Anxiety Treatment News

/ April 15th, 2011/ Posted in Mental Health / No Comments »

End of Chemo Treatment, Relief or Anxiety?

There is no question that completing a course of chemotherapy treatment is a milestone in the life of a patient. Tomorrow, my 89-yr-old mother will receive her sixth and final dose of chemotherapy for lymphoma. She was initially hesitant about chemo and the effects it would have on her but eventually agreed to go through treatment. As she approaches her final dose, I honestly wonder whether it’s time for celebration or anxiety.

Chemotherapy gives the patient the ability to confront cancer cells head on. The possible side effects are a reminder that the toxins are doing their job and crushing the cancer cells. The chemotherapy has been a ‘body guard’ of sorts for my Mom, attacking her tumor with a prescribed course of action. After tomorrow, my Mom will part ways with this powerful partner and protector and be on her own. Without the toxic soldiers on her side, I imagine she might feel vulnerable, anxious, and alone. My role as her caregiver and advocate will change again as I encourage and support her as she gets back to living life as a cancer-free woman.

Cognitive behaviour therapy (CBT) for anxiety and depression in adults with mild intellectual disabilities (ID): a pilot randomised controlled trial

Several studies have showed that people with intellectual disabilities (ID) have suitable skills to undergo cognitive behavioural therapy (CBT). Case studies have reported successful use of cognitive behavioural therapy techniques (with adaptations) in people with ID.

Modified cognitive behavioural therapy may be a feasible and effective approach for the treatment of depression, anxiety, and other mood disorders in ID. To date, two studies have reported group-based manaulised cognitive behavioural treatment programs for depression in people with mild ID.

However, there is no individual manualised programme for anxiety or depression in people with intellectual disabilities. The aims of the study are to determine the feasibility of conducting a randomised controlled trial for CBT in people with ID.

The data will inform the power calculation and other aspects of carrying out a definitive randomised controlled trial.

Methods: Thirty participants with mild ID will be allocated randomly to either CBT or treatment as usual (TAU). The CBT group will receive up to 20 hourly individual CBT over a period of 4 months.

TAU is the standard treatment which is available to any adult with an intellectual disability who is referred to the intellectual disability service (including care management, community support, medical, nursing or social support). Beck Youth Inventories (Beck Anxiety Inventory &Beck Depression Inventory) will be administered at baseline; end of treatment (4months) and at six months to evaluate the changes in depression and anxiety.

Medication Plus CBT Effective for Anxiety in Primary Care

Cognitive behavior therapy (CBT) in combination with psychotropic medication is highly effective for treating most anxiety disorders in primary care, new research suggests.

In a study of more than 1000 patients, those who underwent the Coordinated Anxiety Learning and Management (CALM) collaborative care program had significantly decreased symptoms of principal generalized anxiety disorder (GAD), panic disorder (PD), and social anxiety disorder (SAD), and comorbid SAD than did those randomized to receive usual treatment from their primary care physician.

“The purpose of this study was to address disorder-specific outcomes for each participant’s constellation of anxiety disorders,” write Michelle Craske, PhD, from the Department of Psychology at the University of California, Los Angeles, and colleagues.

They note that the study was designed to compare the CALM intervention and usual care for both principal and comorbid disorders “while mimicking real-world conditions” — and is the first to do so in a generalizable sample population.

The study is published in the April issue of Archives of General Psychiatry.

Learning to Stay CALM

The investigators note that it is common for people with anxiety disorders to seek treatment in primary care, “where evidence-based mental health treatments often are unavailable or suboptimally delivered.”

For this study, 1004 patients (70.9% female; mean age, 43.7 years) diagnosed as having GAD (n = 549), PD (n = 262), SAD (n = 132), or posttraumatic stress disorder (PTSD; n = 61) were enrolled at 1 of 17 primary care clinics in Seattle, Washington, San Diego, California, Los Angeles, California, or Little Rock, Arkansas, between 2006 and 2008.

The patients were randomized to receive either the CALM intervention (n = 503) for up to 12 months or usual care (n = 501).

Usual care consisted of continued treatment of medication and/or counseling by the current primary care physician and referral to a mental health specialist, if needed.

The CALM intervention included pharmacotherapy, computer-assisted CBT, or both, depending on patient preference.

“Given the relative dearth of highly trained mental health providers available in primary care settings, we designed the CBT program to be used by persons with minimal or no training in mental health,” report the researchers, adding that that the computerized program was developed to guide both the provider and patient.

The collaborative care pharmacotherapy model allowed patients to continue being treated by their primary care physicians while healthcare managers or anxiety clinical specialists relayed advice from psychiatrists and helped manage medications.

All study participants were evaluated at baseline and at follow-ups conducted by telephone survey 6, 12, and 18 months later.

Measurement tools included the Generalized Anxiety Disorder Severity Scale, Panic Disorder Severity–Self-report Scale, Social Phobia Inventory, and PTSD Checklist–Civilian Version. These tools for used to assess both GADs and comorbidities.

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