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Biomedical subjects

P Légeron

Publications and source records attributed to P Légeron.

At least 19 recordsLinked to original sources
PubMed2005

Virtual reality therapy versus cognitive behavior therapy for social phobia: a preliminary controlled study.

Social phobia is one of the most frequent mental disorders and is accessible to two forms of scientifically validated treatments: anti-depressant drugs and cognitive behavior therapies (CBT). In this last case, graded exposure to feared social situations is one of the fundamental therapeutic ingredients. Virtual reality technologies are an interesting alternative to the standard exposure in social phobia, especially since studies have shown its usefulness for the fear of public speaking. This paper reports a preliminary study in which a virtual reality therapy (VRT), based on exposure to virtual environments, was used to treat social phobia. The sample consisted of 36 participants diagnosed with social phobia assigned to either VRT or a group-CBT (control condition). The virtual environments used in the treatment recreate four situations dealing with social anxiety: performance, intimacy, scrutiny, and assertiveness. With the help of the therapist, the patient learns adapted cognitions and behaviors in order to reduce anxiety in the corresponding real situations. Both treatments lasted 12 weeks, and sessions were delivered according to a treatment manual. Results showed statistically and clinically significant improvement in both conditions. The effect-sizes comparing the efficacy of VRT to the control traditional group-CBT revealed that the differences between the two treatments are trivial.

Adaptation, Psychological↗
PubMed2003

Definition of a VR-based protocol to treat social phobia.

Social phobia is an anxiety disorder that is accessible to two forms of treatment yielding scientifically validated results: drugs and cognitive-behavioral therapies. Graded exposure to feared social situations is fundamental to obtain an improvement of the anxious symptoms. Traditionally, exposure therapies are done either in vivo or by imagining the situations. In vivo exposure is sometimes difficult to control and many patients have some difficulties in using imagination. Virtual reality (VR) seems to bring significant advantages. It allows exposures to numerous and varied situations. This paper reports the definition of a clinical protocol whose purpose is to assess the efficiency of a VR therapy compared to a CBT and to the absence of treatment for social phobic patients. It explains the illness' diagnosis and its usual treatments. It exposes all the architecture of the study, the assessment tools, the content and unfold of the therapy sessions. It finally reports first results of a clinical trial in a between-group design in 10 patients suffering from social phobia. The virtual environments used in the treatment reproduce four situations that social phobics feel the most threatening: performance, intimacy, scrutiny and assertiveness. With the help of the therapist, the patient learns adapted cognitions and behaviors with the aim of reducing her or his anxiety in the corresponding real situations. The novelty of our work is to address a group of situations that the phobic patient is most likely to experience and to treat patients according to a precise protocol.

Adult↗
PubMed1995

A controlled study of cognitive behaviour therapy with buspirone or placebo in panic disorder with agoraphobia.

BACKGROUND: This multicentre study compared a 16-week buspirone treatment with placebo in patients presenting with panic disorder with agoraphobia and also receiving cognitive behaviour therapy (CBT). METHOD: Double-blind testing was maintained until week 68, but not tested; 91 patients were included; 14 placebo-responders excluded; 77 patients randomised; 48 reached week 16 and 41 reached week 68. RESULTS: At week 16, within-group analysis showed significant improvements in agoraphobia, panic attacks, and depression in both groups. Generalised anxiety improved only in CBT+buspirone. Between-group comparisons showed buspirone to have an effect on generalised anxiety and agoraphobia. Changes in degree of agoraphobia and depression were correlated in subjects on CBT+buspirone only. A significantly higher proportion of women, and of subjects showing high avoidance dropped out. Positive expectations regarding medication predicted success in both groups. At week 68, improvement was retained without significant buspirone effect. CONCLUSION: Buspirone enhanced the effects of cognitive behaviour therapy on generalised anxiety and agoraphobia in the short term.

Adolescent↗
PubMed1993

[Behavioral and cognitive strategies in stress management].

Stress is a specific response of the individual to all nonspecific demands. However, this process of adaptation is very complex and varies considerably from person to person. The stress response or "stress reactivity" is triggered by various stressors, ranging from live events to daily hassles and including chronic stressors. These stressors need to be identified. The stress response is not univocal: it has physiological, cognitive and behavioral components. Most of the time, physiological, cognitive and behavioral responses are maladaptive and harmful for the individual. Stress management is directed at teaching individuals specific skills to modify parts of these responses in order to reduce stress. Relaxation therapies are the cornerstone of any stress management program. They mostly include autogenic training and progressive relaxation training, sometimes biofeedback. The relaxation response is a learned response. There are a variety of different methods of inducing this response. They share the common goal of countering the physiological aspects of the stress reaction. All the relaxation techniques involve long and exacting training. But proper training leads to a gradual reduction in time and effort required to relax. When properly pursued, these techniques produce a state of relaxation quickly and on demand. Cognitive approaches to stress management derive from the constatation that the individual's interpretation of events or situations which have been labeled stressful, the individual's anticipation of the consequences of the stressor and the individual's view of his or her ability to cope with the stressor or the stress reaction are fundamental in the stress process. There are a variety of cognitive theories and techniques, ranging from Beck's cognitive therapy to Ellis' Rational-Emotive Therapy. Initial phases of these therapies are directed at teaching the individual to recognize, record, analyse and modify maladaptive cognitions. The second phase is usually devoted to identifying and modifying the dysfunctional attitudes which give rise to the stressful cognitions. The basic behavioral stress response falls in line with the expectations of the fight or flight response, and a stressed individual will typically display a pattern of either aggressive or avoidance behavior (as shown in the "Type A Behavioral Pattern"). The relation between stress and behavior is bidirectional: some behaviors occur in response to stress, whereas others produce stress. Assertive training is often a component of stress management programs as it is accepted that behaving in an assertive manner (i.e. a non passive and non aggressive manner) results in an increased feeling of well-being.(ABSTRACT TRUNCATED AT 400 WORDS)

Arousal↗
PubMed1992

[Stress management].

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Cognitive Behavioral Therapy↗
PubMed1991

[Predictive factors of a good response to cognitive therapies in depression].

Thanks to Beck's cognitive model of depression, cognitive therapies for depressive disorders have been developed. Such therapies have been proven effective when used alone or in conjunction with antidepressant drugs. However, it seems that the effectiveness of such therapies depends on some factors related either to the type of depression itself or to the specificity of the cognitive therapy. Understanding these factors helps both to know under what conditions cognitive therapy is best prescribed and to improve the therapeutic procedures used. The nature of depression and the disturbed associated cognitions is likely to have more influence on the effectiveness of cognitive therapy than the intensity of the depressive syndrome. The type of cognitive therapy used does not appear to be an essential factor in predicting therapeutic success. Two factors, however, are fundamental: carrying out assigned homework tasks; establishing a therapeutic relationship based on trust and cooperation. This is not a surprise for anyone familiar with the "didactic" as well as "therapeutic" process of cognitive therapy.

Cognition↗
PubMed1987

[Self esteem].

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Aggression↗
PubMedDate not supplied

[Cognitive approach to anticipation in depression].

There is an extensive philosophical and humanistic literature concerning anticipation. Behavioural and cognitive theories have approached the concept of anticipation and have led to therapeutic solutions. The Lewinsohn model enables prediction and restoration of the activities of mastery and pleasure. The social psychology model (Bandura) forms the basis of training in assertiveness, using role-playing in order to be able to produce the relational situations which the patient will encounter. Learned helplessness for action (Seligman), teaches the reattribution of failures or successes, which leads the depressed patient to once again become involved in the action concerned. Exposure to feared situations (Marks) modifies catastrophic anticipations. The social reinforcement model (Liberman) enables prediction by functional analysis of factors involved in the persistence of problems and their modification. The mechanisms of anticipation have been reviewed since Bartlett and Ellis and up to the work of Beck. Structured patterns during existence determine thought processes in face of the circumstances which provoke them. Thus, in the opinion of the authors, our past affects our future in terms of the manner in which these patterns deal with information and determine our thoughts (cognitive events) and our vision of the future. The experimental basis of the cognitive model and the validation of these therapeutic approaches are described. The depressed patient makes negative predictions. Negative cognitions vary in conjunction with mood. Modification of these cognitions changes mood. Numerous studies are presented. They establish the effectiveness of this model, comparable to the action of antidepressant drugs and appearing to have a prolonged effect. The evaluation and cognitive treatment of anticipation are described: cognitive rating scales and analysis are proposed.(ABSTRACT TRUNCATED AT 250 WORDS)

Cognition↗
PubMedDate not supplied

[A new therapeutic approach: the behavioral prescription of anxiolytics].

Nowadays, two major therapeutic approaches (pharmacological and behavioural) have proven their efficiency and efficacy in the treatment of anxious disorders. These two methods have been used separately, alternatively or simultaneously. The prescription of benzodiazepines is necessary, because they are efficient and fast-acting. But this is not enough and may be hazardous for a prolonged period. Behavioural methodology and therapeutics improve the assessment of anxious disorders and offer a large variety of specific techniques to the physician. The innovative and integrative behavioural prescription (BP) is pragmatic and reliable. For instance, drugs are markers for assessment of anxious behaviours, in an agenda and may be used both to support functional analysis, and as agents of therapeutic contracts. The synergic action of behavioural prescription is clear in three dimensions: BP deepens muscle relaxation and gives better self-control and self-regulation of arousal level. BP alleviates social inhibition by developing social skills. BP modifies cognitions and affective disorders, which is necessary for permanent results and drug withdrawal. Other applications of BP will be considered in the future.

Anti-Anxiety Agents↗
PubMedDate not supplied

[Social phobia: clinical and therapeutic approach].

Although social phobia is a real pathological condition, it has often been neglected. In fact, social phobia is among the least studies of the major anxiety disorders. This is quite surprising, as approximately 2% of the population suffer from debilitating social phobia with devastating effects on career and quality of life, and as this disorder can now be considered as a treatable condition. After defining social phobia, the authors will describe the prevalence, clinical features and etiology of social phobia. Effective psychopharmacological and psychological treatments of social phobia will also be reviewed. The drugs that have been most studied are monoamine oxidase inhibitors and beta-blockers. Several controlled studies have also concluded that behavioral and cognitive therapies (exposure in vivo therapy, social skills training, cognitive restructuring) are beneficial for social phobics. The combination of psychopharmacotherapy and psychological interventions also seems promising. Finally, as it is necessary to distinguish among various subtypes of social phobia, further studies will have to investigate whether specific subtypes do better or worse with specific treatments.

Cognitive Behavioral Therapy↗
PubMedDate not supplied

[Anticipatory Cognitions Questionnaire (ACQ). Presentation and validation].

The capacity of anticipation is fundamentally disturbed in depressed patients. These patients make negative predictions. Anticipation disturbances are reflected in different symptoms but also in the patient's cognitions. The cognitive approach is an operational way to deal with the concept of anticipation. The cognitive model of depression has been extensively studied and cognitive therapies have been validated as effective treatments of depression. A self-questionnaire has been elaborated, taking into account the different cognitive mechanisms disturbed in depressed patients. The "Anticipatory Cognitions Questionnaire" (ACQ) explores patient's cognitions in concrete daily life situations that require anticipation. The first version of this questionnaire contained 18 items. A previous study had led to reduce the number of items and to modify the form of the questionnaire. In its final version, the ACQ has 8 items. Each of them refers to a concrete situation (i.e. "I have no news from a loved one") and the patient is asked to say how a proposed cognition (i.e. "I will call him to get in touch") applies to him, choosing one of the four answers "true", "rather true", "rather wrong" and "wrong". The validation of this questionnaire has been carried out, in comparison with the MADRS and Pichot's QD2A. 151 subjects were included in this validation study, 72% of them meeting with the DSM III-R diagnostic criteria of clinical depression and 28% not having any psychiatric disorder. Statistical analysis shows that the ACQ is more sensible than the QD2A but less than the MADRS.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗