acknowledgement Type of funding source: None

Cognitive-Behavioral Therapy for Paruresis: A Case Report

1998 ◽  
Vol 83 (1) ◽  
pp. 187-196 ◽  
Author(s):  
Jan P. C. Jaspers
Keyword(s):  
Behavioral Therapy ◽  
Single Case ◽  
Treatment Model ◽  
Cognitive Approach ◽  
Social Phobias ◽  
Cognitive Interventions ◽  
Cognitive Components ◽  
Exposure In Vivo

This article reviews directive interventions for paruresis, the inability to urinate in the proximity of others. As in treatments for other anxiety disorders, historical interventions have included the use of paradoxical intention and several different forms of exposure. The results of pharmacological treatment have not proven promising. Although a multidimensional treatment model has been recommended, little attention has been paid to treating cognitive components of the problem. In this paper, a single case is described in which cognitive components of the problem of paruresis were evident. A cognitive approach and exposure in vivo were applied. Measures of successful trials were obtained over 18 weeks. The combination of cognitive interventions and gradual exposure was effective in reducing paruresis. At follow-up 6 mo. later results had been maintained. The results of this case suggest more attention to the cognitive components is appropriate in the treatment of paruresis, as was stated previously for other specific social phobias.

scholarly journals The Effects of the EMDR Group Traumatic Episode Protocol With Cancer Survivors

2018 ◽  
Vol 12 (3) ◽  
pp. 105-117
Author(s):  
Amanda Karen Patricia Roberts
Keyword(s):  
Treatment Group ◽  
Cancer Survivors ◽  
Posttraumatic Stress ◽  
Repeated Measures ◽  
Randomized Clinical Trials ◽  
Psychological Treatment ◽  
Delayed Treatment ◽  
Oncology Treatment ◽  
Traumatic Episode

The purpose of this pre-experimental case study was to explore the efficacy and safety of the Eye Movement Desensitization and Reprocessing (EMDR) Group Traumatic Episode Protocol (G-TEP) in the psychological treatment of cancer survivors and its potential effects on posttraumatic stress, anxiety, and depressive symptoms. Participants (N = 35) were patients with various types of cancer, in different stages, initial or recurring, with diagnosis or oncology treatment received within the past year. Following an individual psychoeducational intake session, participants received two 90-minute EMDR G-TEP sessions, administered on consecutive days. They were randomly assigned to a treatment group or a delayed treatment group. Assessments were administered at pre, post, and follow-up using the Short PostTraumatic Stress Disorder Interview (SPRINT), State-Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI-II). Repeated measures comparisons of PTSD symptoms, anxiety, and depression revealed significant differences between pretest and posttest, with most results maintained at follow-up. Pre-follow-up effect sizes showed medium effects. These promising results suggest the value in providing a lengthier course of treatment. They support the need for research with large sample, randomized clinical trials to examine the viability of providing EMDR G-TEP in the psychological treatment of cancer survivors. No serious adverse effects were reported and we conclude that the EMDR G-TEP may be effective and safe in the psychological treatment of an oncology population.

scholarly journals Effects of Different Imagery Strategies in the Psychological Treatment of Chronic Headache

1998 ◽  
Vol 3 (4) ◽  
pp. 225-232
Author(s):  
Gisela Peters
Keyword(s):  
Chronic Headache ◽  
Treatment Effects ◽  
Psychological Treatment ◽  
Group Differences ◽  
Headache Frequency ◽  
Pain Experience ◽  
Treatment Groups ◽  
Treatment Conditions ◽  
Imagery Techniques

This study investigates the effects of four different imagery techniques: pleasant imagery versus imaginative transformations, and response versus stimulus imagery. One may expect imaginative transformations to be more effective than pleasant imagery. Response imaginative transformations should be more effective than stimulus imaginative transformations, while the pleasant imagery conditions are not expected to have different effects. In a 2x2 design, treatment conditions were compared. Forty patients (33 females, seven males) with different types of chronic headache were referred by their physicians and took part in the study. Pain diaries and questionnaires of pain experience and pain behaviour were used as outcome measures. Imaginative transformations - irrespective of response or stimulus orientation - were found to be more effective than pleasant imagery in reducing headache frequency. Reductions remained stable over an eight-month follow-up. There are no significant differences between response and stimulus imagery. Treatment effects were manifested in a reduction of headache frequency, while headache duration and headache intensity did not change. Suffering and avoidance behaviours were reduced in all treatment groups, while the use of distraction strategies was increased. The reductions in suffering were significantly greater in the groups treated with imaginative transformations. In the eight-month follow-up, group differences in reductions in suffering were no longer significant, which is probably due to the reduced sample size. The results support the hypothesis that a cognitive redefinition is responsible for the beneficial treatment effects because only instructions to imagine a change in pain sensations and/or pain responses led to significant improvements.

Follow-up of Agoraphobic Patients Treated with Exposure in Vivo or Applied Relaxation

1986 ◽  
Vol 149 (4) ◽  
pp. 486-490 ◽  
Author(s):  
L. Jansson ◽  
A Jerremalm ◽  
L. G. Öst
Keyword(s):  
Treatment Results ◽  
Cognitive Behavioural ◽  
End Of Treatment ◽  
Applied Relaxation ◽  
Response Systems ◽  
Exposure In Vivo ◽  
Clinically Significant ◽  
Made In

The present study describes the results of a 7-month and a 15-month follow-up of 32 agoraphobic patients treated with exposure in vivo or applied relaxation. During the followup period, all patients were given self-exposure instructions. Assessments were made in three response systems-subjective-cognitive, behavioural, and physiological-at the follow-up points. The study showed overall maintenance of treatment results in all three response systems for exposure-treated patients. For applied relaxation/self-exposure, there was a relapse on Δ heart-rate at 7 months for physiologically reactive patients, but the improvement was regained at the 15 month follow-up. Furthermore, a large proportion of the total improvement occurred during the follow-up period: 36% and 22% for exposure and applied relaxation/self-exposure respectively. The proportion of patients reaching a clinically significant improvement was 50% at the end of treatment and 66% at the 15 month follow-up.

Slow versus Rapid Exposure in vivo of Phobics

1984 ◽  
Vol 12 (3) ◽  
pp. 249-256 ◽  
Author(s):  
Sahika Yuksel ◽  
Isaac Marks ◽  
Elizabeth Ramm ◽  
Anindya Ghosh
Keyword(s):  
Social Adjustment ◽  
Treatment Time ◽  
Final Outcome ◽  
Balanced Design ◽  
Exposure In Vivo

Twenty-eight chronically phobic patients had therapist-aided exposure either rapidly or slowly. During therapist-aided exposure move to the next hierarchy item occurred after subjective anxiety had dropped, on a scale of 0–8 by two points (rapid) or by four points (slow). Exposure began with the lowest of eight hierarchy items. All patients had self-exposure homework between sessions. In a balanced design 12 patients were treated in London and 16 in Istanbul. Peak anxiety during sessions was comparable in both groups. Compared to slow exposure patients, rapid exposure patients completed treatment to criterion in fewer sessions and less time (4·7 vs. 5·8 sessions P< 0·01; 360 vs. 484 min P< 0·005). Criterion for termination of treatment was toleration of the highest hierarchy item with minimal discomfort, or a maximum of eight sessions. Both in London and in Istanbul rapid and slow groups improved substantially and similarly in phobias, social adjustment and mood; gains continued to 6 months follow-up. Compared to slower exposure, rapid exposure does not enhance final outcome but does shorten treatment time without increasing peak anxiety during sessions.

Clomipramine and Exposure for Chronic Obsessive-Compulsive Rituals: III. Two Year Follow-Up and Further Findings

1982 ◽  
Vol 140 (1) ◽  
pp. 11-18 ◽  
Author(s):  
D. Mawson ◽  
I. M. Marks ◽  
L. Ramm
Keyword(s):  
Social Adjustment ◽  
Age Of Onset ◽  
Drug Effect ◽  
Obsessive Compulsive ◽  
Exposure In Vivo

SummaryForty chronic ritualizers were given clomipramine or placebo from weeks 0 to 36; also all had exposure in vivo, half from weeks 4 to 10 (30 hours) and half from weeks 7 to 10 (15 hours). In the 37 patients available at week 114 there were substantial and maintained improvements in rituals, mood and social adjustment compared to week 0. Reduction of rituals was even greater in those who had 30 hours of exposure. There was no drug effect on rituals at two year follow-up. Greater initial anxiety or depression predicted the superiority of clomipramine over placebo from weeks 10 to 36 and more prescription of tricyclics in follow-up. However, two year outcome was not predicted by initial anxiety or depression, nor by sex, age, age of onset nor duration of rituals.

scholarly journals A hybrid emotion-focused exposure treatment for chronic pain: A feasibility study

2014 ◽  
Vol 5 (3) ◽  
pp. 151-158 ◽  
Author(s):  
Steven J. Linton ◽  
Alan E. Fruzzetti
Keyword(s):  
Chronic Pain ◽  
Emotion Regulation ◽  
Pain Intensity ◽  
Single Subject ◽  
Hybrid Treatment ◽  
Exposure In Vivo ◽  
Clinically Significant ◽  
Regulation Approach

AbstractBackground and aimsExposure in vivo for patients with fear-related chronic pain has a strong theoretical base as well as empirical support. However, the treatment does not work for every patient and overall the effect size is only moderate, underscoring the need for improved treatments. One possible way forward might be to integrate an emotion regulation approach since emotions are potent during exposure and because distressing emotions may both interfere with exposure procedures and patient motivation to engage in exposure. To this end, we proposed to incorporate an emotion-regulation focus into the standard exposure in vivo procedure, and delivered in the framework of achieving relevant personal goals. The aim of this study then was to test the feasibility of the method as well as to describe its effects.MethodWe tested a hybrid treatment combining an emotion-regulation approach informed by Dialectical Behaviour Therapy (DBT) with a traditional exposure protocol in a controlled, single-subject design where each of the six participants served as its own control. In this design participants first make ratings to establish a baseline from which results during treatment and the five month follow-up may then be compared. To achieve comparisons, participants completed diary booklets containing a variety of standardized measures including pain catastrophizing, pain intensity, acceptance, and function.ResultsCompared to baseline, all subjects improved on key variables, including catastrophizing, acceptance, and negative affect, at both post treatment and follow up. For 5 of the 6 subjects considerable gains were also made for pain intensity and physical function. Criteria were established for each measure to help determine whether the improvements were clinically significant. Five of the six participants had consistent results showing clinically significant improvements across all the measures. The sixth participant had mixed results demonstrating improvements on several variables, but not on pain intensity or function.ConclusionsThis emotion-regulation hybrid exposure intervention resulted in considerable improvements for the participants. The results of this study underscore the potential utility of addressing emotions in the treatment of chronic pain. Further, they support the idea that targeting emotional stimuli and using emotion regulation skills in conjunction with usual exposure may be important for obtaining the best results. Finally, we found that this treatment is feasible to provide and may be an important addition to usual exposure. However, since we did not directly compare this hybrid treatment with other treatments, additional research is needed before firm conclusions can be made.ImplicationsAddressing emotional distress in the treatment of patients suffering chronic pain appears to be quite relevant. Emotion regulation skills, employed together with exposure in vivo, hold the promise of being useful tools for achieving better results for patients suffering fear-related and emotionally distressing chronic pain.

The influence of propranolol on the exposure in vivo of agoraphobics

1977 ◽  
Vol 7 (3) ◽  
pp. 419-425 ◽  
Author(s):  
Julian Hafner ◽  
Frank Milton
Keyword(s):  
Treatment Outcome ◽  
Placebo Group ◽  
Double Blind ◽  
Parallel Design ◽  
Propranolol Group ◽  
Exposure In Vivo ◽  
Independent Variable ◽  
Adverse Influence

SynopsisThis study examines the influence of 40 mg of propranolol on agoraphobics throughout 5-hour periods of exposure in vivo on 3 alternate days. Twenty-three patients were studied using a double-blind parallel design and 19 followed up for 3 months. The propranolol group spent significantly less time than the placebo group travelling alone in the month after treatment, and had improved significantly less on a measure of general symptoms at 3 months. The adverse influence of propranolol on treatment outcome appeared mainly due to a waning effect in the last hour of exposure. Attempts to measure coping with panics as an independent variable were largely unsuccessful.

Paradoxical Intention and Exposure In vivo in the Treatment of Psychogenic Nausea: Report of Two Cases

1985 ◽  
Vol 13 (1) ◽  
pp. 69-75 ◽  
Author(s):  
Alain Lesage ◽  
Yves Lamontagne
Keyword(s):  
Experimental Design ◽  
Adverse Outcome ◽  
Single Case ◽  
Exposure In Vivo

Two patients suffering from long-standing psychogenic nausea were treated by paradoxical intention and exposure in vivo within an A–BC–B–BC single case experimental design. Each received six treatment sessions. At the six month follow-up, both patients had improved substantially. Contrary to what was expected, paradoxical intention produced adverse outcome; both patients because nauseous and even vomited a few times while practicing the technique. Exposure in vivo gave better results.

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