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Bunmi O Olatunji - One of the best experts on this subject based on the ideXlab platform.
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efficacy of cognitive behavioral therapy for Anxiety Disorders a review of meta analytic findings
Psychiatric Clinics of North America, 2010Co-Authors: Bunmi O Olatunji, Josh M Cisler, Brett J DeaconAbstract:Numerous clinical trials have supported the efficacy of cognitive behavioral therapy (CBT) for the treatment of Anxiety Disorders. Accordingly, CBT has been formally recognized as an empirically supported treatment for Anxiety-related conditions. This article reviews the evidence supporting the efficacy of CBT for Anxiety Disorders. Specifically, contemporary meta-analytic studies on the treatment of Anxiety Disorders are reviewed and the efficacy of CBT is examined. Although the specific components of CBT differ depending on the study design and the Anxiety disorder treated, meta-analyses suggest that CBT procedures (particularly exposure-based approaches) are highly efficacious. CBT generally outperforms wait-list and placebo controls. Thus, CBT provides incremental efficacy above and beyond nonspecific factors. For some Anxiety Disorders, CBT also tends to outperform other psychosocial treatment modalities. The implications of available meta-analytic findings in further delineating the efficacy and dissemination of CBT for Anxiety Disorders are discussed.
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Anxiety sensitivity and the Anxiety Disorders a meta analytic review and synthesis
Psychological Bulletin, 2009Co-Authors: Bunmi O Olatunji, Kate B WolitzkytaylorAbstract:There has been significant interest in the role of Anxiety sensitivity (AS) in the Anxiety Disorders. In this meta-analysis, we empirically evaluate differences in AS between Anxiety Disorders, mood Disorders, and nonclinical controls. A total of 38 published studies (N = 20,146) were included in the analysis. The results yielded a large effect size indicating greater AS among Anxiety disorder patients versus nonclinical controls (d = 1.61). However, this effect was maintained only for panic disorder patients compared to mood disorder patients (d = 0.85). Panic disorder was also associated with greater AS compared to other Anxiety Disorders except for posttraumatic stress disorder (d = 0.04). Otherwise the Anxiety Disorders generally did not differ from each other in AS. Although these findings suggest that AS is central to the phenomenology of panic disorder and posttraumatic stress disorder, causal inferences regarding the role of AS in these Anxiety Disorders cannot be made. Moderator analyses showed that a greater proportion of female participants was associated with larger differences in AS between Anxiety and nonclinical control groups. However, more female participants were associated with a smaller AS difference between Anxiety and mood disorder groups. This finding suggests that AS is less robust in distinguishing Anxiety from mood Disorders among women. Age also moderated some observed effects such that AS was more strongly associated with Anxiety Disorders in adults compared to children. Type of AS measure used also moderated some effects. Implications of these findings for the conceptualization of AS in Anxiety-related Disorders are discussed.
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quality of life in the Anxiety Disorders a meta analytic review
Clinical Psychology Review, 2007Co-Authors: Bunmi O Olatunji, Josh M Cisler, David F TolinAbstract:There has been significant interest in the impact of Anxiety Disorders on quality of life. In this meta-analytic review, we empirically evaluate differences in quality of life between patients with Anxiety Disorders and nonclinical controls. Thirty-two patient samples from 23 separate studies (N=2892) were included in the analysis. The results yielded a large effect size indicating poorer quality of life among Anxiety disorder patients vs. controls and this effect was observed across all Anxiety Disorders. Compared to control samples, no Anxiety disorder diagnosis was associated with significantly poorer overall quality of life than was any other Anxiety disorder diagnosis. Examination of specific domains of QOL suggests that impairments may be particularly prominent among patients with post-traumatic stress disorder. QOL domains of mental health and social functioning were associated with the highest levels of impairment among Anxiety disorder patients. These findings are discussed in the context of future research on the assessment of quality of life in the Anxiety Disorders.
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health Anxiety hypochondriasis and the Anxiety Disorders
Behavior Therapy, 2007Co-Authors: Jonathan S. Abramowitz, Bunmi O Olatunji, Brett J DeaconAbstract:Although clinical observations suggest that health-related Anxiety is present, to some extent, in a number of Anxiety Disorders, this relationship has not been examined empirically. The present study therefore utilized the Short Health Anxiety Inventory (SHAI) to elucidate the structure of such symptoms among patients with Anxiety Disorders and to empirically investigate the presence of health Anxiety in various Anxiety Disorders. Confirmatory factor analysis yielded equivalent support for either a 2-factor or 3-factor model of the SHAI’s latent structure. The measure demonstrated good reliability, convergent validity, and discriminant validity. Comparison of SHAI scores across groups of patients with various Anxiety Disorders revealed elevated levels of health Anxiety among patients with hypochondriasis and panic disorder relative to those with other Anxiety Disorders. Receiver operating characteristic analyses supported the utility of the SHAI as a diagnostic tool for screening patients with hypochondriasis utilizing empirically derived cut scores. Findings are discussed in terms of cognitive-behavioral models of Anxiety Disorders.
Daniel S Pine - One of the best experts on this subject based on the ideXlab platform.
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attention network functioning in children with Anxiety Disorders attention deficit hyperactivity disorder and non clinical Anxiety
Psychological Medicine, 2015Co-Authors: Karin Mogg, Daniel S Pine, Giovanni Abrahao Salum, Brendan P Bradley, Ary Gadelha, Pedro Mario Pan, P Alvarenga, Luis Augusto Rohde, Gisele Gus ManfroAbstract:Background Research with adults suggests that Anxiety is associated with poor control of executive attention. However, in children, it is unclear (a) whether Anxiety Disorders and non-clinical Anxiety are associated with deficits in executive attention, (b) whether such deficits are specific to Anxiety versus other psychiatric Disorders, and (c) whether there is heterogeneity among Anxiety Disorders (in particular, specific phobia versus other Anxiety Disorders). Method We examined executive attention in 860 children classified into three groups: Anxiety Disorders (n = 67), attention-deficit/hyperactivity disorder (ADHD; n = 67) and no psychiatric disorder (n = 726). Anxiety Disorders were subdivided into: Anxiety Disorders excluding specific phobia (n = 43) and specific phobia (n = 21). The Attention Network Task was used to assess executive attention, alerting and orienting. Results Findings indicated heterogeneity among Anxiety Disorders, as children with Anxiety Disorders (excluding specific phobia) showed impaired executive attention, compared with disorder-free children, whereas children with specific phobia showed no executive attention deficit. Among disorder-free children, executive attention was less efficient in those with high, relative to low, levels of Anxiety. There were no Anxiety-related deficits in orienting or alerting. Children with ADHD not only had poorer executive attention than disorder-free children, but also higher orienting scores, less accurate responses and more variable response times. Conclusions Impaired executive attention in children (reflected by difficulty inhibiting processing of task-irrelevant information) was not fully explained by general psychopathology, but instead showed specific associations with Anxiety Disorders (other than specific phobia) and ADHD, as well as with high levels of Anxiety symptoms in disorder-free children.
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pediatric Anxiety Disorders from neuroscience to evidence based clinical practice
Revista Brasileira de Psiquiatria, 2013Co-Authors: Giovanni Abrahao Salum, Daniel S Pine, Diogo Araujo Desousa, Maria Conceicao Do Rosario, Gisele Gus ManfroAbstract:The objective of this narrative review of the literature is to describe the epidemiology, etiology, pathophysiology, diagnosis, and treatment of pediatric Anxiety Disorders. We aim to guide clinicians in understanding the biology of Anxiety Disorders and to provide general guidelines for the proper diagnoses and treatment of these conditions early in life. Anxiety Disorders are prevalent, associated with a number of negative life outcomes, and currently under-recognized and under-treated. The etiology involves both genes and environmental influences modifying the neural substrate in a complex interplay. Research on pathophysiology is still in its infancy, but some brain regions, such as the amygdala and the prefrontal cortex, have been implicated in fear and Anxiety. Current practice is to establish diagnosis based purely on clinical features, derived from clinical interviews with the child, parents, and teachers. Treatment is effective using medication, cognitive behavioral therapy, or a combination of both. An introduction to the neuroscience behind Anxiety Disorders combined with an evidence-based approach may help clinicians to understand these Disorders and treat them properly in childhood.
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autism spectrum disorder scale scores in pediatric mood and Anxiety Disorders
Journal of the American Academy of Child and Adolescent Psychiatry, 2008Co-Authors: Daniel S Pine, Amanda E Guyer, Michelle Goldwin, Kenneth A Towbin, Ellen LeibenluftAbstract:ABSTRACT Objective: To compare scores on autism spectrum disorder (ASD) symptom scales in healthy youths and youths with mood or Anxiety Disorders. Method: A total of 352 youths were recruited (107 healthy participants, 88 with an Anxiety disorder, 32 with major depressive disorder, 62 with bipolar disorder, and 63 with a mood disorder characterized by severe nonepisodic irritability). Participants received structured psychiatric interviews and parent ratings on at least one of three ASD symptom scales: Children's Communication Checklist, Social Communication Questionnaire, and Social Responsiveness Scale. Results: Relative to healthy youths, youths with mood or Anxiety Disorders exhibited higher scores on each ASD symptom scale. ASD symptom scale scores also showed an association with impairment severity and attention-deficit/hyperactivity disorder. Among patients with mood Disorders but not those with Anxiety Disorders, consistent, statistically significant associations between diagnosis and ASD symptom scale scores remained even after controlling for potential confounders. Conclusions: Patients with mood Disorders exhibit higher scores on ASD symptom scales than healthy youths or youths with Anxiety Disorders. These data should alert clinicians to the importance of assessing ASD symptoms to identify social reciprocity and communication deficits as possible treatment targets in pediatric mood and Anxiety Disorders.
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fear conditioning in adolescents with Anxiety Disorders results from a novel experimental paradigm
Journal of the American Academy of Child and Adolescent Psychiatry, 2008Co-Authors: Jennifer Y F Lau, Shmuel Lissek, Eric E Nelson, Yoon Lee, Roxann Robersonnay, Kaitlin Poeth, Jessica L Jenness, Monique Ernst, Christian Grillon, Daniel S PineAbstract:Objective Considerable research examines fear conditioning in adult Anxiety Disorders but few studies examine youths. Adult data suggest that Anxiety Disorders involve elevated fear but intact differential conditioning. We used a novel paradigm to assess fear conditioning in pediatric Anxiety patients.
Brett J Deacon - One of the best experts on this subject based on the ideXlab platform.
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efficacy of cognitive behavioral therapy for Anxiety Disorders a review of meta analytic findings
Psychiatric Clinics of North America, 2010Co-Authors: Bunmi O Olatunji, Josh M Cisler, Brett J DeaconAbstract:Numerous clinical trials have supported the efficacy of cognitive behavioral therapy (CBT) for the treatment of Anxiety Disorders. Accordingly, CBT has been formally recognized as an empirically supported treatment for Anxiety-related conditions. This article reviews the evidence supporting the efficacy of CBT for Anxiety Disorders. Specifically, contemporary meta-analytic studies on the treatment of Anxiety Disorders are reviewed and the efficacy of CBT is examined. Although the specific components of CBT differ depending on the study design and the Anxiety disorder treated, meta-analyses suggest that CBT procedures (particularly exposure-based approaches) are highly efficacious. CBT generally outperforms wait-list and placebo controls. Thus, CBT provides incremental efficacy above and beyond nonspecific factors. For some Anxiety Disorders, CBT also tends to outperform other psychosocial treatment modalities. The implications of available meta-analytic findings in further delineating the efficacy and dissemination of CBT for Anxiety Disorders are discussed.
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health Anxiety hypochondriasis and the Anxiety Disorders
Behavior Therapy, 2007Co-Authors: Jonathan S. Abramowitz, Bunmi O Olatunji, Brett J DeaconAbstract:Although clinical observations suggest that health-related Anxiety is present, to some extent, in a number of Anxiety Disorders, this relationship has not been examined empirically. The present study therefore utilized the Short Health Anxiety Inventory (SHAI) to elucidate the structure of such symptoms among patients with Anxiety Disorders and to empirically investigate the presence of health Anxiety in various Anxiety Disorders. Confirmatory factor analysis yielded equivalent support for either a 2-factor or 3-factor model of the SHAI’s latent structure. The measure demonstrated good reliability, convergent validity, and discriminant validity. Comparison of SHAI scores across groups of patients with various Anxiety Disorders revealed elevated levels of health Anxiety among patients with hypochondriasis and panic disorder relative to those with other Anxiety Disorders. Receiver operating characteristic analyses supported the utility of the SHAI as a diagnostic tool for screening patients with hypochondriasis utilizing empirically derived cut scores. Findings are discussed in terms of cognitive-behavioral models of Anxiety Disorders.
Michelle G Craske - One of the best experts on this subject based on the ideXlab platform.
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a longitudinal examination of stress generation in depressive and Anxiety Disorders
Journal of Abnormal Psychology, 2012Co-Authors: Amanda A Uliaszek, Richard E Zinbarg, Michelle G Craske, Susan Mineka, James W Griffith, Jonathan M Sutton, Alyssa Epstein, Constance HammenAbstract:The current study compared two competing theories of the stress generation model of depression (stress causation vs. stress continuation) using interview-based measures of episodic life stress, as well as interpersonal and noninterpersonal chronic life stress. We also expanded on past research by examining Anxiety Disorders as well as depressive Disorders. In addition, we examined the role of neuroticism and extraversion in these relationships. Participants were 627 adolescents enrolled in a two-site, longitudinal study of risk factors for depressive and Anxiety Disorders. Baseline and follow-up assessments were approximately one year apart. Results supported the stress causation theory for episodic stress generation for Anxiety Disorders, with neuroticism partially accounting for this relationship. The stress causation theory was also supported for depression, but only for more moderate to severe stressors; neuroticism partially accounted for this relationship as well. Finally, we found evidence for interpersonal and noninterpersonal chronic life stress continuation in both depressive and Anxiety Disorders. The present findings have implications regarding the specificity of the stress generation model to depressive Disorders, as well as variables involved in the stress generation process.
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Anxiety Disorders in older adults a comprehensive review
Depression and Anxiety, 2010Co-Authors: Kate Wolitzkytaylor, M Natalie A Castriotta, J Eric M D Lenze, Melinda A Stanley, Michelle G CraskeAbstract:This review aims to address issues unique to older adults with Anxiety Disorders in order to inform potential changes in the DSM-V. Prevalence and symptom expression of Anxiety Disorders in late life, as well as risk factors, comorbidity, cognitive decline, age of onset, and treatment efficacy for older adults are reviewed. Overall, the current literature suggests: (a) Anxiety Disorders are common among older age individuals, but less common than in younger adults; (b) overlap exists between Anxiety symptoms of younger and older adults, although there are some differences as well as limitations to the assessment of symptoms among older adults; (c) Anxiety Disorders are highly comorbid with depression in older adults; (d) Anxiety Disorders are highly comorbid with a number of medical illnesses; (e) associations between cognitive decline and Anxiety have been observed; (f) late age of onset is infrequent; and (g) both pharmacotherapy and CBT have demonstrated efficacy for older adults with Anxiety. The implications of these findings are discussed and recommendations for the DSM-Vare provided, including extending the text section on age-specific features of Anxiety Disorders in late life and providing information about the complexities of diagnosing Anxiety Disorders in older adults. Depression and Anxiety 27:190–211, 2010. r 2010 Wiley-Liss, Inc.
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functional impact and health utility of Anxiety Disorders in primary care outpatients
Medical Care, 2005Co-Authors: Murray B. Stein, Peter Roybyrne, Michelle G Craske, Alexander Bystritsky, Greer Sullivan, Jeffrey M Pyne, Wayne Katon, Cathy D SherbourneAbstract:OBJECTIVE: The objective of this study was to examine the relative impact of Anxiety Disorders and major depression on functional status and health-related quality of life of primary care outpatients. METHOD: Four hundred eighty adult outpatients at an index visit to their primary care provider were classified by structured diagnostic interview as having Anxiety Disorders (panic disorder with or without agoraphobia, social phobia, and posttraumatic stress disorder; generalized Anxiety disorder was also assessed in a subset) with or without major depression. Functional status, sick days from work, and health-related quality of life (including a preference-based measure) were assessed using standardized measures adjusting for the impact of comorbid medical illnesses. Relative impact of the various Anxiety Disorders and major depression on these indices was evaluated. RESULTS: In multivariate regression analyses simultaneously adjusting for age, sex, number of chronic medical conditions, education, and/or poverty status, each of major depression, panic disorder, posttraumatic stress disorder, and social phobia contributed independently and relatively equally to the prediction of disability and functional outcomes. Generalized Anxiety disorder had relatively little impact on these indices when the effects of comorbid major depression were considered. Overall, Anxiety Disorders were associated with substantial decrements in preference-based health states. CONCLUSIONS: These observations demonstrate that the presence of each of 3 common Anxiety Disorders (ie, panic disorder, posttraumatic stress disorder, and social phobia)-over and above the impact of chronic physical illness, major depression, and other socioeconomic factors-contributes in an approximately additive fashion to the prediction of poor functioning, reduced health-related quality of life, and more sick days from work. Greater awareness of the deleterious impact of Anxiety Disorders in primary care is warranted.
Murray B. Stein - One of the best experts on this subject based on the ideXlab platform.
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relationship of Anxiety Disorders sleep quality and functional impairment in a community sample
Journal of Psychiatric Research, 2009Co-Authors: Holly J Ramsawh, Murray B. Stein, Shaylee Belik, Frank Jacobi, Jitender SareenAbstract:Background: Anxiety Disorders and insomnia are each prevalent, impairing, and highly comorbid. However, little is known about whether specific types of sleep complaints are associated with specific Anxiety Disorders, and whether poor sleep has an additive effect on functional impairment in Anxiety Disorders. Method: Data from the German Health Survey (GHS; N = 4181; ages 18–65) were utilized to examine relationships among Anxiety Disorders, sleep quality (assessed by the Pittsburgh Sleep Quality Inventory; PSQI), and functional impairment (assessed by the Medical Outcomes Scale Short Form; SF-36; and pastmonth disability days due to physical and emotional problems, respectively). Results: Most Anxiety Disorders were significantly associated with global PSQI scores. Social phobia (AOR 3.95, 95% CI 1.73–9.04) and GAD (AOR 3.94, 95% CI 1.66–9.34) had the strongest relationships with global PSQI scores. Daytime dysfunction was the PSQI subscale most strongly associated with Anxiety Disorders, particularly GAD. Having a comorbid Anxiety disorder and poor sleep was associated with significantly lower Mental Component Scores on the SF-36 than having an Anxiety disorder alone (40.87 versus 43.87, p = .011) and with increased odds of one or more disability days due to emotional problems (AOR 2.72, 95% CI 1.35–5.48), even after controlling for sociodemographic factors and past-month mood and substance use Disorders. Conclusions: Most Anxiety Disorders are moderately associated with reduced sleep quality. Individuals with Anxiety Disorders and poor sleep experience significantly worse mental health-related quality of life and increased disability relative to those with Anxiety Disorders alone.
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Role of corticotropin releasing factor in Anxiety Disorders: a translational research perspective.
Hormones and behavior, 2006Co-Authors: Victoria B. Risbrough, Murray B. SteinAbstract:Anxiety Disorders are a group of mental Disorders that include generalized Anxiety disorder (GAD), panic disorder, phobic Disorders (e.g., specific phobias, agoraphobia, social phobia) and posttraumatic stress disorder (PTSD). Anxiety Disorders are among the most common of all mental Disorders and, when coupled with an awareness of the disability and reduced quality of life they convey, they must be recognized as a serious public health problem. Over 20 years of preclinical studies point to a role for the CRF system in Anxiety and stress responses. Clinical studies have supported a model of CRF dysfunction in depression and more recently a potential contribution to specific Anxiety Disorders (i.e., panic disorder and PTSD). Much work remains in both the clinical and preclinical fields to inform models of CRF function and its contribution to Anxiety. First, we will review the current findings of CRF and HPA axis abnormalities in Anxiety Disorders. Second, we will discuss startle reflex measures as a tool for translational research to determine the role of the CRF system in development and maintenance of clinical Anxiety.
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functional impact and health utility of Anxiety Disorders in primary care outpatients
Medical Care, 2005Co-Authors: Murray B. Stein, Peter Roybyrne, Michelle G Craske, Alexander Bystritsky, Greer Sullivan, Jeffrey M Pyne, Wayne Katon, Cathy D SherbourneAbstract:OBJECTIVE: The objective of this study was to examine the relative impact of Anxiety Disorders and major depression on functional status and health-related quality of life of primary care outpatients. METHOD: Four hundred eighty adult outpatients at an index visit to their primary care provider were classified by structured diagnostic interview as having Anxiety Disorders (panic disorder with or without agoraphobia, social phobia, and posttraumatic stress disorder; generalized Anxiety disorder was also assessed in a subset) with or without major depression. Functional status, sick days from work, and health-related quality of life (including a preference-based measure) were assessed using standardized measures adjusting for the impact of comorbid medical illnesses. Relative impact of the various Anxiety Disorders and major depression on these indices was evaluated. RESULTS: In multivariate regression analyses simultaneously adjusting for age, sex, number of chronic medical conditions, education, and/or poverty status, each of major depression, panic disorder, posttraumatic stress disorder, and social phobia contributed independently and relatively equally to the prediction of disability and functional outcomes. Generalized Anxiety disorder had relatively little impact on these indices when the effects of comorbid major depression were considered. Overall, Anxiety Disorders were associated with substantial decrements in preference-based health states. CONCLUSIONS: These observations demonstrate that the presence of each of 3 common Anxiety Disorders (ie, panic disorder, posttraumatic stress disorder, and social phobia)-over and above the impact of chronic physical illness, major depression, and other socioeconomic factors-contributes in an approximately additive fashion to the prediction of poor functioning, reduced health-related quality of life, and more sick days from work. Greater awareness of the deleterious impact of Anxiety Disorders in primary care is warranted.