Michael Gelder's research while affiliated with University of Oxford and other places
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Publications (36)
One of the puzzles surrounding social phobia is that patients with this problem are often exposed to phobic situations without showing a marked reduction in their fears. It is possible that individuals with social phobia engage in behaviors in the feared situation that are intended to avert feared catastrophes but that also prevent disconfirmation...
Exposure therapy and cognitive behaviour therapy (CBT) are both effective in the treatment of panic disorder with agoraphobia. Cognitive theories suggest that the way in which exposure to avoided situations is implemented in either treatment may be crucial. In particular, it is suggested that clinical improvement will be greatest if opportunities f...
Cognitive therapy (CT) is a specific and highly effective treatment for panic disorder (PD). Treatment normally involves 12-15 1-hr sessions. In an attempt to produce a more cost-effective version, a briefer treatment that made extensive use of between-sessions patient self-study modules was created. Forty-three PD patients were randomly allocated...
This study evaluates the hypothesis that safety-seeking behaviours play an important role in maintaining anxiety because they prevent patients from benefiting from disconfirmatory experience. Patients suffering from panic disorder with agoraphobia carried out a behaviour test, closely followed by an experimental session, which included a brief (15...
Cognitive behavior therapy (CBT) has been combined with pharmacotherapy in the treatment of panic disorder in three ways: (1) to treat agoraphobic symptoms in the condition of panic with agoraphobia; (2) to reduce withdrawal effects during drug taper; and (3) to treat panic attacks. Exposure treatment and pharmacotherapy have a modest additive effe...
Hypochondriasis is generally considered difficult to manage. This study aimed to assess the effectiveness of cognitive therapy and to compare it with an equally credible, alternative treatment.
Forty-eight patients with hypochondriasis were initially randomly assigned to either cognitive therapy, behavioural stress management or a no treatment wait...
Resumen
En 1962, William Sargant y sus colaboradores describieron el valor terapéutico de la fenelzina, un inhibidor de la monoamino oxidasa (IMAO), en los trastornos de ansiedad crónicos y, en el mismo año, Klein y Fink comunicaron el tratamiento de condiciones similares con imipramina, un antidepresivo tricíclico. La investigación posterior ha co...
Cognitive accounts of panic predict that panic disorder patients will be particularly prone to misinterpret autonomic sensations. Several studies have produced results consistent with this prediction, but each is open to alternative interpretation. To clarify matters, 2 studies administered the Body Sensations Interpretation Questionnaire (BSIQ) to...
Although behavior therapy is designed to modify observable behaviors, it also brings about cognitive change. To achieve the best results with behavior therapy, it is sometimes necessary to combine it with cognitive procedures. The author gives examples of the uses of behavior therapy on its own and as combined cognitive-behavior therapy. These trea...
In 1962 William Sargant and his colleagues described the therapeutic value of phenelzine, a monoamine oxidase inhibitor (MAOI), in chronic anxiety disorders and in the same year Klein and Fink reported the treatment of similar conditions with imipramine, a tricyclic antidepressant. Subsequent research has confirmed these findings and demonstrated t...
Biological psychiatry is a technical term that denotes physiological and biochemical approaches to psychiatric aetiology and, despite the usual wider meaning of the word biological, excludes psychosocial approaches. 'Biological' causes of severe psychiatric disorder have been suspected from the earliest times, and in some periods an excessive focus...
RIASSUNTO
Scopo - Descrivere alcuni problemi che possono emergere quando i risultati degli studi clinici controllati sono utilizzati acriticamente nella pratica clinica quotidiana e mostrare come una prospettiva epidemiologica faciliti l'identificazione di questi problemi. Metodo - Una rassegna degli studi clinici controllati per illustrare i probl...
The cognitive theory of panic disorder proposes that panic attacks occur as a result of an enduring tendency to misinterpret bodily sensations as a sign of imminent catastrophe such as a heart attack. The persistence of such catastrophic cognitions is in part due to the tendency of patients to avoid and/or escape situations where panic occurs. It i...
One of the puzzles surrounding social phobia is that patients with this problem are often exposed to phobic situations without showing a marked reduction in their fears. It is possible that individuals with social phobia engage in behaviors in the feared situation that are intended to avert feared catastrophes but that also prevent disconfirmation...
Authors Reply: - Volume 166 Issue 4 - D.M. Clark, P.M. Salkovskis, A. Hackmann, H. Middleton, A. Wells, M. Gelder
Author's Reply - Volume 165 Issue 4 - David M. Clark, Paul M. Salkovskis, Ann Hackmann, Hugh Middleton, Sarah Durbin, Adrian Wells, Michael Gelder
Recent studies have shown that cognitive therapy is an effective treatment for panic disorder. However, little is known about how cognitive therapy compares with other psychological and pharmacological treatments. To investigate this question 64 panic disorder patients were initially assigned to cognitive therapy, applied relaxation, imipramine (me...
Several kinds of evidence indicate that there are important psychological causes of panic disorder as well as the biological causes that have been demonstrated by others. These psychological causes are fears that physical symptoms of anxiety will be followed by an immediate medical emergency: for example, that palpitations will be followed by a hea...
Discusses the treatment of the neuroses: phobic disorders (agoraphobia, social phobia, and nosophobia), anxiety disorders (panic disorders and generalized anxiety disorder), obsessive-compulsive disorder, dissociative disorder, and depersonalization-derealization syndrome. Three treatment categories are covered: (1) drug treatment, (2) nonpharmacol...
The research evidence strongly suggests that the most effective form of treatment for panic disorder is cognitive therapy. It is more practical, however, to initiate treatment with alprazolam or with imipramine. Either drug will suppress symptoms and even a half of the patients will stay well.
In a controlled clinical trial, 57 Ss meeting DSM-III-R criteria for generalized anxiety disorder, and fulfilling an additional severity criterion, were randomly allocated to cognitive behavior therapy (CBT), behavior therapy (BT), or a waiting-list control group. Individual treatment lasted 4-12 sessions; independent assessments were made before t...
In a controlled clinical trial, 57 Ss meeting DSM—III—R criteria for generalized anxiety disorder, and fulfilling an additional severity criterion, were randomly allocated to cognitive behavior therapy (CBT), behavior therapy (BT), or a waiting-list control group. Individual treatment lasted 4—12 sessions; independent assessments were made before t...
The management of persistent anxiety states often presents problems for the clinician. The long term use of benzodiazepines is no longer recommended because of the risk of physical dependence, sedation and memory impairment. New pharmacological and psychological treatments are being proposed as alternatives but opinions differ as to which patients...
Reviews evidence for a psychological cause for panic anxiety and describes the use of psychological treatments in the management of panic attacks. A hypothesis is presented that states that panic anxiety arises when a person has an enduring tendency to interpret sensations from the body in a catastrophic way. Ways in which this hypothesis has been...
The endocrine responses to the 5-hydroxytryptamine (5HT) precursor, L-tryptophan, were assessed in 10 depressed patients before and after at least 4 weeks of treatment with amitriptyline. Overall, amitriptyline did not alter either prolactin or growth hormone responses to L-tryptophan. When three subjects with severe pretreatment weight loss were e...
Panic attacks are one of the most distressing of all forms of anxiety. The sudden onset of attacks and the intense bodily sensations which accompany them often lead patients to think they are about to die, go crazy, or suffer some other catastrophe. The fact that some attacks also appear to occur without warning is additionally alarming to patients...
A preliminary controlled investigation of the effectiveness of Anxiety Management as a treatment for generalised anxiety disorder (GAD) is described. Patients with a primary diagnosis of GAD, in which the current episode had lasted for at least 6 months but not more than 2 years, were included. Anxiety Management, a self-help treatment including pr...
This paper focuses on three aspects of generalised anxiety; anxious cognitions, avoidance behaviour and the efforts made to cope with symptoms. It presents information from structured interviews and informal observations which were collected during a clinical trial of anxiety management for generalised anxiety disorder. The findings are discussed i...
This replication study was designed to follow up the suggestion (Jannoun, Munby, Catalan, & Gelder, 1980) that problem solving without exposure may provide an effective treatment for agoraphobia. A consecutive series of 14 agoraphobic women was treated with problem solving by two therapists. Results suggest that problem solving is not as effective...
The effects of anxiety management training in reducing generalized anxiety using a self-help format were examined. Twenty-seven anxiety state patients were randomly allocated to one of three groups which differed only in the length of time patients waited for treatment. Self-ratings of anxiety and depression were made at the start of the wait perio...
Twenty-eight agoraphobic women were randomly allocated to one of two treatments: programmed practice in entering feared situations or a treatment aimed at anxiety reduction by resolving life problems. Each treatment was conducted by one of two therapists and both were carried out at the patient's home, involved the spouse, and used the same structu...
This article reviews evidence about the value of behaviour therapy for the treatment of patients who present with phobic disorders anxiety states, obsessional neuroses, and hysteria. Although progress has been made in developing effective behaviour therapy for the major neurotic syndromes, much remains to be done. Only in the phobic disorders is th...
Citations
... Avoidance of awareness of these emotions (i.e., alexithymia) could therefore be interpreted as a psychological defense strategy to protect against the pain of rejection through a general avoidance (Bilotta et al., 2016;Lampe & Malhi, 2018). Too much avoidance of awareness of emotions is considered maladaptive, because it may maintain unrealistic beliefs about the threatening situation and emotions (Salkovskis, 1991;Wells et al., 2016) and contribute to the development and maintenance of psychopathology (Helbig-Lang & Petermann, 2010;Lampe & Malhi, 2018). Therefore, our results suggest that, in treatment, attention should be given to avoidance of awareness of emotions in the treatment of individuals with high levels of both Negative Affect and Detachment to diminish their distress, teaching them coping skills to deal with the associated emotions, and to decrease avoidance tendencies. ...
... The efficacy of CBT has also been established for the treatment for generalized anxiety disorder (Butler et al., 1991;Durham et al., 1994;Linden et al., 2005;Carpenter et al., 2018) and social anxiety disorder (Heimberg et al., 1990;Gelernter et al., 1991;Davidson et al., 2004;Clark et al., 2006;Carpenter et al., 2018). Exposure and response prevention (ERP), a treatment that is primarily behavioral in focus, is the best established therapy for OCD, whether alone or typically combined with CBT in comprehensive treatment packages (Salkovskis & Westbrook, 1989;James & Blackburn, 1995;Simpson et al., 2008). ...
Reference: Cognitive and Behavioral Therapies
... These refer to companies who struggle with a shortage of goods and services, marketing strategies during a severe and lasting recession (Naidoo 2010), reputational and product-harm crises (Gao, Xie, Wang, and Wilbur 2015). In marketing, a crisis refers to a large-scale situation that causes a drastic and negative impact on manufacturers, their customers, competitors, employees, and other relevant stakeholders (see Clark 1988; Grewal and Tansuhaj 2001). The objective of this paper is to identify the chances and challenges caused by COVID-19 as they are associated with B2B sales and purchasing interactions. ...
Reference: ADJUSTING B2B SALES INTERACTIONS TO COVID19
... Situational exposure has been central to the psychological treatment of agoraphobic individuals for decades. Although variations in procedures exist, effective exposure involves repeated contact with the avoided situation while the client experiences moderate levels of anxiety (Gelder, 1991). See Hazlett-Stevens and Craske (2003) for a description of in vivo exposure procedures. ...
Reference: Agoraphobia
... Current teaching models in psychiatry and mental health differ across the world due to historical factors and geographical perspectives on health and the health needs and priorities of countries. While the World Psychiatric Association (WPA) and the World Federation for Medical Education advocated for integrating psychiatry into undergraduate medical education in a landmark report in 1998 (Gelder 1998), major disparities exist even in the structure of courses worldwide. A recent survey of medical students across the world, co-developed by WPA and the International Federation of Medical Students, revealed disparities in the length of psychiatry courses across 83 countries. ...
... Although the particular form of behavioural treatment may differ depending on diagnosis, it targets the same principles and processes in each instance. Variants of behavioural treatments have been successful in treating a moderate proportion of people with just about every form of anxiety disorder, (Coffey, Stasiewicz, Hughes & Brimo, 2006;Lee, et al., 2006;Wolpe, 1987b;Hand, 2000;Cox, Endler, Lee & Swinson, 1992;de Beurs, van Balkom, Lange, Koele, & van Dyck, 1995;Gelder, 1979;Franklin, Abramowitz, Kozak, Lewitt & Foa, 2000;Grayson, Foa & Steketee, 1986;Muris, Mayer, & Merckelbach, 1998;Buchanan & Houlihan, 2008;Egbochuku & Obodo, 2005;Wald & Taylor, 2005;Wald & Taylor, 2008). ...
... 4. A variety of studies have shown that the same drug may be effective for disorders of different symptomology. For example, clomipramine, fluoxetine, fluvoxamine, monoamine oxidase inhibitors , and tricyclic antidepressants are effective in the treatment of both OCD (e.g., Abramowitz, 1997; Demal, Zitterl, Lenz, Zapotoczky, & Zitterl-Eglseer, 1996; Park, Jefferson, & Greist, 1997; Piccinelli, Pini, Bellantuono, & Wilkinson, 1995; Van Balkom et al., 1994) and agoraphobia and panic disorders (e.g., Alexander, 1991; Black, Wesner, Bowers, & Gabel, 1993; Burrows, Judd, & Norman, 1993; Gelder, 1992; Klerman, 1992; Westenberg, 1996). Similar results were reported for eating disorders (e.g., Hoffman & Halmi, 1993; Wolfe, 1995). ...
... Clinical interventions which incorporate the identification and assessment of perceptions of chance and powerful others in panic disorder and social phobia may show enhanced efficacy. Indeed, recent successful cognitive behavioral treatments of panic disorder involve the identification of internal or external cues that trigger panic attacks, so that the client may develop a sense of predictability, and thus a sense of control, about the attacks (Barlow & Cerny, 1988;Clark, 1986). Similarly, current cognitive-behavioral treatments of social phobia focus not only on clients' negatively colored beliefs about others' perceptions of them but also on their limited expectations concerning their ability to participate in and guide the outcome of social interactions (Heimberg, 1990; Heimberg, Dodge, Hope, Kennedy, Zollo, & Becker, 1990). ...
... A replication of the Mathews et al. home-based treatment program (Jannoun, Munby, Catalan, & Gelder, 1980) provided additional evidence for the efficacy of this self-directed exposure treatment. Twenty-eight women with agoraphobia were randomly assigned to the self-directed exposure program or a problem-solving control condition. ...
Reference: Agoraphobia
... This anxiety is frequently associated with avoidance of the anxiety-inducing situation and/or performance of safety behaviors (e.g., hand-washing compulsions in case of obsessive-compulsive disorder) to prevent or reduce anxiety. However, such avoidance and safety behaviors are ultimately counterproductive because they sustain the anxiety and prevent the individual from responding flexibly and learning that the feared consequences do not occur (Foa and Kozak, 1986;Salkovskis et al., 1996). Exposure-based psychotherapies aim to tackle this behavioral inflexibility by systematically guiding patients to approach anxiety-provoking situations they would rather avoid. ...