Objective-The authors sought to observe the long-term clinical course of anxiety disorders over 12 years and to examine the influence of comorbid psychiatric disorders on recovery from or recurrence of panic disorder, generalized anxiety disorder, and social phobia.Method-Data were drawn from the Harvard/Brown Anxiety Disorders Research Program, a prospective, naturalistic, longitudinal, multicenter study of adults with a current or past history of anxiety disorders. Probabilities of recovery and recurrence were calculated by using standard survival analysis methods. Proportional hazards regression analyses with time-varying covariates were conducted to determine risk ratios for possible comorbid psychiatric predictors of recovery and recurrence.Results-Survival analyses revealed an overall chronic course for the majority of the anxiety disorders. Social phobia had the smallest probability of recovery after 12 years of follow-up. Moreover, patients who had prospectively observed recovery from their intake anxiety disorder had a high probability of recurrence over the follow-up period. The overall clinical course was worsened by several comorbid psychiatric conditions, including major depression and alcohol and other substance use disorders, and by comorbidity of generalized anxiety disorder and panic disorder with agoraphobia.Conclusions-These data depict the anxiety disorders as insidious, with a chronic clinical course, low rates of recovery, and relatively high probabilities of recurrence. The presence of particular comorbid psychiatric disorders significantly lowered the likelihood of recovery from anxiety disorders and increased the likelihood of their recurrence. The findings add to the understanding of the nosology and treatment of these disorders.Anxiety disorders are more common than any other major group of diagnoses, with the exception of substance use disorders. According to the National Comorbidity Survey, the overall lifetime prevalence of anxiety disorders is 24.9%, including rates of 3.5%, 13.3%, 5.1%, for panic disorder with or without agoraphobia, social phobia, and generalized anxiety disorder, respectively (1). The effects of these disorders on both physical health and occupational functioning have been well documented (2-6). In the WHO Collaborative Study on Psychological Problems in General Health Care, more than one-half of the patients with panic disorder without or with agoraphobia reported moderate to severe occupational Address correspondence and reprint requests to Dr. Bruce, Department of Psychiatry and Human Behavior, Brown University, Box G-BH, Providence, RI 02906; Steven_Bruce_PhD@Brown.edu (e-mail). NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript dysfunction and physical disability (3). The severity of disability reported was similar to that reported for depressive episodes and higher than that for alcohol dependence.Despite the high prevalence of anxiety disorders and the morbidity associated with these disorders, much is yet...

Examined the effects of witnessing community violence on emotional distress and frequency of violent behavior across three time points within a predominantly African American sample of 436 sixth-grade students in an urban public school system. A high percentage of students, particularly boys, reported witnessing a variety of violent incidents (e.g., shootings, beatings, and stabbings). Comparison of structural equation models revealed a number of significant gender differences in the effects of exposure to violence and in the measurement of violent behavior. Exposure to violence was related to subsequent changes in the frequency of violent behavior among girls, but not among boys. Exposure to violence was not related to subsequent changes in emotional distress for either boys or girls. Cross-sectional results replicated previous studies that have found relations between exposure to violence and frequency of violent behavior; however neither variable was related to emotional distress.

Anxiety disorders are chronic illnesses that occur more often in women than men. Previously, we found a significant sex difference in the 5-year clinical course of uncomplicated panic disorder that was attributable to a doubling of the illness relapse rate in women compared to men. However, we have not detected a sex difference in the clinical course of panic with agoraphobia, generalized anxiety disorder (GAD), or social phobia (SP), which are conditions generally thought to be more chronic than uncomplicated panic disorder. Given that a longer follow-up period may be required to detect differences in clinical course for more enduring illnesses, we conducted further analyses on this same cohort after a more protracted interval of observation to determine whether sex differences would emerge or be sustained. Data were analyzed from the Harvard/Brown Anxiety Research Program (HARP), a naturalistic, longitudinal study that repeatedly assessed patients at 6 to 12 month intervals over the course of 8 years. Data regarding remission and relapse status were collected from 558 patients and treatment was observed but not prescribed. Cumulative remission rates were equivalent among men and women with all diagnoses. Patients who experienced remission were more likely to improve during the first 2 years of study. Women with GAD continued remitting late into the observation period and experienced fewer overall remission events by 8 years. However, the difference in course failed to reach statistical significance. Relapse rates for women were comparable to those for men who suffered from panic disorder with agoraphobia, GAD, and SP. Again, initial relapse events were more likely to occur within the first 2 years of observation. However, relapse events for uncomplicated panic in women were less restricted to the first 2 years of observation and by 8 years, the relapse rates for uncomplicated panic was 3-fold higher in women compared with men. Anxiety disorders are chronic in the majority of men and women, although uncomplicated panic is characterized by frequent remission and relapse events. Short interval follow-up shows sex differences in the remission and relapse rates for some but not all anxiety disorders. These findings suggest important differences in the clinical course among the various anxiety disorders and support nosological distinctions among the various types of anxiety. It may be that sex differences in the clinical course of anxiety disorders hold prognostic implications for patients with these illnesses.

There is a paucity of empirical study about the effects of evidence-based psychotherapy for posttraumatic stress disorder (PTSD) on concurrent health concerns including sleep impairment. This study compares the differential effects of cognitive processing therapy (CPT) and prolonged exposure (PE) on health-related concerns and sleep impairment within a PTSD sample of female, adult rape survivors (N = 108). Results showed that participants in both treatments reported lower health-related concerns over treatment and follow-up, but there were relatively more improvements in the CPT condition. Examination of sleep quality indicated significant improvement in both CPT and PE across treatment and follow-up and no significant differences between treatments. These results are discussed with regard to the different mechanisms thought to underlie the treatments and future innovations in PTSD treatment.A growing literature implicates traumatic stress in adverse health outcomes when measured by biological and physiological indices, self-report, and mortality rates (Friedman & Schnurr, 1995;Green & Kimerling, 2004). Environmental and behavioral factors unique to traumatized individuals complicate the relationship between exposure to trauma and poor health status. A second factor contributing to negative health consequences within traumatized individuals is the significant sleep impairment observed in this population. A minimally studied area is whether treatment of trauma-related sequelae, specifically posttraumatic stress disorder (PTSD), also ameliorates concerns about physical health. This directly compares the effects of two evidence-based, trauma-focused psychotherapies, cognitive processing therapy (CPT; Resick & Schnicke, 1992, 1993 and prolonged exposure (PE;Foa, Hearst, Dancu, Hembree, & Jaycox, 1994), on both health-related concerns and sleep impairment, within female sexual assault survivors suffering from PTSD.Correspondence concerning this article should be addressed to: Tara E. Galovski, Center for Trauma Recovery, University of MissouriSt. Louis, One University Boulevard, St. Louis, MO 63121-4499. galovskit@msx.umsl.edu. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptPosttraumatic stress disorder and poor health-related outcomes have been consistently linked in cross-sectional research. Several large-scale studies conducted with combat veterans have compared those with and without PTSD, and found that veterans with PTSD report significantly more chronic health conditions and generally poorer perception of physical health than their non-PTSD counterparts (Barrett et al., 2002, Kulka et al., 1990Schnurr & Jankowski, 1999;Schnurr et al., 2000), even when controlling for behaviors known to independently contribute to poor health outcomes such as smoking, alcohol use, deployment status, military status, and demographics (Barrett et al., 2002;Schnurr & Spiro, 1999). Although less research has been conducted in non-veteran populations, specific medical conditions s...

The past decade witnessed considerable debate over the factor structure of the Anxiety Sensitivity Index (ASI), with an eventual consensus emerging that supported a hierarchically organized factor structure. The present study attempted to replicate and examine the overall stability and utility of the hierarchical ASI factor pattern using a large sample of outpatients participating in an ongoing longitudinal study of anxiety disorders. Results supported a hierarchical factor structure for the ASI consisting of three lower-order factors measuring physical concerns, mental incapacitation concerns, and social concerns, all of which loaded significantly on a single second-order factor. Correlational analyses show good test-retest reliability and consistent patterns of intercorrelation for these factor-derived subscales across a 10-month time frame. Additional analyses provide support for the discriminant validity of the ASI subscales with regard to individuals with specific anxiety disorders. The theoretical implications of these findings for future evaluations of anxiety sensitivity are discussed.