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

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

Early Assessment of Online CBT May Improve Care Delivery

New research suggests the efficacy of online cognitive behavioral therapy can be determined within a few weeks of the intervention. Early assessment of therapy outcomes allow practitioners to provide additional support and adjust care plans as needed.

Scientists in Sweden developed the technique to identify patients who face a major risk of treatment failure. Their results also suggest that such patients may nevertheless benefit if their treatment is adjusted to accommodate their specific needs and challenges.

The study findings appear in the American Journal of Psychiatry.

Internet-delivered CBT effectively addresses depression, panic and sleep disorders, and several other psychological issues. Many studies over the past 20 years have demonstrated benefits that are comparable with traditional face-to-face treatment. As a result many clinical practice have adopted the approach.

However, as is the case with any method, not everyone benefits the same. Moreover, researchers have not found a way to prospectively separate those who are likely to benefit from online CBT from those who do not.

The adaptive treatment strategy evaluated by investigators at Karolinska Institutet permits such a classification within a few weeks into therapy. The results come from a study that included 251 patients who were receiving Internet-delivered CBT for insomnia.

“The findings indicate that an accurate assessment of patients who are likely and unlikely to benefit is possible by the fourth week of treatment. The strategy also reduces the risk of insufficient outcome since it enables additional support and adaptation for those who need it,” says Erik Forsell, a psychologist and PhD student.

After four weeks of Internet-delivered CBT, the clinicians performed a structured assessment of the individual risk of failure with a questionnaire and algorithm-based tool. Patients were then classified as either facing a low risk or high risk of failure, i.e., obtaining insufficient benefits.

Those at high risk were randomly assigned to either continuing the treatment or receiving additional support and an adjusted treatment.

High risk patients who continued with the standard treatment obtained less reduction in sleep problems, whereas those who received additional support and the adjusted treatment obtained similar benefits as those in the low-risk group.

Researchers believe the study is a first step in customizing Internet-delivered CBT, and ultimately traditional therapy as well, by constructing structured systems that identify and assist those who do not appear likely to benefit.

“The strategy will help a greater number of patients and minimize the risk of extended therapies without desired benefits. The long-run consequences may be fewer failures and less time between diagnosis and effective treatment.

The healthcare system would be less burdened and individual patients would suffer less,” says Viktor Kaldo, psychologist and associate professor at the Department of Clinical Neuroscience, Karolinska Institutet, and the principal researcher.

Source: Karolinska Institutet

Breathlessness Treatments Can Ease Distress, Depressive Symptoms

New research finds that treatments for breathlessness can reduce distress and symptoms of depression.

Breathlessness is a common symptom in advanced disease and can lead to panic and anxiety for patients and their family. It can trouble people even when resting or performing light activities around the home, researchers at King’s College London note.

“With our aging population and increasing multi-morbidity, the number of people affected by breathlessness worldwide is set to rise,” the researchers report.

Published in the journal Thorax, the study combined the findings of existing research to better understand holistic services for people with advanced disease experiencing breathlessness. These services aim to improve a person’s ability to manage their breathlessness by putting the person before their disease, researchers explained. They do this by providing information and education, psychological support, and encouraging self-management strategies that patients and their caregivers can continue to use, the researchers explained.

While there are no drug treatments for breathlessness, drug-free treatments such as breathing exercises or using a handheld fan have been found to be useful. These treatments and the philosophy of palliative care that focuses on quality of life are brought together in these holistic services, the researchers said.

During the study, researchers found that patients who accessed these services were less distressed and depressed due to breathlessness.

In interviews, people said they felt more in control and more confident in managing their breathlessness, were less isolated, and able to get back to their daily activities. Both patients and their caregivers, including family members, said they appreciated the tailored education that helped them understand their breathlessness better. They particularly valued the simple management tips and the expert staff who took a dignified approach to their care, the study discovered.

“By using breathlessness as a marker of disease burden, these services prompt input from experts across different specialties to manage symptoms and concerns using a person-centered approach,” said senior author Dr. Matthew Maddocks from King’s College London. “Our research uncovered the wide range of benefits and allows us to understand what patients and their family value most.”

“This work forms part of our program to tackle breathlessness,” added Professor Irene Higginson, director of the Cicely Saunders Institute at King’s College London and co-author of the research. “This is such a neglected and frightening symptom. Imagine if every breath you took caused panic and fear and you thought you could not breathe more.”

“These services contain straightforward, usually drug-free, approaches, such as information cards and plans to help at home in a crisis, practical aids and tips, as well as support for the whole person and family through palliative care,” she said.

Source: King’s College London

One-Third of College Freshmen Report Symptoms of Mental Illness

A new study finds that freshmen from 19 colleges in eight countries report symptoms consistent with a diagnosable psychological disorder.

“While effective care is important, the number of students who need treatment for these disorders far exceeds the resources of most counseling centers, resulting in a substantial unmet need for mental health treatment among college students,” said lead author Randy P. Auerbach, Ph.D., of Columbia University.

“Considering that students are a key population for determining the economic success of a country, colleges must take a greater urgency in addressing this issue.”

For the study, Auerbach and his research team analyzed data from the World Health Organization’s World Mental Health International College Student Initiative. In it, almost 14,000 students from 19 colleges in eight countries — Australia, Belgium, Germany, Mexico, Northern Ireland, South Africa, Spain, and the United States — responded to questionnaires to evaluate common mental disorders, including major depression, generalized anxiety disorder, and panic disorder.

The researchers found that 35 percent of the respondents reported symptoms consistent with at least one mental health disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Major depressive disorder was the most common, followed by generalized anxiety disorder.

“The finding that one-third of students from multiple countries screened positive for at least one of six mental health disorders represents a key global mental health issue,” said Auerbach.

Previous research suggests that only 15 to 20 percent of students will seek services at their college’s counseling center, which may already be overtaxed, according to Auerbach. If students need help outside of their school counseling center or local psychologists, Auerbach suggested that they seek Internet resources, such as online cognitive behavioral therapy.

“University systems are currently working at capacity and counseling centers tend to be cyclical, with students ramping up service use toward the middle of the semester, which often creates a bottleneck,” said Auerbach. “Internet-based clinical tools may be helpful in providing treatment to students who are less inclined to pursue services on campus or are waiting to be seen.”

According to Auerbach, future research needs to focus on identifying which interventions work best for specific disorders. For example, certain types of depression or anxiety may be best treated with certain types of Internet interventions, while other disorders, such as substance use, may require treatment in person by a psychologist or other mental health professional.

“Our long-term goal is to develop predictive models to determine which students will respond to different types of interventions,” said Auerbach.

“It is incumbent on us to think of innovative ways to reduce stigma and increase access to tools that may help students better manage stress.”

The study was published in the Journal of Abnormal Psychology.

Source: The American Psychological Association

Psychedelic Drugs Show Promise for Treating Anxiety, Depression, PTSD

New findings add to the growing body of evidence suggesting that psychedelic drugs may be effective at treating a variety of psychological disorders, including depression, social anxiety and post-traumatic stress disorder (PTSD) and could one day be prescribed to patients.

The research was presented recently at the American Psychological Association’s annual meeting and included studies on the use of LSD, psilocybin (magic mushrooms), MDMA (ecstacy) and ayahuasca (used by indigenous Amazonian people for spiritual ceremonies).

After the discovery of LSD in the 1940s, American researchers began studying hallucinogens for their potential healing benefits, but this research mostly came to a halt after psychedelics were outlawed in the late 1960s.

A shift may be coming soon, however, as MDMA is beginning its third and final phase of clinical trials in an effort to win Food and Drug Administration approval for treatment of post-traumatic stress disorder, said Adam Snider, MA, of Alliant International University Los Angeles, and co-chair of the symposium.

“Combined with psychotherapy, some psychedelic drugs like MDMA, psilocybin and ayahuasca may improve symptoms of anxiety, depression and post-traumatic stress disorder,” said Cristina L. Magalhaes, PhD, of Alliant International University Los Angeles, and co-chair of a symposium on psychedelics and psychotherapy.

“More research and discussion are needed to understand the possible benefits of these drugs, and psychologists can help navigate the clinical, ethical and cultural issues related to their use.”

Findings from another study suggest that symptoms of social anxiety in adults with autism may be treatable with a combination of psychotherapy and MDMA. Twelve autistic adults with moderate to severe social anxiety who were given two treatments of pure MDMA, plus ongoing therapy, showed significant and long-lasting reductions in their symptoms.

“Social anxiety is prevalent in autistic adults and few treatment options have been shown to be effective,” said Alicia Danforth, PhD, of the Los Angeles Biomedical Research Institute at the HarborUCLA Medical Center, who conducted the study. “The positive effects of using MDMA and therapy lasted months, or even years, for most of the research volunteers.”

Other research presented at the meeting shows how LSD, psilocybin and ayahuasca may benefit people with anxiety, depression and eating disorders.

Adele Lafrance, PhD, of Laurentian University, discussed a study of 159 participants who reported on their past use of hallucinogens, level of spirituality and relationship with their emotions. Hallucinogen use was associated with greater levels of spirituality, which led to improved emotional stability and fewer symptoms of anxiety, depression and disordered eating.

“This study reinforces the need for the psychological field to consider a larger role for spirituality in the context of mainstream treatment because spiritual growth and a connection to something greater than the self can be fostered,” said Lafrance.

One study suggests that ayahuasca may help relieve depression and addiction, as well as assist people in coping with trauma. “We found that ayahuasca also fostered an increase in generosity, spiritual connection and altruism,” said Clancy Cavnar, PhD, with Núcleo de Estudos Interdisciplinares sobre Psicoativos.

In addition, for people suffering from life-threatening cancer, psilocybin may offer significant and long-lasting reductions in anxiety and distress.

When combined with psychotherapy, psilocybin helped 13 study participants grapple with loss and existential distress. It also helped the participants reconcile their feelings about death as nearly all participants reported that they developed a new understanding of dying, according to Gabby Agin-Liebes, BA, of Palo Alto University, who conducted the research.

“Participants made spiritual or religious interpretations of their experience and the psilocybin treatment helped facilitate a reconnection to life, greater mindfulness and presence, and gave them more confidence when faced with cancer recurrence,” said Agin-Liebes.

Source: American Psychological Association