Risa Weisberg
Boston University, Psychiatry, Faculty Member
- Brown University, Family Medicine, Faculty Memberadd
- Dr. Weisberg is Assistant Chief of Psychology and Clinical Psychology Internship Training Director at VA Boston Healt... moreDr. Weisberg is Assistant Chief of Psychology and Clinical Psychology Internship Training Director at VA Boston Healthcare System. She is also Professor of Psychiatry at Boston University School of Medicine and Adjunct Professor of Psychiatry and Human Behavior and of Family Medicine at the Alpert Medical School of Brown University.
Dr. Weisberg's research and clinical interests focus on primary care - behavioral health integration and evidence-based treatment for common problems encountered in medical settings, including anxiety, chronic pain, depression, reproductive and sexual health problems, and opiate misuse.edit
ABSTRACT Objective This study aimed to determine whether HIV-Pain and Sadness Support (HIV-PASS), a collaborative behavioral health intervention based on behavioral activation, is associated with decreased pain-related interference with... more
ABSTRACT Objective This study aimed to determine whether HIV-Pain and Sadness Support (HIV-PASS), a collaborative behavioral health intervention based on behavioral activation, is associated with decreased pain-related interference with daily activities, depression, and other outcomes in people living with HIV. Methods We conducted a three-site clinical trial (n = 187) in which we randomly assigned participants to receive either HIV-PASS or health education control condition. In both conditions, participants received seven intervention sessions, comprising an initial in-person joint meeting with the participant, their HIV primary care provider and a behavioral health specialist, and six, primarily telephone-based, meetings with the behavioral health specialist and participant. The intervention period lasted 3 months, and follow-up assessments were conducted for an additional 9 months. Results Compared with health education, HIV-PASS was associated with significantly lower pain-related interference with daily activities at the end of month 3 (our primary outcome; b = −1.31, 95% confidence interval = −2.28 to −0.34). We did not observe other differences between groups at 3 months in secondary outcomes that included worst or average pain in the past week, depression symptoms, anxiety, and perceived overall mental and physical health. There were no differences between groups on any outcomes at 12 months after enrollment. Conclusions A targeted intervention can have positive effects on pain interference. At the end of intervention, effects we found were in a clinically significant range. However, effects diminished once the intervention period ended. Trial Registration ClinicalTrials.gov NCT02766751.
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Insomnia and anxiety disorders are highly prevalent and are associated with significant impairment and disability. There is evidence that insomnia and anxiety disorders commonly co-occur, in addition to both being highly comorbid with... more
Insomnia and anxiety disorders are highly prevalent and are associated with significant impairment and disability. There is evidence that insomnia and anxiety disorders commonly co-occur, in addition to both being highly comorbid with major depressive disorder. Thus, it is important for health care providers to be familiar with the literature in this area. Therefore, the purpose of this review was to examine the empirical literature on the co-occurrence of insomnia and anxiety disorders, as well as discuss the clinical and research implications of the findings. Studies were identified through PubMed and PsycINFO searches (1975-2007) and a bibliographic review of published articles. The results from this literature review suggest that certain anxiety disorders, such as panic disorder and generalized anxiety disorder, are clearly associated with symptoms of insomnia (eg, delayed sleep onset, restless sleep). Although there are some discrepancies in the literature, the findings suggest that individuals with posttraumatic stress disorder also experience significant sleep problems (eg, middle-of-the-night insomnia, poor sleep quality, nightmares), and the presence of such problems during the early posttrauma period predicts later development of the disorder. Few empirical studies examine sleep in other anxiety disorders, and the majority of studies on insomnia and anxiety disorders in general have not examined the effects of comorbid major depressive disorder, indicating a need for additional research. Overall, the findings highlight the importance of screening for and treating anxiety symptoms when a patient presents with symptoms of insomnia and vice versa. Clearly, treatment development work on interventions that address co-occurring insomnia and anxiety disorders is greatly needed.
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The current study examined comorbidity and clinical correlates of eating disorders in a large sample of individuals with body dysmorphic disorder (BDD). Two hundred individuals with DSM-IV (4th ed. of the Diagnostic and Statistical Manual... more
The current study examined comorbidity and clinical correlates of eating disorders in a large sample of individuals with body dysmorphic disorder (BDD). Two hundred individuals with DSM-IV (4th ed. of the Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association; 1994) BDD completed reliable interviewer-administered and self-report measures, including diagnostic assessments and measures of body image, symptom severity, delusionality, psychosocial functioning, quality of life (QOL), and history of psychiatric treatment. A total of 32.5% of BDD subjects had a comorbid lifetime eating disorder: 9.0% had anorexia nervosa, 6.5% had bulimia nervosa, and 17.5% had an eating disorder not otherwise specified. Comparisons of subjects with a comorbid lifetime eating disorder (n = 65) and subjects without an eating disorder (n = 135) indicated that the comorbid group was more likely to be female, less likely to be African American, had more comorbidity, and had significantly greater body image disturbance and dissatisfaction. There were no significant group differences in BDD symptom severity, degree of delusionality, or suicidal ideation or attempts. Functioning and QOL were notably poor in both groups, with no significant between-group differences. However, a higher proportion of the comorbid eating disorder group had been hospitalized for psychiatric problems. This group had also received a greater number of psychotherapy sessions and psychotropic medications. Eating disorders appear relatively common in individuals with BDD. BDD subjects with a comorbid eating disorder differed on several demographic variables, had greater comorbidity and body image disturbance, and had received more mental health treatment than subjects without a comorbid eating disorder. These findings have important implications for the assessment and treatment of these comorbid body image disorders.
Research Interests: Psychology, Psychiatry, Eating Disorders, Body Image, Adolescent, and 15 moreMedicine, Comorbidity, Anorexia Nervosa, Bulimia Nervosa, Delusions, Body dysmorphic disorder, Humans, Child, Female, Male, Eating, Eating Disorder, Personal Satisfaction, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests: Anxiety Disorders, Medicine, Anxiety, Humans, Generalized Anxiety Disorder, and 15 moreMajor Depressive Disorder, Female, Male, Panic Disorder, Obsessive Compulsive Disorder, Clinical Sciences, Middle Aged, Longitudinal Studies, Adult, Longitudinal Study, ANXIETY, Anxiety Disorder, Neurosciences, Logistic Models, and Medical and Health Sciences
For persons with HIV (PWH), aims of psychotherapy can extend beyond HIV-related topics. Issues such as HIV stigmatization and disclosure, and HIV-related self-care including treatment adherence might be ongoing concerns, but, patients... more
For persons with HIV (PWH), aims of psychotherapy can extend beyond HIV-related topics. Issues such as HIV stigmatization and disclosure, and HIV-related self-care including treatment adherence might be ongoing concerns, but, patients often need support to develop skills to manage other problems, whether functional or psychiatric. In the context of an ongoing randomized clinical trial, we delivered an individual, behavioral activation-based intervention to PWH with comorbid chronic pain and depression. Our primary treatment target was to reduce pain-related interference in physical and psychosocial functioning. Throughout the course of the 7-session intervention, clinicians used four core strategies to help patients improve a variety of domains related to their health and well-being: (1) teaching values-based goal setting; (2) developing skills to be an activated and informed patient; (3) focusing on changing behavior despite discomfort; and, (4) facilitating access to care (e.g., flexible scheduling, primarily phone sessions). The application of these strategies to HIV-related and non-HIV-related problems are presented to illustrate how and when clinicians can utilize these strategies. These practical lessons will inform a flexible approach to helping PWH address a myriad of health and functional issues related to their overall well-being.
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Research Interests: Clinical Psychology, Anxiety Disorders, Medicine, Anxiety, Agoraphobia, and 15 moreProspective studies, Population, Humans, Generalized Anxiety Disorder, Major Depressive Disorder, Female, Male, Panic Disorder, Middle Aged, Longitudinal Studies, Adult, European Continental Ancestry Group, ANXIETY, Anxiety Disorder, and Phobic disorders
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ObjectivesThere is a great need for low‐intensity, scalable treatments in primary care, where most anxious patients first present for treatment. We describe Stage IA treatment development and a Stage IB feasibility trial of cognitive bias... more
ObjectivesThere is a great need for low‐intensity, scalable treatments in primary care, where most anxious patients first present for treatment. We describe Stage IA treatment development and a Stage IB feasibility trial of cognitive bias modification (CBM) for transdiagnostic anxiety in primary care.MethodsThe online intervention, Mental Habits, comprised eight sessions of a personalized CBM targeting attention and interpretation biases. Coaches assisted patients in using the website, monitored progress via a dashboard, and shared information with primary care providers. We evaluated Mental Habits in an open trial (N = 14) and a randomized controlled trial (RCT) (N = 40) in primary care patients with anxiety disorders.ResultsWe compared results to a priori benchmarks of clinically meaningful outcomes. In the open trial, Mental Habits met feasibility, acceptability, and efficacy benchmarks. In the pilot RCT, there was greater dropout at one study site which ultimately closed. In the intent‐to‐treat analyses, Mental Habits met the benchmark for self‐report, but not the interview measure of anxiety. Symptom Tracking did not meet the benchmark for self‐report or interview measures of anxiety. In per‐protocol analyses, Mental Habits exceeded the benchmark for both self‐report and interview measures, whereas Symptom Tracking met the benchmark for self‐report. Interpretation bias improved in the Mental Habits group, but not in Symptom Tracking. No effects were observed for attention bias.ConclusionThe online CBM intervention demonstrated good acceptability and, when delivered at a stable primary care clinic, preliminary effectiveness in primary care. A larger RCT is warranted to test effectiveness.Practitioner points A personalized, transdiagnostic Cognitive Bias Modification (CBM) intervention for anxiety in primary care is acceptable to primary care patients with social anxiety disorder, generalized anxiety disorder, and/or panic disorder /agoraphobia. With training and supervision from licensed mental health clinicians, bachelor’s‐level coaches can assist primary care patients to self‐administer CBM. Offering a low‐intensity, self‐directed anxiety intervention in primary care can greatly expand the reach of anxiety treatment, with minimal need for additional resources. Interpretation bias may be an important clinical target for primary care patients with anxiety.
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The Liebowitz Social Anxiety Scale (LSAS) is one of the most commonly used measures of social anxiety symptoms. To date, no study has examined its psychometric properties in a Latino sample. The authors examined the reliability, temporal... more
The Liebowitz Social Anxiety Scale (LSAS) is one of the most commonly used measures of social anxiety symptoms. To date, no study has examined its psychometric properties in a Latino sample. The authors examined the reliability, temporal stability, and convergent validity of the LSAS in 73 Latinos diagnosed with an anxiety disorder. The original LSAS subscales showed excellent internal consistency and temporal stability over a 1-year period. Participants with social anxiety disorder (SAD) scored significantly higher on all LSAS subscales than participants without SAD, supporting the convergent validity of the LSAS. Similar results were obtained for four subscales proposed by Safren and colleagues. Results have implications for the use of the LSAS as a measure of severity or outcome when comparing diverse populations. Future investigations in larger Latino samples are needed to examine the factor structure of the LSAS.
Research Interests: Psychology, Clinical Psychology, Cognitive Science, Behavioral Sciences, Psychometrics, and 15 moreSocial Anxiety, Data Analysis, Anxiety, Reliability, Comparative Analysis, Psychometric Properties, Social phobia, Public health systems and services research, Longitudinal Study, Social Anxiety Disorder, ANXIETY, Anxiety Disorder, Factor structure, Neurosciences, and LİEBOWİTZ SOCİAL ANXİETY SCALE
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Research Interests: Primary Health Care, Depression, Chronic Pain, General Internal Medicine, Employment, and 15 moreMedicine, Humans, Female, Male, Buprenorphine, Clinical Sciences, Middle Aged, Adult, New England, Opioid, Pain Catastrophizing, Cross Sectional Studies, Pain Measurement, Psychiatric Status Rating Scales, and Opiate substitution treatment
Research Interests: Psychology, Clinical Psychology, Attention, Medicine, Anxiety, and 15 moreHumans, Female, Cognitive Therapy, Male, Cognitive Bias Modification, Patient Satisfaction, Placebos, Clinical Sciences, Anxiety and Depression, Middle Aged, Adult, Randomized Controlled Trial, ANXIETY, Pilot Projects, and Phobic disorders
Research Interests: Psychology, Clinical Psychology, Psychiatry, Family, Body Image, and 15 moreAdolescent, Medicine, Distress, Body dysmorphic disorder, Humans, Female, Male, Psychosocial, Functional impairment, Interpersonal Relations, Adult, Age Groups, Severity of Illness Index, Psychology and Cognitive Sciences, and Medical and Health Sciences
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Chronic pain is highly prevalent among persons with HIV (PWH), as is depression. Both comorbidities might contribute to, as well as be maintained by, avoidance-based coping. A promising alternative to avoidance-based coping is acceptance.... more
Chronic pain is highly prevalent among persons with HIV (PWH), as is depression. Both comorbidities might contribute to, as well as be maintained by, avoidance-based coping. A promising alternative to avoidance-based coping is acceptance. Acceptance of pain is associated with improved functioning and quality of life in chronic pain patients, but this relationship has not been substantially explored among PWH. Cross-sectional data from 187 adult outpatients enrolled in a randomized trial for depressed PWH with chronic pain were analyzed. Controlling for pain severity and demographics, the relationships among pain acceptance and indicators of activity, functioning, and emotional distress (i.e., anxiety and anger) were assessed in seven regression models. No significant relationships were found between self-reported physical activity or objective measurement of mean steps/day with pain acceptance. Results revealed an inverse relationship between chronic pain acceptance and pain-related functional interference (by.x = -.52, p < .01) and a positive relationship with self-reported functioning (by.x = 7.80, p < .01). A significant inverse relationship with anxiety symptoms (by.x = -1.79, p < .01) and pain acceptance was also found. Acceptance of chronic pain can facilitate decreased emotional distress, improved well-being, and better functioning and quality of life. Further investigation of chronic pain acceptance among PWH could inform the development of acceptance-based interventions.
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Research Interests: Primary Care, Psychiatry, Anxiety Disorders, Primary Health Care, Comparative Study, and 15 moreMedicine, Anxiety, Humans, Female, Male, American, Adult, ANXIETY, Anxiety Disorder, Ambulatory Care, Combined Modality Therapy, attitude to health, Health Care Surveys, Delivery of Health Care, and Medical and Health Sciences
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Research Interests: Psychology, Anxiety Disorders, Medicine, Comorbidity, Anxiety, and 15 moreProspective studies, Humans, Female, Male, Obsessive Compulsive Disorder, Regression Analysis, Follow-up studies, Recurrence, Clinical Sciences, Adult, Time Factors, ANXIETY, Anxiety Disorder, Proportional Hazards Models, and Psychiatric Status Rating Scales
Background:Cognitive bias modification (CBM) is a novel treatment for anxiety disorders that utilizes computerized tasks to train attention and interpretation biases away from threat. To date, attitudes toward and acceptability of CBM... more
Background:Cognitive bias modification (CBM) is a novel treatment for anxiety disorders that utilizes computerized tasks to train attention and interpretation biases away from threat. To date, attitudes toward and acceptability of CBM have not been systematically examined.Method:We conducted qualitative interviews with 10 anxious primary care patients to examine attitudes toward and initial impressions of CBM. Interviews explored general impressions, as well as reactions to the treatment rationale and two computer programs, one targeting attention bias and one targeting interpretation bias. Three clinical psychologists independently coded transcripts and collaboratively developed categories and themes guided by grounded theory.Results:A number of facilitators and barriers emerged related to engaging in treatment in general, computerized treatment, and CBM specifically. Participants stated that the written rationale for CBM seemed relevant and helpful. However, after interacting with...
Research Interests: Cognitive Science, Anxiety Disorders, Culture, Attention, Medicine, and 15 moreHumans, Judgment, Behavior Therapy, Female, Cognitive Therapy, Male, Attitude, Patient Satisfaction, Aged, Middle Aged, Adult, Interdisciplinary Communication, Cooperative Behavior, Implosive therapy, and Phobic disorders
Generalized anxiety disorder (GAD) was defined relatively recently, and the diagnostic criteria are still being refined. The essential feature of the disorder has changed from persistent anxiety to excessive worry, and the required... more
Generalized anxiety disorder (GAD) was defined relatively recently, and the diagnostic criteria are still being refined. The essential feature of the disorder has changed from persistent anxiety to excessive worry, and the required symptom duration has changed from 1 month to 6 months. Additionally, exclusion criteria involving permissibility of the diagnosis in children and wording regarding the relationship of GAD with mood disorders have changed. Nosologic controversies still surround the criteria for excessive worry, symptom duration, the relationship between GAD and major depressive disorder, and the required number of associated symptoms. Alterations in the criteria have been suggested, but more research is needed on the validity of these proposed changes. Generalized anxiety disorder appears to be highly prevalent. In the United States, the lifetime prevalence of DSM-IV GAD is estimated to be about 5% and the current prevalence to be about 2% to 3%. The disorder is differenti...
Research Interests: Psychology, Epidemiology, Anxiety Disorders, Mental Health, Evolution, and 15 moreMedicine, Comorbidity, Humans, Age, Generalized Anxiety Disorder, Chronic Disease, Incidence, Mood Disorders, Prevalence, Middle Aged, Adult, Ethnic Group, Clinical Psychiatry, Age of Onset, and Medical and Health Sciences
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In the past decade, a great deal of research has examined the efficacy and mechanisms of attentional bias modification (ABM), a computerized cognitive training intervention for anxiety and other disorders. However, little research has... more
In the past decade, a great deal of research has examined the efficacy and mechanisms of attentional bias modification (ABM), a computerized cognitive training intervention for anxiety and other disorders. However, little research has examined how anxious patients perceive ABM, and it is unclear to what extent perceptions of ABM influence outcome. To examine patient perceptions of ABM across two studies, using a mixed methods approach. In the first study, participants completed a traditional ABM program and received a hand-out with minimal information about the purpose of the task. In the second study, participants completed an adaptive ABM program and were provided with more extensive rationale and instructions for changing attentional biases. A number of themes emerged from qualitative data related to perceived symptom changes and mechanisms of action, acceptability, early perceptions of the program, barriers/facilitators to engagement, and responses to adaptive features. Moreover...
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Sleep disturbance is common among patients receiving long-term opioid therapies, such as methadone maintenance. However, little is known about sleep disturbances in patients receiving medication treatment with buprenorphine. We sought to... more
Sleep disturbance is common among patients receiving long-term opioid therapies, such as methadone maintenance. However, little is known about sleep disturbances in patients receiving medication treatment with buprenorphine. We sought to determine the frequency of subjective sleep disturbance in a sample of patients receiving medication treatment and to examine clinical factors related to sleep disturbance. Participants were 328 persons receiving buprenorphine at 3 primary care sites. Sleep difficulty was assessed 2 questions adapted from the Patient Health Questionnaire-9 (PHQ-9) item assessing sleep. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CESD)-10 and PHQ-2. In addition, information was gathered on participant demographics and treatment characteristics. Demographics, buprenorphine treatment history, and depressive symptoms were compared for those with and without self-reported sleep difficulty. Logistic regression was used to estimate the adjusted association of sleep disturbance with these correlates. Seventy-one percent of persons receiving medication treatment with buprenorphine in the present study reported sleep difficulty. Persons reporting sleep disturbance reported shorter time in buprenorphine treatment and more depressed mood compared with those without sleep difficulty (p &amp;amp;amp;amp;amp;amp;amp;amp;lt; .01). Men were significantly less likely to report disturbed sleep than women (odds ratio [OR] = 0.57, 95% confidence interval [CI]: 0.33, 0.98). Sleep disturbance was not associated significantly with age, ethnicity, educational attainment, or buprenorphine dose. Sleep disturbance is common in patients receiving medication treatment with buprenorphine and is associated with more depressive symptoms as well as a shorter duration of medication treatment. Future research, using subjective and objective sleep measures, is warranted to understand whether sleep disturbance is mitigated by longer buprenorphine treatment and whether difficulty sleeping predicts buprenorphine discontinuation among patients seeking treatment for opioid dependence.
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Anxiety is the most common and costly mental illness in the United States. Reducing avoidance is a core element of evidence-based treatments. Past research shows readiness to address avoidance affects outcomes. Investigating avoidance... more
Anxiety is the most common and costly mental illness in the United States. Reducing avoidance is a core element of evidence-based treatments. Past research shows readiness to address avoidance affects outcomes. Investigating avoidance from a transtheoretical model (TTM) perspective could facilitate tailored approaches for individuals with low readiness. This study developed and examined psychometric properties of TTM measures for addressing anxiety-based avoidance. Cross-sectional survey. Community centers, online survey. Five hundred ninety-four individuals aged 18 to 70 with clinically significant anxiety. Overall Anxiety Severity Questionnaire, stages of change, decisional balance, and self-efficacy. The sample was randomly split into halves for principal component analyses (PCAs) and confirmatory factor analyses (CFAs) to test measurement models. Further analyses examined relationships between constructs. For decisional balance, PCA indicated two 5-item factors (pros and cons). ...
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Commentary on: Malins S, Kai J, Atha C, et al. Cognitive behaviour therapy for long-term frequent attenders in primary care: a feasibility case series and treatment development study. Br J Gen Pract... more
Commentary on: Malins S, Kai J, Atha C, et al. Cognitive behaviour therapy for long-term frequent attenders in primary care: a feasibility case series and treatment development study. Br J Gen Pract 2016;66:e729–36.[OpenUrl][1][Abstract/FREE Full Text][2] High users or FAs of healthcare clinics place significant organisational and financial strain on healthcare systems. It has been estimated that the top 3% of users account for 15% of primary care visits.1 Short-term frequent attendance may be related to acute causes, but long-term frequent attendance has been found to be associated with high health … [1]: {openurl}?query=rft.jtitle%253DBr%2BJ%2BGen%2BPract%26rft_id%253Dinfo%253Adoi%252F10.3399%252Fbjgp16X686569%26rft_id%253Dinfo%253Apmid%252F27432609%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=bjgp&resid=66/651/e729&atom=%2Febnurs%2F20%2F2%2F52.atom
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Depression and anxiety disorders are highly prevalent among primary care patients. Group visits provide a way of delivering interventions to multiple patients at the same time. Group visits for depression and anxiety present an... more
Depression and anxiety disorders are highly prevalent among primary care patients. Group visits provide a way of delivering interventions to multiple patients at the same time. Group visits for depression and anxiety present an opportunity to expand the reach of behavioral health services for primary care patients. The goal of the current study was to evaluate the implementation of an acceptance and mindfulness-based group for primary care patients with depression and anxiety. Adult family medicine patients with Patient Health Questionnaire-9 (PHQ-9) and/or Generalized Anxiety Disorder Scale-7 (GAD-7) scores > 5 were eligible for the group. The group was held biweekly in the family medicine practice with rolling enrollment. The PHQ-9 and GAD-7 were administered at every visit, and changes in depression and anxiety symptoms were analyzed using multilevel modeling. We evaluated feasibility, acceptability/satisfaction, penetration, and sustainability. Over the course of 19 months, 5...
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Little is known about the clinical course of posttraumatic stress disorder (PTSD) and the clinical predictors of its recovery in primary care patients. We examined 5 years of follow-up of PTSD symptoms using rates of recovery and... more
Little is known about the clinical course of posttraumatic stress disorder (PTSD) and the clinical predictors of its recovery in primary care patients. We examined 5 years of follow-up of PTSD symptoms using rates of recovery and recurrence, and the predictive value of comorbid mental disorders, treatment participation and psychosocial functioning, on PTSD recovery. We examined 199 participants with PTSD diagnoses, from the Primary Care Anxiety Disorder Project. We found that the course of PTSD in a sample of primary care patients is chronic. Survival analysis revealed that the likelihood of PTSD recovery was 38.0% and of recurrence it was 29.5%. Cox regression analyses indicated that baseline clinical variables did not have a significant relationship with probability of PTSD recovery. However, time-varying models showed that the course of psychosocial impairment was a significant predictor of the likelihood of recovery from PTSD. Findings provide initial empirical support for treatment approaches that focus on psychosocial functioning to reduce PTSD symptoms.
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Research Interests: Primary Care, Psychiatry, Anxiety Disorders, Psychotherapy, Primary Health Care, and 14 moreTreatment, Public Health, Comparative Study, Humans, Female, Male, American, Adult, Psychotropic Drugs, Anxiety Disorder, Treatment Refusal, Ambulatory Care, Serotonin Uptake Inhibitors, and Combined Modality Therapy
Research Interests: Anxiety Disorders, Comorbidity, Agoraphobia, Prospective studies, Humans, and 19 moreAffective Disorders, Major Depressive Disorder, United States, Female, Male, Panic Disorder, Recurrence, Middle Aged, Longitudinal Studies, Affective, Adult, Longitudinal Study, Anxiety Disorder, Observational Study, Proportional Hazards Models, Logistic Models, Prospective Study, Observer Design, and Age of Onset
Research Interests: Primary Care, Psychiatry, Anxiety Disorders, Psychotherapy, Primary Health Care, and 14 moreTreatment, Public Health, Comparative Study, Humans, Female, Male, American, Adult, Psychotropic Drugs, Anxiety Disorder, Treatment Refusal, Ambulatory Care, Serotonin Uptake Inhibitors, and Combined Modality Therapy
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Evidence-based treatments for adult patients with anxiety are greatly needed within primary care settings. Psychotherapy protocols, including those for cognitive-behavioral therapy (CBT), are often disorder-specific and were developed for... more
Evidence-based treatments for adult patients with anxiety are greatly needed within primary care settings. Psychotherapy protocols, including those for cognitive-behavioral therapy (CBT), are often disorder-specific and were developed for specialty mental health settings, rendering them infeasible in primary care. Behavioral health consultants (BHCs) integrated into primary care settings are uniquely positioned to provide anxiety treatment. However, due to the dearth of empirically supported brief treatments for anxiety, BHCs are tasked with adapting existing treatments for use in primary care, which is quite challenging due to the abbreviated format and population-based approach to care. CBT protocols are highly effective in the treatment of anxiety and fit well with the self-management emphasis of integrated primary care. We review the rationale and procedure for 6 evidence-based CBT intervention techniques (psycho-education, mindfulness and acceptance-based behavioral techniques, relaxation training, exposure, cognitive restructuring, and behavioral activation) that can be adapted for use in the brief format typical of integrated primary care. We offer tips based on our clinical experience, highlight resources (e.g., handouts, websites, apps), and discuss 2 case examples to aid BHCs in their everyday practice. Our goal is to provide BHCs with practical knowledge that will facilitate the use of evidence-based interventions to improve the treatment of anxiety in primary care settings. (PsycINFO Database Record
The authors examined the relationship between posttraumatic stress disorder (PTSD), trauma, and self-reported nonpsychiatric medical conditions in a sample of 502 primary care patients with one or more anxiety disorders. Primary care... more
The authors examined the relationship between posttraumatic stress disorder (PTSD), trauma, and self-reported nonpsychiatric medical conditions in a sample of 502 primary care patients with one or more anxiety disorders. Primary care patients with one or more DSM-IV anxiety disorders were assessed for comorbid psychiatric and substance use problems and for a history of trauma. These individuals also completed a self-report measure of current and lifetime medical conditions, lifetime tobacco use, and current regular exercise. Of 502 participants with at least one anxiety disorder, 84 (17 percent) reported no history of trauma, 233 (46 percent) had a history of trauma but no PTSD, and 185 (37 percent) met DSM-IV criteria for PTSD. Patients with PTSD reported a significantly greater number of current and lifetime medical conditions than did participants with other anxiety disorders but without PTSD. Primary care patients with PTSD were more likely to have had a number of specific medical problems, including anemia, arthritis, asthma, back pain, diabetes, eczema, kidney disease, lung disease, and ulcer. Possible explanations for the greater rates of medical conditions among participants with PTSD were examined as predictors in multiple regression. PTSD was found to be a stronger predictor of reported number of medical problems than trauma history, physical injury, lifestyle factors, or comorbid depression. These findings suggest that PTSD is associated with a higher rate of general medical complaints.
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In this pilot study, we assessed feasibility and acceptability of a behavior therapy intervention for pain and depressive symptoms in persons living with HIV/AIDS (PLWH). We randomly assigned 23 participants to HIV-PASS (HIV-Pain and... more
In this pilot study, we assessed feasibility and acceptability of a behavior therapy intervention for pain and depressive symptoms in persons living with HIV/AIDS (PLWH). We randomly assigned 23 participants to HIV-PASS (HIV-Pain and Sadness Study) or a health education control arm for 3 months. On average, participants attended more than 5 sessions (of 7 possible) in both arms. Qualitative data suggest HIV-PASS participants understood key messages and made concrete behavioral changes. HIV-PASS was associated with effects in the expected direction for three of four outcomes, including the primary outcome (pain-related interference with functioning). Findings suggest that HIV-PASS is promising.
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Recently, attention has been drawn to a range of disturbances in personality functioning that commonly characterize individuals with a history of severe or prolonged trauma. Many of these features overlap with criteria for some of the... more
Recently, attention has been drawn to a range of disturbances in personality functioning that commonly characterize individuals with a history of severe or prolonged trauma. Many of these features overlap with criteria for some of the Axis II personality disorders. The current study investigated the similarity of personality disorder features in different samples of patients with trauma histories, and specificity of such features compared to other psychiatric samples. Profiles of Axis II features, based on relative frequencies of individual disorder &quot;diagnoses&quot; derived from a common measure (Personality Diagnostic Questionnaire-Revised), were compared in three trauma samples: male Vietnam combat veterans with PTSD, female inpatients with a history of childhood sexual abuse, and female outpatients with a history of childhood sexual abuse. The PDQ-R derived profiles in each of the three trauma samples were then compared with similar PDQ-R derived profiles in published reports of psychiatric samples selected for other diagnoses. Each of the three Spearman rank correlations among the three trauma samples were significant, ranging from .72 to .94. There was a clear pattern of higher correlations within the trauma samples (average correlation of .81) than between the trauma and nontrauma samples (average correlations of .11, .36, and .25 between the nontrauma samples and the combat sample, inpatient sexual abuse sample, and outpatient sexual abuse sample, respectively). The findings suggest that a pattern of personality disorder features may be distinctly associated with individuals with trauma histories, at least of the type examined here. Future studies using more clinically valid measures of personality features and including other types of trauma samples are needed to determine the generalizability of the current findings. Also needed are studies with longitudinal designs to address questions of causal pathways that may underlie such associations.