1992 — 1993 |
Chambless, Dianne L. |
R03Activity Code Description: To provide research support specifically limited in time and amount for studies in categorical program areas. Small grants provide flexibility for initiating studies which are generally for preliminary short-term projects and are non-renewable. |
Assessment of Avoidant Personality Disorder
Avoidant Personality Disorder (APD) is characterized by long-standing avoidance of social interaction and extreme fears of criticism, humiliation, and rejection. APD is the most common personality disorder among patients with social phobia and panic disorder with agoraphobia and is prevalent among depressed patients as well. APD may be related to poor treatment outcome with psychological as well as pharmacological treatment of panic disorder, and is of interest in its own right as a disorder that interferes with effective social functioning. Research on APD has been hampered by changing diagnostic criteria, the lack of adequately validated diagnostic instruments, and the paucity of basic empirical research on the psychopathology of this disorder. Two studies are proposed to address issues in the assessment of APD. In Study 1 (a) the effects of short-term treatment for an Axis I disorder (agoraphobia) on the stability of the diagnosis of APD will be examined in a sample of 40 patients; and (b) and replication of a previous study wherein APD predicted poor treatment response for agoraphobia in this program will be conducted. In Study 2, the responses of two groups of generalized social phobic patients (26 with APD and 26 without) will be contrasted on behavioral and self-report measures of social phobia and APD. This study will serve as a pilot for a projected treatment study on APD and for a larger psychopathology study to determine whether APD can be empirically and usefully distinguished from the Axis I disorder of generalized social phobia. Finally, the pooled samples of Studies 1 and 2 will be used to examine (a) the interrater and test-retest reliability of APD measures, and (b) the concurrent validity of self-report, relatives' report, and interview measures of APD.
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0.954 |
1995 — 1996 |
Chambless, Dianne L. |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Expressed Emotion in Anxiety Disorders @ University of North Carolina Chapel Hill
Exposure, the best-validated treatment for panic disorder complicated by agoraphobia (PDA) and for obsessive-compulsive disorder (OCD, for whom response prevention is added) leads to good improvement in 60-75% of patients who complete treatment. However, residual disability generally remains, and these figures ignore the problems of treatment refusal, drop-out, and relapse. Attempts to explain the highly variable outcome and to improve upon these rates of change have yielded few cross- validated findings. Given the marked disability associated with these disorders and the concomitant public health costs, it is important to understand better why some patients drop-out, fail to benefit, or relapse. Identifying predictors of treatment success should help in the design of more effective treatment. In the proposed study, the investigators will complete the 6-month to 2-year follow-up data collection and analysis of data from 105 patients with PDA or OCD entering exposure-based treatment (with response prevention for OCD) during years 1-5 of this study. The effects of two major classes of predictors will be examined: Comorbidity and Expressed Emotion (EE). Defined as relatives' criticism of, and/or emotional over-involvement with the patient, EE has consistently predicted relapse at follow-up for schizophrenic and depressed patients treated as inpatients. In this study, the effects of EE on drop-out, immediate outcome, and relapse of outpatients with PDA and OCD are examined, and the construct of EE is explored to achieve a better understanding of its validity and meaning. EE and related measures were assessed via multiple methods: self-report, patients' report, videotaped relative-patient interactions, and the widely used Camberwell Family Interview administered to relatives. Treatment outcome was assessed with self-report, interview, and behavioral measures. Preliminary data analyses of this sample indicate that the patients' perceptions of their relatives' criticism may be an important predictor of poor outcome at follow-up, and that relatives who are poor problem-solvers may become critical when frustrated by the patients' behavior. Research on the effects of comorbid conditions on treatment is scant, but suggests that comorbid depression, generalized anxiety, and anxious personality disorders predict poor posttreatment outcome for PDA patients. Preliminary data from this sample suggest that comorbidity predicts poor outcome for both patient groups These data have important treatment implications and will be pursued Into follow-up in this application. Findings that comorbidity and EE are associated with poor outcome for patients with these severe anxiety disorders would have clear implications for development of adjunctive treatments to boost treatment response and maintenance of gains in these groups. Completion of the follow-up data collection is required for clear findings.
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0.951 |
2010 |
Chambless, Dianne L. |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Dynamic Therapy Vs. Cbt For Panic Disorder @ University of Pennsylvania
DESCRIPTION (provided by applicant): Panic disorder (PD) is a prevalent and debilitating condition. Efficacious treatments for this condition exist, including several classes of medication. Cognitive behavioral therapy, (CBT) has been shown to be efficacious for PD. However, over 30% of PD patients decline medication, and nearly one half do not remit from CBT, there is a pressing need for additional nonpharmacologic approaches. We have developed and tested a manualized psychodynamic psychotherapy for panic disorder, Panic Focused Psychodynamic Psychotherapy (PFPP). We have completed treatment development stages I and II and have demonstrated efficacy in 40 patients with DSM-IV primary PD in comparison with Applied Relaxation Training (ART). This application will investigate the indications, overall utility, and mechanisms of action of PFPP. We are conducting this study at two sites with broad inclusion criteria, to recruit sufficient patients, and to increase generalizability. The project has 3 aims: 1. Acute Efficacy. (Primary Aim) To conduct a 12-week randomized controlled trial of Panic-Focused Psychodynamic Psychotherapy (PFPP), and CBT, versus Applied Relaxation Training (ART) in a 2:2:1 ratio of randomization in 233 subjects with primary PD with or without Agoraphobia. 2. To compare the sustained effects of these two treatments in these patients at 12 months post-treatment termination, 3. To test specific mediator and moderator hypotheses for PFPP and CBT. We shall enroll 233 participants, ages 18 to 70, who meet DSM-IV criteria for PD with or without Agoraphobia as their primary diagnosis. All subjects will be randomly assigned to 19-24 sessions over 12 weeks of CBT, PFPP, or ART in a 2:2:1 ratio. Patients will be followed monthly with standard rating instruments for 12 months post treatment termination to compare durability of effects. Subjects in the ART condition will be given their choice of CBT or PFPP (nonrandomized) if they do not respond at treatment termination.
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