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).

Here are six recent papers on CBT treatment for a variety of disorders - for fuller details, abstracts and links, see further down this page.  Lamb et al explored the value of "Group cognitive behavioural treatment for low-back pain in primary care".  That their results were reported in the Lancet, highlights the importance of their findings.  The active treatment group received an additional assessment and then six 1.5 hour group therapy sessions (average group size, eight participants).  Therapy focused on "guided discovery, identifying and countering negative automatic thoughts, pacing, graded activity, relaxation, and other skills."   Outcomes demonstrated that "Over 1 year, the cognitive behavioural intervention had a sustained effect on troublesome subacute and chronic low-back pain at a low cost to the health-care provider."

Nearly every year for the last twenty years I've come down to a four day Spring residential "Mixed Group" in Cumbria.  I wrote about this group last year and the year before, and I'm also involved with a similar pattern of autumn "Men's Groups".

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.

Emotional reappraisal (changing the way we see a situation) and emotional suppression (inhibiting our already present emotional response) have very different effects on our feelings, relationships and wellbeing.  As a generalisation, reappraisal tends to work well, while suppression comes at higher cost.  I wrote about this last month  in a first post on James Gross's Psychophysiology Lab at Stanford . I went on, in a subsequent post, to put together a handout on reappraisal entitled Getting a better perspective.

Because there is so much interesting research being conducted at the Stanford Lab, I thought it worthwhile to write a further post mentioning some of this other work.  The webpage detailing their current research projects mentions nine different areas.  These include the following descriptions:

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.  

Note this list of resources has been updated ... see the "Good Knowledge" section's folder on "Social anxiety information & assessment".  It is also worth clicking on "social anxiety" in the "Tag Cloud".

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.

This week's recent research post is a mixed bag of six studies covering the physiological & psychological changes triggered by being separated from one's partner, why similar levels of anxiety & interpersonal sensitivity can lead to social anxiety in some individuals and paranoia in others, how difficulty identifying feelings is associated with increased somatization, the frequency of burnout in family doctors around Europe, personality factors that predict a longer life, and how wrong the old saying is that "Sticks & stones may break my bones, but words will never hurt me"!