Hope Can Aid in Recovery from Anxiety Disorders

New research suggests hope is a trait that can predict resilience and recovery from anxiety disorders.

In a new study, clinical psychologist Dr. Matthew Gallager and colleagues examined the role of hope in predicting recovery in a clinical trial of adults in cognitive behavior therapy (CBT) for common anxiety disorders.

Historically, the concept of hope has long stirred opinion. In the 16th century, German theologian Martin Luther celebrated its power, claiming “Everything that is done in this world is done by hope.” Two centuries later, Benjamin Franklin warned that “He that lives upon hope will die fasting.”

In the study, Gallagher — University of Houston associate professor of clinical psychology — assessed the role of hope in predicting recovery among a clinical trial of 223 adults. In the trial, adults were receiving cognitive-behavior therapy (CBT) for one of four common anxiety disorders: social anxiety disorder, panic disorder, generalized anxiety disorder and obsessive-compulsive disorder.

Gallagher discovered that psychotherapy can result in clear increases in hope and that changes in hope are associated with changes in anxiety symptoms. His findings appear in the journal Behavior Therapy.

“In reviewing recovery during CBT among the diverse clinical presentations, hope was a common element and a strong predictor of recovery,” said Gallagher. He also reports that moderate-to-large increases in hope and changes in hope were consistent across the five separate CBT treatment protocols.

In terms of psychotherapy, hope represents the capacity of patients to identify strategies or pathways to achieve goals and the motivation to effectively pursue those pathways.

Significantly, the results of this study indicate that hope gradually increases during the course of CBT, and increases in hope were greater for those in active treatment than for those in the waitlist comparison.

The magnitude of these changes in hope were consistent across different CBT protocols and across the four anxiety disorders examined, which underscores the broad relevance of instilling hope as an important factor in promoting recovery during psychotherapy.

“Our results can lead to a better understanding of how people are recovering and it’s something therapists can monitor. If a therapist is working with a client who isn’t making progress, or is stuck in some way, hope might be an important mechanism to guide the patient forward toward recovery,” said Gallagher.

Hope is closely related to other positive psychology constructs, such as self-efficacy and optimism, that have also been shown to have clear relevance to promoting resilience to and recovery from emotional disorders, said Gallagher.

Gallagher’s research is part of a larger project examining the efficacy of CBT for anxiety disorders led by Dr. David H. Barlow, founder and director emeritus of the Boston University Center for Anxiety and Related Disorders.

Source: University of Houston

Study: OCD Research Needs to Focus on the Patients Themselves

In a new paper published in the journal, Clinical Psychology Review, psychology researchers assert that scientific research into obsessive compulsive disorder (OCD) has become further and further removed from the people these studies are supposed to help: OCD patients and the therapists who treat them.

On one hand, cognitive science has been extremely beneficial in furthering our understanding of mental health disorders. The interdisciplinary study of the mind and its processes embraces elements of psychology, philosophy, artificial intelligence, neuroscience and others topics. The field is rife with areas of exploration for researchers, and it has contributed enormously to the study of debilitating disorders such as OCD.

But for those living with OCD, research into their condition is not an abstract concept — it should have profound real-life implications.

Adam Radomsky, a professor in the department of psychology and the Concordia University Research Chair in Anxiety and Related Disorders, worries that for all its fascinating studies, cognitive science is becoming further and further removed from OCD patients and their therapists.

Radomsky and two of his former PhD students, Allison Ouimet and Andrea Ashbaugh, both now associate professors at the University of Ottawa, reviewed recent OCD research and found that, as interesting as it was, it did not necessarily translate into real benefits for treatment.

As Radomsky explains it, there are two hallmark symptoms of OCD.

“Obsessions are horrible intrusive thoughts people have over and over in their minds,” he explains. “Compulsions are things people do over and over again, like checking you’ve completed a task, or washing and cleaning.”

A commonly held belief among researchers suggests that memory has something to do with OCD behavior. “People are not sure if something is safe or clean or locked,” he says. An old theory was that the problem may have been cognitive in nature, or perhaps neurological.

Over the years, researchers have conducted countless studies on people with the disorder. However, after reviewing the literature, Radomsky says the overall results are equivocal.

“Research into memory, neurobiological and attention deficits probably have not helped therapists or clinicians and probably have not improved therapy,” he says.

The research did prove beneficial in another area though, that of the individual’s beliefs in their own cognitive functioning.

“It’s not that people with OCD have a memory deficit. It’s that they believe they have a memory deficit. It is not their ability to pay attention that is the problem; it is that they do not believe they can focus,” he says. “In the clinic, we can work with what people believe.”

As both an academic researcher and practicing psychologist, Radomsky says he hopes his review will be of help to colleagues inside and outside the lab.

“We think the review will help therapists focus on areas that will be of use, and hopefully help cognitive scientists look at domains that could be useful to clinicians,” he says.

Radomsky would like to see cognitive scientists and practitioners working closer together with the goal of providing better treatment for people living with OCD.

“We learn a lot from the science that researchers are doing, but we also learn a lot from clients and patients,” he says.

“In fact, in some ways, patients are the better instructors because they are living with these problems. I suspect we are going to increasingly follow their lead, because when they voice a particular concern or doubt in themselves, those are often the best ideas to take into the lab.”

Source: Concordia University

Can Cannabinoids Help Treat OCD?

In a new review published in the journal Cannabis and Cannabinoid Research, the authors explore the potential for targeting the body’s endocannabinoid system to hep relieve symptoms of obsessive-compulsive disorder (OCD) and related disorders such as anxiety, tic and impulse control disorders. The researchers also offer recommendations for the future direction of this line of research.

OCD is a complex psychological condition in which the patient suffers from persistent unwanted thoughts and high levels of anxiety.  The disorder can lead to a severe reduction in one’s quality of life. Up to 30 percent of adult OCD patients have also experienced current or past tics.

Currently, most patients with OCD are treated with cognitive behavioral therapy (CBT) and antidepressants, but recovery rates are still low.

The body’s endocannabinoid system plays a critical role in regulating neurotransmitter signaling and has been an enticing target for drug development against disorders associated with anxiety, stress and repetitive behaviors, such as OCD. Research has shown that medical cannabis oil is effective in other neurological conditions, as it can reduce seizures in children with epilepsy and relieve symptoms in autism.

In the review, the researchers present evidence linking the endocannabinoid system to the pathology underlying OCD. They also include an extensive overview of cannabinoids made by the body, as well as those from outside the body, including phytocannabinoids found in the marijuana plant and synthetic cannabinoids.

Based on both animal study data showing anti-anxiety and anti-compulsive effects of cannabinoid agents and on preliminary human clinical trial data, the authors suggest that continued drug development is warranted.

Which cannabinoid agents to test and how to measure their effects will be among the important questions to consider in designing future studies.

“Is there a place for cannabinoid-based medicines in psychiatry?” asks Editor-in-Chief Daniele Piomelli, Ph.D., University of California-Irvine, School of Medicine.

“Evidence from animal and human studies points to the endocannabinoid system as an important regulator of emotionality, but how can we exploit this knowledge for therapy? This review article offers a critical assessment of the evidence, focused on obsessive compulsive disorder, and clues to future research.”

According to the World Health Organization, it is estimated that one to three percent of the U.S. population suffers from OCD, and approximately one in 200 children has the disorder.

Source: Mary Ann Liebert, Inc./ Genetic Engineering News




Deep Brain Stimulation Eases Specific OCD Symptoms

A new U.K. study published in the journal Biological Psychiatry finds that patients with severe obsessive-compulsive disorder (OCD) experienced significant relief after undergoing deep brain stimulation (DBS) to one of two regions of the brain: the ventral capsule (VC) or the anteromedial subthalamic nucleus (amSTN).

Most notably, depending on which of these regions was stimulated, the technique produced distinct effects: stimulation of the VC drastically improved mood, whereas stimulation of the amSTN in the same patients improved cognitive flexibility. OCD symptoms were reduced to a similar extent regardless of which region was targeted. However, applying DBS to both sites did not appear to enhance the effects.

The findings suggest that both regions are effective DBS sites for treating OCD and that the unique brain networks targeted in each region may underlie specific symptoms of the disorder.

“This is the first study to compare directly the effects of DBS at two brain sites and has discovered important information about the brain changes in OCD responsible for obsessions and compulsions, depressed mood and cognitive inflexibility and how they might be alleviated,” said senior author Eileen Joyce, PhD, from The Institute of Neurology at University College London.

The researchers used tractography to map the brain regions activated by DBS and found that the different effects of VC and amSTN stimulation appeared to arise from the DBS adjusting different brain networks. This finding provides clues as to the roles those specific brain regions play in OCD and has potentially important implications for treatment.

“The notion that particular OCD symptom clusters might particularly benefit from stimulation of distinct brain sites raises the possibility of bringing a precision medicine approach to deep brain stimulation,” said John Krystal, MD, Editor of Biological Psychiatry.

“It also raises the question of whether multiple brain stimulation sites might be required to produce the broadest profile of efficacy,” he added. However, in the study, combined DBS of both sites did not produce substantially greater effects than either of the sites individually.

For individuals with severe OCD whose symptoms have not improved with the standard treatment methods, the findings show that DBS of VC or amSTN may be equally effective and have unique effects for specific symptoms.

“Deep brain stimulation is an emerging treatment for a small number of individuals with extremely severe OCD whose condition has not responded to multiple courses of currently available treatments such as medication or cognitive behavioral therapy,” said Joyce.

Cognitive behavioral therapy is an effective treatment for many OCD patients, but when combined with DBS in the study, it did not further enhance the symptom improvements produced by DBS.

Source: Elsevier

Social Anxiety May Up Risk of Alcoholism

Emerging research suggest that, unlike other anxiety disorders, social anxiety disorder may have a direct effect on alcoholism. Experts generally acknowledge five main types of anxiety disorder including generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, post traumatic stress disorder and social anxiety disorder.

In the study, researchers assessed alcoholism, social anxiety disorder, generalized anxiety disorder, panic disorder, agoraphobia, and specific phobias through interviews with 2,801 adult Norwegian twins.

Social anxiety disorder had the strongest association with alcoholism, and it predicted alcoholism over and above the effect of other anxiety disorders. In addition, social anxiety disorder was linked with a higher risk of later developing alcoholism, whereas other anxiety disorders were not.

The research appears in the journal Depression and Anxiety.

The findings suggest that interventions aimed at prevention or treatment of social anxiety disorder may have an additional beneficial effect of preventing alcoholism.

“Many individuals with social anxiety are not in treatment. This means that we have an underutilized potential, not only for reducing the burden of social anxiety, but also for preventing alcohol problems,” said lead author Dr. Fartein Ask Torvik, of the Norwegian Institute of Public Health.

“Cognitive behavioral therapy with controlled exposure to the feared situations has shown good results,” Torvik said.

Therefore the discovery of the association may have a silver lining as talk therapies are effective in reducing this form of anxiety and may now play a factor in also reducing the incidence of alcoholism.

Source: Wiley/EurekAlert

Obsessive Compulsive Symptoms in Youth Tied to Greater Risk for Psychiatric Disorders

Many children exhibit obsessive compulsive symptoms, such as repetitive and ritualistic behaviors, but when these behaviors become disruptive to the child’s life or when intrusive thoughts emerge, it may be a red flag for serious psychiatric conditions, according to a new study published in the Journal of the American Academy of Child and Adolescent Psychiatry.

“Repetitive actions are common in young children, and are in fact a healthy part of development,” said lead author of the study Ran Barzilay, M.D., Ph.D., child and adolescent psychiatrist and research scientist from the Lifespan Brain Institute (LiBI) at the Children’s Hospital of Philadelphia (CHOP).

“It’s when these symptoms continue into adolescence and start to interfere with day-to-day activities that we really need to examine the cause and treatments available.”

For the study, researchers at LiBI and the Perelman School of Medicine at the University of Pennsylvania aimed to identify patterns in obsessive compulsive symptoms that may serve as a red flag for serious mental disorders. More than 7,000 participants ages 11 to 21 underwent structured psychiatric interviews, including screenings for obsessive compulsive symptoms and other major mental health disorders.

Obsessive compulsive symptoms were divided into four categories: bad thoughts, repeating/checking, symmetry, and cleaning/contamination.

The research team then investigated the association of these symptoms with lifetime diagnoses of obsessive compulsive disorder (OCD), depressive episode, psychosis, and suicidal ideation.

According to the findings, obsessive compulsive symptoms were common (38.2 percent) in young people who were not seeking mental health treatments, particularly in females and after puberty. Only three percent of the cohort actually met the qualifications for OCD.

All obsessive compulsive symptoms were linked to higher rates of OCD, depression, psychosis and suicidal ideation. However, intrusive bad thoughts — prevalent in more than 20 percent of the sample — showed the most substantial associations with major psychiatric conditions.

These bad thoughts include thoughts about harming oneself or others, picturing violent images, or fear that one would do something bad without intending to. Children with these types of thoughts were more likely to develop serious psychopathology beyond OCD, including depression and suicide.

“Our hope is that these results will propel both mental health professionals and non-mental health practitioners, such as pediatricians, to probe for these symptoms during their patients’ visits,” said the study’s principal investigator Raquel Gur, M.D., Ph.D., director of the LiBI and a professor of psychiatry, neurology and radiology in the Perelman School of Medicine.

“These symptoms may be vital for identifying adolescents who are on a potentially debilitating psychiatric trajectory.”

The researchers suggest that screening for obsessive compulsive symptoms during medical visits may offer a window for clinicians to identify serious psychiatric conditions.

Source: Children’s Hospital of Philadelphia