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Agoraphobic Avoidance

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1. Agoraphobic avoidance predicts emotional distress and increased physical concerns in chronic obstructive pulmonary disease. (PubMed)

Agoraphobic avoidance predicts emotional distress and increased physical concerns in chronic obstructive pulmonary disease. Anxiety and panic attacks are more common in chronic obstructive pulmonary disease (COPD) than in the overall population. Individuals with panic attacks often attempt to avoid situations perceived as at risk of eliciting bodily sensations such as dyspnea, which paradoxically may lead to anxiety-related responsivity. Although there is some evidence that COPD individuals (...) restrict their participation in various life activities because they fear that these may trigger breathlessness, little is known about agoraphobic avoidance and its impact on cognitions and emotional distress in this population. It was thus our aim to investigate the degree of agoraphobic avoidance in COPD individuals, its clinical concomitants and consequences.A total of 48 patients with COPD and 48 matched controlled subjects completed measures of anxiety sensitivity, agoraphobic avoidance, anxiety

2017 Respiratory medicine

2. Agoraphobic Avoidance

Agoraphobic Avoidance Agoraphobic Avoidance Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Agoraphobic Avoidance Agoraphobic (...) Avoidance Aka: Agoraphobic Avoidance , Agoraphobia From Related Chapters II. Definition Avoidance behavior to prevent recurrence III. Findings: Types of activities avoided by patients with Agoraphobia Being distant from home Being separated from their safe person Physical exertion associated with s Going to enclosed places without easy egress or escape Restaurant or theater Store Public transportation Driving Social events where would be embarrassing Substance ingestion that would provoke attack Foods

2018 FP Notebook

3. Agoraphobic Avoidance

Agoraphobic Avoidance Agoraphobic Avoidance Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Agoraphobic Avoidance Agoraphobic (...) Avoidance Aka: Agoraphobic Avoidance , Agoraphobia From Related Chapters II. Definition Avoidance behavior to prevent recurrence III. Findings: Types of activities avoided by patients with Agoraphobia Being distant from home Being separated from their safe person Physical exertion associated with s Going to enclosed places without easy egress or escape Restaurant or theater Store Public transportation Driving Social events where would be embarrassing Substance ingestion that would provoke attack Foods

2015 FP Notebook

4. Virtual Reality Exposure Therapy Does Not Provide Any Additional Value in Agoraphobic Patients: A Randomized Controlled Trial. (PubMed)

exposure in vivo was more effective than CBT plus VRET. The results show clear synchrony of temporal processes involved in VRET and exposure in vivo on weekly avoidance measures and cognitive measures. Further, it was shown that initial changes in agoraphobic cognitions during the CBT phase predicted later changes in agoraphobic avoidance behavior.These data support the notion that therapeutic processes involved might be the same in VRET and exposure in vivo. However, given the slight superiority (...) Virtual Reality Exposure Therapy Does Not Provide Any Additional Value in Agoraphobic Patients: A Randomized Controlled Trial. A number of studies have demonstrated the efficacy of virtual reality exposure therapy (VRET) in specific phobias, but research in seriously impaired patients with agoraphobia is lacking. In this randomized controlled trial with patients with agoraphobia and panic disorder, VRET and exposure in vivo were compared in terms of outcome and processes involved.Patients

2013 Psychotherapy and Psychosomatics Controlled trial quality: uncertain

5. Predictors of short- and long-term avoidance in completers of inpatient group interventions for agoraphobia. (PubMed)

Predictors of short- and long-term avoidance in completers of inpatient group interventions for agoraphobia. Little is currently known about predictors of follow-up outcome of psychological treatment of agoraphobia. In this study, we wished to examine predictors of short- and long-term avoidance after inpatient group interventions for agoraphobia.Ninety-six (68%) of 141 agoraphobic patients (74% women) who had completed treatment in two open and one randomized controlled trial (RCT) were (...) followed up 13 to 21 years after start of treatment.Major depression at pre-treatment predicted less short-term (up to one year after end of treatment) improvement in agoraphobic avoidance. Working and being married/cohabiting at pre-treatment predicted greater long-term (across one-year, two-year, and 13-21 years follow-up) improvement. In contrast, the duration of agoraphobia, amount of Axis I and II co-morbidity, being diagnosed with avoidant, dependent, and obsessive-compulsive personality disorder

2015 Journal of Affective Disorders

6. Guidance on the clinical management of anxiety disorders, specifically focusing on diagnosis and treatment strategies

covered in these guidelines is characterised by specific thoughts and behaviours: • • Panic disorder – sudden attacks of fear or anxiety (usually brief, but which may be so severe that the person thinks they might collapse or die), concern about the attacks recurring and avoidance of situa- tions in which they might recur. • • Social anxiety disorder (SAD) – fear and avoidance of situations where the person thinks they might be the centre of attention, concern about doing or saying something (...) embarrassing, and that others might notice the anxiety and be critical. • • Generalised anxiety disorder (GAD) – months of excessive worry over everyday things, avoiding or seeking reassurance about situations where the out- come is uncertain, and being overly concerned about things that could go wrong. Anxiety disorders can be treated Effective treatments are available (Figure 2) but they take time to work. In practice, most people have had their disor- der for years before seeking help and do not expect

2018 Royal Australian and New Zealand College of Psychiatrists

7. CBT for panic disorder

attack is also characterised by worry about the consequences, such as a loss of control or social humiliation. During an attack, sufferers often report a poor ability to concentrate and may have feelings of unreality. Panic attacks can lead to agoraphobic avoidance of places where escape is difficult or embarrassing or where help is not available. The number needed to treat (NNT) with CBT for panic disorder is three. Availability CBT may be provided by GPs or other mental health professionals (eg (...) mental health nurses, psychologists, occupational therapists, accredited mental health social workers). Ideally, GPs should be familiar with the areas of expertise of their local network to ensure an appropriate referral. GPs can provide the appropriate psychoeducation even if they do not use all of the CBT techniques recommended for management of attacks including agoraphobic avoidance. This involves describing the symptoms related to the adrenaline fuelled ‘fight or flight’ response, and how

2016 Handbook of Non-Drug interventions (HANDI)

8. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

that escape might be difficult or help might not be available in the event of panic-like symptoms ? The agoraphobic situations almost always provoke fear or anxiety ? The situations are actively avoided, require presence of a companion, or endured with marked fear or anxiety ? The fear or anxiety is out of proportion to actual danger posed by agoraphobic situation ? The fear, anxiety, or avoidance is persistent, typically lasting =6 months ? The fear, anxiety, and avoidance cause clinically significant (...) . Screen for anxiety and related symptoms Anxiety and related disorders are generally characterized by the features of excessive anxiety, fear, worry, and avoid- ance. While anxiety can be a normal part of everyday life, anxiety disorders are associated with functional impair- ment; as part of the key diagnostic criteria for anxiety dis- orders is the requirement that the symptoms cause clinically significant distress or impairment in social, occu- pational, or other important areas of functioning [26

2014 CPG Infobase

9. Generalised anxiety disorder and panic disorder in adults: management

and functioning (known as active monitoring). This is because education and active monitoring may improve less severe presentations and avoid the need for further interventions. [new 2011] [new 2011] 1.2.10 Discuss the use of over-the-counter medications and preparations with people with GAD. Explain the potential for interactions with other prescribed and over- the-counter medications and the lack of evidence to support their safe use. [new [new 2011] 2011] Step 2: Diagnosed GAD that has not impro Step 2 (...) to avoid relapse. [new 2011] [new 2011] 1.2.28 T ake into account the increased risk of bleeding associated with SSRIs, particularly for older people or people taking other drugs that can damage the gastrointestinal mucosa or interfere with clotting (for example, NSAIDS or aspirin). Consider prescribing a gastroprotective drug in these circumstances. [new 2011] [new 2011] 1.2.29 For people aged under 30 who are offered an SSRI or SNRI: warn them that these drugs are associated with an increased risk

2011 National Institute for Health and Clinical Excellence - Clinical Guidelines

10. Treatable clinical intervention targets for patients with schizophrenia. (PubMed)

preferences.Patients with non-affective psychosis attending NHS mental health services completed assessments of paranoia, hallucinations, anxious avoidance, worry, self-esteem, insomnia, analytic reasoning, psychological well-being, and treatment preferences.1809 patients participated. Severe paranoia was present in 53.4% and frequent voices in 48.2%. Of the causal mechanisms, severe worry was present in 67.7%, avoidance at agoraphobic levels in 64.5%, analytic reasoning difficulties in 55.9%, insomnia in 50.1 (...) these difficulties treated.Patients with non-affective psychosis have high levels of treatable problems such as agoraphobic avoidance, worry, low self-esteem, and insomnia and they would like these difficulties treated. Successful treatment of these difficulties is also likely to decrease psychotic experiences such as paranoia.Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.

2019 Schizophrenia Research

11. Development of a very brief scale for detecting and measuring panic disorder using two items from the Panic Disorder Severity Scale-Self Report. (PubMed)

, diagnosed and treated with Internet-based cognitive behavioral therapy for panic disorder (n = 1390), social anxiety disorder (n = 1313) or depression (n = 2400), responded to the PDSS-SR. Six criteria related to factor structure, sensitivity to change and clinical representativeness were used to select items. Psychometric analyses for the selected very brief scale were performed.Items 2 (distress during panic attacks) and 4 (agoraphobic avoidance), were selected to create the very brief PDSS-SR version

2019 Journal of Affective Disorders

12. Clinical Practice Guidelines on Anxiety Disorders

of lifestyle changes as appropriate, i.e., stress reduction strategies, reducing alcohol and caffeine intake, avoiding nicotine and drug use, regular exercise Supportive counselling Symptomatic relief with medication prescribed on a short-term basis Evaluation and mobilisation of family and social resources Monitoring and addressing early signs of relapse Grade D, Level 4 22 Executive summary of recommendations Commonly used abbreviations The following is a list of abbreviations commonly used (...) changes as appropriate, i.e., stress reduction strategies, reducing alcohol and caffeine intake, avoiding nicotine and drug use, regular exercise ? Supportive counselling ? Symptomatic relief with medication prescribed on a short-term basis ? Evaluation and mobilisation of family and social resources ? Monitoring and addressing early signs of relapse Grade D, Level 4 22 12 No. Recommendation Grade, Level of evidence CPG Page no. 4 Psychiatric evaluation and treatment is appropriate when

2015 Ministry of Health, Singapore

13. Stress hormone response to the DEX–CRH test and its relation to psychotherapy outcome in panic disorder patients with and without agoraphobia (PubMed)

to the DEX-CRH test. Blood samples were taken for cortisol and adrenocorticotropic hormone (ACTH) assessment. Established panic-specific questionnaires were handed out for the pre-therapy and post-therapy evaluation of disease severity (with reference to panic beliefs and agoraphobic cognitions, fear of bodily sensations, agoraphobic avoidance behaviour). Repeated measures ANCOVA were conducted for the analysis of the pre-therapy hormonal response, and Pearson's correlation analysis to test (...) for associations with the psychotherapy outcome. Data analyses revealed large effect sizes for CBT in the clinical measures (η2 ≥ 0.321), main effects of time for cortisol and ACTH with no differences between both groups, and significant associations between cortisol release and agoraphobic cognitions for the patients. PD diagnosis had no impact on the hormonal response. However, those patients with higher cortisol release showed less improvement after CBT (significantly for agoraphobic cognitions). Clinical

Full Text available with Trip Pro

2018 Translational psychiatry

14. Cannabidiol for the Treatment of Anxiety Disorders: An 8-Week Pilot Study

with a 5-point scale (range: 0-4). The total possible score is ranged from 0 to 52, with higher scores representing increased severity of illness. It contains 5 sub-scales: panic attacks, agoraphobic avoidance, anticipatory anxiety, disability, and functional avoidance (health concerns). Quick Inventory of Depressive Symptomology (QIDS) [ Time Frame: Change from baseline to week 8 ] The QIDS is a self-report measure of depression. It contains 16 items with a 4-point scale (range: 0 to 3) which assess (...) item scale that provides separate scores for fear and avoidance in social and performance situations with higher scores representing increased social anxiety. The LSAS-SR contains three total scores 1) total fear score (0-72), 2) total avoidance score (0-72) and total overall score (0-144). Panic and Agoraphobia Scale (PAS) [ Time Frame: Change from baseline to week 8 ] The PAS is a measure of the severity of illness in patients with panic disorder (with or without agoraphobia). It has 13 items

2018 Clinical Trials

15. The Unified Protocol for the Treatment of Emotional Disorders in Spanish Public Mental Health System

Scale (PDSS-SR) evaluates the severity of symptoms in persons with panic disorders (intensity, frequency, interference, avoidance, and agoraphobic fear, among others) using a semi-structured interview. Seven Likert-type items are administered each with a 0-4 range (0 = minimum severity of symptoms and 4 = maximum severity of symptoms). The internal consistency of this instrument is good (.65). Change in agoraphobia severity [ Time Frame: Up to 12 months ] The Inventory for Agoraphobia (IA) examines (...) existent waiting lists and current costs of individual treatment. So far, studies exploring the effectiveness of the UP in a group format have led to promising findings. Overall, results suggest that the UP has between moderate and strong effect sizes on numerous outcomes, including depression, anxiety, positive and negative affect, quality of life, overall adjustment, and avoidance of negative sensations, for both anxiety and mood disorders. These studies have also revealed that between half and two

2017 Clinical Trials

16. The Association Between Physical Sensations and Thinking Styles

/waitinglist assessment) ] The PDSS (Shear et al., 1997) is a 7-item scale and provides a composite severity score of frequency, distress, and impairment associated with panic attacks. Mobility Inventory (MI) [ Time Frame: Pre-treatment/waitinglist - post-treatment/waitinglist (post is approx. 3 months after the pre-treatment/waitinglist assessment) ] The MI (Chambless, Caputo, Jasin, Gracely, & Williams, 1985, Ehlers, Margraf, & Chambless, 1993) consists of 26 items and measures agoraphobic avoidance (...) /waitinglist - post-treatment/waitinglist (post is approx. 3 months after the pre-treatment/waitinglist assessment) ] The DASS-21 (Lovibond & Lovibond, 1995; Nilges & Essau, 2015) questionnaire comprises three 7-item subscales assessing levels of depression, anxiety, and stress. Agoraphobic Cognitions Questionnaire (ACQ) [ Time Frame: Pre-treatment/waitinglist - post-treatment/waitinglist (post is approx. 3 months after the pre-treatment/waitinglist assessment) ] The ACQ (Chambless, Caputo, Bright

2017 Clinical Trials

17. Relevant and Irrelevant Fear in Flooding - A Crossover Study of Phobic Patients - Republished Article. (PubMed)

Relevant and Irrelevant Fear in Flooding - A Crossover Study of Phobic Patients - Republished Article. This study investigated the role of relevant vs irrelevant fear cues in the flooding of phobic patients. Six specific phobics and 10 agoraphobics were treated in a balanced crossover design. Eight patients had eight sessions of imaginal flooding concerned with their phobias followed by eight imaginal sessions concerned with situations which are normally frightening to anybody. Another eight (...) treatment sessions predicted good outcome to irrelevant fear, but did not correlate with outcome to relevant flooding. The experience of relevant and irrelevant fear in fantasy reduced phobic anxiety and avoidance to a similar extent, but appeared to do so through different mechanisms. These mechanisms need not be mutually exclusive and might be additive.Copyright © 2016 Elsevier Ltd. All rights reserved.

2017 Behavior therapy Controlled trial quality: uncertain

18. Cognitive models for panic disorder with agoraphobia: A study of disaggregated within-person effects. (PubMed)

Cognitive models for panic disorder with agoraphobia: A study of disaggregated within-person effects. The purpose of this study was to test 2 cognitive models of panic disorder with agoraphobia (PDA)-a catastrophic cognitions model and a low self-efficacy model-by examining the within-person effects of model-derived cognitive variables on subsequent anxiety symptoms.Participants were 46 PDA patients with agoraphobic avoidance of moderate to severe degree who were randomly allocated to 6 weeks

2017 Journal of Consulting and Clinical Psychology Controlled trial quality: uncertain

19. Neurobiological and clinical effects of fNIRS-controlled rTMS in patients with panic disorder/agoraphobia during cognitive-behavioural therapy (PubMed)

for the left PFC at baseline. Bilateral prefrontal activation for panic-related stimuli significantly increased after verum iTBS only. Clinical ratings significantly improved during CBT and remained stable at follow-up. However, no clinical differences between the verum- and sham-stimulated group were identified, except for a more stable reduction of agoraphobic avoidance during follow-up in the verum iTBS group.Limitations include insufficient blinding, the missing control for possible state-dependent

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2017 NeuroImage : Clinical Controlled trial quality: uncertain

20. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder

for PTSD Check for GAD Predominant symptom focus intermittent panic/anxiety attacks and avoidance Uncontrollable worry about several areas Some uncued/ spontaneous Fear of social scrutiny Discrete object/ situation Obsessions + compulsions Trauma history and flashbacks? Yes No Figure 1. Suggested scheme for exploring a suspected anxiety disorder. GAD: generalised anxiety disorder; OCD: obsessive-compulsive disorder; PTSD: post-traumatic stress disorder. Table 2. Principal clinical features (...) reach their peak within 10 min and last around 30–45 min. Most patients develop a fear of having further panic attacks. Around two-thirds of patients with panic disorder develop agoraphobia, defined as fear in places or situations from which escape might be difficult or in which help might not be available, in the event of having a panic attack. These situations include being in a crowd, being outside the home, or using public transport: they are either avoided or endured with significant personal

2014 British Association for Psychopharmacology

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