Heart-focused anxiety as a mediating variable in the treatment of noncardiac chest pain by cognitive-behavioral therapy and paroxetine

Autor: Yanda R. van Rood, Philip Spinhoven, A.J. Willem Van der Does, Eduard Van Dijk
Rok vydání: 2010
Předmět:
Adult
Male
Chest Pain
medicine.medical_specialty
medicine.medical_treatment
Anxiety
Chest pain
Placebo
law.invention
Double-Blind Method
Randomized controlled trial
law
medicine
Humans
Noncardiac chest pain Randomized controlled trial Cognitive behavior therapy
Paroxetine Placebo Anxiety Mediation randomized controlled-trial normal coronary-arteries international neuropsychiatric interview follow-up depression scale hospital anxiety panic disorder dsm-iv pharmacotherapy hypochondriasis
Aged
Pain Measurement
Psychiatric Status Rating Scales
Analysis of Variance
Noncardiac chest pain Randomized controlled trial Cognitive behavior therapy
Intention-to-treat analysis
Cognitive Behavioral Therapy
Paroxetine Placebo Anxiety Mediation randomized controlled-trial normal coronary-arteries international neuropsychiatric interview follow-up depression scale hospital anxiety panic disorder dsm-iv pharmacotherapy hypochondriasis
Fear
Middle Aged
Anxiety Disorders
Paroxetine
Intention to Treat Analysis
Cognitive behavioral therapy
Psychiatry and Mental health
Clinical Psychology
Treatment Outcome
Anesthesia
Cognitive therapy
Physical therapy
Female
medicine.symptom
Psychology
Selective Serotonin Reuptake Inhibitors
medicine.drug
Zdroj: Journal of Psychosomatic Research, 69(3), 227-235
ISSN: 0022-3999
Popis: Objective: We compared the efficacy of cognitive behavior therapy (CBT), paroxetine and placebo in the treatment of noncardiac chest pain (NCCP). We also investigated whether pre- to mid-treatment reduction of (heart-focused) anxiety mediated mid- to post-treatment pain reduction. Methods: Sixty-nine adults with NCCP were randomly assigned to 16 weeks of outpatient treatment with CBT, paroxetine or placebo. The comparison between placebo and paroxetine was carried out in a double-blind fashion. The main outcome measure was a chest pain index (duration*intensity) as derived from daily pain diaries. Putative mediator measures were general anxiety (HADS:A) and heart-focused anxiety (Cardiac Anxiety Questionnaire). Results: Eleven patients treated with paroxetine or placebo dropped out prematurely. Intent-to-treat analysis showed that CBT was significantly superior to placebo and to paroxetine in reducing NCCP at posttreatment. Only CBT significantly reduced heart-focused anxiety compared to placebo at mid- and post-treatment. Pre- to mid-treatment reduction of heart-focused anxiety predicted mid- to post-treatment NCCP reduction. The indirect effect of CBT on pain reduction by reducing heart-focused anxiety was significant compared to placebo but not to paroxctine. Conclusion: CBT is an effective treatment option for patients with NCCP. Paroxetine is not more effective than placebo on the short term. Reduction of heart-focused anxiety by CBT seems to mediate subsequent reduction of NCCP compared to placebo. The results provide further support for cognitive behavioral models of NCCP and point to the potential benefits of, in particular, cognitive-behavioral interventions to modify heart-focused anxiety. (C) 2010 Elsevier Inc. All rights reserved.
Databáze: OpenAIRE
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