The post-traumatic stress disorder (PTSD) represents an original and frequent pathological entity concerning people confronted with one or more significant traumatic events. We present here a comparative study concerning subjects who present a post-traumatic stress disorder received in an anxiety disorder unit (ADU) or in a victims support association (VSA). One hundred and twenty seven people have been included in the study, according to DSMIV for PTSD, during three years. Fifty-seven came from a victim support association, 54 came from an anxiety disorder unit and 16 were common to both structures. The PCL-S (PTSD Checklist Scale) was used to rate the intensity of the PTSD. Age, sex, marital statute, type of traumatism, comorbidity and previous traumatisms were compared. PCLS scores were equivalent in the two settings. More women, younger subjects and more aggression were received in the victim support association. In the anxiety disorder unit more psychiatric comorbidity and more frequent antecedents of traumatism were seen. In the whole sample, two thirds of the people lived alone. Our results show that a victim support association receives people suffering from a definite post-traumatic stress disorder as intense on the PCL-S as in an anxiety disorder unit. More work has to be done on support association in the community, as they are confronted with significant PTSD problems.

Adolescent↗

PubMedDate not supplied

Validation of the French translation of the agoraphobic cognitions questionnaire.

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.

Adult↗

PubMedDate not supplied

Cognitive behavior therapy versus supportive therapy in social phobia: a randomized controlled trial.

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.

Adult↗

PubMedDate not supplied

A randomized controlled trial of cognitive therapy versus intensive behavior therapy in obsessive compulsive disorder.

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.

Adult↗

PubMedDate not supplied

[The evaluation of perceived responsibility among obsessive-compulsive patients].

Although many authors agree that excessive responsibility is associated with Obsessive-Compulsive Disorder (OCD), some believe that the manifestations of responsibility are more easily observed among patients suffering from checking compulsions (36, 42). This study compares a group of obsessive-compulsive patients that have been sub-divided into three groups (washers, checkers, ruminators) with a group of normal volunteers that are healthy with regards to responsibility. The sample consisted of 58 adults who meet diagnostic criteria for OCD and 20 normal individuals. During an individual interview, a clinician administered the ADIS III-R (section on OCD) as well as other instruments in order to precise the diagnosis. The participants then filled out questionnaires that assess symptoms, responsibility, perfectionism and general functioning. The results confirm that OC patients obtain higher scores than the normal group with regards to responsibility. However, no significant difference was found between the three sub-groups of OC patients. Thus, it seems to be pertinent of consider excessive responsibility as a characteristic of OC clients, for checkers and washers, as well as ruminators.

Adult↗

PubMedDate not supplied

[Preliminary studies of the structured diagnostic interview for personality disorders: SCID II].

The aim of the study was to compare control subjects and consultant patients with the SCID II (interview and questionnaire), then to compare clinical diagnosis with the SCID II (interview and questionnaire). The preliminary study was carried out to assess the feasibility of the procedure. This appraisal was conducted with a group of patients (n = 26) and a control group (n = 16). Only the patients were diagnosed according to DSM IV criteria. The patients and the control group completed the Mini-Mult and the SCID II (questionnaire and interview). The two groups were matched on sex, age and educational level. The two groups were discriminated on all Mini-Mult scales but one: the internalization index. The results showed that the SCID questionnaire and the SCID interview differentiate the two groups. The SCID questionnaire showed high sensitivity in the group of patients. It is a more efficient instrument to screen control subjects except one personality disorder (obsessive-compulsive). The diagnostic agreement between the clinical diagnosis and the structured interview was poor. However our results are comparable to the other studies.

Adult↗

PubMedDate not supplied

[Social anxiety in patients with social phobia: validation of the Liebowitz social anxiety scale: the French version].

The Liebowitz's Social Anxiety Scale (LSAS) (Liebowitz, 1987) is a rating scale of fear and avoidance in social interaction (12 items) and performance-oriented situations (12 items). This paper present the study of empirical and concurrent validation of the LSAS. Ninety-six patients suffering from social phobia according to DSM IV were included and compared with 64 non-clinical control subjects. Both patients and controls were divided into two sub-groups: the LSAS passation by hetero-evaluation or auto-evaluation. Social phobics had much higher scores on anxiety and avoidance of the LSAS than control subjects, whatever the method. There were no differencies between hetero and auto-evaluation in both groups of patients and non-clinical subjects, either on anxiety or on avoidance. The LSAS correlated better with social anxiety and negative cognition in social situations than with anxiety-depression in social phobics. The French version of the LSAS showed a good empirical and concurrent validity and the scale presents a good sensitivity to change after cognitive behavioral therapy in social phobics.

Adult↗

PubMedDate not supplied

[A controlled study of irrational interpretations of intrusive thoughts in obsessive-compulsive disorder].

UNLABELLED: Recent research suggested that the irrational interpretations of intrusive thoughts might be cognitive structures underlying obsessive compulsive disorder (OCD). We present a study on intrusive thoughts and their interpretations in 36 patients suffering from OCD (DSM IV criteria), compared with 36 sex and age matched non clinical subjects, with the Intrusive Thoughts and their Interpretations Questionnaire-revised version (ITIQ-r). This questionnaire measures intrusive thoughts intensity and three types of interpretation: responsibility, guilt and inferiority. The measures of OCD, of depression, of social phobia and of anxiety have been used. RESULT: OCD patients reported more frequent intrusive thoughts and higher irrational interpretations than controls. The higher the intrusive thoughts, the higher the irrational interpretations. The multiple regression showed that both intrusive thoughts and irrational interpretations were respectively predicted by obsessional compulsive pathology (the Obsessive Thoughts Checklist or the Y-BOCS). The Y-BOCS was the only predictor for inferiority interpretation, but there was no significant predictor for responsibility or for guilt interpretations. Responsibility correlated only with aggressive intrusive thoughts. Guilt was related to intrusions about fear of loss. Inferiority was highly correlated with intrusive thoughts about perfectionism and sexuality.

Adolescent↗

PubMedDate not supplied

[Validation of a scale for responsibility (Salkovskis Responsibility Scale)].

Appraisal of inflated responsibility for harm is the cornerstone of Salkovskis's cognitive theory for obsessive compulsive disorder. The aim of our study is to present the validation study of the French translation of the R scale. The present study compared 50 subjects with obsessive compulsive disorder, 37 patients suffering from social phobia and 183 control subjects on a responsibility questionnaire (R scale). The cognitive hypothesis of Obsessive Compulsive Disorder (OCD) specifies two levels of responsibility-related cognitions: responsibility assumptions (attitudes) and responsibility appraisals (interpretations). The R scale evaluates the responsibility assumptions. Such attitudes should reflect the more generalized tendency to assume responsibility in a given situation, particularly situations involving intrusions and doubts. It is possible that such assumptions may be less specific to OCD. The inclusion of social phobia subjects in the present study allows evaluation of the specificity of any findings to OCD. Patients were diagnosed and classified according DSM IV criteria. The control subjects were taken in the general population. No formal interview was conducted. The three groups were compared for sex, age and educational level. Before treatment, all the participants filled in the Responsibility Scale of Salkovskis (27 items), the Beck Depression Inventory (21 items), the Beck Anxiety Inventory and the Bouvard's Obsessive Compulsive Thoughts Checklist. The results indicate that the two anxious groups scored significantly higher than the control group on Beck Depression and Anxiety Inventories but no significant difference was observed between the two anxious groups. OCD patients scored significantly higher than both social phobic patients and control subjects on the Obsessive Compulsive Thoughts Checklist (OCTC). The social phobic group scored this checklist significantly higher than the control group. In sum, the three groups were different on obsessive compulsive thoughts. On the washing subscale of the Obsessive Compulsive Thoughts Checklist, the OCD patients differed significantly from the control group and the social phobia patients. No difference was observed between the social phobia subjects and the control group. On the two other subscales of the OCTC, the checking and the responsibility scales, the three groups were different: OCD patients scored significantly higher than both social phobic patients and control subjects; the social phobic patients scored higher than the control group. Results support the reliability (test retest) and the internal consistency of the questionnaire. Patients with obsessive compulsive disorder (OCD) and social phobia subjects had significantly elevated score on the total scale compared to control subjects. However social phobia patients did not differ from patients with OCD. So, the responsibility for harm, evaluated by the R-scale seems not to be specific of OCD. This finding does not support the results of two studies (28, 30). But these two studies compared OCD patients with an anxious group including panic disorder with agoraphobia, generalized anxiety disorder and social phobia. The correlations with a measure of OCD symptoms were higher than the correlations with anxiety and depression. Finally, the factor structure was only studied on the control group. The exploratory factor analysis indicates that the R scale is a two-dimensional scale, reflecting a need to prevent risks and the belief that one has power to harm. The first dimension is less specific to the pathology than the second. Only patients with OCD had significantly elevated score on the "need to prevent risks" compared to the non-clinical group. The two anxious groups differed on "the belief that one has power to harm" from the non-clinical group but social phobia patients did not differ from patients with OCD. In sum, the two subscales of the R scale did not discriminate OCD patients and social phobic subjects. Further research is needed to replicate the present findings and to confirm the two dimensions of the R scale. Overall, the results are consistent with the hypothesis that responsibility beliefs are important in the experience of obsessional problems. However, responsibility assumptions such as the belief that one has the power to harm are shared with social phobia.

Adult↗

PubMedDate not supplied

[Inferiority in normal and anxious populations].

BACKGROUND: The construct of inferiority can be defined as an intimate, unrealistic and persistent conviction to be always low-ranking in merit, value, intellectual and/or physical capacities (Weiner et Mohl, 1996; Yao et al., 1996). This can be considered as an important cognitive factor in anxiety disorders. But, does a feeling of inferiority also exist in normal subjects? We hypothesized that the feeling of inferiority might be a normal phenomenon if it is a transient experience, in relation to external events, and represents an aspect of self esteem. The Inferiority Scale (Yao et al., 1998), aimed at measuring the feeling of inferiority in anxiety, is a self-report instrument including 17 items assessing self-appraisal of inferiority and 17 items assessing inferiority linked to others' judgements. It showed good psychometric properties of reliability and validity in previous studies. The aim of our study was to confirm the existence of inferiority feeling in non-clinical subjects, and its continuity between normal and anxious populations. Method - We included 264 non-clinical subjects in the study. The mean age of the sample was 30.38 years old (SD=10.25) and 36% (94 Ss) were men. The anxious population was composed with 57 subjects suffering from obsessive compulsive disorder (OCD) and 43 patients with social phobia according to DSM IV. The mean age of this population was 34.0 years old (SD=10.6) and 51% of them were men. The Inferiority Scale was used in our study for evaluating the feeling of inferiority. RESULTS: Most of non-clinical subjects reported low inferiority feelings and a part of the non-clinical subjects (15%) presented a moderate or strong feeling of inferiority, on the Inferiority Scale. The non-clinical subjects group was divided into two sub-groups (Low and High Inferiority) with the median of the Inferiority Scale total score. The total score and the sub-scores of the Inferiority Scale were all significantly higher in the two anxiety groups than in the two non-clinical sub-groups (p<0.0001) and higher in non-clinical subjects with high inferiority, compared to those with low inferiority (p<0.0001). Noting that the social phobic group presented higher scores of the Inferiority Scale than the OCD group (p=0.0058). There was a significant and negative correlation between age and the Inferiority Scale in non-clinical subjects, but there was no between-sex difference on the scale. CONCLUSION: Our results confirm the existence of inferiority feeling in non-clinical subjects and suggest the existence of continuity of inferiority feeling as a psychological trait between normal and pathological populations.

Adult↗

PubMedDate not supplied

[Evaluation of Post-traumatic Stress Disorder: validation of a measure, the PCLS].

Post-Traumatic Stress Disorder (PTSD) is a psychiatric disorder frequently found in psychiatric clinic and in the population of victims of traumatic events. PTSD, characterized by an intense fear, helplessness or horror, resulting from exposure to a traumatic event, is clinically manifested with three main syndromes: reexperiencing, avoidance behavior and numbing of emotion, and physiological hyperarousal. The Post-Traumatic Checklist Scale (PCLS) is a brief and self-report questionnaire for evaluating the severity of three main syndromes of PTSD. The scale can be divided into three sub-scores corresponding to the three main syndromes of the disorder: reexperiencing (items 1-5), avoidance (items 6-12) and hyperarousal (items 13-17). The validation studies in English version (Weathers et al., 1993, Blanchard et al., 1996) and French version (Ventureyra et al., 2001) showed that the PCLS possesses good psychometric properties. But the discriminating validation with another pathological group and the sensitivity of the scale to change of treatment have not yet been studied up to now. The aim of this study is the validation of the French version of the PCLS in Post-Traumatic Stress Disorder (PTSD) subjects compared with subjects suffering from other anxiety disorders and non-clinical subjects. The sensitivity of the PCLS after a cognitive behavioral therapy (CBT) for PTSD was studied for the first time. Fifty-seven outpatients suffering from PTSD according to DSM IV criteria, 23 patients suffering from other anxiety disorders and 28 non-clinical subjects were included in this study. All subjects were assessed with the PCLS. The Beck Depression Inventory--13 items (BDI-13) and the Fear Questionnaire (FQ) were used for the two groups of patients. Fifty-five PTSD patients were administered the PCLS twice over an interval of one to two weeks without any intervention in order to determine the test-retest reliability of the PCLS. And 24 PTSD patients were reassessed with the PCLS after 16 sessions of cognitive behavioral therapy (CBT) in order to study the sensitivity to treatment of the PCLS. The CBT technique for PTSD consisted of relaxation, exposition, recital, cognitive restructuration and stress management. The total score and the subscores on the PCLS were found to be significantly higher in PTSD patients than in two control groups: suffering from other anxiety disorders subjects (61.2/41.4, p<0.0001) and non-clinical subjects (61.2/28.8, p<0.0001). The correlation between the PCLS total score and the others measures showed that the PCLS correlated significantly with the depression measure, the BDI-13 (p<0.001), and the sub-scores of Fear Questionnaire (agoraphobia: p<0.001; anxiety-depression: p<0.001; distress: p<0.001), but not with the social phobia sub-score of the FQ. The PCLS showed a satisfactory test-retest reliability in 55 patients (the total score: r=0.75, p<0.0001; the sub-score of reexperiencing: r=0.844, p<0.0001; the sub-score of avoidance: r=0.702, p<0.0001; the sub-score of hyperarousal: r=0.712, p<0.0001). The t-test showed that the total score of the PCLS was significantly reduced in 24 patients after 16 sessions of CBT (the mean gain=13.1, t=5.63, p<0.0001). The results of our study confirm that the PCLS possesses good empirical and discriminating validity and a good sensitivity. The fact that the PTSD patients reported significantly higher total scores on the PCLS and its three subscores than other anxiety disorder subjects and non-clinical subjects indicates that the PCLS differentiates well the patients presenting PTSD from other anxiety disorder subjects and non-clinical subjects. The PCLS total score also correlates significantly with the other measures of psychopathology used in the study, such as measures of phobia (the Fear Questionnaire agoraphobia subscale), depression (the Beck Depression Inventory -13) and distress (the Fear Questionnaire distress subscale). This may be explained by the fact that some PTSD symptoms overlap with those of depression and of anxiety or phobia. The PCLS showed anxiety or phobia. The PCLS showed a satisfactory test-retest reliability. The PCLS is therefore a valid and effective measurement of PTSD. It may be a useful tool for screening and assessing PTSD in clinical practice and research in psychiatry.

Adult↗

PubMedDate not supplied

[Study of Beck's hopelessness scale. Validation and factor analysis].

The validation study and factorial analysis of the Beck's hopelessness scale is presented. Two groups were compared including patients suffering from depression (n = 100) and a control group (n = 93). Age and sex were comparable in the two groups. The hopelessness scale is valid, and differentiates depressive patients from control subjects. The scale has a good reliability (test-retest, r = .81) and a good internal consistency (alpha = .97) for depressive subjects and alpha = .79 for control subjects). It also shows a good concurrent validity with other scales assessing depressive cognitions, the automatic thoughts questionnaire, the dysfunctional attitudes scale (form A) and a scale assessing the suicidal risk (ERSD). No concurrent validity is found with scales assessing the intensity of depression, the Beck depression inventory and the Hamilton scale. The factorial analysis elicits a general factor, accounting for 38.15% of the variance, and reflecting negative feelings about the future. The study of all the factorial analysis shows the stability of the factorial structure.

Adult↗

PubMedDate not supplied

[Cognitive therapy in obsessive-compulsive disorders].

Cognitive approach is presented both at a theoretical and clinical level. It enlarges and enriches the classical behavioral approach of obsessive-compulsive disorders. To date, controlled studies are too few to fully assert its value. Further investigations are justified to ascertain whether cognitive therapy has a value as such, or enhances the effects of more classical pharmacological and/or behavioral treatments.

Cognitive Behavioral Therapy↗