Highlights • Imagery Rescripting (IR) aims to alter negative meanings associated with distressing memories. • The current study assessed the impact of IR on social anxiety disorder (SAD). • 60 SAD ...participants completed IR, Cognitive Restructuring (CR) or a Control procedure. • Both IR and CR showed large positive effects, but mechanisms of action differed. • IR for SAD may benefit from prior CR to target both verbal and imaginal self-representations
Background
Current “gold standard” treatments for social anxiety disorder (SAD) are limited by the limited emphasis of key etiological factors in conceptualization, and many individuals with SAD ...experience residual symptoms posttreatment. Hence, the novel application of the Schema Therapy Mode Model may provide a helpful framework for extending clinical understanding and treatment options for SAD. This exploratory study aimed to investigate the presence and pattern of schema modes among SAD individuals.
Method
Forty individuals with SAD completed questionnaire measures of symptomatology, social anxiety‐relevant cognitions, schema modes, childhood trauma, and parental style.
Results
Key maladaptive schema modes identified in SAD were Vulnerable Child, Punitive Critic, Demanding Critic, Compliant Surrender, and Detached Self‐Soother.
Conclusion
Outcomes provide the basis for a proposed schema mode case conceptualization for SAD and are hoped to provide a rationale for testing the applicability of Schema Therapy as a novel treatment for SAD. Key limitations are discussed.
Research has demonstrated a strong link between intolerance of uncertainty and generalized anxiety disorder (GAD). The current systematic review and meta-analysis aimed to evaluate how effective ...evidence-based psychological treatments are at reducing intolerance of uncertainty for adults with GAD. An extensive literature search identified 26 eligible studies, with a total of 1199 participants with GAD. Psychological treatments (k = 32 treatment groups) yielded large significant within-group effect size from pre- to post-treatment and pre-treatment to follow-up for intolerance of uncertainty (g = 0.88; g = 1.05), as well as related symptoms including worry (g = 1.32; g = 1.45), anxiety (g = 0.94; g = 1.04) and depression (g = 0.96; g = 1.00). Psychological treatment also yielded a large significant between-group effect on intolerance of uncertainty (g = 1.35). Subgroups analysis found that CBT that directly targeted intolerance of uncertainty (CBT-IU) throughout treatment was significantly more effective than general CBT at reducing intolerance of uncertainty (p < 0.01) and worry (p < 0.01) from pre- to post treatment, however, this result was not maintained at follow-up. Meta-regression analyses supported this finding as increases in the amount of time spent directly targeting intolerance of uncertainty, significantly increased the effect size for both intolerance of uncertainty (z = 2.01, p < 0.01) and worry (z = 2.23, p < 0.01). Overall, these findings indicate that psychological treatments are effective at reducing IU, and related symptom measures of GAD.
•Meta-analysed the impact of psychological treatment on intolerance of uncertainty (IU) in GAD.•Systematic search led to the inclusion of 26 studies (N participants = 1199).•Significant large effects were observed at post-treatment and follow-up for IU and worry.•Meta-regression found evidence that time spent targeting IU increased the effect size for IU and worry.
Context
The cultivation of mindfulness and acceptance has been theoretically and empirically associated with psychological ancillary well‐being and has demonstrated efficacy in the treatment of ...various disorders. Hence, mindfulness and acceptance‐based treatments (MABTs) have recently been explored for the treatment of social anxiety disorder (SAD). This review aims to evaluate the benefits of MABTs for SAD.
Methods
Systematic review of studies investigating an MABT for individuals with SAD, using PsycInfo, Medline, PubMed, and Cochrane Central Register of Controlled Trials.
Results
Nine studies were identified. Significant improvements in symptomatology were demonstrated following the MABT, but benefits were equivalent or less than yielded by cognitive‐behavioral therapy (CBT).
Limitations
The few treatment studies available were compromised by significant methodological weaknesses and high risk of bias across domains. Studies were largely uncontrolled with small sample sizes. The hybrid nature of these interventions creates ambiguity regarding the specific utility of treatment components or combinations.
Conclusions
MABTs demonstrate significant benefits for reducing SAD symptomatology; however, outcomes should be interpreted with caution until appropriate further research is conducted. Furthermore, the benefit of MABTs above and beyond CBT must be considered tentative at best; thus, CBT remains best practice for first‐line treatment of SAD.
Social anxiety disorder (SAD) is characterised by a marked and persistent fear of social or performance situations. Cognitive models suggest that self-focused cognitive processes play a crucial role ...in generating and maintaining social anxiety, and that self-focused cognition occurs prior to, during, and following social situations (Clark & Wells, 1995; Rapee & Heimberg, 1997). There is a substantial body of empirical evidence demonstrating that socially anxious individuals engage in self-focused cognition during and following a social or performance situation. A smaller but growing body literature suggests that a similar process occurs prior to such situations, and that these three processes are interdependent. Furthermore, the vast majority of research to date indicates that self-focused cognitive processes are detrimental, and that they generate and maintain social anxiety in a variety of ways. However, there remains considerable scope for research to further explicate the role of these processes in the maintenance of SAD, and to enhance interventions designed to ameliorate their negative effects.
The ongoing investigations into clusters of children affected by severe acute hepatitis of unknown aetiology have put our global capacity for a coordinated, effective response to the test. The global ...health community have rapidly convened to share data and inform the response. In the UK, where most cases were initially identified, a coordinated public health and clinical research response was rapidly initiated. Since then, cases have been reported from other countries, predominantly from higher-income countries. While agencies are keeping an open mind to the cause, the working hypothesis and case notifications raise important questions about our capacity to detect emerging cases in lower-resourced settings with a recognised lack of access to diagnostics even for commonly circulating viruses such as hepatitis A. The limited capability to generate integrated global pathogen surveillance data is a challenge for the outbreak investigations, highlighting an urgent need to strengthen access to diagnostics, with a focus on lower-resourced settings, to improve the capacity to detect emerging diseases to inform care and to improve outcomes and outbreak control.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Remote cognitive behaviour therapy (CBT) for social anxiety disorder (SAD) has the potential to improve access to treatment by reducing economic, geographic, and psychological barriers. The aim of ...this study was to use a meta-analytic approach to examine the efficacy of the different remote CBT methods for treating SAD. A systematic electronic database search was used to identify 31 studies (n = 2905; mean age range: 24.73–41.65 years; mean female representation = 60.2 %). Pooled within-group analyses indicated large effect sizes from pre-treatment to post-treatment (Hedges’ g = 1.06; 95 % CI: 0.96–1.16) and pre-treatment to follow up (g = 1.18; 95 % CI: 1.03–1.33) for remote CBT. Internet-delivered CBT (g = 1.08; 95 % CI: 0.98–1.19) and application-delivered CBT (g = 1.19; 95 % CI: 0.75–1.64) produced large within-group effect sizes. Bibliotherapy-delivered CBT (g = 0.79; 95 % CI: 0.45–1.13) produced medium within-group effect sizes. Pooled between-group findings indicate that remote CBT treatments were more effective than passive control (g = 0.87; 95 % CI: 0.70–1.03) and non-CBT remote treatments (g = 0.41; 95 % CI: 0.17–0.66), and were at least as effective, or slightly more effective, than face-to-face CBT treatments (g = 0.34; 95 % CI: 0.14–0.54). These findings have important implications for the dissemination of remote and stepped-care treatments for SAD.
•Remote CBT for SAD has been shown to be efficacious in both high and low intensity formats.•All delivery formats of low intensity remote CBT produce large effect sizes.•The amount of clinician guidance in low intensity treatments does not moderate outcomes.•Future research investigating high intensity CBT for SAD is urgently needed.
Management of Evans syndrome Norton, Alice; Roberts, Irene
British journal of haematology,
January 2006, Letnik:
132, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Summary
Evans syndrome is an uncommon condition defined by the combination (either simultaneously or sequentially) of immune thrombocytopenia (ITP) and autoimmune haemolytic anaemia (AIHA) with a ...positive direct antiglobulin test (DAT) in the absence of known underlying aetiology. This condition generally runs a chronic course and is characterised by frequent exacerbations and remissions. First‐line therapy is usually corticosteroids and/or intravenous immunoglobulin, to which most patients respond; however, relapse is frequent. Options for second‐line therapy include immunosuppressive drugs, especially ciclosporin or mycophenolate mofetil; vincristine; danazol or a combination of these agents. More recently a small number of patients have been treated with rituximab, which induces remission in the majority although such responses are often sustained for <12 months and the long‐term effects in children are unclear. Splenectomy may also be considered although long‐term remissions are less frequent than in uncomplicated ITP. For very severe and refractory cases stem cell transplantation (SCT) offers the only chance of long‐term cure. The limited data available suggest that allogeneic SCT may be superior to autologous SCT but both carry risks of severe morbidity and of transplant‐related mortality. Cure following reduced‐intensity conditioning has now been reported and should be considered for younger patients in the context of controlled clinical trials.
Flowers have evolved remarkable diversity in petal color, in large part due to pollinator-mediated selection. This diversity arises from specialized metabolic pathways that generate conspicuous ...pigments. Despite the clear link between flower color and floral pigment production, quantitative models inferring predictive relationships between pigmentation and reflectance spectra have not been reported. In this study, we analyze a dataset consisting of hundreds of natural Penstemon hybrids that exhibit variation in flower color, including blue, purple, pink, and red. For each individual hybrid, we measured anthocyanin pigment content and petal spectral reflectance. We found that floral pigment quantities are correlated with hue, chroma, and brightness as calculated from petal spectral reflectance data: hue is related to the relative amounts of delphinidin vs. pelargonidin pigmentation, whereas brightness and chroma are correlated with the total anthocyanin pigmentation. We used a partial least squares regression approach to identify predictive relationships between pigment production and petal reflectance. We find that pigment quantity data provide robust predictions of petal reflectance, confirming a pervasive assumption that differences in pigmentation should predictably influence flower color. Moreover, we find that reflectance data enables accurate inferences of pigment quantities, where the full reflectance spectra provide much more accurate inference of pigment quantities than spectral attributes (brightness, chroma, and hue). Our predictive framework provides readily interpretable model coefficients relating spectral attributes of petal reflectance to underlying pigment quantities. These relationships represent key links between genetic changes affecting anthocyanin production and the ecological functions of petal coloration.
•First study to assess the factor structure of the SARQ in a clinical SAD sample.•One factor solutions demonstrated for the SARQ: Pre-event and SARQ: Post-event.•The SARQ demonstrated good validity ...and reliability.•The SARQ showed responsivity to treatment and clinical utility.•SARQ assesses rumination in relation to a range of social threat tasks in SAD.
Cognitive models have consistently recognised pre-event and post-event rumination as maintaining factors in Social Anxiety Disorder (SAD). This study aimed to investigate the psychometric properties of a state-based measure of pre-event and post-event rumination in SAD: The Socially Anxious Rumination Questionnaire (SARQ), which was formerly known as the Thoughts Questionnaire. In particular, we examined the factor structure, internal consistency, test-retest reliability, construct validity, sensitivity to treatment response, clinical cut-off scores (relative to non-clinical participants), and associated test performance indicators of the SARQ. The sample comprised 505 adults with a principal diagnosis of SAD and 130 non-clinical controls. Pre-event and post-event rumination were assessed in relation to a three-minute impromptu speech. Results indicated single factors for the SARQ: Pre-event and SARQ: Post-event scales, along with excellent internal consistency, good test-retest reliability, sound sensitivity to cognitive-behavioural treatment response, and a clear ability to discriminate between individuals with a principal diagnosis of SAD and non-clinical controls. The findings justify the SARQ’s use as a robust and reliable measure of state rumination for individuals with SAD that can be used both before and after encountering a social threat.
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