WWW.DISSERTATION.XLIBX.INFO
FREE ELECTRONIC LIBRARY - Dissertations, online materials
 
<< HOME
CONTACTS



Pages:   || 2 | 3 |

«EXPERIENTIAL COGNITIVE THERAPY FOR THE TREATMENT OF PANIC DISORDERS WITH AGORAPHOBIA: DEFINITION OF A CLINICAL PROTOCOL F. Vincelli1-2, M.S.; Y.H. ...»

-- [ Page 1 ] --

© Mary Ann Liebert Inc. Publishers, 2000 1

EXPERIENTIAL COGNITIVE THERAPY FOR THE

TREATMENT OF PANIC DISORDERS WITH

AGORAPHOBIA: DEFINITION OF A CLINICAL PROTOCOL

F. Vincelli1-2, M.S.; Y.H. Choi3, M.D.; E. Molinari2, Ph.D.; B.

Wiederhold4, Ph.D.;G. Riva1-2, Ph.D.

1

ATN-P Lab, Istituto Auxologico Italiano, Verbania, Italy 2 Department of Psychology, Università Cattolica, Milan, Italy 3 Seoul Paik Hospital, Inje University, Seoul, South Korea 4 Center for Advanced Multimedia Psychotherapy, CSPP Research and Service Foundation, San Diego, California This is a unrevised version of the paper published by the journal ”CyberPsychology and Behavior”, 3 (3), 375-386, 2000 Journal web site: http://www.liebertpub.com/cpb/default.htm Copyright Notice This paper is included as a means to ensure timely dissemination of scholarly and technical work on a non-commercial basis. Copyright and all rights therein are maintained by the authors or by other copyright holders, notwithstanding that they have offered their works here electronically. It is understood that all persons copying this information will adhere to the terms and constraints invoked by each author's copyright. These works may not be reposted without the explicit permission of the copyright holder. Please contact the authors if you are willing to republish this work in a book, journal, on the Web or elsewhere. Thank you in advance.

FRANCESCO VINCELLI

Applied Technology for Neuro-Psychology Lab. - Istituto Auxologico Italiano P.O. Box 1, 28044 Verbania, Italy Tel: +39-323-514246 - Fax: +39-323-587694 E-mail: fvincelli@hotmail.com © Mary Ann Liebert Inc. Publishers, 2000 2

EXPERIENTIAL COGNITIVE THERAPY FOR THE TREATMENT OF

PANIC DISORDERS WITH AGORAPHOBIA:

DEFINITION OF A CLINICAL PROTOCOL

1. Introduction Through the development of epidemiologic studies we are able to say that 3.5% of the general population suffer from panic disorder1, with serious personal and social repercussions, such as depression, substance abuse and suicidal tendencies2.

According to DSM-IV3, the essential feature of panic disorder (PD) is the occurrence of panic attacks. A panic attack is a sudden onset period of intense fear or discomfort associated with at least four symptoms that include: palpitations, breathlessness, dizziness, trembling, a feeling of choking, nausea, de-realization, chest pain, and paraesthesias. The panic is characterized by a cluster of physical and cognitive symptoms, which occurs unexpectedly and recurrently, such as pervasive apprehension about panic attacks, persistent worry about future attacks, worry about the perceived physical, social or mental consequences of attacks, or major changes in behavior in response to attacks.

Panic disorder is often associated with circumscribed phobic disorders such as specific phobias, social phobias, and especially with agoraphobia4-5. Agoraphobia is described separately from panic disorder in the DSM-IV to highlight the occurrence of agoraphobic avoidance in individuals with or without a history of panic disorder3.

Agoraphobia consists of a group of fears of public places such as going outside, using public transportation and being in public places, i.e.

supermarkets, theaters, churches, football stadia, etc, which cause serious interference in daily life. Other fears may spring from this core phobia, such as going through tunnels, using lifts, crossing bridges, etc., as well as other internal fears, such as excessive worry about physical sensations (palpitations, vertigo, dizziness, etc.) or an intense fear of panic attacks, including fear of social interaction. The results of these psychopatological symptoms are that the patient tends to avoid the feared situation and, from then on, this avoidance carries over into other situations. Indeed, avoidance of public places in order to reduce fear or panic becomes the main cause of incapacity in patients, who, in more serious cases, are confined to their homes6-7.

The recognition of panic disorder as specific syndrome was introduced by Klein8-9. He disclosed that patients with recurrent panic attacks responded to imipramine but not benzodiazapines, and vice versa for anxious patients without recurrent panic attacks. His studies were © Mary Ann Liebert Inc. Publishers, 2000 3 particularly influential in establishing panic disorder as a separate diagnostic entity.

In the aetiopathology of PD, Barlow10 describes the initial panic attack as a misfiring of the "fear system," under stressful life circumstances, in physiologically vulnerable individuals. But an isolated panic attack does not necessarily lead to the development of panic disorder, as evidenced by the scientific literature1,11. The individuals who developed a panic disorder had a physiological vulnerability, a sort of anxious apprehension conceptualized by Barlow as a set of danger-laden beliefs about the symptoms of panic and about the meaning of panic attacks. After the initial panic attack the unrealistic interpretations persist because patients engage in cognitive and behavioural strategies that are intended to prevent the feared events from occurring. As the fears are unrealistic, the main effect of these strategies is to prevent patients from disconfirming their negative beliefs. Then, such as in many anxiety disorders, the symptoms of anxiety are additional sources of perceived danger, and produce a series of vicious circles which further contribute to the maintenance of the disorders10,12.





The words of Clark13 clarify the aetiopathogenetic model of PD:

“Individuals who experience recurrent panic attacks do so because they have a relatively enduring tendency to interpret certain bodily sensations in a catastrophic fashion. The sensations that are misinterpreted are mainly those involved in normal anxiety responses (e.g., palpitations, breathlessness, dizziness, paresthesias) but also include some other sensations. The catastrophic misinterpretation involves perceiving these sensations as much more dangerous than they really are and, in particular, interpreting the sensations as indicative of immediately impending physical or mental disaster-for example, perceiving a slight feeling of breathlessness as evidence of impending cessation of breathing and consequent death, perceiving palpitations as evidence of an impending heart attack, perceiving a pulsing sensation in the forehead as evidence of a brain haemorrhage, or perceiving a shaky feeling as evidence of impending loss of control and insanity”. (Clark 1988, p. 149).

2. The treatment of Panic Disorder and Agoraphobia

–  –  –

disorder with agoraphobia14-17.

Clark, Salkovskis, Barlow, and other colleagues6,7,10,13-15 have outlined the treatment for PD with agoraphobia. The traditional protocol involves a mixture of cognitive and behavioral techniques which are intended to help patients identify and modify their dysfunctional anxiety-related thoughts, beliefs and behavior. Emphasis is placed on reversing the maintaining factors identified in the cognitive and behavioral patterns.

The treatment protocol includes exposure to the feared situation, interoceptive exposure, cognitive restructuring, breathing retraining, and applied relaxation. On an average the duration of the protocol is twelve-fifteen sessions. Readers interested in a more detailed description of CBT for panic disorder and agoraphobia can consult Salkovskis and Clark18, Mathews, Gelder and Johnston19 and Barlow10.

3. Virtual reality in Psychotherapy

In Psychotherapy, the virtual cyberspace offers a series of powerful and valid applications for diagnosis and treatment.

The qualities that make VR software reliable and particularly useful in the practice of assessment and rehabilitation of certain psychopathological dysfunctions emerge with extreme clarity from the specialist literature20,21.

VR consists of a three-dimensional interface that puts the interacting subject in a condition of active exchange with a world re-created via the computer. The possibility of not limiting the paradigm of interaction in a

unidirectional sense represents the strong point of the new technology:

man is not simply an external observer of pictures or one who passively experiences the reality created by the computer, but on the contrary may actively modify the three-dimensional world in which he is acting, in a condition of complete sensorial immersion21. The nature of this exchange means that the subject feels actually present in this new context. The feeling of “actual presence” is perhaps the peculiar characteristic of this tool22, 23 and is made possible both by the realistic reproduction of the cybernetic environments and by the involvement of all the sensorimotor channels during interaction.

To describe in what way the development of science and technology may favour the buttressing of the therapeutic effects associated with traditional strategies of care, we introduce two elements: the costbenefits in psychotherapy and the exposure technique23.

One of the fundamental parameters in assessing the effectiveness of therapies is the ratio existing between the “cost” of administration of the therapeutic procedure and the resulting “benefits”. By cost it is meant © Mary Ann Liebert Inc. Publishers, 2000 5 the expenditure not only in terms of money and time, but also in terms of emotional involvement by the person to whom the therapy is directed. The benefits regard the effectiveness of the treatment, i.e., the achievement of the target set, in the shortest time possible.

Exposure therapy traditionally is carried out “in imagination” or “in vivo”.

In the first case, the subject is trained to produce the anxiety-provoking stimuli through mental images; in the second case, the subject actually experiences these stimuli in semi-structured situations. Both of these methods present advantages and limitations as regards the costbenefit ratio. In the first case, the prevalent difficulty is represented by teaching the subject to produce the images that regard experiences associated with anxiety: the majority of failures linked to this therapy are those subjects who present particular difficulties in visualizing scenes of real life. The cost of the application, however, is minimal, because the therapy is administered in the physician’s office, thus avoiding situations that might be embarrassing for the patient and safeguarding his privacy. In the second case, the difficulty lies in structuring, in reality, experiences regarding the hierarchically ordered anxiety-provoking stimuli, with the result that the cost in terms of time, money and emotions is high. At the same time, the advantage of contending with real contexts increases the likelihood of effectiveness of the “in vivo” procedure24.

In this context, emerges the need to favour the possibilities of intervention on psychological dysfunctions by overcoming the limits that render the cost-benefit ratio disadvantageous, and in this framework, virtual reality technology takes its place as an experience that is able to reduce the gap existing between imagination and reality24, 25.

The prevalent elements in cognitive-behavioural therapies are that of exposing the subject to the stimuli that produce the dysfunction and of generating responses that are antagonistic to the maladaptive ones26.

VR facilitates both of these processes of treatment. Using VR software, it is possible to re-create, together with the subject undergoing treatment, a hierarchy of situations corresponding to reality, which he may experience in an authentic way thanks to the involvement of all his sensorimotor channels 27. The realistic reproduction of virtual environments enables the interacting individual to immerse himself in a dimension of real presence. This makes it possible to limit the costs as compared to traditional procedures of treatment, as pointed out above, and to consolidate the effectiveness of the treatment thanks to the possibility of re-creating a “three-dimensional world” within the walls of the clinical office23, 24.

© Mary Ann Liebert Inc. Publishers, 2000 6

4. Experiential-Cognitive Therapy Protocol: A multicomponent approach The preliminary treatment protocol for Panic Disorder and Agoraphobia, named Experiential-Cognitive Therapy (ECT), was developed at the Applied Technology for Neuro-Psychology Lab of Istituto Auxologico Italiano, Verbania, Italy, in cooperation with the Psychology Department of the Catholic University of Milan, Italy28. The actual version included the efforts of researchers from the Center for Advanced Multimedia Psychotherapy, California School of Professional Psychology, San Diego (CA), USA, and from the Seoul Paik Hospital, Inje University, Seoul, Korea.

The goal of ECT is to decondition fear reactions, to modify misinterpretational cognition related to panic symptoms and to reduce anxiety symptoms. This is possible in an average of seven sessions of treatment plus an assessment phase and booster sessions, through the integration of Virtual Experience and traditional techniques of CBT.

We decided to employ the techniques included in the cognitivebehavioral approach because they showed high levels of efficacy.

Through virtual environments we can gradually expose the patient to feared situation: virtual reality consent to re-create in our clinical office a real experiential world. The patient faces the feared stimuli in a context that is nearer to reality than imagination28.

4.1 VR design and implementation

For ECT we developed the Virtual Environments for Panic Disorders - VEPD - virtual reality system.

VEPD was developed using a Thunder 600/C virtual reality system by Virtual Engineering of Milano-Italy. The Thunder 600/C is a Pentium III

based immersive VR system (600mhz, 64 mega RAM, graphic engine:

Matrox G400 Dual Head, 32Mb WRam) including an HMD subsystem and a two-button joystick-type motion input device.



Pages:   || 2 | 3 |


Similar works:

«TECHNISCHE UNIVERSITÄT MÜNCHEN Lehrstuhl für Aquatische Systembiologie Bioindication tools for measuring the success of stream restoration Joachim Wolfgang Pander Vollständiger Abdruck der von der Fakultät Wissenschaftszentrum Weihenstephan für Ernährung, Landnutzung und Umwelt der Technischen Universität München zur Erlangung des akademischen Grades eines Doktors der Naturwissenschaften genehmigten Dissertation. Vorsitzender: Univ.-Prof. Dr. A. Melzer Prüfer der Dissertation: 1....»

«ADDIS ABABA UNIVERSITY COLLEGE OF EDUCATION AND BEHAVIORAL STUDIES SCHOOL OF PSYCHOLOGY Perceived parental supports and children’s psychological wellbeing: The case of Children living with stepparents around Sheromeda area By Matewos Gena ADDIS ABABA UNIVERSITY COLLEGE OF EDUCATION AND BEHAVIORAL STUDIES SCHOOL OF PSYCHOLOGY Perceived parental supports and children’s psychological wellbeing: The case of Children living with stepparents around Sheromeda area A Thesis Submitted to the School...»

«Pandemic Influenza Preparedness Framework for the sharing of influenza viruses and access to vaccines and other benefits (PIP Framework) Questions and Answers September 2011 Contents: Page I. General 3 II. Advisory Group 4 III. Global Influenza Surveillance & Response System (GISRS) 6 IV. Pandemic Influenza Benefit Sharing 7 V. Partnership Contribution 7 VI. Standard Material Transfer Agreements 8 VII. Intellectual Property Rights 9 VIII. Influenza Virus Traceability Mechanism (IVTM) 10 This...»

«INTRODUCTION My first introduction to Fessenden was sometime in the 1950’s whilst collecting gulls eggs near the Inneans. I remember asking “what were the gigantic concrete structures near the Gauldrans. The answer was either “they were something to do with the war” or “something to do with the nearby airfield.” This answer seemed to satisfy me at that time. Next meeting was in the late 1980’s whilst sitting in a dentist’s surgery in Wick I picked up the Scots Magazine and there...»

«UCC/UGC/ECCC Proposal for New Academic Plan Fall 2016 If this new plan is not listed in the current NAU academic program inventory, then you must first complete the academic planning framework If this new certificate will be eligible for federal financial aid, then please submit the gainful employment application. All Plans with NCATE/CAEP designation, or plans seeking NCATE/CAEP designation, must include an NCATE/CAEP Accreditation Memo of Approval from the NAU NCATE/CAEP administrator prior...»

«A Message from the Conference Chair A warm welcome to the Meaning Conference 2010! It has been ten years since our first International Meaning Conference in Vancouver. Over the years, we have made many new friends and spread the message of positive revolution through meaning around the globe. We have now reached a significant milestone the 10th anniversary of Meaning Conference. This calls for celebration and reflection. We have gone through our highs and lows, and overcome overwhelming...»

«SPATIAL MEMORY RECALL IN THE GIANT PANDA (AILUROPODA MELANOLEUCA) A Thesis Presented to The Academic Faculty By Bonnie M. Perdue In Partial Fulfillment Of the Requirements for the Degree Masters of Science in Psychology Georgia Institute of Technology August, 2008 SPATIAL MEMORY RECALL IN THE GIANT PANDA (AILUROPODA MELANOLEUCA) Approved By: Dr. Terry L. Maple, Advisor School of Psychology Georgia Institute of Technology Dr. M. Jackson Marr School of Psychology Georgia Institute of Technology...»

«Volume 1 of An Analytical Commentary on the Philosophical Investigations Wittgenstein: Understanding and Meaning Part II: Exegesis §§1–184 G. P. Baker and P. M. S. Hacker Fellows of St John’s College · Oxford Second, extensively revised edition by P. M. S. Hacker Wittgenstein: Understanding and Meaning Part II: Exegesis §§1–184 Other volumes of this Commentary Wittgenstein: Rules, Grammar and Necessity, Volume 2 of An Analytical Commentary on the Philosophical Investigations G. P....»

«The Hand-drill By Alan Halcon Introduction Growing up, I had a fascination with the outdoors. Every summer my dad would take us camping. After each trip, I would find myself preparing for the next trip by reading anything that I could on camping and outdoor survival. I remember hopping on my bike, riding to the local library, and sitting there for hours just looking through all the books on camping. I would constantly beg my mom to take me to the local sporting goods store in order to check out...»

«What Indoor Cats Need To enrich the lives of indoor cats, we have developed this resource checklist; and some suggestions for making changes. Informed Owners As an owner, one of the most important things you can do for you cat is to educate yourself about feline idiosyncrasies. These resources will help you do just that. Books From the Cat's Point of View answers nearly every question the new cat owner could have and gives the experienced cat owner a look at life from the other side of the...»

«1 The Clinical Developmental Handbook 2013-2014 Department of Psychology York University Updated: August 27, 2013 by Mary Desrocher 2 Table of Contents: Handbook Introduction.. Welcome to the Program... 5 CD Area Timeline... 6 Curriculum for Students Who Entered the CD area prior to 2013. 11 Curriculum for Students Who Entered the CD in 2013 or later. 24 Who’s Who – Department Celebrities.. 39 Learning Experiences for all C-D Students.. 41 M.A.Degree Information for the C-D Program M.A....»

«Fools Die Mario Puzo Book I Chapter 1 “Listen to me. I will tell you the truth about a man’s life. I will tell you the truth about his love for women. That he never hates them. Already you think I’m on the wrong track. Stay with me. Really—I’m a master of magic. “Do you believe a man can truly love a woman and constantly betray her? Never mind physically, but betray her in his mind, in the very ‘poetry of his soul.’ Well, it’s not easy, but men do it all the time. “Do you...»





 
<<  HOME   |    CONTACTS
2016 www.dissertation.xlibx.info - Dissertations, online materials

Materials of this site are available for review, all rights belong to their respective owners.
If you do not agree with the fact that your material is placed on this site, please, email us, we will within 1-2 business days delete him.