Sept 2011 - Institut de Recherche en Santé Mentale
Sept 2011 - Institut de Recherche en Santé Mentale
Sept 2011 - Institut de Recherche en Santé Mentale
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ReseaRch and clinic al highlights cont’d<br />
anxiety Program at the Royal: advances in cBt<br />
by Drs. Andy Jacobs,<br />
Dave Davies and<br />
Jakov Shlik, Anxiety<br />
Disor<strong>de</strong>rs Program,<br />
Royal Ottawa M<strong>en</strong>tal<br />
Health C<strong>en</strong>tre.<br />
Anxiety disor<strong>de</strong>rs are striking in both their preval<strong>en</strong>ce<br />
and the oft<strong>en</strong> <strong>de</strong>vastating impact they can have on<br />
quality of life. Fortunately, anxiety disor<strong>de</strong>rs are also<br />
among the most treatable of m<strong>en</strong>tal health conditions.<br />
At the Royal’s Anxiety Disor<strong>de</strong>rs Program, we are<br />
fortunate to serve a very large volume of consumers<br />
and offer effective and effici<strong>en</strong>t evi<strong>de</strong>nce-based<br />
cognitive-behavioural treatm<strong>en</strong>ts (CBT). Ongoing<br />
outcome evaluation research efforts suggest that our<br />
group-based CBT protocols are helpful in diminishing<br />
symptoms of anxiety, <strong>de</strong>pression, and functional<br />
impairm<strong>en</strong>t, and we are continually exploring new<br />
av<strong>en</strong>ues for advancing our ability to greater serve our<br />
cli<strong>en</strong>ts and our community. The results of rec<strong>en</strong>tly<br />
completed and ongoing research activities are being<br />
regularly pres<strong>en</strong>ted at national and international<br />
confer<strong>en</strong>ces (Anxiety Disor<strong>de</strong>rs Association of America,<br />
Canadian Association of Cognitive Behavioural<br />
Therapy, Canadian Psychological Association and<br />
Canadian Psychiatric Association).<br />
In keeping with the Royal’s values on innovation in<br />
treatm<strong>en</strong>t, optimizing outcomes, and increasing<br />
effici<strong>en</strong>cy of service <strong>de</strong>livery, a primary focus in our<br />
work has be<strong>en</strong> the examination of the role of<br />
comorbid <strong>de</strong>pression in predicting treatm<strong>en</strong>t<br />
response and outcome for participants in group<br />
CBT. Data collected thus far have <strong>de</strong>monstrated,<br />
reassuringly, that the pres<strong>en</strong>ce of comorbid<br />
<strong>de</strong>pression does not interfere with the robust<br />
improvem<strong>en</strong>t in anxiety symptoms that a cli<strong>en</strong>t can<br />
expect from participation in treatm<strong>en</strong>t. However,<br />
cli<strong>en</strong>ts who do experi<strong>en</strong>ce clinically significant<br />
<strong>de</strong>pressive symptoms at the outset of treatm<strong>en</strong>t<br />
typically <strong>en</strong>dorse more severe anxiety symptoms<br />
(compared to their non-<strong>de</strong>pressed counterparts) at<br />
both treatm<strong>en</strong>t outset and completion.<br />
In response to these findings, our Anxiety Disor<strong>de</strong>rs<br />
Program team has focused our program <strong>de</strong>velopm<strong>en</strong>t<br />
efforts on evolving groups that address<br />
comorbid anxiety and <strong>de</strong>pression in one<br />
unified treatm<strong>en</strong>t protocol. A pilot study of<br />
this protocol has prov<strong>en</strong> promising, and the<br />
Program expects to be running these<br />
comorbidity groups regularly within the curr<strong>en</strong>t<br />
aca<strong>de</strong>mic year. Additionally, rec<strong>en</strong>t additions to the<br />
program’s staffing complim<strong>en</strong>t bring the ability to<br />
easily incorporate Behavioural Activation-based<br />
<strong>de</strong>pression treatm<strong>en</strong>t strategies into existing<br />
exposure-based anxiety treatm<strong>en</strong>t protocols in both<br />
group and individual formats. The ability to explore<br />
and expand upon the common threads in the<br />
cognitive-behavioural treatm<strong>en</strong>t of mood and<br />
anxiety disor<strong>de</strong>rs is curr<strong>en</strong>tly a major focus of<br />
international research and clinical <strong>de</strong>velopm<strong>en</strong>t in<br />
psychotherapy, and these efforts of the Anxiety<br />
Disor<strong>de</strong>rs Program at the Royal <strong>en</strong>sure we remain<br />
on the cutting edge of effective, effici<strong>en</strong>t, and<br />
evi<strong>de</strong>nce-based treatm<strong>en</strong>t.<br />
The Anxiety Disor<strong>de</strong>rs Program also remains<br />
committed to maintaining an awar<strong>en</strong>ess of the<br />
needs in our greater community and targeting our<br />
services in a way that will maximize our ability to<br />
reach the greatest numbers of people in the most<br />
need. Toward this <strong>en</strong>d, Program members have<br />
completed a compreh<strong>en</strong>sive assessm<strong>en</strong>t of the<br />
needs of individuals with severe, treatm<strong>en</strong>t-resistant<br />
obsessive-compulsive disor<strong>de</strong>r (OCD) and their<br />
healthcare provi<strong>de</strong>rs – frequ<strong>en</strong>tly one of the most<br />
un<strong>de</strong>rserved anxiety disor<strong>de</strong>rs populations. Our<br />
findings have <strong>de</strong>monstrated a clear need for<br />
int<strong>en</strong>sive OCD treatm<strong>en</strong>t modalities that are thus<br />
far largely unavailable; a lack not only within our<br />
own Champlain District, but across Canada as a<br />
whole. The i<strong>de</strong>ntification of this need is serving as<br />
a rich springboard for further <strong>de</strong>velopm<strong>en</strong>t of<br />
resources for these individuals, and the Program is<br />
<strong>en</strong>thusiastically exploring options on this front.<br />
At the same time, Program staff is <strong>de</strong>veloping a<br />
compreh<strong>en</strong>sive workshop (to be <strong>de</strong>livered in<br />
November <strong>2011</strong>) that will serve to disseminate<br />
effective exposure-based treatm<strong>en</strong>t strategies to a<br />
wi<strong>de</strong> range of m<strong>en</strong>tal healthcare professionals<br />
involved in the treatm<strong>en</strong>t of OCD.<br />
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