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Biomedical subjects

Edna B Foa

Publications and source records attributed to Edna B Foa.

At least 55 records · Page 3Linked to original sources
PubMed2003

Demographic and social adjustment characteristics of patients with comorbid posttraumatic stress disorder and alcohol dependence: potential pitfalls to PTSD treatment.

The present study examined the demographic and social adjustment characteristics of a sample seeking treatment for comorbid posttraumatic stress disorder (PTSD) and alcohol dependence (AD). Using descriptive statistics, we compared the characteristics of this group to those of a sample seeking treatment for PTSD alone and to another sample seeking treatment for AD alone. Results indicated that compared to the PTSD alone and AD alone samples, a greater percentage of the comorbid sample was unemployed, with low income and living without the support of a spouse or intimate partner. Further, participants in the comorbid sample were less likely than those in the PTSD alone sample to have received more than a high school education, though the comorbid and AD samples were comparable on education level. These results are discussed with attention to how poor social adjustment may place comorbid AD-PTSD patients at greater risk for premature termination of therapy, particularly when that treatment is focused on alleviating PTSD symptoms. Suggestions are made to enhance retention of these difficult patients in treatment programs.

Adult↗
PubMed2003

Intolerance of uncertainty in obsessive-compulsive disorder.

Pathological doubt, a prominent feature of obsessive-compulsive disorder (OCD), may be related to difficulty tolerating ambiguous or uncertain situations. This is thought to be particularly true of those patients with checking compulsions. Intolerance of uncertainty (IU) has been studied extensively within the domains of worry and generalized anxiety; however, it has received relatively little empirical attention in OCD patients. We administered the Intolerance of Uncertainty Scale [Personality and Individual Differences 17 (1994) 791] to 55 clinic patients with OCD, 43 of whom had checking compulsions, and 14 nonanxious controls. OC checkers showed greater IU than did OC noncheckers and NACs. The latter two groups did not differ from each other. Furthermore, both repeating and checking rituals were associated with IU. Pathological doubt may be understood not only in terms of knowledge-based constructs, but also patients' emotional reaction to feelings of uncertainty. We discuss the implications for increasing tolerance via cognitive-behavioral therapy.

Adult↗
PubMed2003

Study refusal and exclusion from a randomized treatment study of generalized social phobia.

We examine treatment exclusion and refusal rates as well as reasons for non-participation in a sub-sample of phone interviews conducted to determine eligibility for a randomized study of treatments for generalized social phobia (GSP). This study compared group comprehensive cognitive behavioral therapy (CCBT) to fluoxetine (FLU), placebo (PLA), or their combination. Results suggest that the major exclusion for the study was due to comorbid depression, followed by having a different diagnosis as primary. Patient refusal to enter the study was also common, with the most frequently reported reason being not wanting to take medication. Notably, few people who refused stated an objection to entering CCBT or PLA. These results suggest that there is a need to develop and evaluate a treatment for social anxiety with comorbid depression and to systematically study reasons for reluctance to take medication among individuals with GSP.

Adult↗
PubMed2003

Long-term efficacy of exposure and ritual prevention therapy and serotonergic medications for obsessive-compulsive disorder.

What is the long-term outcome of patients with obsessive-compulsive disorder (OCD) who are treated with exposure and response (ritual) prevention (EX/RP) alone, serotonergic medications alone, or their combination? How is the long-term outcome of these patients affected by the discontinuation? Follow-up assessments were conducted with 62 patients treated for OCD an average of 17 months posttreatment (range: 6-43 months). Patients received one of three treatments: serotonergic medications (fluvoxamine or clomipramine), intensive behavior therapy involving EX/RP, or intensive EX/RP with concurrent antidepressant medication. At follow-up, no differences in OCD symptom severity were found among the three treatment groups. However, when current medication use was taken into consideration, differences among the three treatment groups emerged. Among patients who were medication-free at the time of follow-up assessment (n=37), those in the EX/RP-alone and EX/RP-with-medication groups had lower symptom severity ratings than those in the medication-only group on 4 out of 6 measures. There were no differences in OCD severity ratings among patients taking medications at follow-up (n=25). Although these findings are interpreted with caution due to the uncontrolled nature of the study, results suggested that long-term outcome may be superior following EX/RP than following serotonergic medications, after discontinuation. For patients who remain on medications, the treatment produced benefits equivalent to EX/RP.

Clomipramine↗
PubMed2003

Interventions for trauma-related emotional disturbances in adult victims of crime.

This paper provides an overview of several treatment interventions for trauma-related disturbances in adult victims of crime. Following a brief discussion of mental health service utilization among crime victims, we describe interventions for acute and chronic reactions to trauma. We present some controlled studies of psychosocial treatments for posttraumatic stress disorder (PTSD) that have gained empirical support and are recommended as first line interventions by expert consensus (E. B. Foa, J. R. T. Davidson, & A. Francis, 1999) including exposure therapy, cognitive therapy, and stress inoculation training, followed by a brief summary of selected studies examining the efficacy of pharmacological treatment for PTSD. Finally, we discuss multicultural issues, factors associated with treatment outcome, and challenges we have encountered in treating crime victims.

Adult↗
PubMed2003

Are the dissociative criteria in ASD useful?

Acute stress disorder (ASD) is a new DSM-IV diagnostic category, characterized by dissociative, intrusive, avoidance, and hyperarousal symptoms in the first month after a traumatic experience. The goal of the present study was to examine the utility of this diagnosis. In a prospective study, 79 mixed trauma victims who met DSM-IV symptom criteria for PTSD within 1 month following a traumatic event were followed through three months post-event. Dissociative symptoms in ASD only partially captured distress and dysfunction during the first month. Participants with and without ASD showed similar patterns of recovery, with only small differences that disappeared at three months post-event. Interestingly, initial PTSD avoidance but not ASD dissociative symptoms predicted PTSD severity at 3 months.

Adult↗
PubMed2003

Do patients drop out prematurely from exposure therapy for PTSD?

Many studies have demonstrated the efficacy of exposure therapy in the treatment of chronic post-traumatic stress disorder (PTSD). Despite the convincing outcome literature, a concern that this treatment may exacerbate symptoms and lead to premature dropout has been voiced on the basis of a few reports. In this paper, we examined the hypothesis that treatments that include exposure will be associated with a higher dropout rate than treatments that do not include exposure. A literature search identified 25 controlled studies of cognitive-behavioral treatment for PTSD that included data on dropout. The results indicated no difference in dropout rates among exposure therapy, cognitive therapy, stress inoculation training, and EMDR. These findings are consistent with previous research about the tolerability of exposure therapy.

Humans↗
PubMed2003

Directed forgetting following mood induction in chronic posttraumatic stress disorder patients.

Current research of posttrauma sequelae suggests that intrusive rather than avoidant-dissociative models more accurately represent the encoding processes of trauma cues. However, posttraumatic stress disorder (PTSD) is often conceptualized as a phasic phenomenon, altering between arousal and avoidance states. The failure to support a relationship between avoidant encoding style and PTSD may reflect this alteration. To explore this hypothesis, participants with PTSD and controls (no PTSD) completed an item-cued directed-forgetting task, following either a dissociative or a serenity (control) mood induction. Results suggested that, following the serenity induction, a standard directed-forgetting effect was observed. However, following the dissociation induction, this effect was not observed. The role of dissociation in impairing encoding via lack of selective rehearsal or source discrimination is discussed.

Adult↗
PubMed2003

Exposure and ritual prevention for obsessive-compulsive disorder: effects of intensive versus twice-weekly sessions.

Exposure and ritual prevention (ERP) is the most effective treatment for obsessive-compulsive disorder (OCD), yet the intensive treatment schedule often described is not transportable to many settings. In the present study, the authors examined whether a twice-weekly (TW) ERP program reduced the effectiveness of intensive (IT) ERP. Forty OCD patients received 15 sessions of ERP: 20 received daily treatment over 3 weeks and 20 received twice weekly therapy over 8 weeks. Results indicated that both programs were effective. The effect of therapy schedule was moderate, with a trend toward more improvement in the intensive group at posttreatment. No differences were found at follow-up; some evidence of relapse was found with IT but not TW.

Adult↗
PubMed2002

Context in the clinic: how well do cognitive-behavioral therapies and medications work in combination?

Cognitive-behavioral therapy (CBT) and pharmacotherapy demonstrate efficacy across the anxiety disorders, but recognition of their limitations has sparked interest in combining modalities to maximize benefit. This article reviews the empirical literature to examine whether combining treatments influences efficacy of either monotherapy. We conducted a comprehensive literature search of published randomized trials that compared combined treatment with pharmacologic or CBT monotherapies. Ten studies that met our inclusion criteria were reviewed in detail, and within-subjects effect sizes were calculated to compare treatment conditions within and across studies. At posttreatment and follow-up, effect size and percentage responder data failed to clearly demonstrate an advantage or disadvantage of combined treatment over CBT alone for obsessive-compulsive disorder, social phobia, and generalized anxiety disorder. Some advantage of combined treatment over pharmacotherapy alone emerged from the few studies that allowed for such a direct comparison. In contrast, combined treatment for panic disorder seems to provide an advantage over CBT alone at posttreatment, but is associated with greater relapse after treatment discontinuation. The advantage of combined treatment may vary across the anxiety disorders. The potential differences in usefulness of combined treatment are discussed, directions for future research are suggested, and implications for clinical practice are considered.

Anxiety Disorders↗
PubMed2002

Cognitive-behavior therapy for PTSD in rape survivors.

In recent years, new data have appeared, further suggesting the utility of cognitive-behavioral interventions for posttraumatic stress disorder (PTSD) subsequent to sexual assault. In this article, we present a model of cognitive-behavioral treatment (CBT) for PTSD in rape survivors. Emotional-processing theory, which proposes mechanisms that underlie the development of disturbances following rape, is reviewed. A CBT-based therapy (Prolonged Exposure) is presented that entails education about common reactions to trauma, relaxation training, imaginal reliving of the rape memory, exposure to trauma reminders, and cognitive restructuring. Current research regarding the use of prolonged exposure is discussed. The case example of a young female rape survivor is described in detail, and her prior substance dependence and intense shame are highlighted. The therapy was successful in reducing the client's symptoms of PTSD, as well as her depressive symptoms, and these gains were maintained at a one-year follow-up assessment.

Adult↗
PubMed2002

Directed forgetting in obsessive-compulsive disorder: replication and extension.

Previous research indicates that patients with obsessive-compulsive disorder (OCD) show impaired ability to forget negative material (Behav Res Ther 34 (1996) 633). The present study was intended to replicate and extend these findings by separating emotional valence from personal relevance, using idiographic stimulus selection to control for heterogeneity of OCD concerns, and the addition of an anxious control group. We used a directed forgetting paradigm, in which participants were instructed to either remember or forget a series of words. No differences in impairment were found among the groups during a free recall test, in which they were asked to recall both "remember" and "forget" words. However, during a recognition test, OCD patients showed greater impaired forgetting for OCD-relevant words than did nonanxious and anxious controls. Valence of words did not emerge as a contributing factor to impaired forgetting.

Adult↗
PubMed2002

Thought suppression in obsessive-compulsive disorder.

Social cognition research has indicated that attempts to suppress thoughts can lead to a paradoxical increase in the frequency of that thought. This phenomenon has been a central component of cognitive-behavioural models of obsessive-compulsive disorder (OCD); however, research has yet to demonstrate deficient thought suppression ability in OCD patients. We examined whether individuals with OCD (OCs) exhibit a deficit in the ability to suppress thoughts. In Experiment 1, attempted thought suppression led to a paradoxical increase in self-reported thoughts for OCs, but not for nonanxious controls (NACs) or anxious controls (ACs). In order to rule out self-report biases, in Experiment 2 we utilized a lexical decision paradigm that measured priming strength of a target word under thought suppression conditions. Results paralleled those of Experiment 1: OCs showed decreased lexical decision latency of the 'suppressed' thought (thought to reflect either increased priming strength or disrupted processing of nonsuppressed thoughts), thus exhibiting a paradoxical effect of thought suppression. This effect was not seen in NACs or ACs. These findings suggest that deficits in cognitive inhibitory processes may underlie the intrusive, repetitive nature of clinical obsessions.

Adolescent↗
PubMed2002

Hyperhidrosis in social anxiety disorder.

PURPOSE: Excessive sweating (hyperhidrosis) is an overlooked and potentially disabling symptom, which is often seen in social anxiety disorder (SAD). We conducted a retrospective review of data acquired in patients with SAD who had participated in placebo-controlled clinical trials of fluoxetine, cognitive behavior therapy, clonazepam and gabapentin. Four specific topics were addressed: (1) overall levels of sweating; (2) characteristics of those with hyperhidrosis; (3) a comparison of active treatments relative to placebo on hyperhidrosis; and (4) an examination of baseline sweating severity as a predictor of treatment outcome. METHODS: Using the Brief Social Phobia Scale (BSPS) and Social Phobia Inventory (SPIN), we examined the above questions. RESULTS: Hyperhidrosis was found in 24.8-32.3% of 375 subjects assessed, depending upon the scale used. Hyperhidrosis was associated with higher levels of disability, fear, avoidance, and other physiologic symptoms. While treatment in general was associated with a reduction in the rate of hyperhidrosis from 23.7% to 9.7% (BSPS), and 34.0% to 15.5% (SPIN), only fluoxetine differed significantly from placebo in respect of change in sweating score from baseline to endpoint. In an ANCOVA, gabapentin differed from placebo on the SPIN. CONCLUSION: We conclude that hyperhidrosis is frequently seen in patients with SAD, and that its response to treatment is variable. Further attention should be paid to the possible importance of this symptom in social anxiety.

Acetates↗
PubMed2002

Inflated perception of responsibility for harm in OCD patients with and without checking compulsions: a replication and extension.

In a follow-up study to [J. Anxiety Disord., in press] examination of inflated perception of responsibility for harm among individuals with obsessive compulsive disorder (OCs), 22 OC checkers, 24 OC non-checkers, and 25 non-anxious controls (NACs) completed the Obsessive Compulsive Responsibility Scale (OCRS), which consisted of written descriptions of Low-Risk (LR), Moderate-Risk (MR), and High-Risk (HR) scenarios. In LR and MR scenarios, OC checkers reported greater perception of responsibility for harm and greater relief upon rectifying the situation, than did NACs. OC checkers also reported greater urges to rectify LR situations than did NACs. OC non-checkers did not differ from NACs on any of the scales. No group differences emerged for HR scenarios. The results suggest that, compared to OC non-checkers and to NACs, OC checkers have an inflated perception of responsibility for harm; and that this perception leads to a need to rectify potentially harmful situations.

Analysis of Variance↗
PubMed2002

Brief screening instrument for post-traumatic stress disorder.

BACKGROUND: Brief screening instruments appear to be a viable way of detecting post-traumatic stress disorder (PTSD) but none has yet been adequately validated. AIMS: To test and cross-validate a brief instrument that is simple to administer and score. METHOD: Forty-one survivors of a rail crash were administered a questionnaire, followed by a structured clinical interview 1 week later. RESULTS: Excellent prediction of a PTSD diagnosis was provided by respondents endorsing at least six re-experiencing or arousal symptoms, in any combination. The findings were replicated on data from a previous study of 157 crime victims. CONCLUSIONS: Performance of the new measure was equivalent to agreement achieved between two full clinical interviews.

Accidents↗
PubMed2002

Peritraumatic dissociative experiences, trauma narratives, and trauma pathology.

Peritraumatic dissociation, i.e., dissociation during or immediately after a traumatic event, has been associated with persistence of trauma-related pathology. Peritraumatic dissociation may interfere with encoding of traumatic memories and this style may impede recovery. This study examines this hypothesis by analyzing trauma narratives from 28 female sexual and nonsexual assault victims who reported either high or low peritraumatic dissociation. Participants were asked to recount their assault. Narratives were videotaped, transcribed, and coded. Narratives of individuals with high peritraumatic dissociation had higher grade levels and a trend toward lower reading ease than those with low peritraumatic dissociation. Both higher grade levels and lower reading ease of prethreat sections of trauma narratives were related to posttreatment reexperiencing and anxiety symptoms.

Adult↗