Anxiety Disorders: Boston University

Otto MW, Perlman CA, Wernicke R, Reese HE, Bauer MS, Pollack MH. · Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. · Bipolar Disord. · Pubmed #15541062 No free full text.

Abstract: OBJECTIVES: In this article, we review the evidence for, and implications of, a high rate of comorbid posttraumatic stress disorder (PTSD) in individuals with bipolar disorder. METHODS: We reviewed studies providing comorbidity data on patients with bipolar disorder, and also examined the PTSD literature for risk factors and empirically supported treatment options for PTSD. RESULTS: Studies of bipolar patients have documented elevated rates of PTSD. Based on our review, representing 1214 bipolar patients, the mean prevalence of PTSD in bipolar patients is 16.0% (95% CI: 14-18%), a rate that is roughly double the lifetime prevalence for PTSD in the general population. Risk factors for PTSD that are also characteristic of bipolar samples include the presence of multiple axis I disorders, greater trauma exposure, elevated neuroticism and lower extraversion, and lower social support and socio-economic status. CONCLUSIONS: These findings are discussed in relation to the cost of PTSD symptoms to the course of bipolar disorder. Pharmacological and cognitive-behavioral treatment options are reviewed, with discussion of modifications to current cognitive-behavioral protocols for addressing PTSD in individuals at risk for mood episodes.

Hofmann SG, Heinrichs N, Moscovitch DA. · Department of Psychology, Boston University, 648 Beacon Street, 6th Fl, Boston, MA 02215, USA. · Clin Psychol Rev. · Pubmed #15501556 No free full text.

Abstract: Social phobia (social anxiety disorder) was officially recognized as a distinct clinical entity only with the publication of the DSM-III in 1980. Research on the psychopathology of this disorder has revealed a great degree of heterogeneity in its symptomatology. In order to acknowledge this heterogeneity, later versions of the nosological system introduced the generalized subtype of social phobia to describe individuals who fear most or all social situations. The empirical literature on the differences between the diagnostic subtypes has yielded inconsistent findings. Based on the recent emotion literature and concepts from evolutionary psychology, we discuss fearfulness, anxiousness, shyness, self-consciousness, submissiveness, and anger as dimensions of social phobia. The empirical evidence for this classification system and its relationship to the diagnostic subtypes will be discussed.

Culpepper L. · Department of Family Medicine, Boston Medical Center at Boston University School of Medicine, Boston, MA 02118, USA. · J Clin Psychiatry. · Pubmed #15078114 No free full text.

Abstract: Many individuals who experience a panic attack at some point in their lives will meet criteria for panic disorder. However, although most primary care physicians recognize broad-spectrum mood and anxiety disorders, they may not make a specific diagnosis such as major depressive disorder or panic disorder. Comorbid panic disorder and other anxiety conditions are a well-established phenomenon in depressive disorders and can have a negative impact on treatment and worsen prognosis. This negative impact underscores the importance of specifically identifying these disorders and their comorbidities. Although an analysis of other potential causes of presenting symptoms is at times indicated, diagnosis should be made positively by identifying the symptoms diagnostic of the anxiety conditions rather than negatively by eliminating other conditions. Treatment of patients with panic disorder can improve quality of life and productivity as well as reduce health care costs. Pharmacotherapy, cognitive-behavioral therapy, and collaborative relationships with patients and psychiatrists can all aid primary care physicians in providing acute and long-term treatment for patients with panic as well as other mood and anxiety disorders.

Kimble M, Kaufman M. · Boston University School of Medicine/Veterans Administration Boston Healthcare System, 150 South Huntington Avenue, Psychology 116B-2, Boston, MA 02130, USA. · Psychiatr Clin North Am. · Pubmed #15062630 No free full text.

Abstract: Knowledge about the biological basis of psychological trauma is changing at an exponential rate. A PsychlNFO search on the search terms "locus coeruleus" and "PTSD" revealed one peer-reviewed journal article between 1982 and 1992 and 51 in the subsequent decade. A similar search revealed zero articles on "hippocampus" and "PTSD" between 1982 and 1992 and 170 in the past decade. As clinicians, it is important to become increasingly familiar with this growing literature to use that knowledge to treat and educate patients. Imagine the relief that can be provided to survivors of trauma if clinicians can tell them that they have a good idea about what causes their symptoms and even clearer ideas about how to treat them.One ancillary but invaluable outcome to this work is the fact that understanding the neurological underpinnings of PTSD will go a long way to establishing a necessary equilibrium in nature and nurture's role in the etiology and maintenance of the disorder. In its early conceptualization, PTSD was thought by many to be an ordinary reaction to an extraordinary event, thus placing responsibility for the disorder firmly in the hands of environmental factors. A subsequent emphasis on vulnerability and resiliency factors in the disorder, however, gave the impression that genetic and potentially hard-wired neurological factors were dominant in the expression of the disorder. Appreciating the balance between nature and nurture in the development of stress disorders like PTSD will allow clinicians and patients alike to appreciate the role of personal responsibility in the process of recovery. A parallel, albeit more mature process, has occurred in the area of schizophrenia in the past four decades. Early conceptualizations of schizophrenia placed a heavy burden on parenting and behavioral factors, leaving the patients angry at their parents and parents with unnecessary guilt. The later dominance of genetic and biological theories in the disorder allayed parents of their guilt, but left both parents and patients wondering what might be done in the face of such an affliction. Modern theories of schizophrenia seem to have achieved an appropriate balance that recognizes biological vulnerabilities, but also emphasizes familial and patient responsibilities in recovery and care.In PTSD, a similar equilibrium needs to be found, and understanding the neurobiology of the disorder will go far in achieving that goal. When it is understood how trauma affects the brain and how treatment produces neurobiological changes that may remediate trauma-related effects, the patient will be in a better position to make choices about what can and cannot be done in the process of recovery. Giving patients this critical internal locus of control will provide therapeutic benefits such as confidence,self-esteem, and hope that are likely to enhance changes that occur with intervention.

Chen HF, Cohn ES. · Boston University, Sargent College of Health and Rehabilitation Sciences, 635 Commonwealth Avenue, Boston, MA 02215, USA. · Phys Occup Ther Pediatr. · Pubmed #14750309 No free full text.

Abstract: Children with Developmental Coordination Disorder (DCD) often have limited participation in social activities, causing isolation, anxiety, emotional and social problems in children themselves and their families. This paper reviews studies that investigated participation in activities of children with DCD in home, community and school. Assessments to evaluate social participation of children with DCD, intervention, strategies and future research considerations for children with DCD are suggested.

Lustig SL, Kia-Keating M, Knight WG, Geltman P, Ellis H, Kinzie JD, Keane T, Saxe GN. · Department of Psychiatry, Boston University School of Medicine, Boston, MA 02115, USA. · J Am Acad Child Adolesc Psychiatry. · Pubmed #14691358 No free full text.

Abstract: OBJECTIVE: To review stressful experiences and stress reactions among child and adolescent refugees, as well as interventions and ethical considerations in research and clinical work, within the framework of the chronological experiences of child refugees; namely, the phases of preflight, flight, and resettlement. Highlighted are special refugee populations such as unaccompanied minors, asylum seekers, and former child soldiers. Pertinent medical findings are summarized. METHOD: The authors reviewed articles from 1990 to 2003 addressing the topics above. Literature was gathered from databases including PsycINFO, Medline, and SocioFile. Pertinent earlier papers and those from other disciplines cited in database-identified articles were also included. RESULTS: Child and adolescent refugees suffer from significant conflict-related exposures. Reactions to stress may be mediated by coping strategies, belief systems, and social relations. CONCLUSIONS: More research is needed on interventions, specifically on efficacy and cultural relevance. Interventions that have an impact on multiple ecological levels need further development and evaluation.

Steketee G, Van Noppen B. · Boston University School of Social Work. Boston, MA, United States. · Rev Bras Psiquiatr. · Pubmed #12975679 links to  free full text

Abstract: This article reviews the family constellation of patients with obsessive compulsive disorder (OCD), the presence of OCD symptoms among family members, and familial aspects including parental attachment, expressed emotion (EE), and family accommodation. Some evidence supports a negative effect of hostility, emotional over-involvement, and criticism perceived by the patient on behavioral treatment outcome. However, actual criticism observed by the relative during an interview was associated with more benefit from therapy. Family accommodation predicted poorer family functioning and more severe OCD symptoms after behavioral treatment. A review of the limited treatment literature indicates no actual tests of the effects of psycho-educational and supportive treatments, although several reports suggest they are useful for families and patients. Including relatives in treatment has proved beneficial in some studies, especially with children, but not in others. Multiple family groups that focus on behavioral contracting for exposure and stopping rituals may be a promising intervention. Likewise, efforts to reduce family accommodation in the context of behavioral treatment have proved useful. Additional research on the content, process and effects of family interventions for OCD is much needed.

van der Kolk BA. · Department of Psychiatry, Boston University School of Medicine, 227 Babcock Street, Boston, MA 02215, USA. · Child Adolesc Psychiatr Clin N Am. · Pubmed #12725013 No free full text.

Abstract: During the past decade there has been rapid progress in the understanding of the effects of exposure to traumatic life experiences on subsequent psychopathology in children. Trauma exposure affects what children anticipate and focus on and how they organize the way they appraise and process information. Trauma-induced alterations in threat perception are expressed in how they think, feel, behave, and regulate their biologic systems. The task of therapy is to help these children develop a sense of physical mastery and awareness of who they are and what has happened to them to learn to observe what is happening in present time and physically respond to current demands instead of recreating the traumatic past behaviorally, emotionally, and biologically.

Auerbach S, Karow CM. · Department of Neurology and Psychiatry, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA. · Semin Speech Lang. · Pubmed #12709886 No free full text.

Abstract: Patients with neurological disorders are particularly susceptible to a variety of affective and mood disorders. Unfortunately, several factors confound the analysis of the individual case. These factors include the fact that neurological deficits may limit the capacity of the individual to communicate mood and feelings. In some cases, the deficits might mimic affective disorders. In this article we will review the traditional presentation of affective disorders in the normal patient. We offer a discussion of specific aspects of the neurobehavioral assessment that might confound the analysis of the individual case. The confounding factors include frontal lobe deficits, aspects of impairments in language, and memory disorders. We also direct attention to motor system deficits and other problems such as sleep disorders that might contribute to a better diagnosis of affective and mood disorders. Finally, we summarize this information and present a general approach for the analysis of the individual.

Culpepper L. · Boston University, Mass. 02118, USA. · J Clin Psychiatry. · Pubmed #12044106 No free full text.

Abstract: Generalized anxiety disorder (GAD) is highly prevalent in primary care patients and is a source of major morbidity. The low rate of recognition and diagnosis of GAD is often the result of insufficient knowledge on the part of primary care physicians, time pressures, and competing demands during patients' visits. Patient attribution of symptoms and the stigma related to mental illness also contribute to underrecognition. Other contributing factors include the natural history of GAD, the bimodal age of presentation, a chronic but waxing and waning course, frequent comorbidity with other anxiety and depressive disorders, and the controversy regarding the best diagnostic criteria. However, proper diagnosis is critical to appropriate management. Primary care management of GAD and associated comorbidities includes education about the nature of GAD as a medical disorder that is amenable to treatment and counseling about treatment alternatives and coping strategies. Most patients with GAD suffer from insomnia, and treating insomnia can be of great benefit to them. While cognitive-behavioral therapy and relaxation therapy are effective in treating GAD, most patients in primary care settings are likely to require pharmacologic treatment. Although commonly used, benzodiazepines and their short-term benefits are overshadowed by their decreased long-term effectiveness, their minimal treatment of psychic symptoms, and their degradation of patient performance. The selective serotonin reuptake inhibitor (SSRI) paroxetine is indicated for the short-term treatment of GAD, although adequate data supporting the use of most SSRIs for GAD are not yet available. The serotonin-norepinephrine reuptake inhibitor venlafaxine provides a treatment option resulting in both short- and long-term improvement of symptoms, attaining not only a response but also remission from GAD and prevention of relapse.

Moreno A, Grodin MA. · Boston University School of Public Health, 715 Albany Street, MA 02118-2526, USA. · Spinal Cord. · Pubmed #11987003 links to  free full text

Abstract: BACKGROUND: Refugees and asylum seekers continue to enter the United States and the European Union in record numbers. Some have estimated that between 5-35% of all refugees have suffered torture in their countries of origin. Although general practitioners and specialized physicians are likely to encounter victims of torture as patients, few providers are familiar with the health problems that may affect this patient population. PURPOSE: :To provide neurologists, neurosurgeons, and rehabilitation medicine physicians with basic knowledge about survivors of torture that can help in the diagnosis, treatment, and referral of such patients. METHODS: A MEDLINE (1966-October 2001) search using keywords torture and sequelae (nervous system diseases and brain injuries) was conducted. Other data sources included books, reference lists, online resources and expert opinion. FINDINGS: :Forms of torture that may affect the nervous system include beatings, gunshot wounds, stab wounds, asphyxiation, prolonged suspension and electrocution. Victims of torture commonly experience neurological symptoms such as headaches, vertigo, loss of consciousness and dizziness during and after torture. A successful and meaningful clinical interaction with a survivor of torture includes avoiding retraumatization, building trust, spelling out any limits on confidentiality, and above anything else, establishing empathy with the patient. CONCLUSIONS: Neurological sequelae of torture can be devastating physically and psychologically. The treatment of these neurological conditions does not differ from other patient populations. However, the clinical approach is unique and must focus on avoiding retraumatization and helping the victim reintegrate into society as quickly as possible.

Heinrichs N, Hofmann SG. · Boston University, USA. · Clin Psychol Rev. · Pubmed #11434229 No free full text.

Abstract: This review critically discusses the empirical evidence for information-processing biases in social phobia. Distortions in attention, interpretation, and memory processes are analyzed as they apply to individuals with social phobia. The literature provides evidence for a specific attentional bias towards socially threatening stimuli and a specific interpretational/judgment bias towards self-relevant social information. However, there is little evidence to suggest that social phobia is associated with a memory bias for socially threatening stimuli. Furthermore, the relationship between the empirical evidence from information processing studies and the cognitive model of social phobia by Clark and Wells (1995) will be discussed.

Kleespies PM, Dettmer EL. · Psychology Service, VA Boston Healthcare System and Boston University School of Medicine, MA 02130, USA. · J Clin Psychol. · Pubmed #11051063 No free full text.

Abstract: This article presents evidence from the literature on the incidence and impact of behavioral emergencies on clinicians as well as suggestions for improved education and support for work in this area. Behavioral emergencies are conceptualized as including imminent life-threatening behaviors such as patient suicidal behavior, patient violence, and instances in which patients become the victims of interpersonal violence. Suggestions are offered for how clinicians can understand and cope with their own reactions during and after such patient emergencies. Additionally, data on deficits in the education and training of psychologists are presented along with suggestions for how programs and clinical sites can improve their training in emergency and crisis work.

Barlow DH, Campbell LA. · Center for Anxiety and Related Disorders, Boston University, MA 02215-2015, USA. · Compr Psychiatry. · Pubmed #10746905 No free full text.

Abstract: Recent findings have suggested that there is a distinct group of patients presenting with subthreshold levels of mixed anxious and depressive symptoms associated with significant functional impairment. Accumulating evidence of this type ultimately led to a multisite field trial which investigated the possibility of developing a new category of mixed anxiety-depression (MAD) for the DSM-IV. The field trial confirmed both the existence and impairment of a sizable group of patients with mixed subclinical anxious and depressive symptoms, and provisional criteria for MAD were proposed. Although the validity of the tentative MAD category has yet to be established, the unique characteristics of patients presenting with MAD symptoms have important implications for models of mood and anxiety disorders. We argue that the particular pattern of impairment associated with MAD provides additional evidence that anxiety and depressive disorders have a shared diathesis best captured by the construct of nonspecific negative affect.

Dinn WM, Harris CL, Raynard RC. · Department of Psychology, Boston University, MA, USA. · Psychiatry. · Pubmed #10693226 No free full text.

Abstract: This paper presents a three-factor causal model of obsessive-compulsive disorder (OCD), which posits that exposure to long-term traumatic stress generates an inordinate degree of anxiety during the psychological development of the premorbid OCD child. In response to these conditions the child evolves a distinct cognitive style characterized by exaggerated threat appraisal and magical beliefs, and experiences alterations in brain metabolism. An entire functional brain system (a basal ganglia-orbitofrontal circuit) enters into a state of enhanced responsiveness following exposure to protracted threat. Over time the threshold for stimulation is dramatically lowered, resulting in a hypersensitivity to cues that signify potential harm. Individuals adapt to this hypersensitivity through a variety of strategies, which constitute OCD.

Spiegel DA. · Center for Anxiety and Related Disorders, Boston University, Massachusetts, USA. · J Clin Psychopharmacol. · Pubmed #10587280 No free full text.

Abstract: Successful discontinuation of therapeutic drugs requires patients to negotiate two potentially difficult phases. First, they must complete the drug discontinuation procedure itself, which may entail coping with rebound and withdrawal symptoms as well as anxiety due to stopping a treatment on which they depend psychologically. Second, they must maintain drug abstinence over time, despite possible exacerbations or recurrences of the disorder that the drug was treating. For optimal success, interventions aimed at assisting patients to discontinue drug use must address both of those tasks. Patients' ability to discontinue benzodiazepines seems to be strongly influenced by cognitive appraisals of the threat represented by symptoms and of their own competence to cope with it without medication. For problems of that kind, cognitive and behavioral techniques such as those developed for the treatment of panic disorder may be especially well-suited. Currently, the most successful approaches to benzodiazepine discontinuation include the following components: (1) assisting with initial drug discontinuation, educating patients about benzodiazepine dependence and withdrawal, and about the kinds of symptoms that can emerge as the drug dose is decreased, combined with a flexible drug taper conducted in supportive collaboration with the patient; and (2) dealing with exacerbations of the illness, and providing disorder-specific cognitive-behavioral treatment as an alternative to the resumption of pharmacotherapy. It seems to be crucial that the drug taper be completed before psychological treatment concludes.

Barlow DH, Levitt JT, Bufka LF. · Center for Anxiety and Related Disorders, Boston University, MA 02215, USA. · Behav Res Ther. · Pubmed #10402700 No free full text.

Abstract: An ideological and scientific struggle spanning decades has borne fruit with the development and documentation of psychological interventions for a variety of disorders and problems with proven efficacy. Termed variously 'empirically supported treatments' or 'evidence-based psychological practice' highly regarded scientific methods have established these interventions as effective as, and often more effective than, pharmacological treatments, particularly in the long run. In some cases, combined efficacious psychological and pharmacological treatments are most effective. Despite these developments, evidence exists that these psychological treatments are not readily available to the public who requires them, because they have not been effectively disseminated to the mental health professionals who deliver them. The variety of barriers to successful dissemination are outlined, and recent developments in clinical research and public health policy are described that may facilitate the advancement of evidence-based psychological practice.

Hofmann SG. · Department of Psychology, Boston University, MA 02215, USA. · Depress Anxiety. · Pubmed #10356647 No free full text.

Abstract: Although panic attacks and schizophrenic symptoms are common comorbid conditions, little is known about the reason for this association. A critical review of the literature on the association between panic attacks and schizophrenic symptoms is presented. The findings reported in the literature are discussed as evidence for one of four competing hypotheses: 1) the reported association is due to a methodological artifact, 2) panic attacks cause schizophrenic symptoms, 3) schizophrenic symptoms cause panic attacks, and 4) panic attacks and schizophrenic symptoms share common etiologic factors. No firm conclusions can be drawn due to insufficient empirical data. The best preliminary explanation for the association is that the two disorders share common etiologic factors.

Hofmann SG, Spiegel DA. · Department of Psychology, Boston University, MA 02215, USA. · J Psychother Pract Res. · Pubmed #9888103 links to  free full text

Abstract: Panic Control Treatment (PCT) is a widely used, empirically validated cognitive-behavioral treatment for panic disorder. Initially developed for the treatment of panic disorder with limited agoraphobic avoidance, PCT more recently has been finding broader applications. It has been used as an aid to pharmacotherapy discontinuation in panic disorder; in the treatment of panic attacks associated with other disorders such as schizophrenia; and, in combination with a situational exposure component, in the treatment of patients with moderate to severe agoraphobia. The authors critically review the evidence for the clinical efficacy of PCT and recent work directed at further enhancing the long-term efficacy and cost-effectiveness of treatment.

Streeter CC, Jensen JE, Perlmutter RM, Cabral HJ, Tian H, Terhune DB, Ciraulo DA, Renshaw PF. · Division of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA. · J Altern Complement Med. · Pubmed #17532734 No free full text.

Abstract: OBJECTIVES: The aim of this study was to compare changes in brain gamma-aminobutyric (GABA) levels associated with an acute yoga session versus a reading session. It was hypothesized that an individual yoga session would be associated with an increase in brain GABA levels. DESIGN: This is a parallel-groups design. SETTINGS/LOCATION: Screenings, scan acquisitions, and interventions took place at medical school-affiliated centers. SUBJECTS: The sample comprised 8 yoga practitioners and 11 comparison subjects. INTERVENTIONS: Yoga practitioners completed a 60-minute yoga session and comparison subjects completed a 60-minute reading session. OUTCOME MEASURES: GABA-to-creatine ratios were measured in a 2-cm axial slab using magnetic resonance spectroscopic imaging immediately prior to and immediately after interventions. RESULTS: There was a 27% increase in GABA levels in the yoga practitioner group after the yoga session (0.20 mmol/kg) but no change in the comparison subject group after the reading session ( -0.001 mmol/kg) (t = -2.99, df = 7.87, p = 0.018). CONCLUSIONS:These findings demonstrate that in experienced yoga practitioners, brain GABA levels increase after a session of yoga. This suggests that the practice of yoga should be explored as a treatment for disorders with low GABA levels such as depression and anxiety disorders. Future studies should compare yoga to other forms of exercise to help determine whether yoga or exercise alone can alter GABA levels.

Heinrichs N, Hofmann SG. · Center for Anxiety and Related Disorders, Boston University, Boston, USA. · Cogn Behav Ther. · Pubmed #15844683 No free full text.

Abstract: The goal of the present study was to compare 2 cognitive assessment methods for social anxiety: a thought listing and a self-report method. The focus of this study was on the convergent and divergent validity of these methods using a multi-trait multi-method approach. Furthermore, treatment sensitivity was explored. Fifty-eight patients with social phobia completed thought listings followed by 2 different social stress tasks before and after an exposure group treatment (n = 33), or following a waiting period (n = 25). One task consisted of speaking in front of 2 confederates while the other task involved initiating a conversation with an opposite-sex confederate. Two questionnaires measuring positive and negative self-statements regarding public speaking and social interactions were also completed. To compare the balance of positive and negative thoughts, the State of Mind ratio [positive thoughts/(positive+negative thoughts)] was calculated for both cognitive assessment methods. Results demonstrate that methods related to social interaction anxiety showed better convergent validity than methods related to public speaking anxiety; however, public speaking methods captured treatment effects better than methods related to social interaction anxiety. This study questions the common assumption that different cognitive assessment methods measure the same construct.

Stern RA, Davis JD, Rogers BL, Smith KE, Harrington CJ, Ott BR, Jackson IM, Prange AJ. · Department of Neurology, Boston University School of Medicine, Robinson Suite 7800, 715 Albany Street, Boston, MA 02118, USA. · Cogn Behav Neurol. · Pubmed #15622018 No free full text.

Abstract: OBJECTIVE: To investigate whether variations within normal ranges of thyroid functioning are related to cognitive and neuropsychiatric functioning in Alzheimer disease (AD). BACKGROUND: Mild alterations of thyroid hormone levels, even in the normal range, are associated with changes in mood and cognitive functioning in older, nondemented adults, and lower concentrations of thyroid hormones have been shown to be associated with an increased risk for cognitive decline. Less is known about the relationship between thyroid hormone levels and cognitive and neuropsychiatric dysfunction in AD. METHOD: Twenty-eight euthyroid patients with AD on donepezil underwent evaluation of thyroid status, including measures of thyroid-stimulating hormone (TSH) and free thyroxine (FT4), and cognitive and neuropsychiatric assessment with the Alzheimer's Disease Assessment Scale, Neuropsychiatric Inventory, and Visual Analog Mood Scales. RESULTS: Correlational analyses indicated statistically significant associations between FT4 concentrations and self-reported feelings of fear and fatigue. Fear and fatigue were negatively correlated with FT4. There were no significant relationships between thyroid hormones and cognition and other depressive and anxiety symptoms. CONCLUSIONS: Results of this preliminary study support a relationship between thyroid status and neuropsychiatric symptoms in euthyroid individuals with AD, with lower concentrations of FT4 associated with fear and fatigue.

Hofmann SG, Moscovitch DA, Kim HJ, Taylor AN. · Department of Psychology, Boston University, Boston, MA 02215, USA. · J Consult Clin Psychol. · Pubmed #15301643 No free full text.

Abstract: Ninety individuals with social phobia were randomly assigned to a waitlist control group, a cognitive-behavioral therapy group, or an exposure therapy group without explicit cognitive intervention. Two independent raters classified more than 2,000 thoughts that were reported by participants while anticipating socially stressful situations at pretest and posttest. Each thought was classified on the basis of its valence (positive, negative, or neutral) and attentional focus (self or other). The 2 treatments demonstrated a greater reduction in the frequency of negative self-focused thoughts than the control group. Changes in negative self-focused thoughts and changes in social anxiety were significantly correlated only in the cognitive-behavioral therapy group. The implications of these findings for the cognitive model of social phobia are discussed.

Hofmann SG. · Department of Psychology, Boston University, MA 02215-2002, USA. · J Consult Clin Psychol. · Pubmed #15279523 links to  free full text

Abstract: Ninety individuals with social phobia (social anxiety disorder) participated in a randomized controlled trial and completed cognitive-behavioral group therapy, exposure group therapy without explicit cognitive interventions, or a wait-list control condition. Both treatments were superior to the wait-list group in reducing social anxiety but did not differ from one another at posttest. Changes in estimated social cost mediated treatment changes in both treatment conditions from pre- to posttest. However, only participants who received cognitive-behavioral therapy showed continued improvement from posttest to 6-month follow-up, which was associated with a reduction of estimated social cost from pretest to posttest. These results suggest that cognitive intervention leads to better maintenance of treatment gains, which is mediated through changes in estimated social cost.

Monnelly EP, Ciraulo DA, Knapp C, Keane T. · Division of Psychiatry, Boston University School of Medicine, Boston Massachusetts 02118, USA. · J Clin Psychopharmacol. · Pubmed #12640221 No free full text.

Abstract: Increased aggressive behavior can occur in association with posttraumatic stress disorder (PTSD). This study tested the hypothesis that low-dose risperidone reduces aggression and other PTSD-related symptoms in combat veterans. Subjects were male combat veterans with PTSD who scored 20 or higher on cluster D (hyperarousal) of the Patient Checklist for PTSD-Military Version (PCL-M). Subjects were randomly assigned to either risperidone or placebo treatment groups. Drugs were administered over a 6-week treatment period in a double-blind manner. Subjects received either risperidone (0.5 mg/day; n = 7) or matched placebo (n = 8) tablets during the first 2 weeks of the treatment period. The dose of risperidone could then be increased up to 2.0 mg/day on the basis of response. Prerandomization psychotropic regimens were continued. Subjects were evaluated with the PCL-M and the Overt Aggression Scale-Modified for Outpatients (OAS-M). In comparison with placebo treatment, reductions in scores between baseline and the last week of treatment were significantly greater for OAS-M irritability and PCL-M cluster B (intrusive thoughts) subscales and on the PCL-M total scale. These results suggest that low-dose risperidone administration reduces irritability and intrusive thoughts in combat-related PTSD.