Combined Case of Blood-Injury-Injection Phobia and Social Phobia: Behavior Therapy Management and Effectiveness through Tilt Test

The efficacy of behavior therapy based mainly on real-life exposure situations as well as applied tension was examined for a combined case of blood-injury-injection (BII) phobia and social anxiety disorder. Treatment involved 28 behavior therapy sessions, while applied tension technique was also described and practiced. The specific contribution of social skills techniques, fantasy, and real-life situations exposure was examined in a single case design. The subject was a 39-year-old male with anxiety symptoms when confronting an audience, as well as symptoms of the autonomic nervous system (bradycardia and syncope), which were better explained by BII. All self-report measures regarding fear, social phobia, and anxiety were reduced after behavior therapy and remained maintained at followup, while BII decreased further after applied tension techniques. The contribution of behavior therapy to the overall outcome of the case is considered significant for many reasons that are discussed in the pape

Caffeine challenge and breath-holding duration in patients with panic disorder

Objective: Breath-holding (BH) has been used as a simple probe to increase endogenous carbon dioxide (CO2). In patients with Panic Disorder (PD), lower baseline BH duration is associated with caffeine-induced panic attacks. In this paper, we assessed BH duration in PD patients in relation to panic attacks induced by caffeine intake. Methods: BH duration and state anxiety were assessed in 40 PD patients (12 males), both at baseline and after a 400-mg caffeine challenge test. Results: Patients panicking after caffeine administration (14 patients, 4 males) exhibited a significant reduction of their post-challenge BH duration, while no change of the BH duration was observed in non-panicking patients (26 patients, 8 males), Reduction in post-challenge BH duration was not related to higher anxiety levels - as reflected in the State-Trait Anxiety Inventory-State Form scores - independently of the occurrence of a panic attack. Panickers exhibited significantly lower baseline BH duration, compared to non-panickers. Conclusions: Our findings indicate that in PD patients, caffeine-induced panic attacks are strongly associated with a significant reduction of BH duration at both pre- and post-challenge. jointly, these findings suggest that in a Subgroup of PD patients, sensitivity to endogenous CO2 accumulation may underlie both the lower BH durations and the caffeine-induced panic attacks. In this subgroup of PD patients, caffeine might exert its panicogenic properties through the exacerbation of patients’ already pathological hypersensitivity to CO2 accumulation, as indicated by both the significant decrease of their BH duration at post-challenge and by their significantly lower baseline BH duration respectively. (c) 2008 Elsevier Inc. All rights reserved