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Background: acceptance and commitment therapy (ACT) and cognitive-behavioral therapy (CBT) are empirically supported treatments for anxiety and panic disorder (PD), though they differ in their putative vulnerability and maintenance processes. The present study examined the incremental validity of several of these models' proposed core processes, including anxiety sensitivity (AS), dispositional avoidance, experiential avoidance (EA), cognitive fusion (CF), and mindfulness, as well as the interaction of the processes within each model, in the prediction of anxiety and panic symptomology. Methods: a sample of US adults (n = 316) completed self-report measures of AS, dispositional avoidance, EA, CF, mindfulness, anxiety, and PD symptoms. A series of hierarchical multiple regression analyses were conducted. Results: hierarchical regression analyses indicated that AS, dispositional avoidance, and EA predicted anxiety and panic symptoms even after controlling for one another, CF, mindfulness, and demographic variables. Although mindfulness and CF was correlated with anxiety and panic at the univariate level, they did not predict either outcome above and beyond AS, dispositional avoidance, and EA. When interaction terms were added to the models, the interaction between AS and -dispositional avoidance was a significant predictor of panic and anxiety symptoms, whereas the interaction between EA and CF only predicted panic symptoms. None of the interactions that included mindfulness were significant predictors. Conclusions: these findings provide support the independent and interactive predictive value of traditional CBT (AS, dispositional avoidance, and AS-dispositional avoidance) and ACT (EA) processes for anxiety and panic symptoms, but raise questions about the incremental predictive utility of CF and mindfulness. [ABSTRACT FROM AUTHOR]

Estimated rates of co-occurrence between obsessive and compulsive disorder (OCD) and panic disorder (PD) are notable, but vary considerably, with rates from epidemiological and clinical studies ranging from 1.8% to 22% (Rector et al., 2017). We reviewed the current empirical literature on the etiology, treatment, diagnostic assessment, and differential diagnosis of co-occurring OCD/PD. Best practices for cognitive-behavioral treatment, including identifying and addressing treatment barriers are also addressed. Although it is acknowledged in current literature that co-occurring OCD and PD levels may be clinically significant, there remains a need to thoroughly examine the possible consequences and future research directions of this overlap. Future research must continue to elucidate the biological and environmental causes of OCD/PD co-occurrence. [ABSTRACT FROM AUTHOR]

Little is known about disparities in depression prevalence, treatment, and remission by psychiatric comorbidities and substance use among persons living with HIV (PLWH). We conducted a cross-sectional analysis in a large cohort of PLWH in routine care and analyzed conditional probabilities of having an indication for depression treatment, receiving treatment, receiving indicated treatment adjustments, and achieving remission, stratified by alcohol use, illicit drug use, and panic symptoms. Overall, 34.7% (95% CI 33.9-35.5%) of participants had an indication for depression treatment and of these, 55.3% (53.8-56.8%) were receiving antidepressants. Among patients receiving antidepressants, 33.0% (31.1-34.9%) had evidence of remitted depression. In a subsample of sites with antidepressant dosage data, only 8.8% (6.7-11.5%) of patients received an indicated treatment adjustment. Current drug users (45.8%, 95% CI 43.6-48.1%) and patients reporting full symptoms of panic disorder (75.0%, 95% CI 72.9-77.1%) were most likely to have an indication for antidepressant treatment, least likely to receive treatment given an indication (current drug use: 47.6%, 95% CI 44.3-51.0%; full panic symptoms: 50.8%, 95% CI 48.0-53.6%), or have evidence of remitted depression when treated (22.3%, 95% CI 18.5-26.6%; and 7.3%, 95% CI 5.5-9.6%, respectively). In a multivariable model, drug use and panic symptoms were independently associated with poorer outcomes along the depression treatment cascade. Few differences were evident by alcohol use. Current drug users were most likely to have an indication for depression treatment, but were least likely to be receiving treatment or to have remitted depression. These same disparities were even more starkly evident among patients with co-occurring symptoms of panic disorder compared to those without. Achieving improvements in the depression treatment cascade will likely require attention to substance use and psychiatric comorbidities. [ABSTRACT FROM AUTHOR]

Background: Although research conducted within the military has assessed the health and mental health problems of military personnel, little information exists about personnel who seek care outside the military. The purpose of this study is to clarify the personal characteristics, mental health diagnoses, and experiences of active duty U.S. military personnel who sought civilian sector services due to unmet needs for care.Materials and Methods: This prospective, multi-method study included 233 clients, based in the United States, Afghanistan, South Korea, and Germany, who obtained care between 2013 and 2016 from a nationwide network of volunteer civilian practitioners. A hotline organized by faith-based and peace organizations received calls from clients and referred them to the network when the clients described unmet needs for physical or mental health services. Intake and follow-up interviews at 2 wk and 2 mo after intake captured demographic characteristics, mental health diagnoses, and reasons for seeking civilian rather than military care. Non-parametric bootstrap regression analyses identified predictors of psychiatric disorders, suicidality, and absence without leave (AWOL). Qualitative analyses of clients' narratives clarified their experiences and reasons for seeking care. The research protocol has been reviewed and approved annually by the Institutional Review Board at the University of New Mexico.Results: Depression (72%), post-traumatic stress disorder (62%), alcohol use disorder (27%), and panic disorder (25%) were the most common diagnoses. Forty-eight percent of clients reported suicidal ideation. Twenty percent were absence without leave. Combat trauma predicted post-traumatic stress disorder (odds ratio [OR] = 8.84, 95% confidence interval [CI] 1.66, 47.12, p = 0.01) and absence without leave (OR = x3.85, 95% CI 1.14, 12.94, p = 0.03). Non-combat trauma predicted panic disorder (OR = 3.64, 95% CI 1.29, 10.23, p = 0.01). Geographical region was associated with generalized anxiety disorder (OR 0.70, 95% CI 0.49, 0.99, p = 0.05). Significant predictors were not found for major depression, alcohol use disorder, or suicidal ideation. Clients' narrative themes included fear of reprisal for seeking services, mistrust of command, insufficient and unresponsive services, cost as a barrier to care, deception in recruitment, voluntary enlistment remorse, guilt about actual or potential killing of combatants or non-combatant civilians, preexisting mental health disorders, family and household challenges that contributed to distress, and military sexual trauma.Conclusions: Our work clarified substantial unmet needs for services among active duty military personnel, the limitations of programs based in the military sector, and the potential value of civilian sector services that are not linked to military goals. We and our institutional review board opted against using a control group that would create ethical problems stemming from the denial of needed services. For future research, an evaluative strategy that can assess the impact of civilian services and that reconciles ethical concerns with study design remains a challenge. Due to inherent contradictions in the roles of military professionals, especially the double agency that makes professionals responsible to both clients and the military command, the policy alternative of providing services for military personnel in the civilian sector warrants serious consideration, as do preventive strategies such as non-military alternatives to conflict resolution. [ABSTRACT FROM AUTHOR]

Objective: Anxiety disorders are the most prevalent psychiatric disorders in the United States and result in substantial burden to the individual and society. Although effective treatments for anxiety disorders have been developed, there has been substantially less focus on interventions aimed at the amelioration of anxiety-related risk and maintenance factors. Anxiety sensitivity (AS) is a well-established, malleable risk and maintenance factor for panic disorder and other psychopathology. The aim of the current investigation was to enhance the efficacy of AS treatment through the refinement of a previously validated intervention. Method: This 1-session intervention utilized psychoeducation and interoceptive exposure to target AS and was compared with a health-focused control intervention among a nontreatment seeking sample (N = 104) of individuals with elevated AS. Results: Study findings indicate that the active treatment group demonstrated significantly greater reductions in AS than the control group at posttreatment and across the 1-month study period. These treatment gains were seen across the ASI subscales. A Month 6 follow-up assessment indicated that the treatment group retained the majority of their AS reduction, whereas the control group retained their elevated AS scores. The intervention responses of participants meeting Axis I diagnostic criteria did not differ from the responses of those without a current diagnosis. Conclusions: Despite the brevity of the treatment intervention, findings demonstrate that it resulted in substantial reductions in AS that were largely maintained 6 months posttreatment. Anxiety treatment and prevention implications axe discussed. [ABSTRACT FROM AUTHOR]

Routine outcome monitoring (ROM) is a method devised to systematically collect data on the effectiveness of treatments in everyday clinical practice. ROM involves documenting the outcome of treatments through repeated assessments. Assistants are employed who perform a baseline assessment comprising a standardized diagnostic interview, administration of rating scales and completion of several self-report measures by the patient. At fixed time intervals, assessments are repeated. Dedicated Web-based software has been developed to assist in this task. ROM informs therapists and patients on the severity of the complaints at intake, and the waxing and waning of symptoms over the course of treatment. Researchers can use ROM for effectiveness research, and managers can use it for benchmarking. The use of ROM for research is illustrated by presenting data on the diagnostic status of patients participating in ROM and data on treatment outcome of a subgroup of patients (with panic disorder) in our database. The results show that implementation of ROM is feasible, and after some initial reservations, most therapists now consider ROM to be a necessary and important adjunct to the clinical treatment. In addition, ROM furthers research as the data can be used to study the phenomenology of psychiatric disorders and the outcome of treatments delivered in everyday practice. Copyright © 2010 John Wiley & Sons, Ltd. • A form of tracking the progress of treatment through routine outcome monitoring (ROM) is described. • Implementation of ROM appears feasible and can be carried out in large institutions as well as smaller practices. • Providing feedback about outcome in an appealing format is highly valued by both therapists and patients. • ROM data enable investigation of the effectiveness of treatments in everyday clinical practice. [ABSTRACT FROM AUTHOR]

Examines the relationship of expressed emotion (EE) to behavior therapy outcome for obsessive-compulsive and panic disorders with agoraphobia in the United States. Role of EE in treating anxiety disorders; Assessment of hostility by Camberwell Family Interview (CFI); Relation of nonhostile criticism on CFI with outcome on behavioral avoidance test.

The article reports on a study that examines the efficacy of cognitive behavioral therapy (CBT), selective serotonin reuptake inhibitor (SSRI) monotherapy, or a combination of CBT with SSRI on treatment of panic disorder in the U.S. A total of 150 patients with panic disorders with or without agoraphobia were the subject of the study. Findings of the study revealed the effectiveness of the three modalities in improving anxiety and coping ability of panic disorder patients.

Presents news briefs on issues related to therapeutics as of July 2006. Initiation of a phase 2A clinical trial for a panic disorder inhalant by Alexza Pharmaceuticals Inc.; Approval by the U.S. Food and Drug Administration for the indiplon capsules and tablets from Neurocrine Biosciences Inc.

After receiving approval from the U.S. Food and Drug Administration last year, paroxetine mesylate, an alternative to paroxetine hydrochloride, is now available. Paroxetine mesylate is issued for the treatment of depression, obsessive-compulsive disorder and panic disorder.

Reports on the availability of antipsychotic drug paroxetine mesylate (Pexeva) in the United States. Use of Pexeva as an alternative to paroxetine hydrochloride (Paxil); Food and Drug Administration's approval of the drug; Use of Pexeva to treat depression, obsessive/compulsive disorder and panic disorder.