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Cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are both effective treatments for some patients with obsessive-compulsive disorder (OCD), yet little is known about the neurochemical changes related to these treatment modalities. Here, we used positron emission tomography and the α-[11C]methyl-l-tryptophan tracer to examine the changes in brain regional serotonin synthesis capacity in OCD patients following treatment with CBT or SSRI treatment. Sixteen medication-free OCD patients were randomly assigned to 12 weeks of either CBT or sertraline treatment. Pre-to-post treatment changes in the α-[11C]methyl-l-tryptophan brain trapping constant, K* (ml/g/min), were assessed as a function of symptom response, and correlations with symptom improvement were examined. Responders/partial responders to treatment did not show significant changes in relative regional tracer uptake; rather, in responders/partial responders, 12 weeks of treatment led to serotonin synthesis capacity increases that were brain-wide. Irrespective of treatment modality, baseline serotonin synthesis capacity in the raphe nuclei correlated positively with clinical improvement. These observations suggest that, for some patients, successful remediation of OCD symptoms might be associated with greater serotonergic tone.

Resume Le questionnaire abrege des schemas (YSQ-S2) propose par Young (1998) [13] est un instrument bref (75 items) permettant de mesurer 15 schemas precoces inadaptes (SPI). L’objectif de cette etude est de valider empiriquement deux versions du YSQ-S2 (version francaise initiale et version francaise modifiee) aupres d’un echantillon de patients presentant un trouble de la personnalite borderline (n = 37) et de sujets temoins (n = 263). Les resultats indiquent que les deux versions de l’instrument distinguent bien les patients borderline des sujets temoins. Les comparaisons statistiques montrent des differences significatives entre les deux groupes, les scores au YSQ-S2 etant a chaque fois plus eleves pour le groupe pathologique. Pour les deux versions, un seuil pathologique est egalement propose. La version francaise (initiale ou modifiee) du YSQ-S2 apparait etre une mesure valide permettant la mise en evidence des SPI et une bonne echelle de mesure du trouble de la personnalite borderline.

Background: To date, there have been no studies comparing cognitive therapy (CT) with Rogerian supportive therapy (RST) in borderline personality disorder. Method: Sixty-five DSM-IV borderline personality disorder outpatients were recruited at 2 centres: Lyon and Marseille. Thirty-three patients were randomly allocated to CT and 32 to RST. The therapists were the same in both groups. Both treatments shared the same duration (1 year) and amount of therapy. Assessment by independent evaluators utilised the Clinical Global Impression (CGI) Scale, the Hamilton Depression Scale, Beck Depression Inventory, Beck Anxiety Inventory, Hopelessness Scale, Young Schema Questionnaire II, Eysenck Impulsivity Venturesomeness Empathy (IVE) Inventory, a self-harming behaviours checklist and scales measuring quality of life and the therapeutic relationship. The response criterion was a score of 3 or less on the CGI, associated with a Hopelessness Scale score of Results: No patient committed suicide during the trial. Fifty-one patients were evaluated at week 24, 38 at week 52 and 21 at week 104. Cognitive therapy retained the patients in therapy for a longer time. The response criterion found no significant between-group differences at any measurement point in the completers. However, at week 24, CT was better than RST on the Hopelessness Scale, IVE scale and regarding the therapeutic relationship. At week 104, the CGI improvement (patient and evaluator) was significantly better in CT than in RST. High baseline depression and impulsivity predicted dropouts. Conclusions: CT retained the patients in therapy longer, showed earlier positive effects on hopelessness and impulsivity, and demonstrated better long-term outcomes on global measures of improvement.

Accessible online at: www.karger.com/pps ‘Case management’ is a section which addresses biopsychosocial management of cases in clinical medicine. It integrates research evidence with clinical experience. Full disclosure of conflict of interest is required. However, clinicians with substantial conflicts of interest (owing a patent, being a stockholder or executive or serving in the board of directors or being a regular consultant in a company with commercial interests tied to the research discussed) cannot contribute. The patient is a 35-year-old married woman with an obsessive compulsive disorder. She had a 21-year history of obsessive thoughts and ritualistic behaviors including compulsive checking which had become persistent since the birth of her first child. There is no evidence of comorbidity, except for a mild generalized anxiety disorder. She wants to know which treatment is right for her at this point.

Purpose of review Generalized anxiety disorder is associated with a significant economic burden owing to decreased work productivity and increased use of health care services, particularly primary health care. The appropriate use of psychological treatments, especially cognitive behaviour therapy and antidepressants, may improve both anxiety and depression symptoms and may also play a role in preventing comorbid major depression in generalized anxiety disorder. Recent findings Recent research is dominated by works on antidepressants and cognitive behaviour therapy, but alternative pharmacological treatments have recently been studied, especially phytotherapy with limited outcomes and hydroxyzine with more convincing results. A new selective serotonin reuptake inhibitor, citalopram, appears to be a possible candidate for treating generalized anxiety disorder after an open-labels study. However, a controlled study is warranted. Group cognitive behaviour therapy for generalized anxiety disorder is a viable alternative to individual therapy. The longest follow-up (8‐14 years) of cognitive behaviour therapy shows that 50% of the patients are significantly improved. Summary New research on drugs, applied relaxation and cognitive therapy suggest that there is room for improving the treatment methods to increase the rate of responders, which is about 50‐ 60% in most studies.

This article reports on the validation of the Obsessive Beliefs Questionnaire (OBQ) and Interpretations of Intrusions Inventory (III) developed by the Obsessive Compulsive Cognitions Working Group (OCCWG) to assess the primary beliefs and appraisals considered critical to the pathogenesis of obsessions. A battery of questionnaires that assessed symptoms of anxiety, depression, obsessive-compulsive symptoms and worry was administered to 248 outpatients with a DSM-IV diagnosis of Obsessive-Compulsive Disorder (OCD), 105 non-obsessional anxious patients, 87 non-clinical adults from the community, and 291 undergraduate students. Tests of internal consistency and test-retest reliability indicated that the OBQ and III assessed stable aspects of OC-related thinking. Between-group differences and correlations with existing measures of OC symptoms indicated that the OBQ and III assess core cognitive features of obsessionality. However, the various subscales of the OBQ and III are highly correlated, and both measures evidenced low discriminant validity. The findings are discussed in terms of the relevance and specificity of cognitive constructs like responsibility, control and importance of thoughts, overestimated threat, tolerance of uncertainty and perfectionism for OCD.

Background: The Posttraumatic Stress Disorder Checklist Scale (PCLS) is a short self-report inventory for assessing the 3 main syndromes of Posttraumatic Stress Disorder (PTSD). The aim of this study was the validation of the French version of the PCLS in PTSD subjects and nonclinical subjects. Methods: One-hundred and thirteen outpatients suffering from PTSD according to DSM-IV were administered the PCLS. The patients’ scores on the PCLS were then compared to those of 31 nonclinical control subjects. Thirty-five of the patients were administered the PCLS twice over an interval of 1–2 weeks and also completed questionnaires measuring depression, phobia and anxiety. Results: The patients’ total score and subscores on the PCLS were found to be significantly higher than those of control subjects. The cutoff score of 44 on the French version PCLS distinguishes well between the PTSD group and control group with a high diagnostic efficacy (0.94). Factor analysis revealed 3 main factors corresponding to the reexperiencing, numbing and hyperarousal syndromes. The PCLS showed satisfactory test-retest reliability and internal consistency. Conclusions: The PCLS is therefore a valid and effective measurement of PTSD. It may be a useful tool for screening and assessing PTSD in psychiatric as well as in primary-care settings.

The present study was carried out in France to evaluate the reliability and validity of the Scale for Interpersonal Behavior (SIB), a multidimensional measure of difficulty and distress in assertiveness that was originally developed in The Netherlands. This appraisal was conducted with a clinical-sample (N = 166) and a general population sample (N = 150). The clinical series comprised 115 patients with social phobia and 51 patients with personality disorder, 28 of whom were of the avoidant type. Support was found for internal consistency and test-retest reliability of the French SIB.;Compared to:controls, both social phobics and patients with an avoidant personality disorder had significantly lower mean scores on all performance scales and significantly higher ones on:all distress scales, with the social phobics occupying a position in between. Findings in relation to convergent and divergent validity were quite satisfactory. Sensitivity of the French SIE for detecting change was demonstrated in a subgroup of the clinical Ss who had undergone 15 sessions of cognitive;behavioral group therapy for underassertiveness. (C) 1999 Elsevier Science Ltd. All rights reserved.

The French version of the Social Interaction Self-Statement Test (SISST) was studied in 95 social phobia and 87 non-clinical subjects. Total scores on both positive and negative scales significantly discriminated social phobics from non-clinical control subjects. Social phobics had higher scores than controls on negative statements and lower scores on positive statements. The positive and negative subscales of the SISST for social phobic patients were correlated with anxiety, depression and avoidant behaviours. The negative subscale was significantly sensitive to change in patients with social phobia receiving cognitive behavioural therapy. Our findings showed good convergent and discriminant validity of the SISST and the sensitivity of the negative sub-scale to improvement after cognitive behavioural therapy.

Recent theories of obsessive-compulsive disorder (OCD) emphasize the importance of cognitive contents (beliefs and appraisals) and cognitive processes in the etiology and maintenance of OCD. In order to evaluate these theories and to assess the mechanisms of treatment-related change, it is necessary to develop measures of the relevant cognitive contents and processes. Several scales have been developed, although many are unpublished and there is a great deal of overlap among measures. The purpose of the present article is to describe the progress of an international group of investigators who have commenced a coordinated effort to develop a standardized set of cognitive measures. This article describes the theoretical bases and clinical importance of such an endeavor, and the proceedings of the working group meetings are summarized. Several methods of assessment are reviewed, including idiographic methods, information processing paradigms, and self-report measures. The working group is currently developing and evaluating self-report measures of appraisals about intrusions, and self-report measures of OC-related beliefs. Consensus ratings indicated that 6 belief domains are likely to be important in OCD. These are beliefs pertaining to: (1) inflated responsibility; (2) overimportance of thoughts; (3) excessive concern about the importance of controlling one's thoughts; (4) overestimation of threat; (5) intolerance of uncertainty; and (6) perfectionism.

The Obsessive Compulsive Thoughts Checklist (OCTC; Bouvard, Mollard, Cottraux, & Guerin 1989) is a 28 item questionnaire. Patients rate their degree of disturbance of the past week on a 5-point scale. The validation study and factor analysis of the OCTC is presented. Three groups were compared: patients suffering from obsessive compulsive disorders (n = 122), patients suffering from panic disorder with agoraphobia (n = 61) and a control group (n = 80). The three groups were comparable in age and sex. Obsessive compulsive patients scored significantly higher than both agoraphobic patients and control subjects. Spearman rank correlations were used to compute convergent validity in a sub-group of obsessive compulsive patients (n = 96). The Obsessive Compulsive Thoughts Checklist correlated positively with the Compulsive Activity Checklist (rho =. 62; p p p p =. 0002). The factor structure was studied both on the sample which included agoraphobic patients and controls (n = 141) and on the obsessive compulsive patients only (n = 122). In both analyses, three identical factors were found: – factor 1: checking/perfectionism-orderliness – factor 2: responsibility/dread of harming others – factor 3: washing/contamination. Results support the validity and the internal consistency of the Obsessive Compulsive Thoughts Checklist. The factor analysis indicates that the OCTC is a three dimensional scale, reflecting a pathological need to check, a pathological sense of responsibility and a pathological need to wash, probably due to distorted thoughts about perfectionism and orderliness, an excessive need for control and fear of contamination.

Intrusive musical imagery (IMI) consists of involuntarily recalled, short, looping fragments of melodies. Musical obsessions are distressing, impairing forms of IMI that merit investigation in their own right and, more generally, research into these phenomena may broaden our understanding of obsessive-compulsive disorder (OCD), which is phenomenologically and etiologically heterogeneous. We present the first comprehensive review of musical obsessions, based on the largest set of case descriptions ever assembled (N=96). Characteristics of musical obsessions are described and compared with normal IMI, musical hallucinations, and visual obsessional imagery. Assessment, differential diagnosis, comorbidity, etiologic hypotheses, and treatments are described. Musical obsessions may be under-diagnosed because they are not adequately assessed by current measures of OCD. Musical obsessions have been misdiagnosed as psychotic phenomena, which has led to ineffective treatment. Accurate diagnosis is important for appropriate treatment. Musical obsessions may respond to treatments that are not recommended for prototypic OCD symptoms.

Background: Patients with an implanted cardioverter defibrillator (ICD) may experience a certain degree of suffering. A sample of 32 patients was surveyed to determine the psycholog

This contribution focuses primarily on combining pyschological and pharmacological treatments for specific phobias. However, the principles can be applied to anxiety disorders in general. Specific phobias are a frequent problem but most of the time have a limited impact on quality of life, hence only the most severe forms are seen by the clinicians and treated. This explains the limited amount of research devoted to this anxiety disorder compared with social phobia or agoraphobia. The epidemiology and psychopathology of specific phobias are discussed on pages 83–6.

Twenty-four DSM-III-R non-depressed obsessive-compulsive (OCD) patients were compared to 21 normal subjects in three lexical decision experiments, to distinguish neutral, obsessive and responsibility words from pseudo-words. Error frequencies were comparable across groups. A significant taboo effect was found in both groups for obsessive and responsibility words. OCD patients did not differ from control subjects in their processing of neutral words and responsibility words. However, OCD patients were significantly slower than controls when processing obsessive words. Furthermore, OCD patients processed pseudo-words slower than controls if these were presented in the same experiment as obsessive words. When mixed with neutral or responsibility words, the performance of OCD patients with pseudo-words was similar to that of control subjects. The level of sub-clinical depression (as appreciated on the HAM-D scale) and psychotropic drugs (such as serotonin reuptake inhibitor) did not modify these results. Lexical decision performances were interpreted in terms of a cognitive disturbance triggered by obsessive stimuli that spreads to a neutral task. These results are compatible with the cognitive model of OCD (Salkovskis, 1985).

Behavioral psychotherapy may promote physical health and treat some behavior-linked medical conditions. Prevention of risk factors, and relapse through self-management, the development of a healthy life-style and the possibility to use its technology in the community at a relatively low cost are emphasized. Controlled studies suggest its effectiveness in cardiovascular diseases, headaches, stuttering, alcoholism, pain and bulimia nervosa. Cancer, psychoneuroimmunology and AIDS are under investigation. Psychogeriatrics in an emerging field. More basic research is needed to establish firmly the theoretical underpinnings of behavioral medicine including a cognitive component and to extend its practice to medical staff.

Fisher's stepwise discriminant analysis was carried out on 10 baseline variables searching for posterior prediction of success in a sample of sixty DSM-III obsessive-compulsive patients. The patients' median score on Hamilton rating scale of depression was 19. In a controlled study they were randomized into three groups: fluvoxamine with antiexposure, fluvoxamine with exposure, or placebo with exposure. In the whole sample, five variables accounted for 76% of the correctly classified patients: avoidance score of the behavioural avoidance test, behaviour therapy expectations, fluvoxamine expectations, Beck depression inventory and rituals repetition. High avoidance score predicted 68% of the correctly classified patients in the whole sample. The discriminant function classified correctly 70% of the patients in the antiexposure with fluvoxamine group, versus 75% in the exposure with fluvoxamine group, and 85% of the patients receiving exposure with placebo (χ2, d.f.2, NS).

Background: To date, there have been no studies comparing cognitive behavior therapy (CBT) with Rogerian therapy in post-traumatic stress disorder. Method: Sixty outpatients with DSM-IV chronic post-traumatic stress disorder were randomized into two groups for 16 weekly individual sessions of CBT or Rogerian supportive therapy (ST) at two centers. No medication was prescribed. Measures included the Post-Traumatic Stress Disorder Checklist Scale (PCLS), the Hamilton Anxiety Scale, Beck Depression Inventory, and Quality of Life. The general criterion of improvement (GCI) was a score of less than 44 on the PCLS. Results: Forty-two patients were evaluated at post-test, 38 at week 52 and 25 at week 104. At post-test, the rate of patients leaving the trial due to worsening or lack of effectiveness was significantly higher in the ST group (p = 0.004). At this point, no between-group difference was found on the GCI and any of the rating scales. Intent-to-treat analysis found no difference for the GCI, but patients in the CBT group showed greater improvement on the PCLS and Hamilton Anxiety Scale. Naturalistic follow-up showed sustained improvement without between-group differences at weeks 52 and 104. Conclusions: CBT retained significantly more patients in treatment than ST, but its effects were equivalent to those of ST in the completers. CBT was better in the dimensional intent-to-treat analysis at post-test.

This paper assesses the psychometric properties of the French version of the Obsessive Beliefs Questionnaire (OBQ-44) and investigates whether the questionnaire discriminates between obsessive-compulsive disorder (OCD), anxious control (AC), and non-clinical control (NCC) participants. A confirmatory factor analysis suggested a poor fit of the model. An exploratory factor analysis replicated the original factor structure. The subscales were moderately intercorrelated and highly correlated with the total score. There was partial support for convergent/divergent validity of the OBQ-44. In analyses of variance comparing the three samples, the participants in the OCD sample scored significantly higher than the participants in the AC and NCC samples on all of the OBQ-44 scores. In analyses of covariance comparing the OCD and NCC samples while controlling for general distress and age, the participants with OCD scored significantly higher than the NCC participants on all of the OBQ-44 scores. Implications of the current study are discussed.

Cognitive Behavior Therapy (CBT) requires the development of specific social skills and the awareness of the influence of the therapist’s cognitions and emotions on the therapeutic process. A historical perspective on the evolution of CBT is presented, within the unfolding of the concept of mental health, followed by an update made on the works dealing with the modification of the therapist’s emotions and cognitions along the supervision process, according to social learning and cognitive psychology principles. New insights on the problem of therapeutic alliance are presented, understood as a collaborative relationship. A three-level supervision and training model regarding the difficulty levels of clinical problems is proposed. We also suggest a broad concept of therapeutic relationship that has implications on training and supervision. The therapist´s role is to help the patient become autonomous, help him to increase his personal and social competences in order to be able to manage his life. We describe the model of training and supervision used in France, at the University Claude Bernard, Lyon I, which gives access to the European Association for Cognitive Behavior Therapy, through the French Association, proposed as guidelines for training and supervision in CBT

The Obsessive Belief Questionnaire (OBQ) and the Interpretation of Intrusions Inventory (III) were designed to assess beliefs and appraisals considered critical to the pathogenesis of obsessions. In previous reports we have described the construction and psychometric properties of these measures. In this study a battery of questionnaires assessing anxiety, depression, and obsessive compulsive symptoms was completed by 410 outpatients diagnosed with obsessive compulsive disorder, 105 non-obsessional anxious patients, 87 non-clinical adults from the community, and 291 undergraduate students. Items from 6 theoretically derived subscales of the OBQ were submitted to factor analysis. Three factors emerged reflecting (1) Responsibility and threat estimation, (2) Perfectionism and intolerance for uncertainty, and (3) Importance and control of thoughts. A 44-item version (OBQ-44) composed of high-loading items from the 3 factors showed good internal consistency and criterion-related validity in clinical and non-clinical samples. Subscales showed less overlap than original scales. Factor analysis of the III yielded a single factor, suggesting the total score be used in lieu of the 3 rationally derived subscales. The scales performed well on tests of convergent validity. Discriminant validity was promising; hierarchical regression analyses indicated that the OBQ subscales and III generally predicted OC symptoms after controlling for general distress. A revision of the OBQ, the OBQ-44, is included in the appendix.

This paper reviews the evidence-based literature concerning the efficacy and effectiveness of cognitive behavior therapy (CBT), drug treatment and their combination for obsessive compulsive disorder (OCD). After a brief outline of the seminal studies, the state of the art is presented with reference to the consensual recommendations proposed in the last 10 years. Management of OCD rests on potent selective serotonin reuptake inhibitors and CBT, used separately, sequentially, or concurrently. A hierarchical model for clinical decision-making is reported. With greater severity of OCD, it is recommended to add medications. However, the response rate is still too low in many patients, and some patients remain refractory to any kind of treatment. This stresses the importance of joint efforts of psychological and biological teams to develop new treatments.

Background: The study was designed to compare cognitive therapy (CT) with intensive behavior therapy (BT) in obsessive-compulsive disorder (OCD) and to study their change process. Methods: Sixty-five outpatients with DSM-4 OCD were randomized into 2 groups for 16 weeks of individual treatment in 3 centers. Group 1 received 20 sessions of CT. Group 2 received a BT program of 20 h in two phases: 4 weeks of intensive treatment (16 h), and 12 weeks of maintenance sessions (4 h). No medication was prescribed. Results: Sixty-two patients were evaluated at week 4, 60 at week 16 (post-test), 53 at week 26 and 48 at week 52 (follow-up). The response rate was similar in the 2 groups. The Beck Depression Inventory (BDI) was significantly more improved by CT (p = 0.001) at week 16. The baseline BDI and Obsessive Thoughts Checklist scores predicted a therapeutic response in CT, while the baseline BDI score predicted a response in BT. At week 16, only the changes in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and a scale measuring the interpretation of intrusive thoughts correlated in CT, while the changes in Y-BOCS, BDI, and interpretation of intrusive thoughts correlated in BT. Improvement was retained at follow-up without a between-group difference. The intent-to-treat analysis (last observation carried forward) found no between-group differences on obsessions, rituals and depression. Conclusions: CT and BT were equally effective on OCD, but at post-test CT had specific effects on depression which were stronger than those of BT. Pathways to improvement may be different in CT and BT. The outcomes are discussed in the light of an effect size analysis.

Studies on attentional processes in obsessive-compulsive disorder (OCD) have been inconsistent. The present study focused on the question of sustained attention in OCD, using the 'Degraded Stimulus Continuous Performance Test' (DS-CPT) sensitivity index over time. This study included 20 OCD patients and 25 control subjects, comparable in sex, age and educational level. All subjects had a neuropsychiatric structured diagnostic interview, as well as a psychometric battery. The DS-CPT evaluated sustained attention. The sensitivity decrement during DS-CPT was significant in both controls and OCD subjects. Contrary to our expectations, OCD patients did not show a greater decrease in sensitivity over time, compared to controls: thus, OCD patients presented a no more important attention decrease than controls. Controls and OCD subjects became more conservative in their response criteria throughout the DS-CPT test. Comparing OCD with and without pharmacological treatment did not reveal any difference in CPT outcome. Moreover, we observed, in OCD, a positive significant correlation between the Y-BOCS compulsion score and the CPT sensitivity index. A significant negative correlation of the Y-BOCS compulsive score with the CPT false alarm score was also found. In conclusion, OCD patients did not present any disturbance in sustained attention during a task requiring an increased processing load.

Panic attacks can be observed in a wide range of situations, but most common are those providing complex and unstructured stimulations, suggesting an impairment in attentional processing of visuo-spatial information. This study evaluated agoraphobics’ attentional processing of neutral (i.e., not anxiety-provoking) visuo-spatial stimulation. Twelve patients suffering from panic attacks with agoraphobia were compared with 22 normal controls on a computerized visual target discrimination task specifically designed for this study. Psychometric measures assessed the phobic avoidance, the level of depression and anxiety. The numbers of errors and reaction times were analysed with a three-way ANOVA (Group x target modality x number of stimulations). No between-group significant difference was found for the reaction time performance and the mean number of detection errors. However, an interaction effect was observed for this last variable depending on the target modality: agoraphobic patients made fewer omission errors than control subjects when the target was present among distractors, while they made more commission errors when the target was absent. Outcomes are discussed in terms of attentional hyperactivation related to anxiety and perseverative decision process in agoraphobic patients.

Background: The efficacy of cognitive behaviour therapy (CBT) in social phobia has been demonstrated in several controlled trials and meta-analyses, but no comparison of CBT with supportive therapy (ST) can be found in the literature. Method: The aim of the trial was to study the effectiveness of CBT versus ST carried out ‘as usual’. Sixty-seven DSM-4 social phobic patients (89% generalized subtype, most with avoidant personality) were randomly allocated into two groups. Group 1 (CBT) received 8 1-hour sessions of individual cognitive therapy (CT) for 6 weeks, followed by 6 2-hour sessions of social skills training (SST) in group weekly. Group 2 received ST for 12 weeks (6 half-hour sessions), then the patients were switched to CBT. All patients agreed not to take any medication during the whole trial. In group 1, 29 patients reached week 6, 27 reached week 12, and 24 weeks 36 and 60 (endpoint). In group 2, 29 patients reached week 6, 28 reached weeks 12 and 18, 26 week 24, and 23 reached weeks 48 and 72 (endpoint). Results: At week 6, after CT, group 1 was better than group 2 on the main social phobia measure. At week 12, after SST, group 1 was better than group 2 on most of the measures and demonstrated a significantly higher rate of responders. This finding was replicated after switching group 2 to CBT. Sustained improvement was observed in both groups at follow-up. Compliance with abstinence from medication increased over time. Conclusions: CBT was more effective than ST and demonstrated long-lasting effects. This may suggest that social phobia management requires more than a simple and inexpensive psychological intervention.

Background: The goal of the present study was to validate the French version of the Agoraphobic Cognitions Questionnaire (ACQ). Methods: Subjects consisted of 115 patients with panic disorder and agoraphobia, 54 obsessive-compulsive patients and 72 normal controls. Patients were referred for outpatient treatment. They filled in the questionnaire before and after entering treatment. The control group consisted of people taken from the general population. It was matched with the clinical groups on age, sex and education. Results: The ACQ appears to have a constant factor structure across US, Dutch and French samples. Results support the validity of the total score of the ACQ. Patients with panic disorder and agoraphobia scored significantly higher than obsessive-compulsive patients and control subjects. On the ACQ physical concerns subscale agoraphobic patients were significantly different from obsessive-compulsive patients and control subjects. On the social/behavioural subscale agoraphobic patients and obsessive-compulsive patients were significantly different from control subjects. The French translation of the ACQ was found to be stable over an interval of 15 days in the control group. The Cronbach coefficients of both subscales were also satisfactory. These results support the stability and the internal consistency of the questionnaire. In addition, the French translation of the ACQ was sensitive to changes with cognitive-behavioural therapy. Conclusions: These results support the findings of Chambless and Gracely [Cogn Ther Res 1989;13:9–20]. The ACQ physical concerns subscale is a specific feature for the anxiety status experienced by patients with panic disorder and agoraphobia. The ACQ social/behavioural subscale seems to be a more general feature of anxious patients.

Cognitive therapy (CT) has been studied in 78 controlled clinical trials from 1977 to 1996.The meta-analysis used Hedges and Olkin d+ and included 48 high-quality controlled trials. The 2765 patients presented non-psychotic and non-bipolar major depression, or dysthymia of mild to moderate severity.At post-test CT appeared significantly better than waiting-list, antidepressants (P0.0001) and a group of miscellaneous therapies (P0.01). But, CT was equal to behaviour therapy. As between-trial homogeneity was not met, the comparisons of CT with waiting-list or placebo, and other therapies should be taken cautiously. In contrast, between-trial homogeneity was high for the comparisons of CT with behaviour therapy and antidepressants. A review of eight follow-up studies comparing CT with antidepressants suggested that CT may prevent relapses in the long-term, while relapse rate is high with antidepressants in naturalistic studies.CT is effective in patients with mild or moderate depression.

Publisher Summary Social phobics and obsessive-compulsive disorder (OCD) patients have higher inferiority scores than normal controls and students and the inferiority score is highly correlated with social phobia (FQ-social phobia subscale) and OCD (Y-BOCS, OCTC). The findings provide preliminary evidence for the validity and usefulness of the inferiority scale as a psychometric instrument for clinical research in social phobia and OCD. The inferiority scale exhibits good internal consistency and stability. The absence of significant difference between social phobics and OCD patients on the inferiority scale, which was significantly correlated to both social phobia and OCD symptoms, suggests that social phobics and OCD patients present a common cognitive schema of inferiority. Inferiority interpretations could also exist in other anxiety disorders and are worth studying. OCD patients have difficulties in social situations although they do not meet the social phobia DSM-IV criteria. OCD and social phobia might be close to one another as far as interpersonal difficulties are concerned. The inferiority scale shows good psychometric properties of reliability and validity. Social phobics and OCD patients have higher inferiority scores than the normal controls and students, but there is no significant difference between the two groups of patients.

Background: The change of psychopathological dimensions during treatment of panic disorder is attracting increasing interest. Methods: A population of subjects experiencing panic disorder with agoraphobia is evaluated with the French version of the factor structure of the Symptom Checklist 90 R (SCL 90 R). Two groups of patients are compared: a group receiving cognitive behaviour therapy (CBT) combined with buspirone and a group receiving cognitive behaviour therapy combined with placebo. Results: Comparative analysis of pre- and post-test changes between both groups completing treatment showed that the combination cognitive behaviour therapy plus buspirone provided better results than those in patients who had received cognitive behaviour therapy plus placebo. This difference between treatments did not persist at the 1-year follow-up, since, while results had been effectively maintained in the CBT plus buspirone group, the CBT plus placebo group continued to improve significantly for the target dimensions of treatment. Conclusions: Psychopathological dimensions on the SCL 90 R show that combination of buspirone and cognitive behaviour therapy accelerates the behaviour modification process only in the short term.

BackgroundThis multicentre study compared a 16-week buspirone treatment with placebo in patients presenting with panic disorder with agoraphobia and also receiving cognitive behaviour therapy (CBT).MethodDouble-blind testing was maintained until week 68, but not tested; 91 patients were included; 14 placebo-responders excluded; 77 patients randomised; 48 reached week 16 and 41 reached week 68.ResultsAt week 16, within-group analysis showed significant improvements in agoraphobia, panic attacks, and depression in both groups. Generalised anxiety improved only in CBT + buspirone. Between-group comparisons showed buspirone to have an effect on generalised anxiety and agoraphobia. Changes in degree of agoraphobia and depression were correlated in subjects on CBT + buspirone only. A significantly higher proportion of women, and of subjects showing high avoidance dropped out. Positive expectations regarding medication predicted success in both groups. At week 68, improvement was retained without significant buspirone effect.ConclusionBuspirone enhanced the effects of cognitive behaviour therapy on generalised anxiety and agoraphobia in the short term.

Memory processes were compared in 26 patients presenting DSM-III-R obsessive-compulsive disorder (OCD) with 20 sex-, age- and education-matched normal controls. A significant between-group difference was found: visual memory was significantly lower in OCD, whereas no significant between-group differences in verbal memory were observed. A subsample of 17 OCD were also compared with the 20 control subjects on an explicit-memory free-recall task and an implicit-memory completion task using neutral, obsessive and guilt-responsibility words to test the effects of an emotional verbal input on memory functioning. No between-group difference was found, suggesting that emotionally laden word processing did not modify implicit and explicit memory performances.

Sixty outpatients with obsessive-compulsive disorder (OCD, 22 men, 38 women) were randomized to receive 6 months of antiexposure therapy with fluvoxamine (group F), exposure therapy with fluvoxamine (group Fe), or exposure therapy with placebo (group Pe). Patients in group F did not comply with antiexposure therapy, so it was in fact a neutral condition. Patients began with depressed mood (mean Hamilton depression score = 19). Fifty patients were reevaluated at week 8, 44 at week 24 (posttest), 37 at week 48, and 33 at 18 months, 1 year posttreatment (group F, n = 10; group Fe, n = 12; group Pe, n = 11). The three groups improved on rituals and depression. There was a drug effect on rituals at week 8 and on depression at week 24; both these effects disappeared at week 48. The 33 18-month completers had been comparable at baseline to those not followed up, apart from having more severe behavioral avoidance. At 18-month followup, patients as a whole remained improved with no between-group differences; over 80% of the Fe and Pe patients versus 40% of the F patients were not receiving antidepressant treatment (Fe vs. F: p < 0.04; Pe vs. F: p = 0.053; Fe vs. Pe: NS). In OCD fluvoxamine and exposure therapy were synergistic in the short term, and exposure reduced subsequent need for antidepressants in the followup year after they had been stopped.

Design: Randomised controlled trial.Allocation: Unclear.Blinding: Single blinded.Follow up period: Twelve months.Setting: University Medical Centre Utrecht, the Netherlands;October 1998 to June 2002.Patients: Ninety six adult outpatients with DSM-IV obsessive-compulsive disorder (OCD) who had responded to 3 months ofmedication (>25% reduction in score on Yale-Brown ObsessiveCompulsive Scale (Y-BOCS)) with venlafaxine (300 mg/day) orparoxetine (60 mg/day). Exclusion criteria: comorbid Axis Idisorder during past six months; Hamilton Rating Scale forDepression score .16; and cognitive and/or behaviour therapywithin six months of randomisation.Intervention: People were allocated to continuing drug treatment(300 mg/day venlafaxine or 60 mg/day paroxetine) plusbehaviour therapy (18 sessions at 45 minutes each), orcontinuing drug treatment alone for a further six months; the lattergroup subsequently received behaviour therapy for additional sixmonths.Outcomes: Severity of obsessive-compulsive symptoms (Y-BOCS); remission rate (Y-BOCS(8).Patient follow up: 61% completed the study.

Fifty DSM-III obsessive-compulsive outpatients underwent the dexamethasone suppression test (DST). Ten patients (20%) were nonsuppressors. A subgroup of secondary major depressions (n=10) did not show a higher rate of nonsuppressors. A subgroup including secondary major depressions and dysthymic disorders (n=24) showed a trend towards higher frequency of nonsuppressors (p=.056). Post-DST cortisol level had a statistically significant correlation with the Beck Depression Inventory and Hamilton Rating Scale for Depression. DST nonsuppression may represent a possible state marker of depression in obsessive-compulsive patients.

The dexamethasone suppression test (DST) was administered after baseline cortisol measurements in 20 patients (10 males, 10 females) who met DSM-III criteria for obsessive-compulsive disorder (OCD). Six patients (30%) showed an abnormal escape from dexamethasone suppression. DST suppressors vs. DST nonsuppressors showed no differences in age, rate of secondary depressive disorders, or scores on the Hamilton Rating Scale for Depression, the Minnesota Multiphasic Personality Inventory D scale, or OCD rating scales. Surprisingly, there was a trend for suppressors to have a stringer family history of depressive disorders, and for nonsuppressors to include an excess of male subjects. Moreover, there was a significant correlation between levels of cortisol before and after DST. In five of six nonsuppressors, both depressive symptoms and obsessive- compulsive behaviors showed a diminution in response to antidepressant therapy combined, in one case, with intensive behavior therapy. The relationships between OCD and endogenous depression, as well as the specificity of the DST, are discussed.