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Adult Anxiety
Cross Cultural & Global Issues
Eating Disorders
Sex, Marital & Family Relationships
Adult Psychosis
Adult Trauma
Therapeutic & Applied Issues
Adult Anxiety
English Programme
"A Life Without Turbulence - I Enjoy Flying
Again"
Latinka Basara, Veljko Djordjevic, , Darko
Marcinko, University Hospital Zagreb
Lately, it seems that the number of people coping with
fear of flying is increasing. Some authors (Van Germen,
Diekstra, Arondeus & Wolfger, 2004)) attribute the
increase to the political and social events that have had a
great impact on our perception of flying security.
Something that has been enjoyed in the past and viewed
as a fast and pleasant way to travel is now a way to open
yourself to diseases, terrorism and generally perceived as
a risk behavior. Person with fear of flying experiences
high levels of anxiety and discomfort, days, weeks even
moths before the flight. In that time it is necessary to try
to reduce all symptoms in order for him/her to function
adequately and to prevent dependency on alcohol or
tranquilizers to overcome the distress. Cognitivebehavioral treatment of fear of flying includes behavioral
(relaxation, behavior experiment, exposure...) and
cognitive techniques (identification of automatic negative
thoughts, dysfunctional schemas, irrational beliefs and
distortions). Exposure in vivo has proven to be the most
effective psychological technique for the treatment of
phobias in general (Bothell, Soma, Garcia-Palacios,
Query & Banes, 2004; Emmelkamp & Kuipers, 1985;
Marks, 1987;Oest, Brandberg & Alm, 1997) and we used
it in our treatment as well. Our patient, a 31 year old
male, has earlier been treated with medications
(tranquilizers) and after several months we started oncea-week CBT treatment which also included pre-treatment
diagnostic evaluation (using psychological clinical tests,
instruments to measure type of fears, intensity and
avoidant behaviors). Patient was asked to keep a diary of
negative (distorted) automatic thoughts, sensations,
emotions and maladaptive behaviors concerning flying.
Together with the patient we constructed a hierarchy of
feared situations regarding flying with SUDs (subjective
units of distress) rating from 1-10. Along with cognitive
interventions, we started with behavioral techniques
(relaxation, exposure in vivo, which, in the beginning,
included going to the airport, having a session at the
airport, watching the planes take of and land as well as
simply watching a plane in the sky). Exposure in
imagination was included in the later sessions. Three
meetings were organized with an official pilot with the
purpose to expose the patient to all the official information
concerning flying security, procedures and measures.
Cognitive interventions were used during and after these
meetings. In the beginning of the treatment patient was
experiencing high levels of anxiety (rating 9 or 10 on a
scale from 0-10) months before the actual flight and for
the last year was avoiding all opportunities to fly. After
four moths of treatment he reported of much lower
anxiety levels planning and thinking about flying (the day
before the flight anxiety was rated 2 on a scale rating
from 0 -10) , he reported excitement and joy rather than
anticipatory anxiety. He reported no negative thoughts or
arbitrary predictions during the flight, and no safety
behaviors. After the flight he attributed the successful
flight not to pure luck as before, but to an expected
outcome. A four month cognitive bihevioral treatment of
fear of flying included cognitive and behavioral
interventions based on identifying and working on
cognitive distortions and maladaptive assumptions,
ongoing relaxation, exposure in vivo (both to the situation
and information provided by the pilot) and exposure in
imagination. After the treatment, patient's experienced
fear rated 2 (on a scale rating from 0-10) which is about
5x lower than before the treatment. Right now he is
looking forward to his next flight, feeling only excitement
and joy to keep up with his exposures in vivo.
Action-versus-State-Orientation' and
Successful Treatment of Anxiety
Edgar Geissner, Psychosomatic Hospital
'Roseneck', University of Munich; Madlen Kraft,
Petra Ivert, Psychosomatic Hospital 'Roseneck'
Germany
Patients with anxiety disorders participating in a cognitivebehaviorally oriented treatment program gained in
different ways, as clinical observations show. Difficulties
can result from comorbid disorders, reduced self esteem
to successfully stand anxiety provoking situations,
negative expectations, or style of attribution and
searched professional help bringing the complaint of a 2year persistent occurrence of what was named by her as
'manias'. The environmental evaluation of the complaint
was based on registration and reports of the client during
sessions. Further, the content was compared to the
concerning literature. Two different types of mania were
described. The first was the repetition of parts of routine
behavior chains. The client felt uncontrollably pushed to
repeating these actions. Another type of mania was
related to usual but unpleasant thoughts, followed by
varied actions. According to the client, those actions
would allow her to escape from unpleasant thoughts,
even though she could not tell any functional relation
between such behaviors and her thoughts. There were
not any meaningful levels of proved anxiety or social
abilities deficit, although these items were investigated.
Therefore, the traditional explanations for the case were
set aside. A reasonable hypothesis was once the client
started to live apart from her family, she could spend
more time by herself. Also, the client attended a university
program which was related to the study of the human
body and its functions. These two new environmental
variables made it possible for the client to drive more
attention to her body sensations and perceptions, hidden
behaviors and to the stimulation produced by the
repetition of routine actions. From driving her attention to
them, she possibly started to manipulate them. She was
able to establish, during these attempts, superstitious
relations between unpleasant thoughts and some public
behaviors. It resulted in some disorganization of both,
thoughts and behavior chains, what was noticed by the
client as 'something strange'. On the other side, the
stimulation itself, produced by the actions seemed to be
strong reinforcements to her behavior of repeated
actions. The intervention was based on the functional
analysis which consisted of 1) developing a repertory of
behavioral self-description along with the client, 2)
providing the client with normality boundaries of public
and hidden behaviors, 3) decreasing the level of
importance and attention to the manias and, finally, 4)
developing self-control over the behavior of manias and
the acceptance of undesirable feelings. The results were
1) an abrupt decrease of some maniac responses, 2) the
client allowed herself to feel and think about unpleasant
usual things. Although some of those still happened, they
were understood as an usual behavior. It is important to
attempt, in this case, to the functional understanding
based on the description of contingencies, even when
different from literature.
patients in Group A achieved superior improvement (1.45; 95% CI -1.55, -1.35) compared to Group B (-1.13;
95%CI -1.23, -1.03); p-value <0.0001. Total score = 10
was observed in statistically more patients in Group A
(70.8 %) than in Group B (23.8%), p-value <0.0001.
Assessment performed by using the scale Q-LES-Q
shows improvement in both groups, however
improvement of patients in Group A (-1.09) is more
significant, p-value 0.0275. Intensive CBT program is
effective in prevention of relapses in patients with anxious
disorders. As assessed by the HAM-A, there was
significantly less symptoms in patients randomized to
Group A than Group B after one year of monitoring. Also
quality of life of patients who completed CBT program
was better. Presented results are in agreement with
previous controlled studies, where CBT was compared
with other treatment strategies. It is also important to
underline our finding that more patients in Group A
completed the study, which means that intensive group
CBT improves compliance of patients throughout their
entire disease.
the present study implicate that HOC Ss will not show the
bias to the OCSW, but they have difficulty in
differentiating the threat-related information. And the
disability to differentiate threat-related information is one
of the causes for lower confidence of HOC Ss, but this
relationship merits further study.
An Examination of Self-Administered
Interventions to Reduce Pathological
Academic Worry
Kate Wolitzky-Taylor, ; Michael Telch, University
of Texas at Austin USA
Despite the prevalence of academic worry at the college
and university level, there is a paucity of research in this
area. In addition, there is an even greater dearth of
research investigating treatments for excessive and
uncontrollable academic worry. Further, the research on
psychosocial treatment strategies for reducing
pathological worry (as seen in its most severe form in
generalized anxiety disorder; GAD) is limited, with several
behavioral treatments seen in treatment manuals still
untested in controlled trials. Finally, GAD is associated
with high medical utilization and significant costs to
society (see Wittchen, 2002, for reviews). Researching
cost-effective treatments may have important public
health implications. The current study investigates the
efficacy of two self-administered interventions in reducing
pathological academic worry. Participants reporting
significant levels of academic worry that is either causing
significant distress or significant interference were
randomized to one of four conditions: a) worry exposure
(WE), b) expressive writing (EW), c) a placebo control,
consisting of pulsed audio-photic stimulation (APS), and
d) wait-list control (WLC). Participants practiced their
interventions three times per week for one month at
home, and were assessed at pre, post, and a three
month follow-up. Measures include questionnaires (with
the primary outcome questionnaire being the Academic
Worry Questionnaire, AWQ), number of visits to the
student health service, and grade-point average.
Structured diagnostic interviews were also conducted at
pre-treatment and follow-up assessment to determine
GAD status. Results from the first 75 participants indicate
that those in the WE and EW conditions showed
significantly lower academic worry (as measured by the
AWQ), significantly lower levels of overall worry, and
significantly more improvement on GPA than those in the
APS placebo and WLC conditions. No differences were
found on health outcomes (i.e., number of visits to the
health center). The efficacy of worry exposure and
expressive writing with this population suggests there are
cost-effective treatments for pathological academic worry.
There are significant public health implications for these
Adult Anxiety
Spanish Programme
Intervencin grupal para trastornos de
ansiedad en un Centro de Salud Mental.
Datos preliminares
Silvia Acosta, C B Mulet, ; M Checa, ; S Cholvi, ;
E Basabe; J Pujol, P Casaus, Centro de Salud
Mental de Tarragona Spain
Los trastornos de ansiedad (TA) consumen un gran
nmero de los recursos asistenciales disponibles en los
Centros de Salud Mental. El abordaje cognitivoconductual ha demostrado ser eficaz y las intervenciones
grupales permiten economizar recursos manteniendo la
calidad de la intervencin. El objetivo del presente trabajo
es comprobar si una terapia de estas caractersticas
ejerce mejora sobre la sintomatologa ansioso-depresiva
en pacientes con TA y si sta se mantiene una vez
finalizada la intervencin.Nuestro tratamiento grupal se
Eating Disorders
English Programme
Anger regulation, autonomy-connectedness,
and eating disorders
Marrie Bekker, Tilburg University
Recent evidence suggests that autonomy-connectedness,
particularly its components self-awareness (SA) and
sensitivity to others (SO), contribute importantly to sex
differences in prevalence of mental disorders. Two
experiments were targeted on emotion-regulatory
mechanisms between these developmental personality
characteristics and disturbed behavior such as emotional
(binge) eating and restricted eating. Study 1 Methods:
High school students were randomly assigned to either
an anger-inducing condition, or a neutral condition using
the Ultimatum Game. Self-reported and behavioral anger
were assessed after the manipulation, and trait anxiety,
autonomy-connectedness, and attachment styles were
examined as dispositional factors.
Study 2 replicates Study 1 but also emotional eating and
restricted eating (cognitive and behavioral) were added
as dependent variables. Study 1
Subjects in the experimental condition were angrier than
controls, with women being less angry than men. An
interesting interaction effects appeared. Women in the
experimental condition compared to controls felt more
angry but were less willing to show their angry feelings
dependent on their level of SO; in men, the moderating
effect of SO was absent.
Study 2 Results will be presented during the conference.
Attachment-based, high sensitivity to others seems to
lead particularly women to experience stronger anger
feelings on the one hand, but more anger inhibition on
the other. If this factor also shows to play an important
role in anger regulation associated with eating disorders
(Study 2), more attention for this factor is needed in order
to improve treatment.
Evaluation of Treatment Efficacy of a shortterm CBT for in Patients with Binge Eating
Disorder using Ecological Momentary
Assessment
Mller Roland, ; Andrea Hartmann, Andrea
Meyer, Simone Munsch, Institute of Psychology,
University of Basel Switzerland
It has been shown that Ecological Momentary
Assessment (EMA) with palm top computers has several
advantages in assessing target behaviour: It enhances
compliance with self-monitoring and minimizes the risk of
retrospective memory bias (Gorin & Stone, 2000). It
further allows assessing behaviour change in the natural
environment of the patient. We used EMA to assess the
outcome of a randomized CBT short-term program in
terms of number of daily binges according to DSM-IV and
daily mood course. 41 female patients attending a short
intervention programm for BED were assigned to either a
group with two EMA measurements (before and after
treatment) or with three measurements (eight weeks
before treatment, before and after treatment). The
compliance of BED patients in self-monitoring their eating
behaviour in our study was high (74.2 of the alarms were
answered by the patients) and underlines the feasibility of
the EMA method (le Grange et al., 2002). We found that
daily mood course estimates were enhanced during
treatment and that the number of daily binges was
significantly reduced until post treatment (p<.05). EMA is
a valuable method to assess behaviour change and
treatment efficacy in naturalistic daily live of patients with
BED. Assessing antecedents of binges as mood course
in natural environment of the patients might help to
further identify risk situations and enhance efficacy of
CBT treatments.
Adult Psychosis
English Programme
Clinical determinants of quality of life in
outpatients with schizophrenia
Hirofumi Aki, Masahito Tomotake; l; Ken
Yamauchi,l, Yasuhiro Kaneda; c, Shu-ichi Ueno,
Tetsuro Ohmori, Department of Psychiatry, The
University of Tokushima Graduate School , Japan
Although there seems to be no unanimous definition of
quality of life (QOL), QOL has been measured from two
different viewpoints. One is subjective QOL rated by
patients themselves and another is objective QOL rated
by observers. Although patients with schizophrenia were
thought to be unable to assess their QOL by themselves
because of their cognitive deficit function, it would be
reasonable to assume that symptomatically stabilized
patients are able to evaluate their QOL by themselves.
However, the relationship between these two QOL
measures is not clear. Further research is needed to
clarify clinical factors influencing subjective and objective
QOL by using appropriate measures. Moreover, previous
studies reported that insight into illness did not correlate
with subjective QOL. So we think that the relation
between insight and subjective QOL should be
investigated. The purpose of the present study is to
investigate the relationship between subjective and
objective QOL and their clinical determinants in
outpatients with schizophrenia by using schizophrenia
disease-specific QOL measures. Data collected from
eighty outpatients with schizophrenia (mean age = 40.6
years) was analyzed. Informed consent was obtained
from all subjects for the research involved in the study.
Subjective QOL was measured with the Schizophrenia
Quality of Life Scale (SQLS) and objective one was
measured with the Quality of Life Scale (QLS). Clinical
symptoms were also assessed with the Positive and
Negative Syndrome Scale (PANSS), the Calgary
Depression Scale for Schizophrenia (CDSS), the DrugInduced Extrapyramidal Symptoms Scale (DIEPSS), and
the Global Assessment of Functioning (GAF).
Psychosocial scale of the SQLS was correlated with the
QLS total, instrumental role subscale, and intrapsychic
foundation subscale. However, other two scales of the
SQLS, motivation/energy and symptoms/side effects,
were not correlated with the QLS. The PANSS positive
symptoms subscale score, the PANSS general
psychopathology subscale score, and the CDSS score
were correlated with the SQLS psychosocial scale and
symptoms/side effects scale. The luck of judgment and
insight item score in the PANSS was correlated with the
SQLS motivation/energy scale. The dosage of
antipsychotics, the PANSS negative symptoms subscale
score, the PANSS general psychopathology subscale
score, the luck of judgment and insight item score, and
the GAF score were correlated with the QLS total score.
Stepwise regression analyses were done to assess the
independent contribution of other clinical variables to
each subjective and objective QOL. The CDSS score
predicted psychosocial scale and symptoms/side effects
scale of the SQLS. The luck of judgment and insight item
score predicted motivation/energy scale of the SQLS.
The PANSS negative symptom subscale score and the
GAF score predicted the QLS total independently. These
results suggest that subjective and objective QOL have
different determinants and the active treatment for
depressive symptoms may improve subjective QOL.
Adult Psychosis
Spanish Programme
Validacin de la versin espaola de la escala
de Insight de Birchwood
Alberta Almela, Parc Hospitalari Mart Juli
(PHMJ). Institut d'Assistncia Sanitria (IAS);
Natalia Camprub, Parc Hospitalari Mart Juli
(PHMJ). Institut d'Assistncia Sanitria (IAS)
Introduccin: El objetivo de este estudio fue realizar una
adaptacin y validacin al castellano de la Insight Scale
(IS) (Birchwood y cols., 1994) escala autoaplicada que
evala el insight multidimensionalmente Mtodo: Estudio
observacional de una muestra clnica de pacientes
psicticos. Se realiz una traduccin y retrotraduccin de
la IS. Se calcul la factibilidad, la validez de criterio
concurrente con el item 12 de la PANSS, la validez de
constructo convergente con la DAI y divergente con la
BPRS, la validez de constructo discriminante entre las
puntuaciones de la IS de pacientes ingresados voluntaria
e involuntariamente, la fiabilidad test-retest y la
consistencia interna Resultados: La muestra const de
55 pacientes. La factibilidad fue del 100%. El CCI entre el
tem 12 de la PANSS y la IS fue de 0,51. El CCS entre la
IS y la DAI, y la IS y la BPRS fue de 0,398 (p=0,003) y 0,064 (p=0,645) respectivamente. Las puntuaciones
medias de la IS fueron significativamente diferentes (U
Adult Trauma
English Programme
How am I Feeling?: Work Stress and
Secondary Traumatization in Mental Health
Workers in Turkey
Zara Page Ayten, Gulcan Akcalan, Istanbul Bilgi
University Turkey
In their day-to-day work mental health workers come into
direct contact with other peoples' distress, especially in
the course of working with victims of traumatic events,
and workers themselves can fall victim to secondary
traumatic stress reactions brought on by helping. A
number of studies have shown that secondary traumatic
stress is experienced both similarly and somewhat
differently by trauma workers. The observed symptoms
appear to result from assimilating other peoples'
traumatic material and have general distress plus some
burnout as a shared symptom manifestation. This study
examined specifically the traumatic stress and burnout
levels of mental health workers who work in the trauma
field in the Marmara and South East Regions of Turkey
using a questionnaire measure of Burnout and Traumatic
Attachment Belief. The overall prevalence of current
role-play. The third step is engaging the client in a roleplay, and the fourth step involves providing feedback to
the client and suggestions for improvement. Fifth step
clients are encouraged to practice on their own. In
training take part 6-10 clients; duration 3 to 6 mounts; 1,
5 hours weekly.
2. Cognitive-behavioral trainings group: The group
training program lasts 3-6 mounts (6-8 clients); 1, 5 hours
weekly sessions. Aimed is to identify, challenging and
changing cognitions, learn problem solving strategies,
learn and experiment new behavior in job-search
situations and new work situations, support clients in jobsearch and new work situations. The training includes
techniques such as eliciting, recording and testing the
validity of thoughts and behavior, reattribution, behavioral
monitoring and experimentation. It is focused on actual
problems of clients. Our Institute has been initializing
parts of cognitive behavioral approach in rehabilitation
since 2001. Psychosocial trainings have been modified
step by step. Today we use trainings as explained above.
We established that cognitive-behavioral trainings and
social skills trainings are significant part of
vocational/work programs. Cognitive - behavioral group
training is one of possible approached to help
unemployed individuals and we find it very successful.