To see the other types of publications on this topic, follow the link: Panic disorder and agoraphobia.
Dissertations / Theses on the topic 'Panic disorder and agoraphobia'
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 dissertations / theses for your research on the topic 'Panic disorder and agoraphobia.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse dissertations / theses on a wide variety of disciplines and organise your bibliography correctly.
1
Wittmann, A., F. Schlagenhauf, A. Guhn, U. Lueken, C. Gaehlsdorf, M. Stoy, F. Bermpohl, et al. "Anticipating agoraphobic situations: the neural correlates of panic disorder with agoraphobia." Cambridge University Press, 2014. https://tud.qucosa.de/id/qucosa%3A39008.
Full textAbstract:
Background: Panic disorder with agoraphobia is characterized by panic attacks and anxiety in situations where escape might be difficult. However, neuroimaging studies specifically focusing on agoraphobia are rare. Here we used functional magnetic resonance imaging (fMRI) with disorder-specific stimuli to investigate the neural substrates of agoraphobia. Method. We compared the neural activations of 72 patients suffering from panic disorder with agoraphobia with 72 matched healthy control subjects in a 3-T fMRI study. To isolate agoraphobia-specific alterations we tested the effects of the anticipation and perception of an agoraphobia-specific stimulus set. During fMRI, 48 agoraphobia-specific and 48 neutral pictures were randomly presented with and without anticipatory stimulus indicating the content of the subsequent pictures (Westphal paradigm). Results: During the anticipation of agoraphobia-specific pictures, stronger activations were found in the bilateral ventral striatum and left insula in patients compared with controls. There were no group differences during the perception phase of agoraphobia-specific pictures. Conclusions: This study revealed stronger region-specific activations in patients suffering from panic disorder with agoraphobia in anticipation of agoraphobia-specific stimuli. Patients seem to process these stimuli more intensively based on individual salience. Hyperactivation of the ventral striatum and insula when anticipating agoraphobiaspecific situations might be a central neurofunctional correlate of agoraphobia. Knowledge about the neural correlates of anticipatory and perceptual processes regarding agoraphobic situations will help to optimize and evaluate treatments, such as exposure therapy, in patients with panic disorder and agoraphobia.
2
Wittchen, Hans-Ulrich, Agnes Nocon, Katja Beesdo, Daniel S. Pine, Michael Höfler, Roselind Lieb, and Andrew T. Gloster. "Agoraphobia and Panic." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2012. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-100091.
Full textAbstract:
Background: The relationship of panic attacks (PA), panic disorder (PD) and agoraphobia (AG) is controversial. The aim of the current study is to prospectively examine the 10-year natural course of PA, PD and AG in the first three decades of life, their stability and their reciprocal transitions.
Methods: DSM-IV syndromes were assessed via Composite International Diagnostic Interview – Munich version in a 10-year prospective-longitudinal community study of 3,021 subjects aged 14–24 years at baseline.
Results: (1) Incidence patterns for PA (9.4%), PD (with and without AG: 3.4%) and AG (5.3%) revealed differences in age of onset, incidence risk and gender differentiation. (2) Temporally primary PA and PD revealed only a moderately increased risk for subsequent onset of AG, and primary AG had an even lower risk for subsequent PA and PD. (3) In strictly prospective analyses, all baseline groups (PA, PD, AG) had low remission rates (0–23%). Baseline PD with AG or AG with PA were more likely to have follow-up AG, PA and other anxiety disorders and more frequent complications (impairment, disability, help-seeking, comorbidity) as compared to PD without AG and AG without PA.
Conclusions: Differences in incidence patterns, syndrome progression and outcome, and syndrome stability over time indicate that AG exists as a clinically significant phobic condition independent of PD. The majority of agoraphobic subjects in this community sample never experienced PA, calling into question the current pathogenic assumptions underlying the classification of AG as merely a consequence of panic. The findings point to the necessity of rethinking diagnostic concepts and DSM diagnostic hierarchies.
3
Dijkman-Caes, Chantal Irma Mauricette. "Panic disorder and agoraphobia in daily life." [Maastricht : Maastricht : Rijksuniversiteit Limburg] ; University Library, Maastricht University [Host], 1993. http://arno.unimaas.nl/show.cgi?fid=6673.
Full text
4
Goodwin, Renee D., Carlo Faravelli, S. Rosi, F. Cosci, E. Truglia, Ron de Graaf, and Hans-Ulrich Wittchen. "The epidemiology of panic disorder and agoraphobia in Europe." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-110237.
Full textAbstract:
A literature search, in addition to expert survey, was performed to estimate the size and burden of panic disorder in the European Union (EU). Epidemiologic data from EU countries were critically reviewed to determine the consistency of prevalence estimates across studies and to identify the most pressing questions for future research. A comprehensive literature search focusing on epidemiological studies in community and clinical settings in European countries since 1980 was conducted (Medline, Web of Science, Psychinfo). Only studies using established diagnostic instruments on the basis of DSM-III-R or DSM-IV, or ICD-10 were considered. Thirteen studies from a total of 14 countries were identified. Epidemiological findings are relatively consistent across the EU. The 12-month prevalence of panic disorder and agoraphobia without history of panic were estimated to be 1.8% (0.7–2.2) and 1.3% (0.7–2.0) respectively across studies. Rates are twice as high in females and age of first onset for both disorders is in adolescence or early adulthood. In addition to comorbidity with agoraphobia, panic disorder is strongly associated with other anxiety disorders, and a wide range of somatoform, affective and substance use disorders. Even subclinical forms of panic disorder (i.e., panic attacks) are associated with substantial distress, psychiatric comorbidity and functional impairment. In general health primary care settings, there appears to be substantial underdiagnosis and undertreatment of panic disorder. Moreover, panic disorder and agoraphobia are poorly recognized and rarely treated in mental health settings, despite high health care utilization rates and substantial long-term disability.
5
Richter, Jan, Alfons O. Hamm, Christiane A. Pané-Farré, Alexander L. Gerlach, Andrew T. Gloster, Hans-Ulrich Wittchen, Thomas Lang, et al. "Dynamics of Defensive Reactivity in Patients with Panic Disorder and Agoraphobia: Implications for the Etiology of Panic Disorder." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-120100.
Full textAbstract:
Background: The learning perspective of panic disorder distinguishes between acute panic and anxious apprehension as distinct emotional states. Following animal models, these clinical entities reflect different stages of defensive reactivity depending upon the imminence of interoceptive or exteroceptive threat cues. The current study tested this model by investigating the dynamics of defensive reactivity in a large group of patients with panic disorder and agoraphobia (PD/AG).
Methods: Three hundred forty-five PD/AG patients participated in a standardized behavioral avoidance test (being entrapped in a small, dark chamber for 10 minutes). Defense reactivity was assessed measuring avoidance and escape behavior, self-reports of anxiety and panic symptoms, autonomic arousal (heart rate and skin conductance), and potentiation of the startle reflex before and during exposure of the behavioral avoidance test.
Results: Panic disorder and agoraphobia patients differed substantially in their defensive reactivity. While 31.6% of the patients showed strong anxious apprehension during this task (as indexed by increased reports of anxiety, elevated physiological arousal, and startle potentiation), 20.9% of the patients escaped from the test chamber. Active escape was initiated at the peak of the autonomic surge accompanied by an inhibition of the startle response as predicted by the animal model. These physiological responses resembled the pattern observed during the 34 reported panic attacks.
Conclusions: We found evidence that defensive reactivity in PD/AG patients is dynamically organized ranging from anxious apprehension to panic with increasing proximity of interoceptive threat. These data support the learning perspective of panic disorder.
6
Goodwin, Renee D., Carlo Faravelli, S. Rosi, F. Cosci, E. Truglia, Ron de Graaf, and Hans-Ulrich Wittchen. "The epidemiology of panic disorder and agoraphobia in Europe." Technische Universität Dresden, 2005. https://tud.qucosa.de/id/qucosa%3A26823.
Full textAbstract:
A literature search, in addition to expert survey, was performed to estimate the size and burden of panic disorder in the European Union (EU). Epidemiologic data from EU countries were critically reviewed to determine the consistency of prevalence estimates across studies and to identify the most pressing questions for future research. A comprehensive literature search focusing on epidemiological studies in community and clinical settings in European countries since 1980 was conducted (Medline, Web of Science, Psychinfo). Only studies using established diagnostic instruments on the basis of DSM-III-R or DSM-IV, or ICD-10 were considered. Thirteen studies from a total of 14 countries were identified. Epidemiological findings are relatively consistent across the EU. The 12-month prevalence of panic disorder and agoraphobia without history of panic were estimated to be 1.8% (0.7–2.2) and 1.3% (0.7–2.0) respectively across studies. Rates are twice as high in females and age of first onset for both disorders is in adolescence or early adulthood. In addition to comorbidity with agoraphobia, panic disorder is strongly associated with other anxiety disorders, and a wide range of somatoform, affective and substance use disorders. Even subclinical forms of panic disorder (i.e., panic attacks) are associated with substantial distress, psychiatric comorbidity and functional impairment. In general health primary care settings, there appears to be substantial underdiagnosis and undertreatment of panic disorder. Moreover, panic disorder and agoraphobia are poorly recognized and rarely treated in mental health settings, despite high health care utilization rates and substantial long-term disability.
7
Richter, Jan, Alfons O. Hamm, Christiane A. Pané-Farré, Alexander L. Gerlach, Andrew T. Gloster, Hans-Ulrich Wittchen, Thomas Lang, et al. "Dynamics of Defensive Reactivity in Patients with Panic Disorder and Agoraphobia: Implications for the Etiology of Panic Disorder." Technische Universität Dresden, 2012. https://tud.qucosa.de/id/qucosa%3A27104.
Full textAbstract:
Background: The learning perspective of panic disorder distinguishes between acute panic and anxious apprehension as distinct emotional states. Following animal models, these clinical entities reflect different stages of defensive reactivity depending upon the imminence of interoceptive or exteroceptive threat cues. The current study tested this model by investigating the dynamics of defensive reactivity in a large group of patients with panic disorder and agoraphobia (PD/AG).
Methods: Three hundred forty-five PD/AG patients participated in a standardized behavioral avoidance test (being entrapped in a small, dark chamber for 10 minutes). Defense reactivity was assessed measuring avoidance and escape behavior, self-reports of anxiety and panic symptoms, autonomic arousal (heart rate and skin conductance), and potentiation of the startle reflex before and during exposure of the behavioral avoidance test.
Results: Panic disorder and agoraphobia patients differed substantially in their defensive reactivity. While 31.6% of the patients showed strong anxious apprehension during this task (as indexed by increased reports of anxiety, elevated physiological arousal, and startle potentiation), 20.9% of the patients escaped from the test chamber. Active escape was initiated at the peak of the autonomic surge accompanied by an inhibition of the startle response as predicted by the animal model. These physiological responses resembled the pattern observed during the 34 reported panic attacks.
Conclusions: We found evidence that defensive reactivity in PD/AG patients is dynamically organized ranging from anxious apprehension to panic with increasing proximity of interoceptive threat. These data support the learning perspective of panic disorder.
8
Angle, Susan Pugh. "Perceptions of College Students Diagnosed with Panic Disorder with Agoraphobia: Academic, Psychosocial, and Environmental Views of their College Experience." Diss., Virginia Tech, 1999. http://hdl.handle.net/10919/28107.
Full textAbstract:
The number of reported students with psychiatric disabilities who are seeking services and/or accommodations is steadily increasing on college campuses. Much of the research and documentation that surround the study of college students with psychiatric disorders is extremely broad in focus and tends to group all psychiatric diagnoses together when reporting outcome studies.
The research literature that is devoted to the study of the college student diagnoses with Panic Disorder with Agoraphobia is limited in scope and nature. The majority of the literature is devoted to the physiological and behavioral ramifications of the disorder or treatment modalities. a review of the extant literature reveals that there is no substantive research available that provides insight into the college experiences of the student diagnoses with Panic Disorder with Agoraphobia.
In summary, it is safe to say that there is not enough pertinent information readily available to enlighten college and university faculty and staff about the experiences of college students diagnosed with Panic Disorder with Agoraphobia. specifically, little is known about: (1) the academic, psychosocial, and environmental needs of these students (2) what disability related barriers these student may have experienced (3) what coping mechanisms are typically employed, and (4) what services and accommodations these students have found to be the most effective while they were enrolled in college.
The purpose of this study was to examine the nature and the scope of the college experiences of students who were diagnosed with Panic Disorder with Agoraphobia. The subjects for this study consisted of a select group of upperclassmen at Virginia Tech. Gender or age was not a factor in the selection process. For purposes of this study, the qualitative in-depth interview method was considered the most appropriate form of data collection.
Analysis of the data revealed the following common experiences among the subjects in the study: (1) All subjects experienced difficulties in the classroom due to their Panic Disorder. (2) All of the subjects had concerns with the physical setting of the campus (i.e. preferential seating, avoidance of large classrooms and auditoriums, and anxiety-like symptoms as the result of bright or fluorescent lighting). (3) A lack of social contacts both in and out of the classroom was a common experience. (4) While all subjects had tried medication to control their Panic Disorder, two of the subjects stopped their medication even though they reported an improvement I their symptoms. The majority of the subjects stated that they did not want to remain on the medication for fear of addiction or using the medication as a "crutch." (5) All of the subjects sought out counseling while attending Virginia Tech. All of the subjects, with the exception of one, did not seek any treatment for their anxiety of Panic Attacks until after they arrived at Virginia Tech. (6) All of the subjects, with the exception of one suffered with either chronic anxiety, or Panic Attacks for over one year before seeking any medical relief or counseling. (7) All of the subjects reported that counseling was helpful and for the most part, they all tried to use relaxation techniques when experiencing a Panic Attack. (8) All of the subjects are still having difficulty with chronic anticipatory anxiety and occasional Panic Attacks. (9) While the majority of the subjects interviewed were optimistic about their career options, it was evident that all of the subjects have encountered significant anxiety-related barriers that have impacted their choice of major and possible future jobs. the majority of the subjects reported that it was important to have a job where the workload was not too stressful and the workplace was viewed as a "safe" environment.Ph. D.
9
Lüken, Ulrike, Markus Mühlhan, Hans-Ulrich Wittchen, Thilo Kellermann, Isabelle Reinhardt, Carsten Konrad, Thomas Lang, et al. "(Don't) panic in the scanner! How panic patients with agoraphobia experience a functional magnetic resonance imaging session." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-120053.
Full textAbstract:
Although functional magnetic resonance imaging (fMRI) has gained increasing importance in investigating neural substrates of anxiety disorders, less is known about the stress eliciting properties of the scanner environment itself. The aim of the study was to investigate feasibility, self-reported distress and anxiety management strategies during an fMRI experiment in a comprehensive sample of patients with panic disorder and agoraphobia (PD/AG). Within the national research network PANIC-NET, n = 89 patients and n = 90 controls participated in a multicenter fMRI study. Subjects completed a retrospective questionnaire on self-reported distress, including a habituation profile and exploratory questions about helpful strategies. Drop-out rates and fMRI quality parameters were employed as markers of study feasibility. Different anxiety measures were used to identify patients particularly vulnerable to increased scanner anxiety and impaired data quality. Three (3.5%) patients terminated the session prematurely. While drop-out rates were comparable for patients and controls, data quality was moderately impaired in patients. Distress was significantly elevated in patients compared to controls; claustrophobic anxiety was furthermore associated with pronounced distress and lower fMRI data quality in patients. Patients reported helpful strategies, including motivational factors and cognitive coping strategies. The feasibility of large-scale fMRI studies on PD/AG patients could be proved. Study designs should nevertheless acknowledge that the MRI setting may enhance stress reactions. Future studies are needed to investigate the relationship between self-reported distress and fMRI data in patient groups that are subject to neuroimaging research.
10
Sharp, Donald MacFie. "The psychological and pharmacological treatment of panic disorder and agoraphobia in primary care." Thesis, University of Stirling, 1997. http://hdl.handle.net/1893/21521.
Full textAbstract:
Following a review of treatment outcome study methodology, a comparative study of psychological versus pharmacological treatments was conducted; subsidiary studies investigated aspects of treatment outcome in more detail. 193 patients with DSM III-R panic disorder with or without agoraphobia were randomly allocated to; fluvoxamine, placebo, fluvoxamine + CBT (cognitive behaviour therapy), placebo + CBT, or CBT alone. Patients received no concurrent treatments and were treated to the same schedule, with therapist contact balanced across groups. Treatments were conducted in the primary care setting. Outcome at treatment end-point and 6 month follow-up, assessed in terms of both statistical and clinical significance, showed patients receiving active treatments improved significantly, with improvement better preserved over follow-up in the groups receiving CBT. The CBT alone and fluvoxamine + CBT groups showed the most consistent gains, the latter group showing gains earliest in treatment. Outcome was also investigated using brief global ratings of symptom severity, change in symptoms following treatment, general wellbeing and social disruption, completed by psychologist, referring GPs, and patients. Using these measures all active treatments showed statistical advantage over placebo with the groups employing CBT showing the most robust and consistent response. Overall there were no significant differences in drop-out rates between groups although the drop-out rate for patients receiving CBT alone was higher than that for placebo + CBT. Agreement with main outcome measures was demonstrated for psychologist and patient ratings, but not for GP ratings. An investigation of panic attack variables as treatment outcome measures indicated that these did not function as discriminative treatment outcome measures with all treatment groups showing significant reductions in panic attack variables over treatment with few significant differences between treatment groups on any variable throughout treatment. An investigation of prognostic indicators of treatment outcome indicated good prediction of post treatment response using pre-treatment measures of anxiety level, frequency of panic attacks, extroversion and treatment group. Predictions of outcome at 6 month follow-up were less robust. Results are discussed in terms of their relevance to wider clinical practice.
11
Lüken, Ulrike, Markus Mühlhan, Hans-Ulrich Wittchen, Thilo Kellermann, Isabelle Reinhardt, Carsten Konrad, Thomas Lang, et al. "(Don't) panic in the scanner! How panic patients with agoraphobia experience a functional magnetic resonance imaging session." Technische Universität Dresden, 2011. https://tud.qucosa.de/id/qucosa%3A27099.
Full textAbstract:
Although functional magnetic resonance imaging (fMRI) has gained increasing importance in investigating neural substrates of anxiety disorders, less is known about the stress eliciting properties of the scanner environment itself. The aim of the study was to investigate feasibility, self-reported distress and anxiety management strategies during an fMRI experiment in a comprehensive sample of patients with panic disorder and agoraphobia (PD/AG). Within the national research network PANIC-NET, n = 89 patients and n = 90 controls participated in a multicenter fMRI study. Subjects completed a retrospective questionnaire on self-reported distress, including a habituation profile and exploratory questions about helpful strategies. Drop-out rates and fMRI quality parameters were employed as markers of study feasibility. Different anxiety measures were used to identify patients particularly vulnerable to increased scanner anxiety and impaired data quality. Three (3.5%) patients terminated the session prematurely. While drop-out rates were comparable for patients and controls, data quality was moderately impaired in patients. Distress was significantly elevated in patients compared to controls; claustrophobic anxiety was furthermore associated with pronounced distress and lower fMRI data quality in patients. Patients reported helpful strategies, including motivational factors and cognitive coping strategies. The feasibility of large-scale fMRI studies on PD/AG patients could be proved. Study designs should nevertheless acknowledge that the MRI setting may enhance stress reactions. Future studies are needed to investigate the relationship between self-reported distress and fMRI data in patient groups that are subject to neuroimaging research.
12
Wittmann, André, Florian Schlagenhauf, Anne Guhn, Ulrike Lueken, Manja Elle, Meline Stoy, Carolin Liebscher, et al. "Effects of Cognitive Behavioral Therapy on Neural Processing of Agoraphobia-Specific Stimuli in Panic Disorder and Agoraphobia." Karger, 2018. https://tud.qucosa.de/id/qucosa%3A38916.
Full textAbstract:
Background: Patients suffering from panic disorder and agoraphobia are significantly impaired in daily life due to anxiety about getting into a situation due to apprehension about experiencing a panic attack, especially if escape may be difficult. Dysfunctional beliefs and behavior can be changed with cognitive behavioral therapy; however, the neurobiological effects of such an intervention on the anticipation and observation of agoraphobia-specific stimuli are unknown. Methods: We compared changes in neural activation by measuring the blood oxygen level-dependent signal of 51 patients and 51 healthy controls between scans before and those after treatment (group by time interaction) during anticipation and observation of agoraphobia-specific compared to neutral pictures using 3-T fMRI. Results: A significant group by time interaction was observed in the ventral striatum during anticipation and in the right amygdala during observation of agoraphobia-specific pictures; the patients displayed a decrease in ventral striatal activation during anticipation from pre- to posttreatment scans, which correlated with clinical improvement measured with the Mobility Inventory. During observation, the patients displayed decreased activation in the amygdala. These activational changes were not observed in the matched healthy controls. Conclusions: For the first time, neural effects of cognitive behavioral therapy were shown in patients suffering from panic disorder and agoraphobia using disorderspecific stimuli. The decrease in activation in the ventral striatum indicates that cognitive behavioral therapy modifies anticipatory anxiety and may ameliorate abnormally heightened salience attribution to expected threatening stimuli. The decreased amygdala activation in response to agoraphobia-specific stimuli indicates that cognitive behavioral therapy can alter the basal processing of agoraphobia-specific stimuli in a core region of the fear network.
13
Ramnerö, Jonas. "Behavioral Treatments of Panic Disorder with Agoraphobia : Treatment Process and Determinants of Change." Doctoral thesis, Stockholm University, Department of Psychology, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-404.
Full textAbstract:
The present dissertation comprises four empirical studies within the area of behavioral treatment of panic disorder with agoraphobia. The focus is on studying issues pertaining to outcome, treatment process and determinants of change. The first study is a randomized controlled treatment study of 73 patients undergoing 16 sessions of either exposure in vivo (E), or cognitive behavior therapy (CBT). Both treatments showed clear improvements at post-treatment that were well maintained at 1-year follow up, and there were no significant differences between the treatments.
The second study concerned prediction of outcome in the same sample. From a variety of pre-treatment characteristics severity of avoidance was the one most related to outcome. Most predictors were found unrelated. Two approaches of prediction were also compared: treating outcome as a categorical vs. continuous variable. The different approaches yielded a somewhat dissimilar picture of the impact of pre-treatment severity of avoidance. The third study examined different aspects of the therapeutic relationship, and their relation to outcome. Clients’ perceptions of therapists and their ratings of the working alliance were generally not related to outcome at any point. On the other hand, therapists’ perceptions of patients as showing goal-direction and active participation were related to outcome from early on in therapy. The fourth study examined different aspects of change. It was found that change in indices of the frequency of panic attacks was not closely related to change in agoraphobic avoidance at post-treatment. Change in avoidance was also more related to other aspects of outcome. At one-year follow-up, a more unitary picture, regarding the different aspects of change was observed.
14
Ramnerö, Jonas. "Behavioral treatments of panic disorder with agoraphobia : treatment process and determinants of change /." Stockholm : Department of Psychology [Psykologiska institutionen], Stockholm University, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-404.
Full text
15
Gould, Robert Andrew. "The use of a self-help treatment intervention for panic disorder with agoraphobia." Diss., Virginia Tech, 1993. http://hdl.handle.net/10919/38543.
Full textAbstract:
A recent study suggested that bibliotherapy may be an effective intervention for panic disordered individuals with agoraphobia. The present study attempted to enhance this bibliotherapy intervention by adding audio- and videotape self-help supplements. Thirty subjects suffering panic disorder with mild to moderate agoraphobia were matched on level of avoidance and then randomly assigned to 1) a Wait-list control condition (WL). or 2) a Self-help condition (SH). The intervention lasted four weeks followed by an eight week post treatment phase. and follow-up measures at the end of this phase. Results indicated that, from pre-treatment to follow-up, SH subjects improved significantly on 11 of the 12 dependent measures used in this study. while WL subjects did not. Furthermore. SH subjects were significantly more improved than WL subjects at follow-up with regard to agoraphobic avoidance, coping with panic attacks, self efficacy for mild, moderate and severe attacks, and for two critical measures of distress: frequency of panic attacks. and total severity of each attack. Clinical outcome measures also supported the effectiveness of the self-help approach. More than two-thirds of SH subjects met the criteria for clinical improvement. While only one-quarter of WL subjects met these criteria. Implications for the treatment of panic disordered individuals are discussed, as is the role of self-efficacy in mediating clinical change.Ph. D.
16
Carlbring, Per. "Panic! Its Prevalence, Diagnosis and Treatment via the Internet." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4148.
Full text
17
Lemon, David John. "Living in the shadow of fear: an interactionist examination of agoraphobia." Thesis, University of Canterbury. Sociology, 2004. http://hdl.handle.net/10092/921.
Full textAbstract:
This thesis investigates the experience of agoraphobia among one hundred research participants by focusing on how social interactions contribute to the onset, the unmanaged symptoms stage, and the managed symptoms stage of this anxiety disorder. The study investigates how social interactions such as family upbringings, familial stressful events, one-off and clusters of traumatic events and accumulated stressful events can contribute to the onset of agoraphobia. It examines how research participants' social interactions during their primary and secondary school years, youth, everyday life, travel, marriage/intimate relationships, parenting, post secondary education and employment were affected during the unmanaged symptom stage of agoraphobia. Participants' experiences of the public perception of agoraphobia, stigma and discrimination, coming out experiences and family and friends' reaction to agoraphobia are also explored. The third stage of the study examines social interactions that hinder or promote the management of agoraphobia. The former are found to include hiding panic attacks, making excuses, using flawed personal coping mechanisms and alcohol. Social interactions that were found to assist in the management of agoraphobia include labelling and learning about the mental illness from others, using companions in public places and situations, and seeking help from knowledgeable health professionals. Other forms of interaction that helped with management included participants' usage of Internet chat-rooms and websites as well as the discovery of faith and spiritual experience. Finally the study investigates research participants' changed social interactions following their emergence from the shadow of agoraphobia.
18
Lueken, U., B. Straube, I. Reinhardt, N. I. Maslowski, H. U. Wittchen, A. Ströhle, A. Wittmann, et al. "Altered top-down and bottom-up processing of fear conditioning in panic disorder with agoraphobia." Cambridge University Press, 2014. https://tud.qucosa.de/id/qucosa%3A39007.
Full textAbstract:
Background: Although several neurophysiological models have been proposed for panic disorder with agoraphobia (PD/AG), there is limited evidence from functional magnetic resonance imaging (fMRI) studies on key neural networks in PD/AG. Fear conditioning has been proposed to represent a central pathway for the development and maintenance of this disorder; however, its neural substrates remain elusive. The present study aimed to investigate the neural correlates of fear conditioning in PD/AG patients.
Method: The blood oxygen level-dependent (BOLD) response was measured using fMRI during a fear conditioning task. Indicators of differential conditioning, simple conditioning and safety signal processing were investigated in 60 PD/AG patients and 60 matched healthy controls.
Results: Differential conditioning was associated with enhanced activation of the bilateral dorsal inferior frontal gyrus (IFG) whereas simple conditioning and safety signal processing were related to increased midbrain activation in PD/AG patients versus controls. Anxiety sensitivity was associated positively with the magnitude of midbrain activation.
Conclusions: The results suggest changes in top-down and bottom-up processes during fear conditioning in PD/AG that can be interpreted within a neural framework of defensive reactions mediating threat through distal (forebrain) versus proximal (midbrain) brain structures. Evidence is accumulating that this network plays a key role in the aetiopathogenesis of panic disorder.
19
Wittchen, Hans-Ulrich, Agnes Nocon, Katja Beesdo, Daniel S. Pine, Michael Höfler, Roselind Lieb, and Andrew T. Gloster. "Agoraphobia and Panic: Prospective-Longitudinal Relations Suggest a Rethinking of Diagnostic Concepts." Karger, 2008. https://tud.qucosa.de/id/qucosa%3A25264.
Full textAbstract:
Background: The relationship of panic attacks (PA), panic disorder (PD) and agoraphobia (AG) is controversial. The aim of the current study is to prospectively examine the 10-year natural course of PA, PD and AG in the first three decades of life, their stability and their reciprocal transitions.
Methods: DSM-IV syndromes were assessed via Composite International Diagnostic Interview – Munich version in a 10-year prospective-longitudinal community study of 3,021 subjects aged 14–24 years at baseline.
Results: (1) Incidence patterns for PA (9.4%), PD (with and without AG: 3.4%) and AG (5.3%) revealed differences in age of onset, incidence risk and gender differentiation. (2) Temporally primary PA and PD revealed only a moderately increased risk for subsequent onset of AG, and primary AG had an even lower risk for subsequent PA and PD. (3) In strictly prospective analyses, all baseline groups (PA, PD, AG) had low remission rates (0–23%). Baseline PD with AG or AG with PA were more likely to have follow-up AG, PA and other anxiety disorders and more frequent complications (impairment, disability, help-seeking, comorbidity) as compared to PD without AG and AG without PA.
Conclusions: Differences in incidence patterns, syndrome progression and outcome, and syndrome stability over time indicate that AG exists as a clinically significant phobic condition independent of PD. The majority of agoraphobic subjects in this community sample never experienced PA, calling into question the current pathogenic assumptions underlying the classification of AG as merely a consequence of panic. The findings point to the necessity of rethinking diagnostic concepts and DSM diagnostic hierarchies.
20
Fink, Janet Lynn. "The Evaluation of treatments for agoraphobia and panic disorders a meta-analytic review /." Access abstract and link to full text, 1992. http://0-wwwlib.umi.com.library.utulsa.edu/dissertations/fullcit/9222147.
Full text
21
Gloster, Andrew T., Rainer Sonntag, Jürgen Hoyer, Andrea H. Meyer, Simone Heinze, Andreas Ströhle, Georg Eifert, and Hans-Ulrich Wittchen. "Treating Treatment-Resistant Patients with Panic Disorder and Agoraphobia Using Psychotherapy: A Randomized Controlled Switching Trial." Karger, 2015. https://tud.qucosa.de/id/qucosa%3A71640.
Full textAbstract:
Background: Nonresponsiveness to therapy is generally acknowledged, but only a few studies have tested switching to psychotherapy. This study is one of the first to examine the malleability of treatment-resistant patients using acceptance and commitment therapy (ACT). Methods: This was a randomized controlled trial that included 43 patients diagnosed with primary panic disorder and/or agoraphobia (PD/A) with prior unsuccessful state-of-the-art treatment (mean number of previous sessions = 42.2). Patients were treated with an ACT manual administered by novice therapists and followed up for 6 months. They were randomized to immediate treatment (n = 33) or a 4-week waiting list (n = 10) with delayed treatment (n = 8). Treatment consisted of eight sessions, implemented twice weekly over 4 weeks. Primary outcomes were measured with the Panic and Agoraphobia Scale (PAS), the Clinical Global Impression (CGI), and the Mobility Inventory (MI). Results: At post-treatment, patients who received ACT reported significantly more improvements on the PAS and CGI (d = 0.72 and 0.89, respectively) than those who were on the waiting list, while improvement on the MI (d = 0.50) was nearly significant. Secondary outcomes were consistent with ACT theory. Follow-up assessments indicated a stable and continued improvement after treatment. The dropout rate was low (9%). Conclusions: Despite a clinically challenging sample and brief treatment administered by novice therapists, patients who received ACT reported significantly greater changes in functioning and symptomatology than those on the waiting list, with medium-to-large effect sizes that were maintained for at least 6 months. These proof-ofprinciple data suggest that ACT is a viable treatment option for treatment-resistant PD/A patients. Further work on switching to psychotherapy for nonresponders is clearly needed.
22
Siegel, Suzie. "Safe at Home: Agoraphobia and the Discourse on Women’s Place." Scholar Commons, 2001. http://scholarcommons.usf.edu/etd/3881.
Full textAbstract:
My thesis explores how discourse and material practices have created agoraphobia, the fear of public places. This psychological disorder predominates among women. Throughout much of Western history, women have been encouraged to stay home for their safety and for the safety of society. I argue that agoraphobic women have internalized this discourse, expressing fears of being in public or being alone without a companion to support and protect them; losing control over their minds or their bodies; and endangering or humiliating themselves. Therapeutic discourse also has created agoraphobia by naming it, categorizing the emotions and behaviors associated with it, and describing the characteristics of agoraphobics. The material practice of therapy reinforces this discourse. Meanwhile, practices such as rape and harassment reinforce the dominant discourse on women’s safety.
I survey psychological literature, beginning with the naming of agoraphobia in 1871, to explain why the disorder is now diagnosed primarily in women. I examine nineteenth-century discourse that told women they belonged at home while men controlled the public domain. In 1871, the Paris Commune revolt epitomized the fear of women publicly out of control. I return to Paris a century later for a reading of the novel
Certificate of Absence, in which Sylvia Molloy explores identity through the eyes of a woman who might be labeled agoraphobic. I ask whether homebound women are resisting or retreating from a hostile world. Instead of seeing agoraphobia only as a personal problem, people should question why so many women fear themselves and the world outside their home.
My methodology includes an analysis of nineteenth-century texts as well as current media, prose, and poetry. I also support my arguments with material from professional journals and nonfiction books in different disciplines. Common to feminist research, an interdisciplinary approach was needed to situate a psychological disorder within a social context.
23
Drobny, Juliette Victoria. "Relationships between treatment knowledge, beliefs and outcome following cognitive behaviour therapy for panic disorder and agoraphobia." University of Sydney, 2010. http://hdl.handle.net/2123/6621.
Full textAbstract:
Doctor of Philosophy (PhD)The purpose of this thesis was to investigate relationships between treatment knowledge, beliefs and outcome in Panic Disorder and/or Agoraphobia (Panic-Ag). Research from the psychotherapy and medical literature indicates patients’ treatment knowledge and beliefs, specifically acceptance of the treatment rationale (ATR), expectancies of treatment outcome (ETO) and treatment self-efficacy (TSE), are associated with clinical outcomes for a range of disorders. However, methodological limitations surrounding measurement of these constructs have undermined conclusions and/or such relationships have not been investigated in the field of Panic-Ag. Relationships between treatment knowledge, beliefs and outcome in Panic-Ag were examined using a 2 phase procedure. Phase 1 involved developing measures of treatment knowledge, ATR, ETO and TSE using patient and clinician samples. The psychometric properties of these measures were found to be satisfactory. Phase 2 investigated associations between treatment knowledge, beliefs and outcome following cognitive behaviour therapy (CBT) among 41 Panic-Ag participants. Measures were administered at pretreatment and 6-months posttreatment. It was hypothesised that treatment knowledge, ATR, ETO and TSE would be related to outcome, with associations mediated by belief in catastrophic cognitions. Of 4 Panic- Ag outcome measures (panic attack frequency, panic sensation severity, frequency of catastrophic cognitions and agoraphobic avoidance), results indicated improved treatment knowledge was significantly associated with frequency of catastrophic cognitions and agoraphobic avoidance. Posttreatment TSE was significantly associated with panic attack sensation severity, frequency of catastrophic cognitions and agoraphobic avoidance. Contrary to the hypothesis, ATR was not related to outcome. Similar findings concerning TSE and ATR were obtained in an independent sample of 34 Panic-Ag participants. Exploratory analyses found that pretreatment beliefs including outcome expectancies were unrelated to outcome. Mediational analyses revealed relationships between TSE and outcome were partially mediated by belief in catastrophic cognitions while relationships between treatment knowledge and outcome were not. Results are discussed in light of previous research, methodological limitations, clinical implications and future research directions.
24
Basoglu, Metin. "Patterns and predictors of treatment outcome in panic disorder and agoraphobia treated with alprazolam and exposure." Thesis, King's College London (University of London), 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.295473.
Full text
25
Kircher, Tilo, Volker Arolt, Andreas Jansen, Martin Pyka, Isabelle Reinhardt, Thilo Kellermann, Carsten Konrad, et al. "Effect of Cognitive-Behavioral Therapy on Neural Correlates of Fear Conditioning in Panic Disorder." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-120091.
Full textAbstract:
Background: Learning by conditioning is a key ability of animals and humans for acquiring novel behavior necessary for survival in a changing environment. Aberrant conditioning has been considered a crucial factor in the etiology and maintenance of panic disorder with agoraphobia (PD/A). Cognitive-behavioral therapy (CBT) is an effective treatment for PD/A. However, the neural mechanisms underlying the effects of CBT on conditioning processes in PD/A are unknown.
Methods: In a randomized, controlled, multicenter clinical trial in medication-free patients with PD/A who were treated with 12 sessions of manualized CBT, functional magnetic resonance imaging (fMRI) was used during fear conditioning before and after CBT. Quality-controlled fMRI data from 42 patients and 42 healthy subjects were obtained.
Results: After CBT, patients compared to control subjects revealed reduced activation for the conditioned response (CS+ > CS–) in the left inferior frontal gyrus (IFG). This activation reduction was correlated with reduction in agoraphobic symptoms from t1 to t2. Patients compared to control subjects also demonstrated increased connectivity between the IFG and regions of the “fear network” (amygdalae, insulae, anterior cingulate cortex) across time.
Conclusions: This study demonstrates the link between cerebral correlates of cognitive (IFG) and emotional (“fear network”) processing during symptom improvement across time in PD/A. Further research along this line has promising potential to support the development and further optimization of targeted treatments.
26
Richter, Jan [Verfasser]. "Defensive reactivity in patients with panic disorder and agoraphobia: from basic research to clinical application / Jan Richter." Greifswald : Universitätsbibliothek Greifswald, 2013. http://d-nb.info/1034946048/34.
Full text
27
Ebenfeld, Lara [Verfasser], and Matthias [Akademischer Betreuer] Berking. "Development and evaluation of a hybrid online training for panic disorder and agoraphobia / Lara Ebenfeld ; Betreuer: Matthias Berking." Lüneburg : Universitätsbibliothek der Leuphana Universität Lüneburg, 2020. http://d-nb.info/120754292X/34.
Full text
28
Ebenfeld, Lara Verfasser], and Matthias [Akademischer Betreuer] [Berking. "Development and evaluation of a hybrid online training for panic disorder and agoraphobia / Lara Ebenfeld ; Betreuer: Matthias Berking." Lüneburg : Universitätsbibliothek der Leuphana Universität Lüneburg, 2020. http://nbn-resolving.de/urn:nbn:de:gbv:luen4-opus-146484.
Full text
29
Gloster, Andrew T., Hans-Ulrich Wittchen, Franziska Einsle, Michael Höfler, Thomas Lang, Sylvia Helbig-Lang, Thomas Fydrich, et al. "Mechanism of action in CBT (MAC): methods of a multi-center randomized controlled trial in 369 patients with panic disorder and agoraphobia." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-106614.
Full textAbstract:
Cognitive behavioral therapy (CBT) is efficacious for panic disorder with agoraphobia (PD/A). Nevertheless, the active ingredients of treatment and the mechanisms through which CBT achieves its effects remain largely unknown. The mechanisms of action in CBT (MAC) study was established to investigate these questions in 369 patients diagnosed with PD/A. The MAC study utilized a multi-center, randomized controlled design, with two active treatment conditions in which the administration of exposure was varied, and a wait-list control group. The special feature of MAC is the way in which imbedded experimental, psychophysiological, and neurobiological paradigms were included to elucidate therapeutic and psychopathological processes. This paper describes the aims and goals of the MAC study and the methods utilized to achieve them. All aspects of the research design (e.g., assessments, treatment, experimental procedures) were implemented so as to facilitate the detection of active therapeutic components, and the mediators and moderators of therapeutic change. To this end, clinical, behavioral, physiological, experimental, and genetic data were collected and will be integrated.
30
Seeger, Fabian, Yunbo Yang, Benjamin Straube, Tilo Kircher, Michael Höfler, Hans-Ulrich Wittchen, Andreas Ströhle, et al. "Clinical and Neurofunctional Substrates of Cognitive Behavioral Therapy on Secondary Social Anxiety Disorder in Primary Panic Disorder: A Longitudinal fMRI Study." Karger, 2018. https://tud.qucosa.de/id/qucosa%3A71641.
Full textAbstract:
Clinicians frequently treat patients suffering from more than one mental disorder. As they have to choose which disorder to treat first, knowledge on generalization effects or even comorbidity-associated obstacles should guide the clinician’s decision. Patients with panic disorder (PD) and agoraphobia (AG) often suffer from other mental disorders, e.g. social anxiety disorder (SAD) [1]. Nevertheless, evidence is missing whether cognitive-behavioral therapy (CBT) for PD/AG generalizes to SAD or whether comorbid SAD impedes the treatment of primary PD/AG.
31
Gloster, Andrew T., Hans-Ulrich Wittchen, Franziska Einsle, Michael Höfler, Thomas Lang, Sylvia Helbig-Lang, Thomas Fydrich, et al. "Mechanism of action in CBT (MAC): methods of a multi-center randomized controlled trial in 369 patients with panic disorder and agoraphobia." Technische Universität Dresden, 2009. https://tud.qucosa.de/id/qucosa%3A26684.
Full textAbstract:
Cognitive behavioral therapy (CBT) is efficacious for panic disorder with agoraphobia (PD/A). Nevertheless, the active ingredients of treatment and the mechanisms through which CBT achieves its effects remain largely unknown. The mechanisms of action in CBT (MAC) study was established to investigate these questions in 369 patients diagnosed with PD/A. The MAC study utilized a multi-center, randomized controlled design, with two active treatment conditions in which the administration of exposure was varied, and a wait-list control group. The special feature of MAC is the way in which imbedded experimental, psychophysiological, and neurobiological paradigms were included to elucidate therapeutic and psychopathological processes. This paper describes the aims and goals of the MAC study and the methods utilized to achieve them. All aspects of the research design (e.g., assessments, treatment, experimental procedures) were implemented so as to facilitate the detection of active therapeutic components, and the mediators and moderators of therapeutic change. To this end, clinical, behavioral, physiological, experimental, and genetic data were collected and will be integrated.
32
Shapiro, David Morris. "An experimental investigation of the relationship between physiological arousal, panic expectancy and agoraphobia." Diss., Virginia Tech, 1991. http://hdl.handle.net/10919/39446.
Full text
33
Rayment, Patricia A. "Panic parameters, fear of anxiety, and use of coping strategies as predictors of agoraphobic avoidance in panic disorder /." Adelaide, 1996. http://web4.library.adelaide.edu.au/theses/09AR.PS/09ar.psr267.pdf.
Full text
34
Wichmann, Susann, Stefan R. Bornstein, Thomas Lorenz, and Katja Petrowski. "Stress hormone response to the DEX-CRH test and its relation to psychotherapy outcome in panic disorder patients with and without agoraphobia." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2018. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-233439.
Full textAbstract:
This study tested whether the hormonal stress response to the DEX-CRH test may be predictive of the psychotherapy success for panic disorder (PD). Thirty-four patients diagnosed either with agoraphobia with PD or PD without agoraphobia were subjected to cognitive behavioural therapy (CBT). Patients (pre-therapy) and healthy volunteers were exposed to the DEX-CRH test. Blood samples were taken for cortisol and adrenocorticotropic hormone (ACTH) assessment. Established panic-specific questionnaires were handed out for the pre-therapy and post-therapy evaluation of disease severity (with reference to panic beliefs and agoraphobic cognitions, fear of bodily sensations, agoraphobic avoidance behaviour). Repeated measures ANCOVA were conducted for the analysis of the pre-therapy hormonal response, and Pearson\'s correlation analysis to test for associations with the psychotherapy outcome. Data analyses revealed large effect sizes for CBT in the clinical measures (η2 ≥ 0.321), main effects of time for cortisol and ACTH with no differences between both groups, and significant associations between cortisol release and agoraphobic cognitions for the patients. PD diagnosis had no impact on the hormonal response. However, those patients with higher cortisol release showed less improvement after CBT (significantly for agoraphobic cognitions). Clinical implications of these findings are the prediction of the therapy success from a potential endocrine correlate whose persistency (if assessed repeatedly) during the treatment may predict (non-)response to the current treatment, possibly representing a decision support for a change in treatment to avoid the continuation of an inefficient treatment.
35
Emmrich, Angela, Katja Beesdo-Baum, Andrew T. Gloster, Susanne Knappe, Michael Höfler, Volker Arolt, Jürgen Deckert, et al. "Depression Does Not Affect the Treatment Outcome of CBT for Panic and Agoraphobia: Results from a Multicenter Randomized Trial." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-133613.
Full textAbstract:
Background: Controversy surrounds the questions whether co-occurring depression has negative effects on cognitivebehavioral therapy (CBT) outcomes in patients with panic disorder (PD) and agoraphobia (AG) and whether treatment for PD and AG (PD/AG) also reduces depressive symptomatology. Methods: Post-hoc analyses of randomized clinical trial data of 369 outpatients with primary PD/AG (DSM-IV-TR criteria) treated with a 12-session manualized CBT (n = 301) and a waitlist control group (n = 68). Patients with comorbid depression (DSM-IV-TR major depression, dysthymia, or both: 43.2% CBT, 42.7% controls) were compared to patients without depression regarding anxiety and depression outcomes (Clinical Global Impression Scale [CGI], Hamilton Anxiety Rating Scale [HAM-A], number of panic attacks, Mobility Inventory [MI], Panic and Agoraphobia Scale, Beck Depression Inventory) at post-treatment and follow-up (categorical). Further, the role of severity of depressive symptoms on anxiety/depression outcome measures was examined (dimensional). Results: Comorbid depression did not have a significant overall effect on anxiety outcomes at post-treatment and follow-up, except for slightly diminished post-treatment effect sizes for clinician-rated CGI (p = 0.03) and HAM-A (p = 0.008) when adjusting for baseline anxiety severity. In the dimensional model, higher baseline depression scores were associated with lower effect sizes at post-treatment (except for MI), but not at follow-up (except for HAM-A). Depressive symptoms improved irrespective of the presence of depression. Conclusions: Exposure-based CBT for primary PD/AG effectively reduces anxiety and depressive symptoms, irrespective of comorbid depression or depressive symptomatologyDieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich
36
Lang, Thomas, Sylvia Helbig-Lang, Andrew T. Gloster, Jan Richter, Alfons O. Hamm, Lydia Fehm, Thomas Fydrich, et al. "Effekte therapeutenbegleiteter versus patientengeleiteter Exposition bei Panikstörung mit Agoraphobie." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-117711.
Full textAbstract:
Theoretischer Hintergrund: Die Rolle der Therapeutenbegleitung während Expositionsübungen bei Panikstörung mit Agoraphobie (P/A) ist bislang ungeklärt. Eine kürzlich durchgeführte klinische Studie (MAC-Studie) lieferte Hinweise auf ein günstigeres Behandlungsergebnis bei Therapeutenbegleitung. Fragestellung: Wie lassen sich Effekte therapeutenbegleiteter Exposition (T+) im Vergleich zu Exposition ohne Therapeutenbegleitung (T–) erklären? Methode: Daten von 301 Patienten, die eine expositionsbasierte KVT mit bzw. ohne Therapeutenbegleitung erhalten hatten, wurden analysiert. Untersucht wurden der Einfluss der initialen Störungsschwere, des Sicherheitsverhaltens sowie differenzielle Effekte der Bedingungen auf die Angst vor der Angst. Zusätzlich wurde überprüft, inwieweit die Übungshäufigkeit in den Behandlungsbedingungen variiert und einen Mediator des Behandlungserfolgs darstellt. Ergebnisse: Störungsschwere und Sicherheitsverhalten zeigten keine differenziellen Effekte zwischen den Bedingungen; die T+ Bedingung führte jedoch zu stärkeren Reduktionen der Angst vor der Angst im Angstsensitivitätsindex. Patienten der T+ Bedingung führten häufiger selbständig Expositionsübungen durch, während Patienten in T– im Durchschnitt länger übten. Die Übungshäufigkeit stellte dabei einen Mediator des Behandlungserfolgs dar. Schlussfolgerungen: Günstigere Effekte einer therapeutenbegleiteten Exposition gehen auf stärkere Reduktionen der Angst vor der Angst sowie auf eine höhere Übungshäufigkeit im Selbstmanagement zurückTheoretical background: There is a paucity of studies examining the role of therapist guidance during in-vivo exposure for panic disorder with agoraphobia (PD/AG). A recent study (MAC-study) suggested superior effects of therapist-guided exposure compared to programmed practice. Objectives: Examining potential mechanisms of therapist-guided exposure. Methods: Data from 301 patients with PD/AG who received either CBT with therapist guidance during in-vivo exposure (T+), or CBT with programmed exposure practice (T–) were analysed in regard to effects of initial symptom severity, subtle avoidance behaviours, reductions in fear of fear, and frequency of exposure homework. Results: There were no interaction effects between symptom severity or subtle avoidance and outcome. T+ was associated with higher reductions in fear of fear as well as with higher frequency of exposure homework. Frequency of exposure homework mediated the effect of group on outcome. Conclusion: Advantages of therapist-guided exposure as well as frequency of self-exposure might be attributed to higher reductions in fear of fear
37
Emmrich, Angela, Katja Beesdo-Baum, Andrew T. Gloster, Susanne Knappe, Michael Höfler, Volker Arolt, Jürgen Deckert, et al. "Depression Does Not Affect the Treatment Outcome of CBT for Panic and Agoraphobia: Results from a Multicenter Randomized Trial." Karger, 2012. https://tud.qucosa.de/id/qucosa%3A27520.
Full textAbstract:
Background: Controversy surrounds the questions whether co-occurring depression has negative effects on cognitivebehavioral therapy (CBT) outcomes in patients with panic disorder (PD) and agoraphobia (AG) and whether treatment for PD and AG (PD/AG) also reduces depressive symptomatology.
Methods: Post-hoc analyses of randomized clinical trial data of 369 outpatients with primary PD/AG (DSM-IV-TR criteria) treated with a 12-session manualized CBT (n = 301) and a waitlist control group (n = 68). Patients with comorbid depression (DSM-IV-TR major depression, dysthymia, or both: 43.2% CBT, 42.7% controls) were compared to patients without depression regarding anxiety and depression outcomes (Clinical Global Impression Scale [CGI], Hamilton Anxiety Rating Scale [HAM-A], number of panic attacks, Mobility Inventory [MI], Panic and Agoraphobia Scale, Beck Depression Inventory) at post-treatment and follow-up (categorical). Further, the role of severity of depressive symptoms on anxiety/depression outcome measures was examined (dimensional).
Results: Comorbid depression did not have a significant overall effect on anxiety outcomes at post-treatment and follow-up, except for slightly diminished post-treatment effect sizes for clinician-rated CGI (p = 0.03) and HAM-A (p = 0.008) when adjusting for baseline anxiety severity. In the dimensional model, higher baseline depression scores were associated with lower effect sizes at post-treatment (except for MI), but not at follow-up (except for HAM-A). Depressive symptoms improved irrespective of the presence of depression.
Conclusions: Exposure-based CBT for primary PD/AG effectively reduces anxiety and depressive symptoms, irrespective of comorbid depression or depressive symptomatology.Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.
38
Hauke, Christina [Verfasser], Alexander [Akademischer Betreuer] Gerlach, and Susanne [Akademischer Betreuer] Zank. "The role of therapist adherence in a multicenter randomized clinical trial of patients with panic disorder and agoraphobia / Christina Hauke. Gutachter: Alexander Gerlach ; Susanne Zank." Köln : Universitäts- und Stadtbibliothek Köln, 2014. http://d-nb.info/1065801068/34.
Full text
39
Lang, Thomas, Sylvia Helbig-Lang, Andrew T. Gloster, Jan Richter, Alfons O. Hamm, Lydia Fehm, Thomas Fydrich, et al. "Effekte therapeutenbegleiteter versus patientengeleiteter Exposition bei Panikstörung mit Agoraphobie." Technische Universität Dresden, 2012. https://tud.qucosa.de/id/qucosa%3A27044.
Full textAbstract:
Theoretischer Hintergrund: Die Rolle der Therapeutenbegleitung während Expositionsübungen bei Panikstörung mit Agoraphobie (P/A) ist bislang ungeklärt. Eine kürzlich durchgeführte klinische Studie (MAC-Studie) lieferte Hinweise auf ein günstigeres Behandlungsergebnis bei Therapeutenbegleitung. Fragestellung: Wie lassen sich Effekte therapeutenbegleiteter Exposition (T+) im Vergleich zu Exposition ohne Therapeutenbegleitung (T–) erklären? Methode: Daten von 301 Patienten, die eine expositionsbasierte KVT mit bzw. ohne Therapeutenbegleitung erhalten hatten, wurden analysiert. Untersucht wurden der Einfluss der initialen Störungsschwere, des Sicherheitsverhaltens sowie differenzielle Effekte der Bedingungen auf die Angst vor der Angst. Zusätzlich wurde überprüft, inwieweit die Übungshäufigkeit in den Behandlungsbedingungen variiert und einen Mediator des Behandlungserfolgs darstellt. Ergebnisse: Störungsschwere und Sicherheitsverhalten zeigten keine differenziellen Effekte zwischen den Bedingungen; die T+ Bedingung führte jedoch zu stärkeren Reduktionen der Angst vor der Angst im Angstsensitivitätsindex. Patienten der T+ Bedingung führten häufiger selbständig Expositionsübungen durch, während Patienten in T– im Durchschnitt länger übten. Die Übungshäufigkeit stellte dabei einen Mediator des Behandlungserfolgs dar. Schlussfolgerungen: Günstigere Effekte einer therapeutenbegleiteten Exposition gehen auf stärkere Reduktionen der Angst vor der Angst sowie auf eine höhere Übungshäufigkeit im Selbstmanagement zurück.Theoretical background: There is a paucity of studies examining the role of therapist guidance during in-vivo exposure for panic disorder with agoraphobia (PD/AG). A recent study (MAC-study) suggested superior effects of therapist-guided exposure compared to programmed practice. Objectives: Examining potential mechanisms of therapist-guided exposure. Methods: Data from 301 patients with PD/AG who received either CBT with therapist guidance during in-vivo exposure (T+), or CBT with programmed exposure practice (T–) were analysed in regard to effects of initial symptom severity, subtle avoidance behaviours, reductions in fear of fear, and frequency of exposure homework. Results: There were no interaction effects between symptom severity or subtle avoidance and outcome. T+ was associated with higher reductions in fear of fear as well as with higher frequency of exposure homework. Frequency of exposure homework mediated the effect of group on outcome. Conclusion: Advantages of therapist-guided exposure as well as frequency of self-exposure might be attributed to higher reductions in fear of fear.
40
Siegel, Suzie. "Safe at home [electronic resource] : agoraphobia and the discourse on women's place / by Suzie Siegel." University of South Florida, 2002. http://purl.fcla.edu/fcla/etd/SFE0000025.
Full textAbstract:
Title from PDF of title page.Document formatted into pages; contains 90 pages.
Thesis (M.A.)--University of South Florida, 2001.
Includes bibliographical references.
Text (Electronic thesis) in PDF format.
ABSTRACT: My thesis explores how discourse and material practices have created agoraphobia, the fear of public places. This psychological disorder predominates among women. Throughout much of Western history, women have been encouraged to stay home for their safety and for the safety of society. I argue that agoraphobic women have internalized this discourse, expressing fears of being in public or being alone without a companion to support and protect them; losing control over their minds or their bodies; and endangering or humiliating themselves. Therapeutic discourse also has created agoraphobia by naming it, categorizing the emotions and behaviors associated with it, and describing the characteristics of agoraphobics.
The material practice of therapy reinforces this discourse. Meanwhile, practices such as rape and harassment reinforce the dominant discourse on women&softsign;s safety. I survey psychological literature, beginning with the naming of agoraphobia in 1871, to explain why the disorder is now diagnosed primarily in women. I examine nineteenth-century discourse that told women they belonged at home while men controlled the public domain. In 1871, the Paris Commune revolt epitomized the fear of women publicly out of control. I return to Paris a century later for a reading of the novel Certificate of Absence, in which Sylvia Molloy explores identity through the eyes of a woman who might be labeled agoraphobic.
I ask whether homebound women are resisting or retreating from a hostile world. Instead of seeing agoraphobia only as a personal problem, people should question why so many women fear themselves and the world outside their home.My methodology includes an analysis of nineteenth-century texts as well as current media, prose, and poetry. I also support my arguments with material from professional journals and nonfiction books in different disciplines. Common to feminist research, an interdisciplinary approach was needed to situate a psychological disorder within a social context.
System requirements: World Wide Web browser and PDF reader.
Mode of access: World Wide Web.
41
Sardelli, Lionela Ravera. "Spectrum do panico-agorafobico : um estudo na Região Metropolitana de Campinas, São Paulo, Brasil." [s.n.], 2005. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312099.
Full textAbstract:
Orientadores: Giovanni Battista Cassano, Evandro Gomes de Matos, Luis Alberto MagnaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
Made available in DSpace on 2018-08-04T19:45:50Z (GMT). No. of bitstreams: 1 Sardelli_LionelaRavera_M.pdf: 5978329 bytes, checksum: 971b584cbbbf0036bf7a9e97f8c70921 (MD5) Previous issue date: 2005
Resumo: Objetivo ¿ A presente investigação é parte integrante do ¿Spectrum Project¿, projeto internacional de pesquisa desenvolvido na Europa e nos Estados Unidos, o qual propõe uma metodologia para avaliar características psicopatológicas e clínicas de sintomas relacionados aos transtornos de ansiedade (TA), com enfoque especial no Transtorno do Pânico (TP). Tem como objetivo principal detectar a prevalência de aspectos subclínicos do TP em uma amostra representativa da Região Metropolitana de Campinas (RMC), Brasil. Casuística e Método ¿ Realizou-se um estudo epidemiológico de corte transversal. A amostra de estudo constituiu-se de 405 sujeitos, equilibrada segundo sexo, idade e cidade de moradia da população da Região Metropolitana de Campinas (RMC), São Paulo. Utilizou-se o questionário de auto-avaliação ¿Panic Agoraphobic Spectrum-Self Report¿ (PAS-SR) que contém 114 perguntas divididas em 8 Domínios e 13 subdomínios. O total escore do PAS-SR (total de respostas positivas de cada questionário) permite uma avaliação quantitativa dos sintomas correlacionados ao transtorno do pânico (TP) em cada sujeito entrevistado. Resultados- A idade dos sujeitos da amostra variou entre 16 e 89 anos, com média de 36,82 anos e desvio padrão de 14,74. Em relação ao escore total obteve-se uma média de 31,61 e um desvio-padrão de 19,63. Não foram encontradas diferenças significativas quanto aos valores médios do escore total do PAS-SR em relação a: faixa etária (p=0,21), raça (p=0,59), grau de instrução (p=0,20), estado civil (p=0,21) e região (p=0,13). A diferença mais significativa foi encontrada entre os sexos (p=0,001), onde as mulheres apresentaram em média um valor de escore total de 37,45, enquanto os homens de 25,74. A análise fatorial, utilizada como método de validação de construto, indicou que o questionário possui adequadas características psicométricas. Conclusões: Os dados obtidos neste estudo corroboram os da literatura quanto aos fatores mais freqüentemente associados no TP. O instrumento PAS-SR, traduzido e validado para uso no Brasil foi bem compreendido e teve boa aceitação pelos sujeitos da pesquisa. Isso permitiu a individualização de uma faixa da população geral com maior freqüência de sintomas relacionados ao TP. Revelando-se um instrumento útil para avaliação em nosso meio
Abstract: Objective ¿ The current investigation is part of ¿Spectrum Project¿, an international research project already developed in Europe and in the United States, which proposes a methodology for the evaluation of psychopathologic and clinical characteristics of symptoms related to Anxiety Disorder (AD), with a special focus on Panic Disorder (PD). It aims mainly at detecting the prevalence of sub-clinical PD symptms in a representative sample in the Metropolitan Region of Campinas (RMC), Brazil. Method ¿ An epidemiological study of transversal cut was carried out. The sample for this study consisted of 405 subjects and was balanced according to sex, age and city where they live in the Metropolitan Region of Campinas (RMC), São Paulo. The Panic Agoraphobic Spectrum-Self Report (PAS-SR) questionnaire containing 114 questions divided into 8 fields and 13 sub-fields was applied. The total PAS-SR score (total of positive answers of each questionnaire) allows a quantitative evaluation of the symptoms associated with the Panic Disorder (PD) in each interviewed subject. Results ¿ The age of the subjects ranged from 16 to 89 years, mean 36.82 (±14.74) and the total 31.61 ( ±19.63). There were no significant differences in the median values of the PAS-SR total score in relation to age range (p=0.21), race (p=0.77), education level (p=0.20), marital status (p=0.21) and location (p=0.14). The most significant difference was the one found between both sexes (p=0.001). Females presented a mean value of total score of 37.45, while males presented the average of 25.74. Conclusion ¿ The findings agreed substantially with those found in the literature concerning the most frequent factors associated with PD. The PAS-SR instrument, which was translated and validated for use in Brazil, had a good acceptance and was well understood by the subjects who underwent the research. It allowed the individualization of a sample of general population with greater frequency of symptoms related to PD. Thus, it was revealed as a useful instrument for evaluation in our environment
Mestrado
Ciencias Biomedicas
Mestre em Ciências Médicas
42
Nocon, Agnes. "Die Stellung der Agoraphobie in modernen diagnostischen Klassifikationssystemen: Beitrag zu einer nosologischen Kontroverse." Doctoral thesis, Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2010. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-39344.
Full textAbstract:
Hintergrund:
Seit Einführung des DSM-III-R wird die Frage, ob Agoraphobie eine Komplikation der Panikstörung ist oder eine eigenständige Diagnose darstellt, und deshalb gleichberechtigt mit der Sozialen und Spezifischen Phobie der Gruppe der Phobien zugeordnet werden sollte, kontrovers diskutiert. Die zwei Positionen in dieser Kontroverse finden ihren Ausdruck im unterschiedlichen Gebrauch hierarchischer Regeln in den gegenwärtig gebräuchlichen Klassifikationssystemen für psychische Störungen, dem Diagnostic and Statistical Manual of Mental Disorders (DSM) und der International Classification of Diseases (ICD). Die empirischen Belege für die Validität solcher hierarchischer Regeln sind allerdings bisher unbefriedigend. Ziel der vorliegenden Arbeit ist es deshalb, ohne Berücksichtigung der gültigen Hierarchieregeln das natürliche Auftreten von Agoraphobie und Panikstörung zu untersuchen und damit einen Beitrag zum Fortschritt in der oben genannten Kontroverse zu leisten.
Methoden:
Die Analysen der vorliegenden Arbeit beruhen auf Daten der Early Developmental Stages of Psychopathology (EDSP) Studie. Bei der EDSP handelt es sich um eine prospektiv-longitudinale Studie an einer bevölkerungsrepräsentativen Kohorte von 3021 Jugendlichen und jungen Erwachsenen im Alter von 14 bis 24 Jahren aus München und Umgebung. Die Studienteilnehmer wurden in einem 10-Jahres-Follow-up mit bis zu vier Erhebungszeitpunkten mit der computerisierten Version des Münchener Composite International Diagnostic Interview (DIA-X/M-CIDI) untersucht. Das M-CIDI gestattet es, Panik- und Agoraphobiesyndrome unabhängig von hierarchischen Regeln zu erheben. Risiko- und Vulnerabilitätsfaktoren wurden anhand von Fragebögen erhoben. Die Studie umfasst darüber hinaus zwei familiengenetische Untersuchungen, in deren Rahmen auch die Eltern der Studienprobanden interviewt wurden. Die direkten Elterninterviews wurden durch Informationen der Studienprobanden über ihre Eltern ergänzt.
Ergebnisse:
Studie 1: Agoraphobia and Panic: Prospective-longitudinal Relations Suggest a Rethinking of Diagnostic Concepts
Die Lifetimeinzidenz bis zum Alter von 34 Jahren betrug 9.4% für Panikattacken, 3.4% für Panikstörung (mit und ohne Agoraphobie) und 5.3% für Agoraphobie. Unter den Personen mit Agoraphobie berichteten 51% keine lifetime Panikattacken. Die Inzidenzmuster der drei Syndrome unterschieden sich bezüglich Erstauftrittsalter, Risikoverlauf und Geschlechtseffekten. Zeitlich vorausgehende Panikattacken und Panikstörung waren assoziiert mit einem Risiko für zeitlich nachfolgende Agoraphobie (Panikattacken: OR=26.7, 95% KI=17.2-41.4; Panikstörung: OR=62.5, 95% KI=38.5-101.2). In streng prospektiven Analysen waren Panikattacken/Panikstörung zur Baseline mit Panikattacken/Panikstörung im Follow-up assoziiert und Agoraphobie zur Baseline mit Agoraphobie im Follow-up. Panikattacken, Panikstörung und Agoraphobie zur Baseline hatten niedrige Remissionsraten (0-23%). Alle diagnostischer Gruppen waren bis auf Panikstörung ohne Agoraphobie mit anderen Angststörungen im Follow-up assoziiert. Panikstörung mit Agoraphobie und Agoraphobie mit Panikattacken zur Baseline zeigten höhere Assoziationen mit Komplikationen wie Beeinträchtigung, Komorbidität und Hilfesuchverhalten als Panikstörung ohne Agoraphobie und Agoraphobie ohne Panikattacken. Personen mit Panikattacken/Panikstörung suchten häufiger ärztliche Hilfe als Personen mit Agoraphobie ohne Panikattacken. Besonders ausgeprägt war Hilfesuchverhalten bei Personen mit Panikstörung mit Agoraphobie.
Studie 2: Differential Familial Liability of Panic Disorder and Agoraphobia
Panikattacken, Panikstörung und Agoraphobie der Eltern waren assoziiert mit denselben Syndromen der Kinder. Bei separater Untersuchung der Störungen wurde für Agoraphobie ohne Panikstörung keine Assoziation zwischen Eltern und Kindern beobachtet. Elterliche Panikstörung ohne Agoraphobie war nicht mit Panikstörung ohne Agoraphobie bei den Kindern, aber mit Panikstörung mit Agoraphobie (OR=3.9; 95% KI=1.6-9.4) assoziiert. Panikstörung mit Agoraphobie der Eltern war mit Agoraphobie ohne Panikstörung (OR=3.3; 95% KI=1.01-11.1) und mit Panikstörung ohne/mit Agoraphobie bei den Kindern assoziiert (ohne Agoraphobie: OR=4.2; 95% KI=1.2-13.7; mit Agoraphobie: OR=4.9; 95% KI=1.8-12.5). Bei Kontrolle nach anderen Angststörungen blieb nur die Assoziation von Panikstörung mit Agoraphobie bei Eltern und Kindern stabil. Es fanden sich keine Hinweise auf Assoziationen zwischen Panikstörung oder Agoraphobie der Eltern mit einem früheren Erstauftrittsalter der kindlichen Störung.
Studie 3: Pathways into panic and phobias
Der Komorbidität von Panikstörung, Agoraphobie und Spezifischen Phobien lag eine Vier-Klassen-Struktur zugrunde. Die Klassen konnten beschrieben werden als „sehr niedriges Risiko für Angststörungen“, „niedriges Risiko für Spezifische Phobien“, „moderates Risiko für Agoraphobie und Panikstörung“ und „hohes Risiko für Angststörungen“. Die letztgenannte Klasse zeichnete sich vor allem durch das Vorliegen von Agoraphobie und dem Situativen Subtypus der Spezifischen Phobie aus. Die drei letztgenannten Risikoklassen waren assoziiert mit weiblichem Geschlecht, Behavioral Inhibition, Harm Avoidance, überbehütendem und abweisendem Elternverhalten, elterlichen Angst- und depressiven Störungen, sowie Trennungs- und traumatischen Erlebnissen in der Kindheit. Die Klasse „hohes Risiko für Angststörungen“ war assoziiert mit elterlicher Spezifischer Phobie (OR=5.0, 95% KI=1.9-12.8) und postnatalen Komplikationen (OR=7.4; 95% KI=2.4-22.9). Sie unterschied sich darin von allen anderen Risikogruppen. Die Klasse „moderates Risiko für Agoraphobie und Panikstörung“ war assoziiert mit Trennungsangst in der Kindheit (OR=6.3; 95% KI=2.0-19.8), einem emotional kühlen elterlichen Erziehungsstil (OR=0.7; 95% KI=0.6-0.9) und einer geringen Wahrscheinlichkeit für postnatale Komplikationen (OR=0.3; 95% KI=0.1-0.9).
Schlussfolgerungen:
Unterschiede hinsichtlich des Inzidenzmusters, des Verlaufs und der Korrelate zwischen Panik- und Agoraphobiesyndromen zeigen, dass Agoraphobie getrennt von Paniksyndromen existiert und eine klinisch relevante Störung darstellt. Dabei hatte die Hälfte der Personen mit Agoraphobie keine Panikattacke erlebt und bliebe gemäß DSM-Kriterien undiagnostiziert. Ergebnisse der Familienstudie zeigen, dass Befunde zur familiären Aggregation von Panikstörung und Agoraphobie bisher von angewandten hierarchischen Diagnoseregeln abhängig waren. Ohne Anwendung hierarchischer Kriterien aggregiert Agoraphobie ohne Panikstörung nicht in Familien und die familiäre Aggregation von Panikstörung hängt davon ab, ob bei den Kindern komorbide Agoraphobie oder andere Angststörungen vorliegen. Die Ergebnisse der Latent Class Analysen lassen vermuten, dass Panikstörung, Agoraphobie und Spezifische Phobien sich im Rahmen von Vulnerabilitätsklassen entwickeln, auf zwei pathogene Mechanismen der Agoraphobie hinweisen: Agoraphobie kann sich entweder in naher Verwandtschaft zur Panikstörung, oder zum Situativen Subtypus der Spezifischen Phobie entwickeln. Spezifische Zusammenhänge dieser Risikoklassen mit untersuchten Vulnerabilitätsfaktoren stützen die Hypothese einer unterschiedlichen Ätiopathogenese der Agoraphobie. Zusammenfassend zeigen die vorliegenden Daten, dass Panikattacken und Panikstörung weder eine notwendige noch eine hinreichende Bedingung für Agoraphobie sind, und die derzeit gültige Klassifikation die Untersuchung der Agoraphobie behindert. Die aktuell in Arbeit befindliche Revision des DSM sollte im Sinne einer beschreibenden, durch empirische Daten gestützten Diagnostik das Konzept der Agoraphobie überarbeiten und von einer Diagnostik im Sinne einer nosologischen Kontroverse abrücken.
43
Westphal, Dorte, Alexander L. Gerlach, Thomas Lang, Hans-Ulrich Wittchen, Alfons O. Hamm, Andreas Ströhle, Thomas Fydrich, et al. "Die Effekte interozeptiver Expositionsübungen in der Kognitiven Verhaltenstherapie von Panikstörung mit Agoraphobie." Karger, 2015. https://tud.qucosa.de/id/qucosa%3A70595.
Full textAbstract:
Hintergrund: In der Kognitiven Verhaltenstherapie (KVT) der Panikstörung mit Agoraphobie (PD/AG) werden häufig Körperübungen zur Symptomprovokation (interozeptive Exposition) eingesetzt, jedoch liegen kaum systematische, empirische Untersuchungen zu Wirkung und Wirkweise dieser Übungen vor. Ziel der vorliegenden Studie war die Charakterisierung individueller Reaktionen auf interozeptive Übungen sowie die mit der Wiederholung der Übungen verbundenen Veränderungen dieser Reaktionen. Patienten und Methoden: Selbstberichtdaten zu ausgelösten Körpersymptomen sowie Symptom- und Angststärken von 301 Patienten mit PD/AG, die verschiedene interozeptive Übungen durchführten, wurden ausgewertet. Die Durchführung der interozeptiven Exposition erfolgte im Rahmen einer manualisierten KVT des Psychotherapieverbundes «Panik-Netz». Ergebnisse: Interozeptive Exposition löste Körpersymptome und damit verbunden Angst aus. Am häufigsten wurden vestibuläre, respiratorische und kardiovaskuläre Symptome ausgelöst. Die stärkste Symptomausprägung verbunden mit der stärksten Angst erzeugten die Übungen «Drehen», «Hyperventilieren» und «Strohhalmatmung». Übungswiederholung bewirkte eine Reduktion der Symptom- und Angststärken, insbesondere die Übungen «Drehen», «Strohhalmatmung» und «Hyperventilieren». Diskussion und Schlussfolgerungen: Interozeptive Exposition ist gut geeignet zur Auslösung von Körpersymptomen und zur Reduktion der damit verbundenen Symptom- und Angststärke, insbesondere über die Übungen «Drehen», «Hyperventilieren» und «Strohhalmatmung». Zur größeren Angst- und Symptomstärkenreduktion empfiehlt sich eine hohe Wiederholungsrate. Die Relevanz respiratorischer, vestibulärer und kardiovaskulärer Symptome für den Behandlungserfolg sollte weiterführend untersucht werden.Background: Although interoceptive exposure is a frequent component of cognitive-behavioral therapies (CBT) in panic disorder with agoraphobia, there is a lack of evidence investigating the effect of this treatment component and its underlying mechanisms of change. The present study aimed at characterizing individual responses to interoceptive exposure and response changes after repeated exposure. Patients and Methods: Under the national research initiative ‘Panic Net’, self-report data were analyzed including bodily symptoms, symptom intensity and experienced anxiety during interoceptive exposure of 301 PD/AG patients who participated in a manualized CBT trial. Results: Interoceptive exposure induced bodily symptoms and anxiety. Respiratory, vestibular and cardiovascular symptoms were most frequently reported. Spinning, breathing through a straw and hyperventilation produced most intense symptom reports and anxiety ratings. Repeating the interoceptive exposure reliably reduced reported symptom intensity and anxiety ratings particularly after spinning, breathing through a straw and hyperventilation. Discussion and Conclusions: In PD/AG patients, interoceptive exposure induces bodily symptoms and reduces reported symptom intensity and anxiety, particularly through spinning, hyperventilation and breathing through a straw. Repeated rehearsal is encouraged given that larger reduction of anxiety and symptom reports were associated with more training. Further research is needed to assess the relevance of respiratory, vestibular and cardiovascular symptoms for CBT treatment.
44
Straube, Benjamin, Ulrike Lueken, Andreas Jansen, Carsten Konrad, Andrew T. Gloster, Alexander L. Gerlach, Andreas Ströhle, et al. "Neural Correlates of Procedural Variants in Cognitive-Behavioral Therapy: A Randomized, Controlled Multicenter fMRI Study." Karger, 2014. https://tud.qucosa.de/id/qucosa%3A71639.
Full textAbstract:
Background: Cognitive behavioral therapy (CBT) is an effective treatment for panic disorder with agoraphobia (PD/AG). It is unknown, how variants of CBT differentially modulate brain networks involved in PD/AG. This study was aimed to evaluate the effects of therapist-guided (T+) versus selfguided (T–) exposure on the neural correlates of fear conditioning in PD/AG. Method: In a randomized, controlled multicenter clinical trial in medication-free patients with PD/AG who were treated with 12 sessions of manualized CBT, functional magnetic resonance imaging (fMRI) was used during fear conditioning before (t1) and after CBT (t2). Quality-controlled fMRI data from 42 patients and 42 healthy subjects (HS) were obtained. Patients were randomized to two variants of CBT (T+, n = 22, and T–, n = 20). Results: The interaction of diagnosis (PD/AG, HS), treatment group (T+, T–), time point (t1, t2) and stimulus type (conditioned stimulus: yes, no) revealed activation in the left hippocampus and the occipitotemporal cortex. The T+ group demonstrated increased activation of the hippocampus at t2 (t2 > t1), which was positively correlated with treatment outcome, and a decreased connectivity between the left inferior frontal gyrus and the left hippocampus across time (t1 > t2). Conclusion: After T+ exposure, contingency-encoding processes related to the posterior hippocampus are augmented and more decoupled from processes of the left inferior frontal gyrus, previously shown to be dysfunctionally activated in PD/AG. Linking single procedural variants to neural substrates offers the potential to inform about the optimization of targeted psychotherapeutic interventions.
45
Hamilton, Gia Renee. "Nonclinical panic: A useful analogue for panic disorder?" CSUSB ScholarWorks, 2002. https://scholarworks.lib.csusb.edu/etd-project/2155.
Full textAbstract:
The objective of this study is to see if nonclinical panickers with unexpected panic attacks (NCPs-U) may be a more useful panic disorder (PD) analogue than nonclinical panickers with expected panic attacks (NCPs-E).
46
Duinen, Marlies Alice van. "The stress of panic neuroendocrinological and neuroimmunological studies in panic disorder /." [Maastricht] : Maastricht : UPM, Universitaire Pers Maastricht ; University Library, Maastricht University [Host], 2005. http://arno.unimaas.nl/show.cgi?fid=6447.
Full text
47
Hodges, Laura M. "Candidate gene analysis of panic disorder." Diss., Search in ProQuest Dissertations & Theses. UC Only, 2008. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3311346.
Full text
48
Petrowski, Katja, and Rupert Conrad. "Comparison of Cortisol Stress Response in Patients with Panic Disorder, Cannabis-Induced Panic Disorder, and Healthy Controls." Karger, 2019. https://tud.qucosa.de/id/qucosa%3A71642.
Full textAbstract:
Background/Aims: Little research effort has so far been dedicated to the analysis of the hypothalamic-pituitary-adrenal axis of aetiologically differing subgroups of patients with panic disorder (PD). The current study aimed at a deeper understanding of the cortisol stress response in cannabis-induced PD (CIPD) patients. Methods: Matched groups of 7 PD patients (mean age ± SD: 32.95 ± 9.04 years), 7 CIPD patients (31.94 ± 8.40 years), and 7 healthy controls (HC) (31.13 ± 8.57 years) were included in the study. The Trier Social Stress Test (TSST) was used for stress induction. Salivary cortisol samples were collected and panic- and depression-related questionnaires were applied. Results: A stress response to the TSST was found in 28.6% of PD patients, in 51.1% of CIPD patients, and in 100% of HC subjects. Statistical analyses revealed a cortisol hyporesponsiveness in PD and CIPD patients. While cortisol values of PD patients and HC participantsdiffered significantly, CIPD patients’ cortisol courses balanced between those of PD patients and HC subjects. Conclusions: Current findings show a distinctive pattern of the stress-induced cortisol reaction in CIPD patients, which is markedly different from the hormonal response in PD patients as well as HC subjects. Previous findings of cortisol hyporesponsiveness in PD patients compared to HC subjects were confirmed.
49
Hammel, Jacinda Celeste McGlynn F. Dudley. "Meta worry and generalized anxiety disorder." Auburn, Ala., 2006. http://repo.lib.auburn.edu/2006%20Summer/Dissertations/HAMMEL_JACINDA_58.pdf.
Full text
50
Rees, Clare S. "Panic disorder : symptomatology, medical utilisation and treatment." Curtin University of Technology, School of Psychology, 1997. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=10805.
Full textAbstract:
The overall aim of this project was to investigate the nature and structure of the physiological symptoms of panic attacks and the relationship between these symptoms and use of the health care system by people with a clinical diagnosis of panic disorder. Cioffi's model of somatic interpretation was explored in relation to this issue as it had been previously applied to predominantly physiological conditions and appeared to offer a potentially useful framework for understanding the behaviour of people with panic disorder.The first study consisted of a principal components analysis of 153 panic attack symptom checklists from the Anxiety Disorders Interview Schedule - Third Edition - Revised (ADIS-III-R).Five separate physiological components emerged from the analysis which mirrored common medical conditions. A cluster analysis of the symptoms of 153 individuals indicated that the sample formed five separate groups corresponding to the five physiological components identified. The results of this study supported suggestions put forward in the literature regarding the possible clustering of the physiological symptoms of panic attacks. The study also found evidence to suggest that individuals with panic disorder can be identified in distinct sub-groups according to the most predominant physiological symptoms reported.The second study was made up of two parts. Part one investigated the health utilisation behaviour and associated costs for people with panic disorder and compared them with people with social phobia. Significantly higher costs and rates of utilisation were found for the panic disorder group compared to the group with social phobia. Part two of this study investigated the relationship between a person with panic disorder's most predominant physiological panic symptoms and the type of medical specialists consulted. Fifty three individuals with panic disorder ++were included in the study and the proposed relationship was analysed using a bi-partial regression analysis. The respiratory group was significantly related to the type of specialist seen.The third study was aimed at clarifying the interpretation of ambiguous symptoms in panic disorder. Thirty eight people with panic disorder completed a questionnaire requiring them to give explanations as to the cause of a number of ambiguous somatic sensations. It was hypothesised that there would be a relationship between the persons highest component score (as identified in the first study) and the interpretation of threat made in response to the items on the questionnaire. No such relationship was found although significantly more threat-interpretations were made when the individual's cognitive threat schema was activated.Study four investigated the influence of the type of panic recording measure upon the severity and number of panic symptoms reported. A secondary aim was to compare panic symptoms recorded following a panic provocation procedure in the clinic with those recorded following naturally occurring panic attacks. Thirty seven people with panic disorder recorded the symptoms of panic attacks experienced in the natural environment and those induced via hyperventilation in the clinic. It was hypothesised that there would be an effect for recording measure on the dependent variables of symptom severity and number. This hypothesis was supported with the structured recording measure producing significantly more symptoms of a greater severity than the unstructured or descriptive measure. An interaction effect was found for the neurological group of symptoms whereby the severity of symptoms was significantly higher in the clinic setting than in the natural environment with the descriptive measure resulting in significantly greater severity ratings.The final study ++
investigated the efficacy of information-giving as an intervention for panic disorder. Forty individuals with panic disorder were randomly assigned to either receive two sessions of information-giving as well as self-monitoring of their symptoms or self-monitoring only. As hypothesised the group receiving information as well as self- monitoring had significantly lower levels of general anxiety and depression as well as anticipatory anxiety at the end of the intervention period.Several important implications emerge from these results. The finding that people with panic disorder can be identified according to the predominant set of physiological symptoms they report provides some useful information for identification of the problem in general medical settings. This project demonstrated the need for a screening measure for panic disorder in Australian medical settings as well as the potential effectiveness of the provision of information relating to anxiety and panic. In addition, Cioffi's model of somatic interpretation was found to be a useful framework with which to consider underlying processes relating to the interpretation of panic sensations.