Cognitive-behavioral treatment of panic disorder with agoraphobia

This paper reports a clinical case study on the effectiveness of Cognitive- Behavioral Treatment (CBT) in treating panic attack with agoraphobia in a local health psychology clinic. M.N., a 24 year old male, complained of nightmares, heart palpitations, sweating, tremors and fearful feelings for thepast one and a half years. He felt anxious about going to crowded places such as bus stations, night markets, supermarkets, and mosques and being left alone in any place which he was not familiar with. This case study adopted an ABC design whereby the subject was assessed at three different phases: pre-treatment, mid-treatment and post-treatment. Four standard assessment measures were administered: Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Anxiety Scale of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and State-Trait Anxiety Inventory (STAI). The subject responded well to 12 sessions of intervention employed in the study based on CBT model and this could be noticed by minimal score on the entire psychological test administered. The application of behavioral and cognitive strategies became more effective due to patient’s ability to understand and also due to his cooperative behavior. He responded well to imagery exposure and in-vivo gradual exposure and successfully went to shopping malls, used lifts at Kuala Lumpur Tower, went to night markets and used public transport

Research on experiential psychotherapies

Reviews research on experiential or humanistic psychotherapies, including meta-analysis of outcome research and studies of particular change processes. Outcome meta-analysis shows large client pre-post change, as well as large controlled effects relative to untreated controls and statistical equivalence to nonexperiential psychotherapies, including CBT

La realidad virtual como entorno fortalecedor para el cambio personal: la contribución del laboratorio de tecnología aplicada a la neuropsicología

When we exercise real choice, we gain increased control over our lives and are able to change ourselves. However for many subjects it is not easy to exercise effective choices: patients often don’t have the knowledge, skills, assertiveness, or self esteem needed. In this situation Virtual Reality (VR), an artificial reality that projects the user into a 3D space generated by the computer, may offer a critical advantage to the therapist. The enriched experience and the total level of control on its features, transform VR in an “empowering environment”, where patients can start to explore and act without feeling actually threatened. The attempt of defining, developing and testing VR tools supporting personal empowerment is the main goal of the Applied Technology for Neuro-Psychology Laboratory –ATN-P Lab– at the Istituto Auxologico Italiano. The paper describes the actual work done by the ATN-P Lab. in this area. Specifically, the open source "NeuroVR" system and its potential clinical applications –anxiety disorders, obesity and eating disorders– are presented and discussed.La capacidad de elección nos proporciona control sobre nuestras vidas y nos ofrece posibilidades de cambio. Sin embargo, para muchas personas no es fácil realizar elecciones efectivas; por ejemplo, los pacientes carecen muchas veces del conocimiento, la habilidad, la asertividad o autoestima necesarias. En esas situaciones, la realidad virtual (RV), una realidad artificial que coloca al sujeto en un espacio generado por el ordenador, puede ser para el terapeuta un recurso decisivo. La experiencia enriquecida y el control total sobre todos sus aspectos transforman la RV en un “entorno fortalecedor”, en el que los pacientes pueden comenzar a explorar y actuar sin sentirse amenazados. El principal objetivo del “Applied Technology for Neuro-Psychology Laboratory” (ATN-P Lab), perteneciente al Instituto Auxologico Italiano, es intentar definir, desarrollar y probar aplicaciones basadas en RV que faciliten el fortalecimiento personal. En este artículo se describe el trabajo que se viene realizando sobre este tema en ese laboratorio. Se presenta y discute, específicamente, el sistema de código abierto denominado “NeuroVR”, así como sus aplicaciones clínicas potenciales sobre los trastornos de ansiedad, la obesidad y los trastornos alimentarios

Treating treatment-resistant patients with panic disorder and agoraphobia: A randomized controlled switching trial

Background: Nonresponsiveness to therapy is generally acknowledged, but only a few studies have tested switching to psychotherapy. This study is one of the first to examine the malleability of treatment-resistant patients using acceptance and commitment therapy (ACT). Methods: This was a randomized controlled trial that included 43 patients diagnosed with primary panic disorder and/or agoraphobia (PD/A) with prior unsuccessful state-of-the-art treatment (mean number of previous sessions = 42.2). Patients were treated with an ACT manual administered by novice therapists and followed up for 6 months. They were randomized to immediate treatment (n = 33) or a 4-week waiting list (n = 10) with delayed treatment (n = 8). Treatment consisted of eight sessions, implemented twice weekly over 4 weeks. Primary outcomes were measured with the Panic and Agoraphobia Scale (PAS), the Clinical Global Impression (CGI), and the Mobility Inventory (MI). Results: At post-treatment, patients who received ACT reported significantly more improvements on the PAS and CGI (d = 0.72 and 0.89, respectively) than those who were on the waiting list, while improvement on the MI (d = 0.50) was nearly significant. Secondary outcomes were consistent with ACT theory. Follow-up assessments indicated a stable and continued improvement after treatment. The dropout rate was low (9%). Conclusions: Despite a clinically challenging sample and brief treatment administered by novice therapists, patients who received ACT reported significantly greater changes in functioning and symptomatology than those on the waiting list, with medium-to-large effect sizes that were maintained for at least 6 months. These proof-of-principle data suggest that ACT is a viable treatment option for treatment-resistant PD/A patients. Further work on switching to psychotherapy for nonresponders is clearly needed. © 2015 S. Karger AG, Basel