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Results for “Desensitization, Psychologic”

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PubMed2003

[First onset of panic disorder and agoraphobia induced by a series of inappropriate shocks of an implanted cardioverter/defibrillator].

We report on a 61-year-old patient with an implanted defibrillator due to malignant arrhythmia after myocardial infarction. After several years of appropriate function, the patient suffered a cluster of 16 shocks due to a defect in the defibrillator. Soon the patient developed a panic disorder with agoraphobia which was successfully treated with cognitive-behavioral therapy. Possible cognitive-behavioral mechanisms of panic disorder and special issues of behavioral therapy of patients with serious organic diseases are discussed.

Agoraphobia↗

PubMed2001

[Conflict-centered individual therapy or integration of psychotherapy methods. Process of change in client-centered psychotherapy with and without behavioral exposure therapy in agoraphobia with panic disorder].

The mechanisms of change due to different psychotherapeutic treatments of anxiety disorders are the subject of the present study. Sixty-eight patients with agoraphobia and panic (DSM III R No. 300.21, ICD 10 No. F 40.01) were included, exclusively treated with client-centered treatment (n = 28) or with additional behavioral exposure treatment (n = 40) in an inpatient setting. The patients were examined on admission, at discharge, and at 6 and 12 months follow-ups with the Structured Clinical Interview for DSM III R (SKID), the Freiburg Personality Inventory (FPI R), and the Giessen Test (GIESS). Both treatment modalities significantly reduced panic and avoidance. Differences were found in personality scales. The support of autonomy was superior by client-centered treatment alone: client-centered treated (CCT) patients felt less dependent on the expectations of others, less under stress, and had fewer psychosomatic complaints. Patients with additional exposure treatment feel accepted by their social environment earlier. The results are discussed with regard to open questions of therapy integration and different mechanisms of change.

Adult↗

PubMed1999

Application of a new statistical approach to evaluate a clinical trial with panic disorder patients.

In clinical trials in psychiatry, changes in severity are usually measured with ordinal level scales which are applied repeatedly during the trial, showing a constant decline in psychopathology scores as treatment leads to improvement. Previous non-parametric tests for repeated measures in factorial designs did not test the hypothesis that scale scores decrease constantly during the trial. A recently developed "rank test for ordered alternatives in a mixed model" was developed and applied to the data of a clinical trial in panic disorder. Thirty-seven outpatients with panic disorder and agoraphobia (PDA) were treated with imipramine (75-150 mg/day) in an 8-week open, prospective trial. Patients with intercurrent agoraphobia were instructed in practising self-exposure in their agoraphobic situations. The total score on the Panic and Agoraphobia Scale, the Hamilton Anxiety Scale (HAMA) and the Clinical Global Impression Scale (CGI) were used as the main efficacy measures. The new rank test showed significant treatment results in all scales applied. Treatment results were excellent, as was shown by a decrease in the average Panic and Agoraphobia Scale severity scores from 28.9 (range 14-45) to 13.3 (range 0-37; rank statistic Tn = 6.7; p < 0.0001). The largest effect size r(w) of all clinician-rated scales was seen with the observer-rated version of the Panic and Agoraphobia Scale, although closely followed by the CGI and the HAMA. Among the self-rated scales, the Panic and Agoraphobia Scale also showed the largest effect size. All five subscores of the Panic and Agoraphobia Scale showed significant improvements. The highest treatment effect sizes were seen in the "panic attacks" subscore, followed by the "anticipatory anxiety" subscore. The new statistical test applied in this study, which has some advantages in comparison with previously applied tests, is suitable for psychiatric treatment evaluations since it can also be applied in the case of discrete repeated measurements.

Adult↗

PubMed2005

Treatment of phobic postural vertigo. A controlled study of cognitive-behavioral therapy and self-controlled desensitization.

In balance clinic practice, phobic postural vertigo is a term used to define a population with dizziness and avoidance behavior often as a consequence of a vestibular disorder. It has been described as the most common form of dizziness in middle aged patients in dizziness units. Anxiety disorders are common among patients with vestibular disorders. Cognitive-behavioral therapy is an effective treatment for anxiety disorders, and vestibular rehabilitation exercises are effective for vestibular disorders. This study compared the effect of additional cognitive-behavioral therapy for a population with phobic postural vertigo with the effect of self-administered vestibular rehabilitation exercises. 39 patients were recruited from a population referred for otoneurological investigation. Treatment effects were evaluated with the Dizziness Handicap Inventory, Vertigo Symptom Scale, Vertigo Handicap Questionnaire, and Hospital Anxiety and Depression Scale. All patients had a self treatment intervention based on education about the condition and recommendation of self exposure by vestibular rehabilitation exercises. Every second patient included was offered additional cognitive behavioral therapy. Fifteen patients with self treatment and 16 patients with cognitive- behavioral treatment completed the study. There was significantly larger effect in the group who received cognitive behavioral therapy than in the self treatment group in Vertigo Handicap Questionnaire and the Hospital Anxiety and Depression scale and its subscales. Cognitive-behavioral therapy has an additional effect as treatment for a population with phobic postural vertigo. A multidisciplinary approach including medical treatment, cognitive-behavioral therapy and physiotherapy is suggested.

Adult↗

PubMed2002

[Evaluation of therapeutic success by patients with anxiety disorders after inpatient psychotherapy].

OBJECTIVE: To identify factors influencing the subjective assessment of patients regarding the outcome of in-patient psychotherapy for anxiety disorders. METHODS: A total of 231 patients were tested at admission, discharge and 1-year follow-up in a multi-center study. Subjective outcome assessment was measured with the revised German version of the Helping Alliance Questionnaire. The use of the term "outcome satisfaction" is discussed. RESULTS: Patient outcome assessment did not correlate with age, sex, or education, or with duration or severity of illness or duration of treatment. Outcome assessment was closely connected with therapy success. Reaching a low symptom level ("clinical significance") had a higher impact than a high pre-post-difference ("statistical significance"). CONCLUSIONS: Anxiety patients give a generally positive assessment of their therapy outcome, which is most determined by symptom-related treatment success. The differentiation of "clinical" and "statistical significance" of success is of importance for the patient's subjective view of the therapy outcome.

Adolescent↗

PubMed1980

Therapy of vaginismus by hypnotic desensitization.

Fear and anxiety are of tremendous importance in the production and maintenance of a symptom. Vaginismus, as a reaction of avoidance of an anxiety-producing situation, is readily amenable to treatment by systematic desensitization. This may proceed mainly in two ways: "in vitro" or "in vivo." In order to strengthen and speed up the densensitization process, we used hypnotic techniques in a dynamic approach. The "in vitro" treatment proceeds with imagery, under hypnosis, of an "anxiety hierarchy" of increasingly erotic and sexually intimate situations which will be reproduced at home with the partner, until sexual intercourse is achieved. In the "in vivo" method the patient learns self-hypnosis and then inserts in the vagina first a finger, and then Hegar dilators of gradually increasing sizes. The partner, the patient, and the physician will then successively proceed to insertion, forming a team-referred work situation. This continues until the "female superior position," practiced first with the largest dilator, is reproduced at home by intercourse. Between 1965 and 1974 we treated 71 women with this method. Good results were obtained in 16 of 18 by the "in vitro" technique and in 53 of 54 by the "in vivo" technique. One patient was referred from the "in vitro" group to the "in vivo" group. In follow-up of 2 to 5 years there was no relapse or symptom substitution.

Adult↗

PubMed1981