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).

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"

Handouts & questionnaires for “outcomes toolkit” (IAPT)

The "Improving Access to Psychological Therapies" (IAPT) initiative is very ambitious and exciting.  It states its principal aim is to support English Primary Care Trusts in implementing "National Institute for Health and Clinical Excellence" (NICE) guidelines for people suffering from depression and anxiety disorders.  IAPT go on to say that "At present, only a quarter of the 6 million people in the UK with these conditions are in treatment, with debilitating effects on society."

One aspect of this carefully planned initiative is strong encouragement to assess and monitor the progress of those who are getting help.  Visiting the IAPT "Outcomes Toolkit and FAQ" web page provides access to several freely downloadable documents.  The emphasis is on good assessment measures that are free to use.  See below:

IAPT Outcomes Toolkit 2008/9 PDF - this 81 page 1.1Mb Adobe PDF is the September 08 version with amended IAPT Paper Based Data Set Questionnaires.

Things should be made as simple as possible, but no simpler.
- Einstein

Panic disorder

Panic disorder

 

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