Anxiety Disorders: Başoğlu M

Başoğlu M. · No affiliation provided · BMJ. · Pubmed #17170393 No free full text.

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Salcioğlu E, Başoğlu M. · Section of Trauma Studies, Institute of Psychiatry, King's College London, UK. · World J Pediatr. · Pubmed #18822924 No free full text.

Abstract: BACKGROUND: Treatment of child earthquake survivors is a relatively less investigated issue in disaster research. A review of the evidence on the mental health effects of earthquakes, risk factors, and findings from treatment studies may provide useful insights into effective treatment of traumatized children. DATA SOURCES: Studies of child and adolescent earthquake survivors included the PILOTS database (electronic index for literature on psychological trauma) and relevant evidence from various studies of adult earthquake survivors. RESULTS: Evidence points to elevated rates of posttraumatic stress disorder (PTSD), depression, and earthquake-related fears in children and adolescents. Traumatic stress appears to be mediated by loss of control over fear induced by exposure to unpredictable and uncontrollable earthquakes. This implies that interventions enhancing sense of control over fear are likely to be most effective. Recent studies indeed show that a control focused behavioral treatment (CFBT) involving mainly encouragement for self-exposure to feared situations is highly effective in facilitating recovery from earthquake trauma. Evidence also suggests that CFBT can be delivered through booklets and similar media. CONCLUSIONS: Pilot studies suggest that CFBT has promise in effective treatment of PTSD in children. Further research is needed to confirm these preliminary findings and to develop self-help tools for children.

Başoğlu M, Salcioğlu E, Livanou M. · Section of Trauma Studies, Division of Psychological Medicine, Institute of Psychiatry, King's College London, University of London, England, UK. · J Behav Ther Exp Psychiatry. · Pubmed #18554573 No free full text.

Abstract: Studies showed that earthquake-related posttraumatic stress disorder could be reduced by a single session of therapist instructions for self-exposure to fear cues. Eight single-case experimental studies examined whether such instructions were as effective when delivered through a self-help manual after an initial assessment. After two baseline assessments conducted at the participants homes, the manual was delivered to the participants, who were then assessed at week 10 (post-treatment) and at 1-, 3-, and 6-month post-treatment. After minimal improvement during the baseline, treatment achieved marked improvement in seven survivors, leading to effect sizes comparable to those obtained by therapist-delivered treatment. Self-help appears to be a promising approach in cost-effective survivor care.

Başoğlu M, Livanou M, Salcioğlu E, Kalender D. · Section of Trauma Studies, Institute of Psychiatry, King's College, University of London. · Psychol Med. · Pubmed #12785466 No free full text.

Abstract: BACKGROUND: Natural disasters such as earthquakes affect large numbers of people. Given the extent of the mental health problem following earthquakes, brief, effective and cost-effective treatment interventions are urgently needed. The present study examined whether cognitive-behavioural treatment could be shortened to a minimum number of sessions without undermining its effectiveness in post-traumatic stress disorder (PTSD). METHOD: The study participants (N=231) were consecutive referrals to five project sites in the earthquake region in Turkey a mean of 13 months after the disaster. A modified behavioural treatment (BT) was used, which involved self-exposure instructions based on an enhancement of 'sense of control' rather than a habituation rationale and minimal cognitive interventions. The duration of treatment was variable, involving as many sessions as required for clinical improvement. Survival analysis was used to explore the minimum number of sessions required for clinical improvement, and multiple regression analysis to examine the predictors of outcome. RESULTS: The survivors received a mean of 4-3 sessions. Significant treatment effects and clinically meaningful effect sizes were noted on all measures. The treatment improved all PTSD and depression symptoms. The cumulative proportion of improved cases was 76% after one session and 88% after two sessions. No baseline variable predicted treatment outcome. CONCLUSIONS: The modified BT appears to be promising as an effective one- or two-session intervention for earthquake survivors. It may be particularly useful in large-scale disasters as a cost-effective treatment that can be relatively easily disseminated to mass populations. Further research is needed to clarify the possible role of a treatment focus on sense of control in rapid recovery from traumatic stress.

Kiliç C, Curran HV, Noshirvani H, Marks IM, Başoğlu M. · Hacettepe University, Ankara, Turkey. · Psychol Med. · Pubmed #10077311 No free full text.

Abstract: BACKGROUND: Benzodiazepines (BZs) can impair explicit memory after a single dose and also when taken repeatedly for treatment of anxiety disorders. A previous study with agoraphobia/panic patients found that the BZ alprazolam impaired memory during an 8-week treatment and residual impairments were still manifest several weeks after drug withdrawal (Curran et al. 1994). The present study followed up the same group of patients 3.5 years after treatment to determine whether those memory impairments persisted. METHOD: Thirty-one patients, 15 who had originally been treated with alprazolam and 16 with placebo, were assessed on a battery of psychometric tests and self-rating scales. RESULTS: Ex-alprazolam patients performed at the same levels as ex-placebo patients on the memory task and on other objective tests. Performance levels of both groups were similar to pre-treatment baselines, however there were differences in subjective ratings whereby ex-alprazolam patients rated themselves as less attentive and clear headed and more incompetent and clumsy than ex-placebo patients. CONCLUSIONS: Explicit memory impairments found while patients were taking alprazolam and weeks after drug withdrawal did not persist 3.5 years later. We suggest that the memory impairments observed in our previous study weeks after withdrawal of alprazolam were not residual effects of alprazolam but rather were due to the drug's interference with practice effects on the tests and habituation of anxiety over repeated exposure to the test situation.

Salcoğlu E, Başoğlu M, Livanou M. · Section of Trauma Studies, Division of Psychological Medicine, Institute of Psychiatry, King's College London, University of London, London SE5 8AF, UK. · J Nerv Ment Dis. · Pubmed #18195642 No free full text.

Abstract: Large-scale earthquakes in urban areas displace many people from their homes. This study examined the role of conditioned fears in determining survivors' tendency to live in shelters after the 1999 earthquake in Turkey. A total of 1655 survivors living in prefabricated housing compounds or residential units in the epicenter zone were screened using a reliable and valid instrument. Among participants whose houses were rendered uninhabitable during the earthquake 87.7% relocated to shelters, whereas others remained in the community by moving to a new house. In contrast, 38.7% of the participants whose houses were still inhabitable after the earthquake lived in the shelters. Relocation was predicted by behavioral avoidance, material losses, and loss of relatives. These findings suggested that a multitude of factors played a role in survivors' displacement from their houses and the elevated rates of mental health problems could constitute a cause rather than an effect of relocation.

Salcioğlu E, Başoğlu M, Livanou M. · Section of Trauma Studies, Division of Psychological Medicine, Institute of Psychiatry, King's College London, University of London, London SE5 8AF, UK. · Behav Res Ther. · Pubmed #17570342 No free full text.

Abstract: Although the effectiveness of cognitive-behavioral treatment in posttraumatic stress disorder (PTSD) is well established, few studies examined its effects on individual PTSD symptoms and possible mechanisms of improvement in symptoms. In a previous randomized controlled study [Başog lu, M., Salciog lu, E., Livanou, M., Kalender, D., & Acar, G. (2005). Single-session behavioral treatment of earthquake-related posttraumatic stress disorder: A randomized waitlist controlled trial. Journal of Traumatic Stress, 18, 1-11] a single session of behavioral treatment involving self-exposure instructions was highly effective in reducing earthquake-related PTSD. In the present study we examined the effects of treatment on each PTSD symptom and which symptoms improved early in treatment. Because the intervention focused solely on behavioral avoidance, we hypothesized that avoidance would be the first symptom to change and that reduction in avoidance would generalize to all other symptoms. The results showed significant between-groups treatment effect on only behavioral avoidance early in treatment (week 6). At 6 months post-treatment recovery rates ranged from 60% to 89% for 15 PTSD symptoms, including the numbing symptoms. Lack of improvement in avoidance was associated with lack of improvement in 12 symptoms. The critical process in recovery thus appeared to be increased sense of control associated with reduction in avoidance. These findings imply that live exposure to fear cues designed to enhance sense of control might be sufficient for recovery from PTSD.

Başoğlu M, Livanou M, Crnobarić C. · Section of Trauma Studies, Institute of Psychiatry, King's College, University of London, De Crespigny Park, Denmark Hill, London, England. · Arch Gen Psychiatry. · Pubmed #17339516 links to  free full text

Abstract: CONTEXT: After the reports of human rights abuses by the US military in Guantanamo Bay, Iraq, and Afghanistan, questions have been raised as to whether certain detention and interrogation procedures amount to torture. OBJECTIVE: To examine the distinction between various forms of ill treatment and torture during captivity in terms of their relative psychological impact. DESIGN AND SETTING: A cross-sectional survey was conducted with a population-based sample of survivors of torture from Sarajevo in Bosnia and Herzegovina, Banja Luka in Republica Srpska, Rijeka in Croatia, and Belgrade in Serbia. PARTICIPANTS: A total of 279 survivors of torture accessed through linkage sampling in the community (Banja Luka, Sarajevo, and Rijeka) and among the members of 2 associations for war veterans and prisoners of war (Belgrade). MAIN OUTCOME MEASURES: Scores on the Semi-structured Interview for Survivors of War, Exposure to Torture Scale, Structured Clinical Interview for DSM-IV, and Clinician-Administered PTSD (posttraumatic stress disorder) Scale for DSM-IV. RESULTS: Psychological manipulations, humiliating treatment, exposure to aversive environmental conditions, and forced stress positions showed considerable overlap with physical torture stressors in terms of associated distress and uncontrollability. In regression analyses, physical torture did not significantly relate to posttraumatic stress disorder (odds ratio, 1.41, 95% confidence interval, 0.89-2.25) or depression (odds ratio, 1.41, 95% confidence interval, 0.71-2.78). The traumatic stress impact of torture (physical or nonphysical torture and ill treatment) seemed to be determined by perceived uncontrollability and distress associated with the stressors. CONCLUSIONS: Ill treatment during captivity, such as psychological manipulations, humiliating treatment, and forced stress positions, does not seem to be substantially different from physical torture in terms of the severity of mental suffering they cause, the underlying mechanism of traumatic stress, and their long-term psychological outcome. Thus, these procedures do amount to torture, thereby lending support to their prohibition by international law.

Başoğlu M, Salcioğlu E, Livanou M, Kalender D, Acar G. · Section of Trauma Studies, Institute of Psychiatry, King's College, University of London, London, England. · J Trauma Stress. · Pubmed #16281190 No free full text.

Abstract: In an attempt to develop a brief treatment for disaster survivors, the present study examined the effectiveness of a single session of modified behavioral treatment in earthquake-related posttraumatic stress disorder. Fifty-nine earthquake survivors in Turkey were randomized into either single-session modified behavioral treatment (SSBT) designed to enhance sense of control over earthquake-related fears or waiting list control condition (WL). The WL group received SSBT after a second baseline assessment. Follow-ups were at weeks 6, 12, 24, and at 1-2 years posttreatment. Significant treatment effects were found on all measures at posttreatment. The improvement rate was 49% at week 6; it rose to 80% by week 12, 85% by week 24, and 83% by the 1-2-year follow-up. Brief behavioral treatment has promise as a cost-effective intervention for disaster survivors.

Livanou M, Kasvikis Y, Başoğlu M, Mytskidou P, Sotiropoulou V, Spanea E, Mitsopoulou T, Voutsa N. · Division of Psychological Medicine, Section of Trauma Studies, Institute of Psychiatry, 38, Carver Road, London SE24 9LT, UK. · Eur Psychiatry. · Pubmed #15797698 No free full text.

Abstract: Exposure to earthquakes has been associated with psychological distress and in particular the development of post-traumatic stress disorder (PTSD). Earthquake-related psychological distress can be longstanding. The present study involved 157 Greek survivors of the 1999 Parnitha earthquake assessed approximately 4 years after the earthquake. Assessments were based on the Traumatic Stress Symptom Checklist (TSSC). Using stringent calibrations for the estimation of symptom presence 25% of the survivors endorsed at least 5 and 12% at least 10 TSSC symptoms. Approximately 22% of the survivors reported subjective distress and 15% impaired adjustment due to their symptoms. Intensity of fear during the earthquake and participation in rescue operations related to greater post-earthquake psychological distress. The results suggest that the psychological consequences of earthquakes can be serious and long-standing even when the magnitude of the earthquake is moderate. Psychological treatments that have been proven to reduce fear and PTSD symptoms need to be made available to the survivors. Such treatments may also increase the survivors' psychological preparedness and emotional resilience in view of future earthquakes.

Başoğlu M, Kiliç C, Salcioğlu E, Livanou M. · Section of Trauma Studies, Institute of Psychiatry, King's College, University of London, London, United Kingdom. · J Trauma Stress. · Pubmed #15141786 No free full text.

Abstract: This study examined the prevalence of posttraumatic stress disorder (PTSD) and depression 14 months after the earthquake in Turkey in 2 randomly selected samples from the epicenter (n = 530) and a suburb of Istanbul 100 km from the epicenter (n = 420). The rates of PTSD and depression comorbid with PTSD were, respectively, 23 and 16% at the epicenter and 14 and 8% in Istanbul. The strongest predictor of traumatic stress symptoms was fear during the earthquake, whereas predictions with female gender, past psychiatric illness, damage to home, participation in rescue work, past trauma, and loss of close ones were significant but weak. Our findings suggest that devastating earthquakes have long-term psychological effects. Psychological interventions reducing fear may improve PTSD in survivors.

Başoğlu M, Ekblad S, Bäärnhielm S, Livanou M. · Section of Trauma Studies, Institute of Psychiatry, Division of Psychological Medicine, University of London, 38 Carver Road, London SE24 9LT, UK. · J Anxiety Disord. · Pubmed #15125982 No free full text.

Abstract: The present study examined results of cognitive-behavioral treatment (CBT) in a 22-year-old, male, tortured asylum-seeker living in Sweden. The patient received 16 sessions of CBT involving mainly self-exposure to trauma-related cues. Clinical measures (assessor- and self-rated) were completed at pre-treatment, weeks 6, 8, 12, and 16, post-treatment and at follow-up (1-, 3-, and 6-month). Treatment led to significant improvement across all measures of post-traumatic stress disorder, anxiety, and depression. The improvement was maintained at 6-month follow-up. The results suggest that CBT could be useful in treating tortured asylum-seekers and refugees despite the additional stressors experienced by asylum-seekers and refugees.

Başoğlu M, Livanou M, Salcioğlu E. · Istanbul Center for Behavior Research and Therapy. · Am J Psychiatry. · Pubmed #12668372 links to  free full text

Abstract: OBJECTIVE: This study examined the effectiveness of a single session of earthquake simulator-assisted exposure treatment of traumatic stress in earthquake survivors. METHOD: Ten earthquake survivors in Turkey were given one session of exposure to simulated earthquake tremors. Assessments were at pre- and postsession and at 2, 4, 8, and 12 weeks posttreatment. RESULTS: All measures showed significant improvement at all assessments. Eight patients were markedly and two slightly improved at follow-up. CONCLUSIONS: A single exposure session with an earthquake simulator appears to be effective in treating postearthquake traumatic stress. Controlled studies are needed to confirm these findings.

Livanou M, Başoğlu M, Salcioğlu E, Kalendar D. · Section of Trauma Studies, Division of Psychological Medicine, Institute of Psychiatry, University of London, United Kingdom. · J Nerv Ment Dis. · Pubmed #12486369 No free full text.

Abstract: This study examined the incidence of posttraumatic stress disorder (PTSD) and depression in 1,027 earthquake survivors who were consecutively referred to a community center at a mean of 14 months after the August 1999 earthquake in Turkey. Seventy-seven percent of referrals were women. The estimated rates of PTSD and major depression were 63% and 42%, respectively. More severe PTSD symptoms related to greater fear during the earthquake, female gender, lower education, loss of friends, shorter time since the earthquake, and material loss. More severe depression symptoms related to female gender, longer time since the earthquake, lower educational level, loss of a family member, and past psychiatric illness. In conclusion, long-term public mental health policies are needed for postearthquake psychological problems. These policies need to take into account the risk factors for traumatic stress and the gender differences in referral patterns. The differential stressor-response relationship may have important implications for treatment.

Başoğlu M, Salcioğlu E, Livanou M. · Division of Psychological Medicine, Institute of Psychiatry, King's College London, University of London, United Kingdom. · J Trauma Stress. · Pubmed #12224798 No free full text.

Abstract: This study examined the rates of posttraumatic stress disorder (PTSD) and depression and associated risk factors in earthquake survivors in Turkey. A group of 1,000 people from 3 camps and 2 prefabricated housing sites in the epicenter region was assessed using the Screening Instrument for Traumatic Stress in Earthquake Survivors. The estimated rates of PTSD and major depression were 43 and 31 %, respectively. Traumatic stress symptoms related to more intense fear during the earthquake, female gender, having been trapped under rubble, death of a family member, past psychiatric illness, having participated in rescue work, and lower education. Avoidance of trauma reminders was the most common symptom and needs special attention in survivor care because of its mental health, social, and economic implications.

Başoğlu M, Salcioğlu E, Livanou M, Ozeren M, Aker T, Kiliç C, Mestçioğlu O. · Division of Psychological Medicine, Institute of Psychiatry, University of London, England. · J Trauma Stress. · Pubmed #11534881 No free full text.

Abstract: The validity of a Traumatic Stress Symptom Checklist (TSSC), which was developed as part of a Screening Instrument for Traumatic Stress in Earthquake Survivors (SITSES), was examined in 130 survivors of the recent earthquake in Turkey. Data were obtained on the TSSC, which consists of 17 DSM-IV posttraumatic stress disorder (PTSD) items and 6 symptoms of depression. The Clinician-Administered PTSD Scale and the Major Depressive Episode module of the Semistructured Clinical Interview for DSM-IV were used for comparison with the TSSC. The results indicated that the TSSC has high internal consistency and satisfactory sensitivity and specificity in predicting the diagnosis of PTSD and major depression. The SITSES appeared to be a useful instrument in screening earthquake survivors for PTSD, major depression, illness severity, and risk factors associated with traumatic stress responses.

Başoğlu M. · No affiliation provided · JAMA. · Pubmed #18000195 No free full text.

This publication has no abstract.