Anxiety Disorders: Taylor S

Rosen GM, Taylor S. · University of Washington, USA. · J Anxiety Disord. · Pubmed #17084063 No free full text.

Abstract: Pseudo-posttraumatic stress disorder (pseudo-PTSD) refers to cases in which a patient's presentation is but a simulation of the actual clinical syndrome. The problem of pseudo-PTSD has been neglected by many clinicians and researchers, who often rely on the assumption that a patient's reported symptoms can be accepted as valid. The purpose of this article is to (a) consider the diverse causes of pseudo-PTSD, (b) emphasize the importance of the DSM-IV's guideline to rule out malingering, and (c) discuss the implications that pseudo-PTSD has for research and clinical practice.

Asmundson GJ, Taylor S, Bovell CV, Collimore K. · Department of Psychology, University of Regina, Regina, Saskatchewan, S4S 0A2, Canada. · Expert Rev Neurother. · Pubmed #16466301 No free full text.

Abstract: The purpose of this article is to summarize strategies for effectively managing the symptoms of anxiety. The distinction between the cognitive, physiological and behavioral components of fear and anxiety is explained and various treatment targets are outlined. Empirically-supported strategies that are effective in alleviating common symptoms of anxiety are reviewed. These include various forms of psychosocial intervention (i.e., cognitive and behavioral therapies), pharmacotherapy, in addition combined treatment approaches. Expert consensus guidelines, prognostic factors, patient preferences and accessibility issues are discussed with regard to treatment selection in addition to emerging challenges in the field and future research directions.

Abramowitz JS, Taylor S, McKay D. · Mayo Clinic, Rochester MN 55905, USA. · Cogn Behav Ther. · Pubmed #16195053 No free full text.

Abstract: Exposure and response prevention (ERP) is a well-established treatment for obsessive-compulsive disorder (OCD). However, it is not completely effective for many patients, and some do not benefit from or tolerate this treatment. Over the past 3 decades there has been growing interest in using cognitive interventions, either as adjuncts or alternatives to exposure-based treatments such as ERP, to address these shortcomings. Cognitive therapy and cognitive behavior therapy for OCD have both demonstrated greater efficacy than no treatment at all, and appear to have a lower incidence of dropout than ERP. Unfortunately, however, for the average OCD patient, cognitive interventions have not improved treatment efficacy; that is, cognitive interventions, either alone or combined with ERP, are no more effective than ERP alone. Reasons for this disappointing result are considered, and indications for the use of cognitive interventions are discussed. Future research directions are suggested in order to evaluate more fully the merits of, and indications for, cognitive methods for treating OCD.

Asmundson GJ, Stapleton JA, Taylor S. · Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada. · J Trauma Stress. · Pubmed #15730065 No free full text.

Abstract: We present the conceptual basis and empirical evidence for considering avoidance and numbing as distinct posttraumatic stress disorder (PTSD) symptom clusters. The majority of data from factor analytic studies supports the position that avoidance and numbing are distinct symptom clusters. As well, the available data suggest that (a) different treatment modalities have differential effects on reducing avoidance but not numbing, (b) patients with more severe pretreatment numbing have poorer treatment outcomes, (c) avoidance and numbing have different patterns of correlation with depression, and (d) they have different correlations with physiological indices of attention. We conclude that avoidance and numbing are distinct PTSD symptom clusters. This distinction has implications for revising current diagnostic criteria. The recognition of this distinction may lead to advances in understanding and treating PTSD.

Taylor S. · Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada. · Cogn Behav Ther. · Pubmed #15279317 No free full text.

This publication has no abstract.

McKay D, Abramowitz JS, Calamari JE, Kyrios M, Radomsky A, Sookman D, Taylor S, Wilhelm S. · Department of Psychology, Fordham University, 441 East Fordham Road, Bronx, NY 10458-5198, USA. · Clin Psychol Rev. · Pubmed #15245833 No free full text.

Abstract: Recently, experts have suggested that obsessive-compulsive disorder (OCD), a highly heterogeneous condition, is actually composed of distinct subtypes. Research to identify specific subtypes of OCD has focused primarily on symptom presentation. Subtype models have been proposed using factor analyses that yield dimensional systems of symptom categories, but not necessarily distinct subtypes. Other empirical work has considered the role of neuropsychological functioning and comorbidity as part of a comprehensive scheme for subtyping OCD. The identified dimensions from all of these studies have implications for the treatment of OCD. In this article, we review the research on subtypes of OCD, focusing on subtype schemes based upon overt symptom presentation and neuropsychological profiles. We also review research pertinent to alternative subtyping schemes, both conceptually and methodologically. The research is critically examined and implications for treatment are discussed. Recommendations for future investigations are offered.

Asmundson GJ, Coons MJ, Taylor S, Katz J. · Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK S4S 0A2. · Can J Psychiatry. · Pubmed #12553128 No free full text.

Abstract: It is common for individuals with symptoms of posttraumatic stress disorder (PTSD) to present with co-occurring pain problems, and vice versa. However, the relation between these conditions often goes unrecognized in clinical settings. In this paper, we describe potential relations between PTSD and chronic pain and their implications for assessment and treatment. To accomplish this, we discuss phenomenological similarities of these conditions, the prevalence of chronic pain in patients with PTSD, and the prevalence of PTSD in patients with chronic pain. We also present several possible explanations for the co-occurrence of these disorders, based primarily on the notions of shared vulnerability and mutual maintenance. The paper concludes with an overview of future research directions, as well as practical recommendations for assessing and treating patients who present with co-occurring PTSD or chronic pain symptoms.

Wald J, Taylor S. · Department of Psychiatry, University of British Columbia, Vancouver, B.C., Canada. · Cyberpsychol Behav. · Pubmed #14583121 No free full text.

Abstract: This article presents a review of preliminary research of two studies of the efficacy of virtual reality exposure therapy (VRET) to treat driving phobia. Study 1 describes a case study of a patient who completed a 7-day baseline followed by three sessions of VRET. Her peak anxiety decreased within and across sessions. At the post-treatment assessment, her phobic-related symptoms had diminished and she no longer met diagnostic criteria for driving phobia. Clinical improvement was maintained at 1-, 3-, and 7-month follow-up. In study 2, a multiple baseline across-subjects design was used to treat five patients over eight weekly VRET sessions. Visual and statistical analyses showed clear improvement in driving anxiety and avoidance in three patients between pre- and post-treatment assessments, and they no longer met criteria for driving phobia. There was marginal improvement in one patient, and the remaining individual showed no treatment gains. There was negligible change in actual driving frequency for any of the patients. Some gains were lost at the follow-up, particularly for the two individuals with poorer treatment responses. The results from these preliminary studies suggest that VRET may be a promising intervention for treating driving phobia. Avenues for improving treatment outcome are discussed.

McLean PD, Whittal ML, Thordarson DS, Taylor S, Söchting I, Koch WJ, Paterson R, Anderson KW. · Department of Psychiatry, University of British Columbia, Vancouver, Canada. · J Consult Clin Psychol. · Pubmed #11393598 No free full text.

Abstract: This study examined the effects of cognitive-behavior therapy (CBT) compared with traditional behavior therapy (exposure and response prevention [ERP]) in the group treatment of obsessive-compulsive disorder. Of the 76 participants who started treatment, 38 were wait-listed for 3 months before treatment to assess possible course effects. Both treatments were superior to the control condition in symptom reduction, with ERP being marginally more effective than CBT by end of treatment and again at 3-month follow-up. In terms of clinically significant improvement, treatment groups were equivalent on the conclusion of treatment, but 3 months later significantly more ERP participants met criteria for recovered status. Only 1 of 7 belief measures changed with treatment improvement, and the extent of this cognitive change was similar between CBT and ERP groups. Discussion includes consideration of optimal formats for the delivery of different types of treatment.

Kominski G, Andersen R, Bastani R, Gould R, Hackman C, Huang D, Jarvik L, Maxwell A, Moye J, Olsen E, Rohrbaugh R, Rosansky J, Taylor S, Van Stone W. · UCLA School of Public Health, Los Angeles, CA, USA. · Med Care. · Pubmed #11317098 No free full text.

Abstract: BACKGROUND: The Unified Psychogeriatric Biopsychosocial Evaluation and Treatment (UPBEAT) program provides individualized interdisciplinary mental health treatment and care coordination to elderly veterans whose comorbid depression, anxiety, or alcohol abuse may result in overuse of inpatient services and underuse of outpatient services. OBJECTIVES: To determine whether proactive screening of hospitalized patients can identify unrecognized comorbid psychiatric conditions and whether comprehensive assessment and psychogeriatric intervention can improve care while reducing inpatient use. DESIGN: Randomized trial. SUBJECTS: Veterans aged 60 and older hospitalized for nonpsychiatric medical or surgical treatment in 9 VA sites (UPBEAT, 814; usual care, 873). MEASURES: The Mental Health Inventory (MHI) anxiety and depression subscales, the Alcohol Use Disorder Identification Test (AUDIT) scores, RAND 36-Item Health Survey Short Form (SF-36), inpatient days and costs, ambulatory care clinic stops and costs, and mortality and readmission rates. RESULTS: Mental health and general health status scores improved equally from baseline to 12-month follow-up in both groups. UPBEAT increased outpatient costs by $1,171 (P <0.001) per patient, but lowered inpatient costs by $3,027 (P = 0.017), for an overall savings of $1,856 (P = 0.156). Inpatient savings were attributable to fewer bed days of care (3.30 days; P = 0.016) rather than fewer admissions. Patients with 1 or more pre-enrollment and postenrollment hospitalizations had the greatest overall savings ($6,015; P = 0.069). CONCLUSIONS: UPBEAT appears to accelerate the transition from inpatient to outpatient care for acute nonpsychiatric admissions. Care coordination and increased access to ambulatory psychiatric services produces similar improvement in mental health and general health status as usual care.

Cox BJ, Borger SC, Taylor S, Fuentes K, Ross LM. · Department of Psychiatry, University of Manitoba, Winnipeg, Canada. · Behav Res Ther. · Pubmed #10402688 No free full text.

Abstract: Relations between anxiety sensitivity (AS) and the higher-order and lower-order dimensions of the 'Big Five' model of personality were examined in 317 university students. AS was significantly associated with a number of personality domains and facets of the NEO-PI-R. Regression analyses indicated that only the higher-order domains of neuroticism and extraversion (negatively) and the lower-order N facets of anxiety and self-consciousness, significantly predicted AS. Three lower-order factors within AS were identified and were also compared to NEO-PI-R domains and facets. In a hierarchical regression, the three AS factors significantly predicted variance in a measure of panic-related anxiety after the effects of the six N facets were statistically controlled. Results are discussed in the context of previous work with a Big Three taxonomy of personality and implications for understanding the nature and possible origins of AS are outlined.

Woody S, McLean PD, Taylor S, Koch WJ. · Department of Psychology, Yale University, New Haven, CT 06520-8205, USA. · J Affect Disord. · Pubmed #10360411 No free full text.

Abstract: BACKGROUND: Individuals with major depression frequently have panic attacks, and often panic disorder, but rarely have researchers studied the impact of comorbidity of panic on the outcome of psychological treatment of depression. METHODS: In this study, patients with comorbid panic and depression were first treated with cognitive-behavioral therapy (CBT) for panic. Depression symptoms in this treated group were compared to a group of patients with major depression who were on a minimal therapist contact waitlist. In the second phase of the study, patients in both groups (comorbid and depression-only) were treated with CBT for depression. RESULTS: CBT for panic had little effect on co-existing depression, suggesting a specificity of action for CBT directed at different disorders. In addition, the presence of current or recently remitted panic attacks or agoraphobic avoidance did not interfere with the outcome of CBT for depression. CONCLUSION: These findings stand in contrast to previous studies showing greater linkage between depression and panic in treatment outcome. LIMITATIONS: While there are implications for treatment planning, these conclusions may be limited by the exclusion criteria and the highly structured treatment approach of separating treatment for panic from treatment for depression.

Taylor S, Asmundson GJ, Carleton RN, Brundin P. · Department of Psychiatry, University of British Columbia, British Columbia, Canada. · Am J Disaster Med. · Pubmed #18491838 No free full text.

Abstract: OBJECTIVES: The purpose of this study was to determine the prevalence of acute distress-that is, clinically significant posttraumatic stress symptoms (PTSS) and depression-and to identify predictors of each in a sample of people who witnessed a fatal aircraft collision at the 2005 Saskatchewan Centennial Air Show. DESIGN: Air Show attendees (N = 157) were recruited by advertisements in the local media and completed an Internet-administered battery of questionnaires. RESULTS: Based on previously established cut-offs, 22 percent respondents had clinically significant PTSS and 24 percent had clinically significant depressive symptoms. Clinically significant symptoms were associated with posttrauma impairment in social and occupational functioning. Acute distress was associated with several variables, including aspects of Air Show trauma exposure, severity of prior trauma exposure, low posttrauma social support (ie, negative responses by others), indices of poor coping (eg, intolerance of uncertainty, rumination about the trauma), and elevated scores on anxiety sensitivity, the personality trait of absorption, and dissociative tendencies. CONCLUSIONS: Results suggest that clinically significant acute distress is common in the aftermath of witnessed trauma. The statistical predictors (correlates) of acute distress were generally consistent with the results of studies of other forms of trauma. People with elevated scores on theoretical vulnerability factors (eg, elevated anxiety sensitivity) were particularly likely to develop acute distress.

Wald J, Taylor S. · Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada. · Cogn Behav Ther. · Pubmed #18470740 No free full text.

Abstract: A growing body of evidence suggests that anxiety sensitivity (AS; fear of arousal-related sensations) plays a role in posttraumatic stress disorder (PTSD). Consistent with this, evidence indicates that interoceptive exposure (IE), which is a method for reducing AS, reduces PTSD symptoms. Clinical observations from our treatment studies indicate that IE triggers both anxiety and trauma memories in people with PTSD. The primary aim of this study was to describe the anxiety responses to a series of IE exercises and to examine whether or not trauma memories were activated. A secondary aim was to explore the relationships among AS, PTSD symptom severity, and IE responses. Data were collected from 23 people with PTSD who completed measures of PTSD symptoms and AS and a standardized battery of 10 IE exercises. Elevated anxiety and strong arousal responses were frequently elicited by the exercises, and trauma memories were also frequently triggered. AS and IE-triggered trauma memories significantly predicted IE-induced peak anxiety. The implications of the findings are discussed in terms of how IE might exert its therapeutic effects in the treatment of PTSD.

McLaughlin EN, Stewart SH, Taylor S. · Pediatric Health Psychology, IWK Health Centre, Nova Scotia, Canada. · Cogn Behav Ther. · Pubmed #18049946 No free full text.

Abstract: Anxiety sensitivity (AS) is an established cognitive risk factor for anxiety disorders. In children and adolescents, AS is usually measured with the Childhood Anxiety Sensitivity Index (CASI). Factor analytic studies suggest that the CASI is comprised of 3 lower-order factors pertaining to Physical, Psychological and Social Concerns. There has been little research on the validity of these lower-order factors. We examined the concurrent and incremental validity of the CASI and its lower-order factors in a non-clinical sample of 349 children and adolescents. CASI scores predicted symptoms of DSM-IV anxiety disorder subtypes as measured by the Spence Children's Anxiety Scale (SCAS) after accounting for variance due to State-Trait Anxiety Inventory scores. CASI Physical Concerns scores incrementally predicted scores on each of the SCAS scales, whereas scores on the Social and Psychological Concerns subscales incrementally predicted scores on conceptually related symptom scales (e.g. CASI Social Concerns scores predicted Social Phobia symptoms). Overall, this study demonstrates that there is added value in measuring AS factors in children and adolescents.

Taylor S, Jang KL, Stewart SH, Stein MB. · Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 2A1, Canada. · J Anxiety Disord. · Pubmed #18029140 No free full text.

Abstract: Evidence suggests that anxiety sensitivity (AS) contributes to individual differences in fearfulness and to the risk of developing anxiety disorders. To investigate the origins of AS we administered the Anxiety Sensitivity Index to 245 monozygotic and 193 dizygotic twin pairs, comprising 658 women and 218 men. Scores were calculated for the most widely replicated AS dimensions; physical, cognitive, and social concerns. For women, each dimension was influenced by a combination of genetic and environmental factors. Heritability in women significantly increased with AS scores, indicating that severe forms of AS, compared to milder forms, are more strongly influenced by genetic factors. Correlations among AS dimensions for women could be explained by genetic and environmental factors influencing all three dimensions. For men, dimensions were influenced by environmental but not genetic factors. Correlations among dimensions for men could be explained by environmental factors influencing all dimensions. Overall, the findings reveal that AS has more complex etiology than previously recognized; its dimensions appear to arise from a mix of dimension-specific and non-specific etiologic factors, whose importance vary as a function of sex and severity.

Jang KL, Taylor S, Stein MB, Yamagata S. · Department of Psychiatry, University of British Columbia, Vancouver, Canada. · Twin Res Hum Genet. · Pubmed #17708697 No free full text.

Abstract: People differ markedly in their risk for developing posttraumatic stress symptoms (PTSS) after exposure to traumatic events. Twin studies suggest that the trauma-PTSS relationship is moderated by genetic and environmental influences. The present study tested for specific types of genetic and environmental interaction effects on PTSS. A sample of 222 monozygotic and 184 dizygotic twin pairs reported on lifetime frequency of assaultive and nonassaultive trauma and associated PTSS. Biometric analyses indicated that in the case of nonassaultive trauma, PTSS were directly affected by environmental factors that also influence exposure to nonassaultive trauma. For assaultive trauma both genetic and non-shared environmental influences jointly affected PTSS, and the number of traumatic events moderated the severity of PTSS. Genetic factors were found to become less important beyond some threshold (e.g., 3 or 4 types of serious trauma) suggesting that genetic factors - which may confer either risk or resilience to PTSS - modify these symptoms within a range of human experience, beyond which environmental effects supervene.

Taylor S, Zvolensky MJ, Cox BJ, Deacon B, Heimberg RG, Ledley DR, Abramowitz JS, Holaway RM, Sandin B, Stewart SH, Coles M, Eng W, Daly ES, Arrindell WA, Bouvard M, Cardenas SJ. · Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada. · Psychol Assess. · Pubmed #17563199 No free full text.

Abstract: Accumulating evidence suggests that anxiety sensitivity (fear of arousal-related sensations) plays an important role in many clinical conditions, particularly anxiety disorders. Research has increasingly focused on how the basic dimensions of anxiety sensitivity are related to various forms of psychopathology. Such work has been hampered because the original measure--the Anxiety Sensitivity Index (ASI)--was not designed to be multidimensional. Subsequently developed multidimensional measures have unstable factor structures or measure only a subset of the most widely replicated factors. Therefore, the authors developed, via factor analysis of responses from U.S. and Canadian nonclinical participants (n=2,361), an 18-item measure, the ASI-3, which assesses the 3 factors best replicated in previous research: Physical, Cognitive, and Social Concerns. Factorial validity of the ASI-3 was supported by confirmatory factor analyses of 6 replication samples, including nonclinical samples from the United States and Canada, France, Mexico, the Netherlands, and Spain (n=4,494) and a clinical sample from the United States and Canada (n=390). The ASI-3 displayed generally good performance on other indices of reliability and validity, along with evidence of improved psychometric properties over the original ASI.

Bernstein A, Zvolensky MJ, Norton PJ, Schmidt NB, Taylor S, Forsyth JP, Lewis SF, Feldner MT, Leen-Feldner EW, Stewart SH, Cox B. · Department of Psychology, University of Vermont, Burlington, VT 05405-0134, USA. · Psychol Assess. · Pubmed #17371124 No free full text.

Abstract: This study represents an effort to better understand the latent structure of anxiety sensitivity (AS), as indexed by the 16-item Anxiety Sensitivity Index (ASI; S. Reiss, R. A. Peterson, M. Gursky, & R. J. McNally, 1986), by using taxometric and factor-analytic approaches in an integrative manner. Taxometric analyses indicated that AS has a taxonic latent class structure (i.e., a dichotomous latent class structure) in a large sample of North American adults (N=2,515). As predicted, confirmatory factor analyses indicated that a multidimensional 3-factor model of AS provided a good fit for the AS complement class (normative or low-risk form) but not the AS taxon class (high-risk form). Exploratory factor analytic results suggested that the AS taxon may demonstrate a unique, unidimensional factor solution, though there are alternative indications that it may be characterized by a 2-factor solution. Findings suggest that the latent structural nature of AS can be conceptualized as a taxonic latent class structure composed of 2 types or forms of AS, each of these forms characterized by its own unique latent continuity and dimensional structure.

Wald J, Taylor S. · Department of Psychiatry, University of British Columbia, Vancouver, Canada. · J Anxiety Disord. · Pubmed #17270392 No free full text.

Abstract: The aim of this case series was to examine efficacy of interoceptive exposure (IE) combined with trauma-related exposure therapy (TRE) for posttraumatic stress disorder (PTSD). Seven participants completed treatment consisting of four weekly sessions of IE followed by eight weekly sessions of TRE (four sessions of imaginal exposure and four sessions of in vivo exposure). Assessments were conducted at pretreatment, posttreatment, 1- and 3-month follow-up. Outcome measures included PTSD symptoms, anxiety sensitivity, posttraumatic cognitions, anxiety, and depression. Five of the seven participants showed pre- to posttreatment improvements on these measures, and two participants showed less symptom reduction. Results at the 1-month follow-up showed that treatment gains were generally maintained in five (of the seven) participants and four of these individuals no longer met PTSD diagnostic criteria. Four individuals completed the 3-month follow-up and their symptoms and diagnostic status remained unchanged. These preliminary findings are promising. The next step in this line of research is to conduct a randomized, controlled trial to further to examine the efficacy, tolerability, and mechanisms of using IE in the treatment of PTSD.

Jang KL, Taylor S, Livesley WJ. · Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada. · Twin Res Hum Genet. · Pubmed #17254400 No free full text.

Abstract: The University of British Columbia (UBC) Twin Project is a registry of approximately 1500 pairs of reared-together twins recruited from Vancouver, British Columbia and surrounding municipalities. The focus of the project is to examine personality and its disorders from a behavioral genetic perspective. The primary measures include self-report measures of variables from the major models of personality and personality disorders. Subsamples of the study have also been surveyed on a wide range of psychiatric conditions and symptoms, including, for example, substance use, mood, anxiety, coping, posttraumatic stress disorder, schizotypy, and several measures of the environment and experience. Also surveyed are general health and basic psychological processes including cognitive ability. This broad assessment has enabled us to examine not only the structure of personality, but also its potential role in psychopathology and other psychological processes. A feature of the project is that the measures selected reflect current thinking in the field as opposed to traditional psychiatric diagnostic criteria. The UBC Twin Project has been used in a number of collaborative projects on personality and psychopathology with other world-wide twin registries. At the present time, no DNA has been collected; however the facility to collect these data is available. Collaborative projects on this and future questionnaire studies are welcome.

Stapleton JA, Asmundson GJ, Woods M, Taylor S, Stein MB. · Traumatic Stress Group, University of Regina, Regina, Saskatchewan, Canada S4S 0A2. · Mil Med. · Pubmed #16808142 No free full text.

Abstract: It remains to be determined whether patients with comorbid post-traumatic stress disorder (PTSD) and depression use more health care resources than do those without. United Nations peacekeeping veterans from Canada were divided into four groups, i.e., PTSD alone (n = 23), depression alone (n = 167), comorbid PTSD and depression (n = 119), and neither (n = 164), and compared with respect to total number of visits to any health care professional in the past year. Analysis of variance revealed that the groups significantly differed in total visits. Post hoc analyses indicated that veterans with co-occurring PTSD and depression symptoms had more visits than did those in the other groups and that veterans with PTSD symptoms alone and depression symptoms alone had more visits than did those with neither PTSD nor depression. Additional analyses revealed that veterans with co-occurring PTSD and depression symptoms made more visits to general practitioners, specialists, pharmacists, and mental health professionals than did the others. Future research directions and implications for treatment planning are discussed.

Taylor S, Frueh BC, Asmundson GJ. · Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada. <> · J Anxiety Disord. · Pubmed #16647834 No free full text.

Abstract: Malingering of symptoms of posttraumatic stress disorder (PTSD) has become a growing concern, particularly in healthcare and other settings in which the diagnosis is associated with financial incentives such as disability benefits. Although there is a steadily increasing body of research on methods for detecting PTSD malingering, little has been written on the assessment and practical management of malingering in treatment settings. The present article addresses this important issue, including a review of the methods, obstacles, and possible solutions for assessing PTSD malingering, along with suggestions for managing cases in which malingering is strongly suspected.

Stapleton JA, Taylor S, Asmundson GJ. · University of Regina. · J Trauma Stress. · Pubmed #16568469 No free full text.

Abstract: This study sought to investigate the efficacy of prolonged exposure, eye movement desensitization and reprocessing, and relaxation training on trait anger and guilt and on trauma-related anger and guilt within the context of posttraumatic stress disorder (PTSD) treatment. Fifteen PTSD patients completed each treatment and were assessed at posttreatment and at 3-month follow-up. All three treatments were associated with significant reductions in all measures of anger and guilt, with gains maintained at follow-up. There were no significant treatment differences in efficacy or in the proportion of patients who worsened on anger or guilt measures over the course of treatment. Between-treatment effect sizes were generally very small. Results suggest that all three treatments are associated with reductions in anger and guilt, even for patients who initially have high levels of these emotions. However, these PTSD therapies may not be sufficient for treating anger and guilt; additional interventions may be required.

Taylor S, Abramowitz JS, McKay D, Calamari JE, Sookman D, Kyrios M, Wilhelm S, Carmin C. · Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada. · J Anxiety Disord. · Pubmed #16325116 No free full text.

Abstract: Some but not all models of obsessive-compulsive disorder (OCD) emphasize the role of dysfunctional beliefs in the etiology and maintenance of this disorder. Clinical observations suggest that some OCD patients have prominent dysfunctional beliefs associated with their obsessions and compulsions, while other patients do not show this pattern. It is possible that dysfunctional beliefs play a role in only a subgroup of cases of OCD and, by extension, that different models might apply to different subtypes of the disorder. To examine this issue, patients with OCD (N = 244) completed measures of dysfunctional OC-related beliefs, along with measures of OC symptoms and demographics. These measures were also completed by three comparison groups; anxious (N = 103), student (N = 284), and community (N = 86) controls. Cluster analysis revealed two OCD clusters: low versus high scores on beliefs (OC-low, OC-high). Belief scores for OC-low were in the range of scores for the comparison groups, which were all significantly lower than those of OC-high. Thus, a cluster of OCD patients was identified who did not have elevated scores on measures of dysfunctional beliefs. OC-low and OC-high did not differ on some OC measures (contamination, checking, grooming), but OC-high had higher scores on measures of harming obsessions. These results are consistent with the view that dysfunctional beliefs may play a role in only some types of OCD.