Severity of anxiety and work-related outcomes of patients with anxiety disorders.

BACKGROUND: This study examined associations between anxiety and work-related outcomes in an anxiety disorders clinic population, examining both pretreatment links and the impact of anxiety change over 12 weeks of treatment on work outcomes. Four validated instruments were used to also allow examination of their psychometric properties, with the goal of improving measurement of work-related quality of life in this population. METHODS: Newly enrolled adult patients seeking treatment in a university-based anxiety clinic were administered four work performance measures: Work Limitations Questionnaire (WLQ), Work Productivity and Activity Impairment Questionnaire (WPAI), Endicott Work Productivity Scale (EWPS), and Functional Status Questionnaire Work Performance Scale (WPS). Anxiety severity was determined using the Beck Anxiety Inventory (BAI). The Clinical Global Impressions, Global Improvement Scale (CGI-I) was completed by patients to evaluate symptom change at a 12-week follow-up. Two severity groups (minimal/mild vs. moderate/severe, based on baseline BAI score) were compared to each other on work measures. RESULTS: Eighty-one patients provided complete baseline data. Anxiety severity groups did not differ in job type, time on job, job satisfaction, or job choice. Patients with greater anxiety generally showed lower work performance on all instruments. Job advancement was impaired for the moderate/severe group. The multi-item performance scales demonstrated better validity and internal consistency. The WLQ and the WPAI detected change with symptom improvement. CONCLUSION: Level of work performance was generally associated with severity of anxiety. Of the instruments tested, the WLQ and the WPAI questionnaire demonstrated acceptable validity and internal reliability.

A cognitive-behavioral group for patients with various anxiety disorders.

OBJECTIVE: Cognitive-behavioral therapy (CBT) protocols for each of the anxiety disorders are robust and effective but are best suited for specialty clinics. This study assessed a format more suitable for general clinics: a single protocol based on standard CBT techniques designed to treat patients who have different anxiety disorders in the same group. METHODS: Potential participants in Vancouver, British Columbia, were administered a structured clinical interview to identify those with major anxiety disorders: panic disorder, with or without agoraphobia; obsessive-compulsive disorder; social phobia; generalized anxiety disorder; specific phobia; and posttraumatic stress disorder. Forty-three percent of participants had more than one current anxiety diagnosis. Those with active substance abuse or dependence or with psychosis were excluded. A total of 152 patients were randomly assigned to immediate treatment in the 11-week CBT group or to a wait-list control group. The Beck Anxiety Inventory (BAI) was administered at baseline, at the end of treatment or of the waiting period, and six months later. RESULTS: Reductions in BAI scores for participants in the immediate-treatment groups were greater than those for the control group participants. Patients with panic disorder in particular appeared to benefit. Outcomes for the immediate-treatment group were superior in terms of clinically significant changes, defined as a 20% or 40% improvement. Reductions in BAI scores continued to be present six months later. The improvements correspond to a medium effect size (Cohen's d=.50). CONCLUSIONS: A group CBT protocol for mixed anxiety disorders may make effective treatment more widely available.

Group behavioral therapy for adolescents with tic-related and non-tic-related obsessive-compulsive disorder.

Prior research supports the distinction between tic-related and non-tic-related obsessive-compulsive disorder (OCD) based on phenomenologic, etiologic, and neurobehavioral data. The present study examines whether response to psychosocial treatment differs in adolescents, depending on the presence of comorbid tics. Nineteen adolescents, 12-17 years of age, participated in 7-week, uncontrolled trial of group cognitive-behavioral treatment (CBT) for OCD. Eight of the patients had tic-related and eleven had non-tic-related OCD. The group CBT program included psycho-education, exposure and response prevention, cognitive strategies, and family involvement. Significant improvement was observed for all subjects on the Yale-Brown Obsessive Compulsive Scale ratings of obsessions, compulsions, and total OCD symptoms. Outcomes were similar for subjects with tic-related and non-tic-related OCD. These preliminary results suggest that the presence of comorbid tic disorders may not attenuate response to behavioral group treatment among adolescents.

Too much thinking about thinking?: Metacognitive differences in obsessive-compulsive disorder.

Negative appraisals of intrusive thoughts and beliefs about the importance of thoughts are considered core mechanisms in cognitive models of obsessive-compulsive disorder (OCD). In refinements of cognitive theory, differences in metacognitive processes have been emphasized. Cartwright-Hatton and Wells [J. Anxiety Disord. 37 (1997) 279-296] found that cognitive self-consciousness (CSC), a tendency to be aware of and monitor thinking, was the only metacognitive dimension that differentiated OCD patients from patients with generalized anxiety disorder. To evaluate the relative importance of different cognitive processes to OCD, we administered an expanded CSC scale and two state-of-the-art measures of thought appraisals and beliefs. Scores on the CSC scale reliably differentiated OCD patients (n=30), from an anxious comparison group (OAD, n=25) after controlling for scores on the two cognition measures. The tendency to excessively reflect upon one's cognitive processes may increase opportunities for negative appraisals of intrusive thoughts, foster over-importance of thought beliefs, and increase the likelihood of developing OCD.