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Sleep apnea: how is it recognised & what can be done about it?

I have already written a couple of posts on sleep apnea -"Sleep apnea - what is it, how common is it and how does it affect mortality & physical health?" and "Sleep apnea - how does it affect psychological health?".  In this third & last post of the sequence, I'll explore how we can recognise sleep apnea and what we can do about it.

Sleep apnea - how does it affect psychological health?

I have already written a first post "Sleep apnea - what is it, how common is it and how does it affect mortality & physical health?" which highlights that sleep apnea is a common, regularly unrecognised disorder, occurring in approaching 1 in 5 adults and that, particularly as it becomes more severe - probably approximately 1 in 10 sufferers (Li et al, 2015) - sleep apnea is linked with a wide range of serious diseases and with significantly increased death rates.  In this second post, I'll look at the relevance of sleep apnea for psychiatric disorders.

Maximizing exposure therapy

Michelle Craske & colleagues from the Anxiety Disorders Research Center of UCLA have, for many years, been publishing careful, challenging research on underlying mechanisms & on ways of boosting the effectiveness of exposure therapies for different forms of anxiety.  Craske's list of publications & research presentations runs to 31 pages and begins with a study on musical performance anxiety published in 1984.  As the presentation titles on her list show, for some years the majority of her many lectures at prestigious conferences all over the world have revolved around the theme of how to take evolving scientific findings about fear learning and use them to optimize exposure treatments for anxiety disorders.

BABCP spring meeting: David Barlow's unified protocol - emotional avoidance, edb's & physical sensation tolerance (fifth post)

This is the fifth in a series of posts about David Barlow & colleagues' new unified protocol for treatment of anxiety, depression & related emotional disorders.  The fourth post was on "Emotional awareness training & cognitive reappraisal" and this one is on the fifth & sixth modules in the eight module training - "Emotional avoidance & emotion driven behaviours (EDB's)" (typically taking one to three treatment sessions) and "Awareness & tolerance of physical sensations" (typically taking just one treatment session).

New NICE guidance on the treatment of generalised anxiety disorder (GAD) and panic disorder (with or without agoraphobia)

In January, the National Institute for Health and Clinical Excellence (NICE) published their new evidence-based clinical guideline on the care and treatment of adults with generalised anxiety disorder (GAD) or panic disorder (with or without agoraphobia).  This guideline updates and replaces their 2004 one (which was itself amended in 2007).  The full 56 page guideline is available as a PDF and in Word format.  It also comes as a 24 page "Quick reference guide" for health professionals, and as a 16 page "Treating generalised anxiety disorder and pan

Handouts & questionnaires for improved assessment & monitoring of panic disorder

For quite some time, I've used Katherine Shear's "Panic Disorder Severity Scale (PDSS)" as my main way of assessing and monitoring the severity of panic disorder.  I've recently woken up to the fact that there is a specifically designed "Self Report" version of this scale.  It is copyrighted, but Dr Shear has given permission for clinicians to use the scale freely in their practice and for researchers to use it in non-industry settings.  For other uses of the scale, Dr Shear should be contacted.  Click on "Panic Disorder Severity Scale - Self Report (PDSS-SR)"  to download a PDF of this excellent assessment measure 

Recent research: two studies on panic, two on attention training for anxiety disorders, and three on the effects of child abuse

Here are seven recent papers on panic, attention training, and the effects of childhood sexual abuse (all details & abstracts to these studies are listed further down this blog post).  Pfaltz & colleagues report on a novel ambulatory respiratory monitoring system that seems to demonstrate that panic sufferers are not routinely suffering from breathing abnormalities (e.g. hyperventilation) when they go about their daily lives.  The CBT theory of panic disorder would go along with this - panic being seen as due, in part, to catastrophizing about the meaning of experienced physical sensations rather than due to simply having unusual physical sensations.  Shelby et al's paper extends this understanding concluding that with sufferers from non-cardiac chest pain (NCCP) "Chest pain and anxiety were directly related to greater disability and indirectly related to physical and psychosocial disability via pain catastrophizing.

Recent research: a mixed bag of six papers on anxiety

Here are half a dozen papers with anxiety relevance.  The first couple are about the interaction between genetic vulnerability (or resilience) and childhood experience.  The Stevens et al paper is an update on the large body of research looking at psychological genetic vulnerability/resilience in macaque monkeys and how this interacts with parenting quality to lead, or not lead, to emotional and neurophysiological disturbances in adulthood.  The Battaglia paper particularises this gene/environment investigation by looking at the connections between early human childhood separation anxiety, loss of a parent, and panic disorder in adulthood.  

Recent research: half a dozen studies on cognitive therapy

Here are half a dozen recent studies involving cognitive therapy (CBT).  The first by Craigie et al explores the use of mindfulness-based cognitive therapy (MBCT) to treat generalized anxiety disorder (GAD).  Although, as one would expect, MBCT helped GAD sufferers, it was noteworthy that results "fall well short of outcomes achieved by past research".  This adds to my concern that mindfulness training may at times be being over-hyped - see a blog I wrote in September for for more on this.  The next study by Cuijpers et al also suggests limitations to the march of CBT with interpersonal psychotherapy looking a somewhat better candidate for prevention of depression onset.  I guess one could argue that CBT can - and probably more often should - include  behavioural interventions to promote improved relationships.  Click here for tools that can help this approach.   The third piece of research by Grey et al is exciting.  It challenges the Alice in Wonderland dodo bird suggestion that "everyone has won, and all must have prizes"

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