Biomedical subjects

Michel J Dugas

Publications and source records attributed to Michel J Dugas.

14 recordsLinked to original sources

PubMed2006

Investigating the construct validity of intolerance of uncertainty and its unique relationship with worry.

Although recent findings suggest that intolerance of uncertainty is a fundamental construct involved in excessive worry, additional research is required to further establish the construct validity of intolerance of uncertainty and demonstrate its unique contribution to the understanding of worry. The present study examined the relationships among measures of worry, intolerance of uncertainty, intolerance of ambiguity, perfectionism, and perceived control in a sample of 197 university students. The findings indicated that intolerance of uncertainty moderately overlaps with earlier conceptualizations of intolerance of ambiguity; however, worry was more highly related to intolerance of uncertainty than to intolerance of ambiguity. Intolerance of uncertainty also emerged as the most salient predictor of worry compared to other cognitive processes such as perfectionism and perceived control. Worry and intolerance of uncertainty continued to be significantly related after controlling for intolerance of ambiguity, perfectionism, and perceived control, which implies that intolerance of uncertainty shares a unique association with worry that is not accounted for by these other cognitive factors. Overall, the findings provide evidence of construct validity and underscore the role of intolerance of uncertainty in the conceptualization of worry.

Adaptation, Psychological↗

PubMed2006

Benzodiazepine discontinuation among adults with GAD: A randomized trial of cognitive-behavioral therapy.

This study evaluated the specific effectiveness of cognitive-behavior therapy (CBT) combined with medication tapering for benzodiazepine discontinuation among generalized anxiety disorder (GAD) patients by using a nonspecific therapy control group. Sixty-one patients who had used benzodiazepines for more than 12 months were randomly assigned to the experimental conditions. Nearly 75% of patients in the CBT condition completely ceased benzodiazepine intake, as compared with 37% in the control condition. Results of the 3-, 6-, and 12-month follow-ups confirmed the maintenance of complete cessation. Discontinuation rates remained twice as high in the CBT condition. The number of patients who no longer met GAD criteria was also greater in the CBT condition. The addition of specific CBT components thus seemed to facilitate benzodiazepine tapering among patients with GAD.

Adolescent↗

PubMed2006

Cognitive-behavioral therapy for comorbid generalized anxiety disorder and panic disorder with agoraphobia.

The goal of this study was to evaluate the efficacy of a cognitive-behavioral treatment package for comorbid generalized anxiety disorder (GAD) and panic disorder with agoraphobia (PDA). A single-case, multiple-baseline, across-subjects design was used with 3 primary GAD patients with secondary PDA. The efficacy of the treatment was evaluated with a structured interview, a battery of self-report questionnaires, and daily self-monitoring booklets. Results are promising: At posttreatment, 2 out of 3 participants achieved high endstate functioning and maintained this level at 3-, 6-, and 12-month follow-ups. The 3rd participant also improved but achieved moderate endstate functioning. The strengths and limitations of the treatment are discussed.

Adult↗

PubMed2006

[Comorbidity in generalized anxiety disorder: prevalence and course after cognitive-behavioural therapy].

OBJECTIVE: To evaluate the prevalence and course of Axis I concurrent disorders in a population of patients who underwent cognitive-behavioural therapy (CBT) to treat their generalized anxiety disorder (GAD). METHOD: This study is a secondary analysis combining patients from 3 treatment studies done at Université Laval. A total of 90 patients with a DSM-IV consistent GAD diagnosis received from 12 to 16 CBT sessions to treat GAD. Symptomatology was assessed at pretest, posttest, and 6 months after treatment, with the Anxiety Disorders Interview Schedule, a structured diagnostic interview. RESULTS: Seventy-three per cent of patients had both GAD and a concurrent diagnosis. The most common diagnoses were simple phobia, social phobia, panic disorder, and major depression. CBT applied to GAD decreases the number of concurrent diagnoses. A panic disorder or a greater number of concurrent diagnoses at pretest is associated with a less efficient treatment at follow-up 6 months later. CONCLUSION: Patients with GAD have a high comorbidity rate with other Axis I disorders, but these significantly decrease after a short CBT aimed at GAD. Implications for GAD treatment and mechanisms that might explain these findings are discussed.

Adult↗

PubMed2006

Using the impact of event scale to evaluate distress in the context of genetic testing for breast cancer susceptibility.

The data obtained with two forms of the Impact of Event Scale were compared, one referring to a BRCA1/2 test result (IES-T) and another to cancer (IES-C). The sample consisted of 272 women with a family history suggestive of a BRCA1/2 mutation who underwent genetic testing and received results: noncarrier, carrier, or inconclusive. Globally, mean scores on the IES-C form were higher than those obtained on the IES-T form. Among carriers of a BRCA1/2 mutation, mean scores on the two forms were similar and agreement was good, as measured by the intraclass correlation coefficient (.83; 95% 95% CI=.72, .91). Agreement between the forms was poor to fair among noncarriers (ICC= .38; CI= .15, .57) and women with an inconclusive result (ICC= .40; 95% CI= .26, .52). Having had cancer increased total scores but had little influence on agreement between scores on forms. These findings highlight the importance of carefully selecting the form of the Impact of Event Scale in the context of genetic testing for breast cancer susceptibility.

Adult↗

PubMed2005

Negative problem orientation (Part I): psychometric properties of a new measure.

Negative problem orientation, a set of dysfunctional attitudes toward social problem-solving, has increasingly become an important construct in our understanding of deficits in problem-solving ability in daily life. Until recently, no measure was specifically constructed to assess negative problem orientation directly, other than as a subscale in a more global measure of problem-solving ability. The goal of the present study was to translate the French version of the Negative Problem Orientation Questionnaire (NPOQ), and to examine its psychometric properties. The sample consisted of 201 university students who completed five questionnaires assessing psychological distress, pessimism, components of problem-solving ability, and the NPOQ. A unitary factor structure was revealed, accounting for 54.8% of the variance. The NPOQ had excellent internal consistency, good test-retest reliability at 5 weeks, and demonstrated convergent and discriminant validity when measured against self-reported pessimism, depression, anxiety, and problem-solving ability. The findings suggest that the NPOQ is a measure with sound psychometric properties that will be a valuable tool in future research on problem orientation.

Adult↗

PubMed2005

Negative problem orientation (Part II): construct validity and specificity to worry.

Negative problem orientation, a dysfunctional set of attitudes related to problem-solving ability, has been implicated as a process variable in several psychological disorders, notably depression and generalized anxiety disorder (GAD). The goal of the present study was two-fold: (1) to further examine the construct validity of a new measure of negative problem orientation, the negative problem orientation questionnaire (NPOQ), through its relationship to conceptually similar variables, and (2) to investigate the specificity of negative problem orientation to worry, the cardinal feature of GAD, compared to depression. The sample consisted of 148 university students who completed six questionnaires, the NPOQ and measures of worry, depression, pessimism, self-mastery, and neuroticism. Multiple hierarchical regressions revealed that when entered in the last step following demographic information and personality variables (pessimism, self-mastery, and neuroticism), the NPOQ accounted for 5.6% of the variance in worry scores compared to 1.6% of the variance in depression scores. It was concluded that the NPOQ shows evidence of construct validity, and that the process variable of negative problem orientation appears to have greater specificity to worry than depression. Implications for the understanding of worry and GAD are discussed.

Adult↗

PubMed2005

Further validation of a cognitive-behavioral model of generalized anxiety disorder: diagnostic and symptom specificity.

The goal of this study was to investigate the diagnostic and symptom specificity of a model of GAD that has four main features: intolerance of uncertainty, positive beliefs about worry, poor problem orientation, and cognitive avoidance. The authors compared 17 patients with non-comorbid generalized anxiety disorder (GAD) to 28 patients with non-comorbid panic disorder with agoraphobia (PDA) and found that only intolerance of uncertainty showed evidence of diagnostic specificity, i.e., intolerance of uncertainty scores were higher in the GAD group relative to the PDA group. In terms of symptom specificity, when both groups were combined, all model variables were significantly related to worry but unrelated to fear of bodily sensations, agoraphobic cognitions, and behavioral avoidance. Taken together, these findings provide further support for the link between intolerance of uncertainty and GAD and underscore the importance of pursuing the issue of specificity from both a diagnostic and symptom perspective.

Adult↗

PubMed2005

No evidence of false reassurance among women with an inconclusive BRCA1/2 genetic test result.

BACKGROUND: Little is known about how women who receive an inconclusive result from BRCA1/2 testing interpret their result. Clinical observations suggest that some of them may be falsely reassured and, consequently, may not adhere to recommended surveillance. The purpose of this study is to evaluate whether women with inconclusive BRCA1/2 test results are falsely reassured. METHODS: Participants were adult women with a family history suggestive of a germ-line mutation in either the BRCA1 or the BRCA2 gene who underwent genetic testing in the context of the interdisciplinary research program INHERIT BRCAs. Data were collected using self-administered questionnaires at genetic counseling and 1 month after result disclosure. Reassurance was assessed through indicators of cancer risk perception, cancer worry, relief following result disclosure, painfulness of the test result, and its effect on quality of life. RESULTS: Five-hundred women (105 carriers, 140 noncarriers, and 255 inconclusive) were included in this analysis. Compared to noncarriers, women with inconclusive results had higher cancer risk perception, were more worried about cancer, were less relieved by their test result, and perceived their quality of life as being more adversely affected by it. CONCLUSION: The differences observed between noncarriers and women who received an inconclusive result run counter to the hypothesis that the latter are falsely reassured following BRCA1/2 testing. For clinicians, our findings show the value of taking precautions to fully explain to women that inconclusive results do not rule out the possibility that they still may face a higher risk of developing breast and/or ovarian cancer.

Adult↗

PubMed2003

Gender differences in worry and associated cognitive-behavioral variables.

Research has shown that there is a significant gender difference in the worry report of women and men, with women often reporting more worry than men. The present study investigated this phenomenon by looking at gender differences in cognitive variables associated with worry; namely, intolerance of uncertainty, negative problem orientation, positive beliefs about worry, and cognitive avoidance. The sample consisted of 217 female and 100 male university students who completed six questionnaires assessing worry and associated cognitive variables. Women reported more worry than men on two measures of the tendency to worry, as well as more worries about lack of confidence issues. Women also reported a more negative problem orientation and engaging in more thought suppression, a type of cognitive avoidance. Thought suppression and negative orientation were found to make a significant contribution to the prediction of worry scores. Moreover, when both variables were controlled, the significant prediction of gender to worry disappeared. Hypotheses accounting for gender differences in thought suppression and negative problem orientation are discussed.

Adolescent↗

PubMed2003

Understanding adolescent worry: the application of a cognitive model.

The relationship between worry and 4 cognitive variables, intolerance of uncertainty, positive beliefs about worry, negative problem orientation, and cognitive avoidance, was examined in an adolescent sample of 528 boys and girls aged 14-18. The participants completed questionnaires assessing worry, somatic anxiety symptoms, and the variables mentioned above. The results show that (a) intolerance of uncertainty, positive beliefs about worry, and negative problem orientation each account for a significant amount of variance in adolescent worry scores in the multiple regression, and (b) the discriminant function derived from the 4 variables is effective in classifying moderate and high worriers into their respective groups (72.8% correct classification). Furthermore, analyses demonstrate that intolerance of uncertainty has the strongest association with worry scores and is the most important variable in discriminating between moderate and high adolescent worriers. These results suggest that intolerance of uncertainty plays a key role in our understanding of adolescent worry.

Adaptation, Psychological↗

PubMed2003

Group cognitive-behavioral therapy for generalized anxiety disorder: treatment outcome and long-term follow-up.

A recently developed cognitive-behavioral treatment for generalized anxiety disorder (GAD) targets intolerance of uncertainty by the reevaluation of positive beliefs about worry, problem-solving training, and cognitive exposure. As previous studies have established the treatment's efficacy when delivered individually, the present study tests the treatment in a group format as a way to enhance its cost-benefit ratio. A total of 52 GAD patients received 14 sessions of cognitive-behavioral therapy in small groups of 4 to 6 participants. A wait-list control design was used, and standardized clinician ratings and self-report questionnaires assessed GAD symptoms, intolerance of uncertainty, anxiety, depression, and social adjustment. Results show that the treatment group, relative to the wait-list group, had greater posttest improvement on all dependent variables and that treated participants made further gains over the 2-year follow-up phase of the study.

Adult↗

PubMed2003

Cognitive-behavioral treatment of generalized anxiety disorder among adolescents: a case series.

Seven adolescents received a cognitive-behavioral treatment targeting generalized anxiety disorder. The treatment consisted of awareness training, worry interventions, and relapse prevention. The worry interventions targeted specifically intolerance of uncertainty, beliefs about worry, problem solving, and cognitive avoidance. According to the Anxiety Disorders Interview Schedule for diagnosis of generalized anxiety disorder, self-report questionnaire scores, and time spent worrying every day, three adolescents showed clinically significant change at post-test which was maintained at 6- and 12-month follow-up assessments. Minimal to moderate improvement was observed for other participants. Factors that may explain these differences are discussed.

Adolescent↗

PubMed2003

[Benzodiazepine withdrawal in patients with generalized anxiety disorder: efficiency of a behavioral and cognitive intervention].

Benzodiazepine medication is often prescribed for the short-term treatment of generalized anxiety disorder. The chronic nature of generalized anxiety disorder entails a prolonged use of these psychotropic medication on several months and several years, entailing also a psychological and physical addiction. The current study aims at determining if the combination of a behavioral and cognitive therapy and gradual withdrawal facilitate interrupting the use of benzodiazepine in patients with generalized anxiety disorder. In total, five participants have received the combined intervention according to an experimental protocol of unique case with multiple levels. Four among them have completed the withdrawal plan and have demonstrated important clinical improvements. Data collected during the 3rd and 6th month indicate the preservation of therapeutic gain. These results suggest that behavioral and cognitive therapy facilitates stopping the use of benzodiazepine medication in patients with generalized anxiety disorder by significantly reducing anxious symptoms.

English Abstract↗