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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.brat.2005.03.015 Byline: Bonnie G. Zucker, Michelle G. Craske, Michelle A. Blackmore, Ashley Nitz Keywords: Subclinical obsessions and compulsions; OCD; Prevention; Early intervention; Cognitive behavior therapy; Anxiety disorders; Workshop Abstract: The present study investigates the effectiveness of a 3-h cognitive behavioral workshop for individuals, ages 18-22, with subclinical obsessions and compulsions. It was hypothesized that, compared to individuals in an assessment-only waitlist group (n=42), individuals assigned to the workshop group (n=43) would experience a significant decrease in obsessive-compulsive (OC) symptomatology, comorbidity, and thought action fusion endorsement at 1-month and 5-month follow-up assessments. An additional outcome of interest was the number of incident cases of obsessive-compulsive disorder (OCD) over the course of the study. The results indicated that the workshop group reported a significantly fewer number of OC symptoms at 5-month follow-up and endorsed significantly less thought action fusion at both follow-up points. However, there were no differences between groups in severity of OC symptoms and number of comorbid diagnoses endorsed. Only one incident case of OCD was observed during the study, from a participant in the waitlist group. These results are discussed in reference to treatment of subclinical anxiety symptoms. Author Affiliation: University of California, Los Angeles, USA Article History: Received 26 October 2004; Revised 1 March 2005; Accepted 15 March 2005

This study examined the effects of cognitive-behavioral therapy (CBT) for principal panic disorder with or without agoraphobia, on comorbidity in 30 individuals (16 female). To test the hypothesis that improvements in co-existing conditions were not due to spontaneous fluctuations across time, patients receiving immediate CBT were compared to those assigned to wait list (n = 11). Results indicated clinician-rated severity of comorbid specific phobia declined significantly following immediate CBT compared to no change after wait list. The number of patients without comorbidity of any severity increased after immediate CBT, with no such increase following wait list. However, the groups did not differ in the frequency of additional diagnoses or overall severity of comorbidity. In the total sample, results indicated reductions in comorbidity by 9-month follow-up, with marked declines in the severity of comorbid generalized anxiety disorder (GAD), social and specific phobia. Our findings suggest that targeted CBT for panic disorder has beneficial effects on comorbidity over the longer term and that some of its immediate effects exceed those due to the passage of time alone. Keywords: Panic disorder; Comorbidity; Cognitive-behavioral therapy; Comorbid conditions; Specific phobia

Meta-cognitive beliefs associated with pathological worry and generalized anxiety disorder (GAD) may encompass the likelihood subtype of thought-action fusion (TAF), the belief that one's thoughts can influence outside events. In the current study of 494 undergraduate college students, positive correlations between scores on the Penn State Worry Questionnaire (PSWQ) and the two Likelihood subscales of the TAF Scale were found, and participants endorsing at least some DSM-IV diagnostic criteria for GAD scored significantly higher on both TAF-Likelihood subscales than participants reporting no GAD symptoms. However, these TAF scales did not predict GAD diagnostic status with PSWQ included as a predictor. In contrast to previous research, the TAF-Moral scale did not correlate with worry. Relationships between TAF, pathological worry, and meta-cognition are discussed in relation to GAD. Keywords: Thought-action fusion; Worry; Generalized anxiety disorder; Meta-cognition

Replicating and extending our prior work (Tsao, Lewin, & Craske, 1998), the present study examined the impact of cognitive-behavioral treatment (CBT) for principal panic disorder/agoraphobia (PDA) on the frequency and severity of comorbid conditions in 51 principal PDA patients diagnosed using the Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV; Brown, Di Nardo, & Barlow, 1994). Patients with at least 1 additional diagnosis of clinical severity declined from 60.8% (n = 31) at pretreatment to 37.3% (n = 19) at posttreatment, and 35.3% (n = 18) at follow-up. ADIS-IV severity ratings for comorbid generalized anxiety disorder (GAD), depression, and specific phobia also declined significantly following treatment. Reductions in comorbidity were maintained at 6-month follow-up. Baseline comorbidity was not associated with increased severity of PDA at pretreatment and did not adversely impact outcome for PDA immediately posttreatment or at follow-up. Possible mechanisms, as well as implications for clinical practice and policy decisions, are discussed.

The goal of this study was to investigate whether or not a brief educational intervention delivered prior to engaging in an anxiety-provoking task (writing a sentence about hoping that a friend/relative was in a car accident) would be effective in offsetting anxiety in college students with a strong propensity to endorse statements of thought action fusion (TAF). As hypothesized, individuals receiving the educational intervention were less anxious than a placebo intervention control group at post task; they were also less likely to endorse statements of TAF after receiving the educational intervention. Also, those who chose to neutralize after writing the sentence (regardless of experimental group) were more likely to report feeling guiltier, more immoral and a greater sense of responsibility about writing the sentence prior to neutralizing than those who did not subsequently neutralize. These results are discussed in relation to the cognitive theory of obsessive-compulsive disorder and implications for prevention programs. Keywords: Thought action fusion; Obsessive-compulsive disorder; Anxiety; Non-clinical population; Adults

The last decade has brought exciting advances to the treatment of panic disorder and agoraphobia, and a variety of cognitive-behavioral and pharmacologic treatment strategies offer clear benefit to patients. Nonetheless, treatment nonresponse continues to be a chronic problem, and additional strategies are needed to aid patients who do not respond fully to initial interventions. In the present study, we use 'services' research to document the clinical response of pharmacotherapy nonresponders to a standard program of brief, group cognitive-behavioral therapy. Patients responded well, regardless of whether they had received a full, adequate trial of pharmacotherapy. In addition to its application as an initial treatment for panic disorder, routine application of cognitive-behavioral therapy in pharmacologic treatment algorithms is encouraged, with attention to referral of pharmacotherapy nonresponders to cognitive-behavioral therapy. Keywords: Cognitive-behavior therapy; Behavior therapy; Panic disorder; Nonresponders; Treatment-resistance; Pharmacotherapy