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Journal ArticleDOI

A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder.

01 Jun 1994-British Journal of Psychiatry (Br J Psychiatry)-Vol. 164, Iss: 6, pp 759-769
TL;DR: C cognitive therapy was superior to both applied relaxation and imipramine on most measures and self-exposure homework assignments taken at the end of treatment were significant predictors of outcome at follow-up.
Abstract: Recent studies have shown that cognitive therapy is an effective treatment for panic disorder. However, little is known about how cognitive therapy compares with other psychological and pharmacological treatments. To investigate this question 64 panic disorder patients were initially assigned to cognitive therapy, applied relaxation, imipramine (mean 233 mg/day), or a 3-month wait followed by allocation to treatment. During treatment patients had up to 12 sessions in the first 3 months and up to three booster sessions in the next 3 months. Imipramine was gradually withdrawn after 6 months. Each treatment included self-exposure homework assignments. Cognitive therapy and applied relaxation sessions lasted one hour. Imipramine sessions lasted 25 minutes. Assessments were before treatment/wait and at 3, 6, and 15 months. Comparisons with waiting-list showed all three treatments were effective. Comparisons between treatments showed that at 3 months cognitive therapy was superior to both applied relaxation and imipramine on most measures. At 6 months cognitive therapy did not differ from imipramine and both were superior to applied relaxation on several measures. Between 6 and 15 months a number of imipramine patients relapsed. At 15 months cognitive therapy was again superior to both applied relaxation and imipramine but on fewer measures than at 3 months. Cognitive measures taken at the end of treatment were significant predictors of outcome at follow-up.
Citations
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Journal ArticleDOI
TL;DR: It is suggested that, in evaluating the benefits of a given treatment, the greatest weight should be given to efficacy trials but that these trials should be followed by research on effectiveness in clinical settings and with various populations and by cost-effectiveness research.
Abstract: A scheme is proposed for determining when a psychological treatment for a specific problem or disorder may be considered to be established in efficacy or to be possibly efficacious. The importance of independent replication before a treatment is established in efficacy is emphasized, and a number of factors are elaborated that should be weighed in evaluating whether studies supporting a treatment's efficacy are sound. It is suggested that, in evaluating the benefits of a given treatment, the greatest weight should be given to efficacy trials but that these trials should be followed by research on effectiveness in clinical settings and with various populations and by cost-effectiveness research.

2,728 citations


Cites background from "A comparison of cognitive therapy, ..."

  • ...For example, cognitive therapy for panic has fared better (relative to pharmacotherapy) when it has been implemented by knowledgeable experts ( Clark et al., 1994 ) than when it has not ( Black, Wesner, Bowers, & Gabel, 1993 ). Conversely,...

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  • ...For example, cognitive therapy for panic has fared better (relative to pharmacotherapy) when it has been implemented by knowledgeable experts (Clark et al., 1994) than when it has not (Black, Wesner, Bowers, & Gabel, 1993)....

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Journal ArticleDOI
15 Sep 2016
TL;DR: An overview of the current evidence of major depressive disorder, including its epidemiology, aetiology, pathophysiology, diagnosis and treatment, is provided.
Abstract: Major depressive disorder (MDD) is a debilitating disease that is characterized by depressed mood, diminished interests, impaired cognitive function and vegetative symptoms, such as disturbed sleep or appetite. MDD occurs about twice as often in women than it does in men and affects one in six adults in their lifetime. The aetiology of MDD is multifactorial and its heritability is estimated to be approximately 35%. In addition, environmental factors, such as sexual, physical or emotional abuse during childhood, are strongly associated with the risk of developing MDD. No established mechanism can explain all aspects of the disease. However, MDD is associated with alterations in regional brain volumes, particularly the hippocampus, and with functional changes in brain circuits, such as the cognitive control network and the affective-salience network. Furthermore, disturbances in the main neurobiological stress-responsive systems, including the hypothalamic-pituitary-adrenal axis and the immune system, occur in MDD. Management primarily comprises psychotherapy and pharmacological treatment. For treatment-resistant patients who have not responded to several augmentation or combination treatment attempts, electroconvulsive therapy is the treatment with the best empirical evidence. In this Primer, we provide an overview of the current evidence of MDD, including its epidemiology, aetiology, pathophysiology, diagnosis and treatment.

1,728 citations

Journal ArticleDOI
TL;DR: The evidence indicates that neither the degree by which fear reduces nor the ending fear level predict therapeutic outcome, and strategies for enhancing inhibitory learning, and its retrieval over time and context, are reviewed.

1,219 citations


Cites background from "A comparison of cognitive therapy, ..."

  • ...…propose that cognitive shifts mediate the efficacy of exposure therapy, and some provide supportive empirical evidence, such as the match–mismatch theory (Taylor & Rachman, 1994) and cognitive reappraisal models (e.g., Clark et al., 1994; Hofmann, 2004). original excitatory meaning (CS–...

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Journal ArticleDOI
TL;DR: A three-stage schema-based information processing model of anxiety is described that involves the initial registration of a threat stimulus, the activation of a primal threat mode, and the secondary activation of more elaborative and reflective modes of thinking.

1,167 citations

References
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Journal ArticleDOI
TL;DR: The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out and a wide variety of psychiatric rating scales have been developed.
Abstract: The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out by a number of authors. Pasamanick12in a recent article viewed the low interclinician agreement on diagnosis as an indictment of the present state of psychiatry and called for "the development of objective, measurable and verifiable criteria of classification based not on personal or parochial considerations, but on behavioral and other objectively measurable manifestations." Attempts by other investigators to subject clinical observations and judgments to objective measurement have resulted in a wide variety of psychiatric rating scales.4,15These have been well summarized in a review article by Lorr11on "Rating Scales and Check Lists for the Evaluation of Psychopathology." In the area of psychological testing, a variety of paper-and-pencil tests have been devised for the purpose of measuring specific

35,176 citations

Journal ArticleDOI
TL;DR: Un nouvel inventaire auto-administre destine a mesurer l'anxiete pathologique, le «Beck Anxiety Cheklist» (BAI) est decrit, evalue et compare au «Hamilton Anxiety Rating Scale» (test avec lequel des correlations moderees sont trouvees).
Abstract: Un nouvel inventaire auto-administre destine a mesurer l'anxiete pathologique, le «Beck Anxiety Cheklist» (BAI) est decrit, evalue et compare au «Hamilton Anxiety Rating Scale» (test avec lequel des correlations moderees sont trouvees)

11,139 citations

Book
01 Jan 1984
TL;DR: This chapter discusses the nature of Behavioral Research, the development and testing of research ideas, and the selection of subjects and Stimuli for experiments.
Abstract: PART I: EMPIRICAL INQUIRY AND DECISION CRITERIACHAPTER 1: The Nature of Behavioral ResearchCHAPTER 2: Development and Testing of Research IdeasCHAPTER 3: Standards of Reliability and ValidityPART II: NATURE AND LIMITATIONS OF CONTROL PROCEDURESCHAPTER 4: Structure and Logic of Experimental DesignsCHAPTER 5: Models of Quasi-Experimental DesignsCHAPTER 6: Subject-Experimenter Artifacts and Their ControlPART III: DATA COLLECTION AND MEASUREMENT PROCEDURESCHAPTER 7: Further Strategies for Gathering DataCHAPTER 8: Systematic Observation, Unobtrusive Measures, and Rating FormatsCHAPTER 9: Interviews, Questionnaires, and Self-Recorded DiariesPART IV: BASIC ISSUES IN THE IMPLEMENTATION OF RESEARCHCHAPTER 10: Considerations in the Selection of Subjects and StimuliCHAPTER 11: Ethics and Values in Human Subject ResearchCHAPTER 12: Systematic Pluralism and Statistical Data AnalysisPART V: FUNDAMENTALS OF DATA ANALYSISCHAPTER 13: Describing and Displaying DataCHAPTER 14: CorrelationCHAPTER 15: Comparing MeansPART VI: MORE ON ANALYSIS OF VARIANCECHAPTER 16: Factorial Design of ExperimentsCHAPTER 17: Interaction EffectsCHAPTER 18: Repeated-Measures DesignsPART VII: POWER AND FOCUSED ANALYSESCHAPTER 19: Assessing and Increasing PowerCHAPTER 20: Blocking and the Increase of PowerCHAPTER 21: Contrast Analysis: An IntroductionPART VIII: ADDITIONAL TOPICS IN DATA ANALYSISCHAPTER 22: Meta-Analysis: Comparing and Combining ResultsCHAPTER 23: Chi-Square and the Analysis of TablesCHAPTER 24: Multivariate Procedures

3,782 citations

Journal ArticleDOI
TL;DR: The proposed cognitive model of panic is described, which is consistent with the nature of the cognitive disturbance in panic patients, the perceived sequence of events in an attack, the occurrence of ‘spontaneous’ attacks, the role of hyperventilation in attacks,The effects of sodium lactate and the literature on psychological and pharmacological treatments.

2,222 citations


"A comparison of cognitive therapy, ..." refers background or methods in this paper

  • ...Prediction of long-term outcome The cognitive theory of panic predicts that long-term outcome will depend on the extent to which interpretations of bodily sensations have changed during treatment (Clark, 1986)....

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  • ...It is based on the cognitive theory of panic disorder (Beck et al, 1985; Clark, 1986; Ehlers et a!, 1986; Salkovskis, 1988) which proposesthat individuals who experiencere current panic attacks do so becausethey have an enduring tendency to misinterpret benign bodily sensationsasindicationsof an…...

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  • ...The cognitive theory of panic predictsthatsustainedimprovementaftertheend of any treatment (whether psychologicalor pharma cological) will depend on cognitive change having occurred uringthecourseoftherapy(Clark,1986)....

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Journal ArticleDOI
TL;DR: A one-page self-rating form is described to monitor change in phobia patients, derived from earlier versions used in 1000 phobic club members and 300 phobic patients, which is short, reliable and valid.

1,769 citations


"A comparison of cognitive therapy, ..." refers methods in this paper

  • ...763COMPARISONOF TREATMENTSOF PANIC DISORDER Avoidance was assessedby a modified version of the Fear Questionnaire (Marks & Mathews, 1979) which has three avoidance subscales (agoraphobia, social phobia, and blood-injury phobia)....

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