I ndex

Note: Page numbers of article titles are in boldface type.

A
Acceptance and commitment therapy (ACT), for generalized anxiety disorder, 633–634
for obsessive-compulsive disorder, 668
for social phobia, 647
in CBT, 529–530, 537–538
unified treatment protocol for, 539
Acute stress disorder (ASD), comparison of CBT and CBT with adjunctive therapy for,
690–691
critical period for irreversible CNS changes in, 688–689
pharmacotherapy for, 689–690
psychological interventions for, exposure-based, trauma-focused CBT, 690–691
Agomelatine, for generalized anxiety disorder, 615
Agoraphobia, in children and adolescents, course of, 505
prevalence of, 496–499
Amino acid neurotransmitters, in generalized anxiety disorder, 564
in panic disorder, 554–555
in social anxiety disorder, 561
Amygdala, in anxiety disorders, 510–511
in fear response, 550–551
in generalized anxiety disorder, 617
in social anxiety disorder, 561
Anterior cerebral cortex (ACC), in social anxiety disorder, 561
Anticonvulsants, for panic disorder, 594
Antidepressants, for PTSD, 692
for specific phobias, 582
Antiepileptics, for PTSD, 693
Antipsychotics, for PTSD, 690
Anxiety, and depression, models for, 511
criteria for, child-specific, 485
description of, 483–484
developmental issues and implications for DSM-V, 483–524
in children, assessment of, features in, 484
in children and adolescents, assessment instruments for, 492
assessment of, 488–491
categorical inventories of, 493–494
developmental issues in, 485
epidemiology of, 487, 495
normative, 484, 486
onset of, 487, 495–496
prevalence of, 487, 495–496

Psychiatr Clin N Am 32 (2009) 705–718

doi:10.1016/S0193-953X(09)00067-7 psych.theclinics.com
0193-953X/09/$ – see front matter ª 2009 Elsevier Inc. All rights reserved.
706 Index

Anxiety (continued)
sex differences in, 497
pathological, characterization of, 484
Anxiety disorders, assessment of, developmentallhy appropriate, 485
classification of, in ICD-10 and DSM-IV, 484, 488–491
description of, 484
developmental issues and implications for DSM-V, 483–524
diagnostic thresholds for, 485
genetic contribution to, implications for DSM-V, 567–568
in children and adolescents, assessment instruments for, 485, 492–494
assessment of, 483–508
childhood adversities and, 512–514
chronic course of, 502, 504–506
clinical significance criterion for, 497, 500
correlates and risk factors for, 508–514
summary of, 513
demographic variables in, 509, 513
environmental factors in, 512–514
family genetics in, 509–510, 513
frequency of, 487, 498–499
heterotypic continuity in, 507–508
homotypic continuity in, 503, 507
life events and, 514
longitudinal outcomes in, 502–503, 507
natural course of, 502–503
parenting style and, 512
pathophysiology of, 509–510
prevalence of, 487, 498–499
psychobiology of, 510–511
psychopathological factors and metastructure in, 508
symptomatic thresholds for, 500–501
temperament and personality and, 511–513
threshold problem in diagnosis, 500–501
neurobiology of, 549–575. See also Emotional processing.
neuroendocrine signaling in, implications for DSM-V, 566–567
neurotransmitter signaling in, implications for DSM-V, 566–567
position in structural models of mental disorders, 465–481
Anxiolytics. See also Benzodiazepines.
for generalized anxiety disorder, 612
for PTSD, 692

B
Behavioral inhibition, risk factor for anxiety disorders, 511–512
Benzodiazepines. See also Anxiolytics.
for generalized anxiety disorder, 613
for panic disorder, 593
for PTSD, 690
for social phobia, 642
for specific phobias, 581
Brain tumors, generalized anxiety disorder and, 621
 Index 707

Breathing retraining, 599

in CBT, 527
Buspirone, for generalized anxiety disorder, 612

C
Cardiovascular events, generalized anxiety disorder and, 621
Cholecystokinin (CCK), in emotional processing, 551–552
Chronic obstructive pulmonary disease (COPD), generalized anxiety disorder and, 621
Clomipramine, for obsessive-compulsive disorder, 666
Clonazepam, for social phobia, 642
Cognitive behavioral group therapy (CBGT), for social phobia, 644–646
Cognitive behavioral therapy (CBT), acceptance and committment approach to, 537–538
cognitive strategies in, 528
component analyses of, 536
components of, 526
computerized, for generalized anxiety disorder, 616–617
co-occurring disorders and outcomes of, 535
defined, 525–526
developments in, and alternatives to, 525–547
dropout rates, 534
empirical efficacy of, 532–533
meta-analyses of, 532–533
exposure-based, trauma-focused, efficacy of, in acute PTSD, 691
for acute stress disorder and PTSD, 690–691, 694
for panic disorder, components in, 595
efficacy of, 595–596
mechanisms of action in, 598
predictors of response to, 596
for social phobia, exposure with cognitive restructuring in, 643–644
group, 644
implementation of, in primary care setting, 540
in self-directed treatment, 540
learning theory and, 536
long-term follow-up, from 6 to 24 months, 534
from 8 to 14 years, 534–535
from two to 24 years, 534
mediators of, cognitive, 536
self-statement changes, 536
mindfulness approach to, 537–538
newer therapies in, 529–530
psychological interventions in, cognitive restructuring, 527–528
exposure therapy, 528–529
in generalized anxiety disorder, 529–530
in panic disorder, 529
psychoeducation, 526–527
self-monitoring, 526
Socratic questioning, 527–528
somatic techniques, 527
trauma-focused, eye movement desensitization and reprocessing treatment and, 694
for PTSD, 693–694
708 Index

Cognitive (continued)
treatment comparisons of, 536
treatment refusal, 533–534
unified treatment protocols for, 539
with D-cycloserine, for obsessive-compulsive disorder, 668
with pharmacotherapy, for panic disorder, 596
with prolonged exposure, for PTSD, 694
with psychoeducation, for obsessive-compulsive disorder, 667
Cognitive restructuring, exposure therapy and, 531–532
in CBT, 527–528, 536
for panic disorder, 599
for social phobia, 643–644
Cognitive therapy (CT), for obsessive-compulsive disorder, 667
Compulsions, in DSM-IV-R, 672
Corticotropin-releasing factor (CRF), and HPA axis, in generalized anxiety disorder, 565
in PTSD, 559–560
in social anxiety disorder, 562
in emotional processing, 551–552
in panic disorder, 555–556

D
D-cycloserine (DCS), CBT with, for obsessive-compulsive disorder, 668
exposure therapy with, for social phobia, 646
for specific phobias, 582
Deep brain stimulation, for obsessive-compulsive disorder, 668
Depression, and anxiety, models for, 511
and generalized anxiety disorder, 618–619
and PTSD, 687-688
and social phobia, 650
parental, and anxiety in children and adolescents, 510
Diabetes, type 1 and type 2, generalized anxiety disorder and, 621
DSM-IV, classification of anxiety disorders, 484, 488–491
obsessive-compulsive disorder in, 671, 673
PTSD in, 687–688, 697
specific phobias in, 586–587
DSM-V, functional neuroanatomy and, 565–566
implications for, in anxiety disorders, 483–514, 565–568
neuroendocrine signaling and, 565–566
neurotransmitters and, 565–566

E
edit 312, Social phobia, CBT for, mediators of change in, 648
CBT with pharmacotherapy for, vs. for other anxiety disorders, 654
characterization of, 641
comorbid substance disorders and, motivational interviewing and CBT for, 636,
651–652
elements similar to elements of other disorders, comorbid anxiety and mood
disorders, 650
comorbid avoidant personality disorder, 650
 Index 709

depression and, 650

in children and adolescents, assessment instruments for, 492–493
course of, 504–505
prevalence of, 496, 498–499
in DSM-V, implications for, 653
mediators of change in, 648
new treatments for, 646–648
acceptance and commitment therapy, 647
mindfulness/meditation-based stress reduction, 647
motivational interviewing with CBT, 646
panic attacks in, situational, 652
pharmacotherapy for, comparative studies of, 642
inclusion and exclusion criteria for RCTs of, 641–642
maintenance of gains with, 642–643
with CBT, 645–646
predictors of treatment outcome, expectations, 649
group cohesion, 649
homework compliance, 648–649
therapeutic alliance, 649
prevention of, school-based progams, 652
targeting youth at risk for anxiety disorders, 652–653
psychotherapy for, CBT, individual and group, 643–644
comparison of combination with pharmacotherapy and CBT, 645–646
interpersonal therapy, 644
psychodynamic therapy, 644–645
treatment efficacy in, for pharmacotherapy, 642–643
for psychotherapy, 643–654
treatment for, update on, 641–663
Elderly patients, generalized anxiety disorder in, CBT for, 631
treatment of, 622
Emotional processing. See also Anxiety disorders.
amygdala in fear response, 550–551
functional anatomy in, 550–551
genetic contribution to, 553
limbic system in, 550
neuroendocrine pathways in, 551–552
neuropeptides in, 551–552
neurotransmitter pathways in, 551–552
Endocrine challenge tests, for HPA axis activity, 552
Escitalopram, for generalized anxiety disorder, 615
Eszopiclone, for generalized anxiety disorder, 615
Exercise, for panic disorder, 600
Exposure and response prevention (ERP), for obsessive-compulsive disorder, 666–667
Exposure therapy, between-session habituation and, 530
cognitive restructuring and, 532
enhancement of, 532
for acute stress disorder, 690–691, 694
for panic attacks, in social phobia, 652
for panic disorder, mechanisms of action in, 598–599
relaxation technique effect on, 599
for PTSD, 690–691, 694
710 Index

Exposure (continued)
for social phobia, 643–644
for specific phobias, 577–578
comparison of in vivo with virtual reality, 580
comparison with systematic desensitization, 579
single vs. multiple sessions in, 580–581
therapist involvement in, 581
in CBT, 528–529, 536, 643–644
science of, 530–532
emotional processing theory and, 530
fear learning and extinction in, 531
inhibitory learning in, 531
within-session habituation and, 530
Eye movement desensitization and reprocessing (EMDR), for PTSD, 694

F
Fear learning and extinction, anatomic structures in, 531–532
in CBT, 532
neurobiological research in, 531–532
fMRI, in generalized anxiety disorder, 564, 617
for response to treatment, 617
fMRI studies, in panic disorder, 554

G
Gabapentin, for PTSD, 690
Galanin, in emotional processing, 551–552
Generalized anxiety disorder (GAD), anatomical and neuroimaging findings in,
563–564
CBT for, applied relaxation with, 630
comparison with wait-list or treatment-as-usual group, 629–630
efficacy and effectiveness of, 629–631
empirical efficacy of, 533
in elderly patients, 631
in private practitioner setting, 631
characterization of, 611
combined treatments for, evidence for, 614
components of, 634
criteria for, DSM-V and, 637
depression and, 618–619
diagnostic threshold for, in children, 484
failure in diagnosis and referral, 637
from now to DSM-V, 611–628
genetic contribution to, 565
imaging studies of, functional, 564
structural, 563
in children and adolescents, assessment instruments for, 493
prevalence of, 497–499
in late-life, 621–622
in primary care, comorbidity in, 620
 Index 711

symptom complexity in, 619–620

mechanisms of, 617
‘‘anxious apprehension,’’ 634
at phenomenological level, 634
derivation from procedural level of analysis, 635
environmental antecents and, 617–618
genetic vulnerability–environmental stress, 617–618
intolerance of uncertainty, 634
neuroimaging of, 617
neurotransmission, 617
process analysis and, 635
new treatments for, 614–617
acceptance and commitment therapy, 633–634
bibliotherapy, 616
computerized CBT, 616–617
interpersonal aspects in, 633
massed worry exposure, 632
meta-cognitive therapy, 632–633
mindfulness, 633–634
muscle relaxation, 616
pharmacologic, 615–616
virtual reality, 616
psychotherapy for, 629–640
evidence for efficacy and effectiveness of, 629–632
limitations in knowledge of, 631–632
routine care in, 637
challenges in, 620–621
obstacles for dissemination, 620–621
screening for, 620
short-term psychodynamic psychotherapy for, comparison with CBT, 630–631
similarity to other anxiety disorders, 635–636
similarity with other anxiety disorders, 618–619
special patient populations and, 621
specific pharmacotherapy for, approved medications, 613
efficacy of, 613–614
evidence for, 612–613
guidelines for, 613
medications approved for, 613
treatment of, improvement of, 620
prediction research for improvement of, 636
psychoeducation in, 620
worrying in, 635
Genetics, in anxiety disorders, 509–510, 513
DSM-V and, 567–568
in emotional processing, 553
in generalized anxiety disorder, 565, 617–618
in neurobiology of anxiety disorders, 549–575
in obsessive-compulsive disorder, 674–675
in panic disorder, 556
in psychopathology, 553
in PTSD, 560
712 Index

Genetics (continued)
in social anxiety disorder, 563
in specific phobias, 584

H
Hippocampus, in social anxiety disorder, 561
Hypothalamic-pituitary-adrenal (HPA) axis, and corticotropin-releasing factor, 559–560,
562, 565
in emotional processing, 552–553
in panic disorder, 556

I
Inhibitory learning, biological enhancement of, 531
in CBT, 531
Insomnia, in generalized anxiety disorder, 615
International Classification of Disorders (ICD-10), classification of anxiety disorders,
488–491
diagnostic criteria for obsessive-compulsive disorder, 672–673
Interpersonal therapy (IPT), for social phobia, 644

M
Mindfulness-based cognitive therapy (MBCT), 538–539
Mindfulness-based stress reduction (MBSR), 538
comparison with group CBT, 538–539
Mindfulness/meditation-based stress reduction, for social phobia, 647
Mindfulness therapy, for generalized anxiety disorder, 633–634
in CBT, 529, 537–538
Monoamine oxidase inhibitors (MAOIs), for PTSD, 692
for social anxiety disorder, 561
for social phobia, 642
Monoamines, for generalized anxiety disorder, 564–566
in panic disorder, 555
in PTSD, 558–559
in social anxiety disorder, 561–562
Motivational interviewing, defined, 646
with CBT, 640
for comorbid substance use disorders, 651–652
for obsessive-compulsive disorder, 668
for social phobia, 646

N
Neurobiology, of anxiety disorders, guidance for DSM-V, 565–568
of generalized anxiety disorder, 563–565
of panic disorder, 553–557
of posttraumatic stress disorder, 557–561
of social anxiety disorder, 561–563
Neuroendocrine findings, in panic disorder, 556–557
 Index 713

Neuroendocrine signaling, in PTSD, 558–559

Neuroimaging, in neurobiology of anxiety disorders, 549–575
Neurokinins, in PTSD, 559
Neuropeptides, in generalized anxiety disorder, 565
in panic disorder, 555
in PTSD, 559
in social anxiety disorder, 562
Neuropeptide Y, in emotional processing, 551–552
Neurotransmitters, abnormalities in, in MDD and generalized anxiety disorder, 567
in panic disorder, 554–555
in PTSD, 558–559
Norepinephrine, in PTSD, 558

O
Obsessions, in DSM-IV-R, 672
Obsessive-compulsive disorder (OCD), criteria for, clinical significance, 673
time spent on symptoms, 673–674
diagnosis and dissemination of, 670–676
diagnostic and treatment issues, 665–685
diagnostic criteria for, compulsion, 671
delusional patients in DSM-IV, 671
DSM-III, 670–671
DSM-IV, 671, 673
DSM-IV-R, 672–673
improving, 670–674
impulse in, 671
recognition of excessiveness and unreasonableness, 671
dimensions in, non-symptom, 675
exclusion criteria for, 673
financial costs of, 665
mediation of, orbitofrontal-striatal neurocircuitry in, 669
pathophysiology of, molecular imaging techniques and, 669
prevalence of, 665
similarity to other anxiety disorders, 669–670
subclinical, 674
subtyping of, 674–675
with and without tics, 676
with early onset, 676
with evidence of streptococcal infection, 676
with poor insight, 676
symptom dimensions in, 674–675
four factors in, 674
genetic studies and, 674–675
psychobiology of, 675
specifiers of, 675
treatment of, combination, 667–668
need for improvements in, 677
new developments in, 668
pharmacotherapy in, 666
psychotherapy in, 666–667
714 Index

Obsessive-compulsive (continued)
underdiagnosis and undertreatment of, 665
underlying mechanisms of, 669
Obsessive-compulsive spectrum disorders (OCSDs), obsessive-compulsive disorder
classification and, 670
Olanzapine, for panic disorder, 594
for PTSD, 693
Orbitofrontal-striatal neurocircuitry, in mediation of obsessive-compulsive disorder, 669
Oxytocin, for social anxiety disorder, 562
in emotional processing, 551–552

P
Panic disorder, amino acid neurotransmitters in, 554–555
anatomic and neuroimaging findings in, 553–559
CBT for, dropout rates, 534
empirical efficacy of, 532–533
combination treatment strategies in, adherence problems with, 596–597
CBT following medication discontinuation, 597–598
CBT-pharmacotherapy, 596
maintenance of CBT after medication discontinuation, 597
comorbidity in, response to CBT and, 596
corticotropin-releasing factor and HPA axis in, 555–556
genetic contribution to, 556
in children and adolescents, prevalence of, 496–497
monoamines in, 555
neuroendocrine findings in, 556–557
neuropeptides in, 555
neurotransmitter signaling in, 554–555
polymorphisms in, 555–556
relaxation training for, 599
target genes in, 556
treatment of, combination strategies in, 594
computerized therapy for, 601
effect on comorbid conditions in, 594
implications for DSM-V, 601–602
routine CBT for, 600–601
treatments for, CBT for, 595–596, 601
cognitive behavioral, 595–596
combination strategies, 596–598
dissemination of, 600–601
empirically supported, 593–610
implilcations for DSM-V, 601–602
mechanisms of action in, 598–599
novel strategies for combined treatment, 600
pharmacotherapy, 593–595
psychosocial, 599–600
routine care in, 600–601
Phenelzine sulfate, for social phobia, 642
Phobias. See Social phobia; Specific phobias.
Positron emission tomography (PET), in panic disorder, 554
 Index 715

Posttraumatic stress disorder (PTSD), 687–704

acute, 688–692
anatomical and neuroimaging findings in, 557–558
CBT for, empirical efficacy of, 533
challenges to early interventions, barriers to, 691–692
resources and dissemination of treatment skills, 692
time lag from event to treatment, 691
chronic, 692–697
active ingredients of therapies, 695–696
gap between prescribing and empirical evidence of efficacy, 693
new approaches to, 694–695
pharmacotherapy for, 692–693
psychotherapies for, 693–694
comorbidity in, depression, 687–688
mood, anxiety, and substance use disorders, 688
comparison of CBT and CBT with adjunctive therapy, 690–691
corticotropin-releasing factor and HPA axis in, 559–560
DSM-IV and, 687–688
early intervention in, targets for, 689
early life stress and, 560
genetic contribution to, 560–561
gene interaction with early life stress and, 560
monoamines in, 558–559
neurobiology of, 557–561
neuroendocrine signaling in, 558–559
neuropeptides in, 559
neurotransmitters in, 558–559
new therapy approaches, fear-conditioning theory and, 694
inhibition of protein synthesis, 695
modification of endocrine modulators of emotional learning in, 694–695
virtual reality, 695
norepinephrine in, 558
pharmacotherapy for, 689–690
resistance to, 695
stabilizing effect of, 696
prevalence rates for, 687
psychological interventions for, exposure-based, trauma-focused CBT, 690–691
SSRIs in, 559
toward DSM-V, as stress-reactive disorder, 696
causation in, 696–697
contributing conditions and predisposing factors and, 697
DSM-IV desriptive criteria and, 697
place of criterion A (traumatic event), 696
reactive disorders vs. anxiety disorder, 696
Prazosin, for PTSD, 693
Prefrontal cortex (PFC), in social anxiety disorder, 561
Psychoanalytical psychotherapy, for panic disorder, 599–500
Psychodynamic therapy, for social phobia, 644–645
Psychoeducation, in CBT, 526–527, 667
Psychoneuroendocrinology, in neurobiology of anxiety disorders, 549–575
Psychotherapy, and generalized anxiety disorder, 629–640
716 Index

Q
Quetiapine, for generalized anxiety disorder, 615

R
Relaxation, for generalized anxiety disorder, 616
for panic disorder, 599
in CBT, 527, 536, 616, 630
Riluzole, for obsessive-compulsive disorder, 668
Risperidone, for PTSD, 690

S
Selective norepinephrine receptor inhibitors (SNRIs), for panic disorder, 593–594
for social anxiety disorder, 561
for social phobia, 642
Selective serotonin-reuptake inhibitors (SSRIs), for acute stress disorder, 689
for obsessive-compulsive disorder, 666
for panic disorder, 593–594, 601
for PTSD, 689, 692–603
for social anxiety disorder, 561
for social phobia, 642
Separation anxiety disorder, course of, 505
prevalence of, 496, 498–499
Short-term psychodynamic psychotherapy (STPP), comparison with CBT, for generalized
anxiety disorder, 630–631
Single-photon emission computed tomography (SPECT), in panic disorder, 554
Social anxiety disorder, amino acid neurotransmitters in, 561
anatomical and neuroimaging findings in, 561
CBT for, dropout rates, 534
empirical efficacy of, 533
corticotropin-releasing factor and HPA axis in, 562
genetic contribution to, 563
monoamines in, 561–562
neuropeptides in, 562
neurotransmitter and neuroendocrine signaling in, 561–562
Social phobia, and avoidant personality disorder, 650, 653–654
brain regions in and response to treatment, 648
CBT for, effectiveness in outpatient, private practice, and community settings, 655
evidence for in university/specialty trials, 655
integration of new treatments into, 651
Specific phobias, CBT for, empirical efficacy of, 533
cognitive therapy for, 582
etiology of, direct experience, 584
gene-environment in, 583
genetic predisposition in, 584
neural mediation in, 583–584
observation in others, 584
exposure-based therapies for, active ingredients of, 579–581
efficacy of, 578–579
in virtual reality, 578
in vivo, 578
 Index 717

systematic desensitization, 577–578

exposure therapy combined with relaxation training for, 582
implications for DSM-V, 586–587
subtypes in DSM-IV and, 586–587
in children and adolescents, assessment instruments for, 493
course of, 505
prevalence of, 496, 498–499
mechanisms of change in, associative learning process in, 585
conditioned inhibition in, 585
extinction learning in, 585–586
rewarding experiences in, 586
pharmacotherapy for, 581–582
Stress-related disorders, 687–704. See also Acute stress disorder (ASD); Posttraumatic
stress disorder (PTSD).
Structural models of mental disorders, anxiety disorders in, 465–481
internalizing-externalizing model, 466–467
implications for DSM-V and ICD-11, 467–468
justification of, 468
Structure of mental disorders, critical reappraisal of, 469–475
factor analysis approach, harmful effects of, 477–478
internalizing-externalizing model, 466–467
adverse effects vs. benefits of, 469
confirmatory factor analysis of, 468, 470–472
core aspects of, developmental stability, 470–471, 473
replication, 470–471
stability, 470–471
deficits and problems with, 469
DSM-IV anxiety disorders and, 474–475
exploratory factor analysis of, 473–474
implications for DSM-V and ICD-11, 476–477
limitations of, 475–476
promises of, 468
psychopharmacology and, 467
six-factor model, 474, 476–477
three-factor model of anxious-misery, fear, externalizing, 466–476, 478

T
Tiagabine, for generalized anxiety disorder, 615
Topiramate, in PTSD, 558
Transcranial magnetic stimulation, for obsessive-compulsive disorder, 668
Transdiagnostic treatment protocols (unified treatment protocols). See Unified treatment
protocols (transdiagnostic treatment protocols).
Tricyclic antidepressants, for generalized anxiety disorder, 613
for panic disorder, 593

U
Unified treatment protocols (transdiagnostic treatment protocols), for acceptance and
commitment therapy, 539
for CBT, 538–539
advantages of, 540
718 Index

V
Valproate, for PTSD, 693
Vasopressin (AVP), for social anxiety disorder, 562
in emotional processing, 551–552
Velafaxine, for generalized anxiety disorder, 612
Virtual reality, for generalized anxiety disorder, 616
for PTSD, 695

W
Worry, in generalized anxiety disorder vs. depressive rumination, 635