Objectification of the effectiveness of psychotherapy in patients with anxiety disorders

Intention – To evaluate the possibility of objectifying the effectiveness of reassessment of events (cognitions) that cause anxiety by monitoring blood pressure (BP) and heart rate (HR).

Methodology. We examined 107 patients with an established diagnosis: “Anxiety disorder” (F41 according to ICD-10). There were 38 men (35.5%) and 69 women (64.5%). Before the start of the study, blood pressure and heart rate were measured in patients. The comparison groups included only those patients in whom the presentation of activating events that caused the most pronounced symptom (more often it was anxiety) resulted in deviations of physiological parameters by more than 5% from baseline. As a result, 104 out of 107 persons were selected. Further, a psychotherapeutic intervention was carried out to change assessment (cognition) of activating events and check how the new assessment was able to prevent BP and HR deviations when activating events were presented. It was found that new assessments prevented and did not prevent BP and HR deviations in 87 persons (Group 1) and 17 persons (Group 2, controls), respectively. After that, patients were asked to independently apply these skills in everyday life and carry out training in reassessment of activating events for 5 days. Mental status was recorded before and after independent work using the Visual Analogue Scale (VAS) to assess severity of the most disturbing symptom, the Clinical Global Impression Scale (CGI-S) , and the Neuroticism Scale (NS).

Results and Discussion. When comparing the mental state of Group 1 patients before and after psychotherapeutic intervention, there was a statistically significant decrease in the subjective severity of the main symptom according to VAS, disease severity according to CGI-S and the level of neuroticism according to NS, while in Group 2 indicators improved, but without statistically significant difference compared to baseline. Group 1 patients showed an improvement of (2.2 ± 0.8) according to CGI-I scale of CGI-S, i.e. quite a strong improvement.

Conclusion. The results indicate the possibility of using physiological indicators to assess the psychotherapy impact and can be used to predict its effectiveness. It seems promising to develop automated methods, such as gadget-control by physiological indicators, to assess the effectiveness of psychotherapy.

1. Bekhterev V.M. Ob”ektivnaya psikhologiya [Objective psychology]. Moscow. 1991. 480 p. (In. Russ.)

2. Bul’ P.I. Gipnoz i vnushenie v klinike vnutrennikh boleznei [Hypnosis and suggestion in the clinic of internal diseases]. Leningrad. 1968. 240 p. (In. Russ.)

3. Bykov K.M., Kurtsin I.T. Kortiko-vistseral’naya patologiya yazvennoi bolezni [Cortico-visceral pathology of peptic ulcer]. Leningrad. 1949. 87 p. (In. Russ.)

4. Varshavskii K.M. Gipnosuggestivnaya terapiya (lechenie vnusheniem v gipnoze) [Hypnosuggestive therapy (treatment by suggestion in hypnosis)]. Leningrad. 1973. 192 p. (In. Russ.)

5. Vundt V. Lektsii o dushe cheloveka i zhivotnykh [Lectures on the soul of man and animals]. St. Petersburg. 1894. 465 p. (In. Russ.)

6. Gubachev Yu.M., Stabrovskii E.M. Kliniko-fiziologicheskie osnovy psikhosomaticheskikh sootnoshenii [Clinical and physiological bases of psychosomatic relationships]. Leningrad. 1981. 214 p. (In. Russ.)

7. Dmitrieva K.P. Izuchenie urovnya nevrotizatsii i psikhopatizatsii uslovno zdorovykh grazhdan [Study of the level of neuroticization and psychopathization of conditionally healthy citizens]. Nauchnoe obozrenie. Meditsinskie nauki [Scientific Review. Medical Sciences]. 2016; (4):26–29. (In. Russ.)

8. Zabolevaniya vegetativnoi nervnoi sistemy [Diseases of the autonomic nervous system]. Ed. A.M. Vein. Moscow. 1991. 624 p. (In. Russ.)

9. Kocherov S.V., Dmitrieva K.P. Ispol’zovanie opredeleniya urovnya nevrotizatsii i psikhopatizatsii kak skriningovoi ekspress-metodiki diagnostiki pogranichnykh psikhicheskikh rasstroistv [The use of determining the level of neuroticism and psychopathization as a screening express method for diagnosing borderline mental disorders]. Nauchnoe obozrenie. Meditsinskie nauki [Scientific Review. Medical Sciences]. 2016; (4):51–53. (In. Russ.)

10. Lazarus R. Teoriya stressa i psikhofiziologicheskie issledovaniya [Theory of stress and psychophysiological research]. Emotsional’nyi stress [Emotional stress]. Ed. L. Levi. Leningrad. 1970. Pp. 178–208. (In. Russ.)

11. Osipov Ya.V. Metodologicheskoe znachenie assotsiativnogo eksperimenta K. Yunga v razrabotke A.R. Lurii osnov reaktologicheskoi teorii affektivnogo povedeniya [The methodological significance of the associative experiment of C. Jung in the development of A.R. Luria of the fundamentals of the reactological theory of affective behavior]. Vestnik Severnogo (Arkticheskogo) federal’nogo universiteta. Seriya Gumanitarnye i sotsial’nye nauki [Bulletin of the Northern (Arctic) Federal University. Ser.: Humanitarian and social sciences]. 2011; (1):123–127.

12. Sechenov I. Refleksy golovnogo mozga [Reflexes of the brain]. St. Petersburg. 1866. 186 p. (In. Russ.)

13. T’yuk Kh. Dukh” i T”lo, deistvie psikhiki i voobrazheniya na fizicheskuyu prirodu chelov”ka [Spirit and Body, the action of the psyche and imagination on the physical nature of man]. Moscow. 1888. 391 p. (In. Russ.)

14. Tsyrlin V.A., Kuz’menko N.V., Pliss M.G. Variabel’nost’ arterial’nogo davleniya – regulyarnye i neregulyarnye volny [Blood pressure variability – regular and irregular waves]. Arterial’naya gipertenziya [Arterial hypertension]. 2020; 26(6):612–619. DOI: 10.18705/1607-419X-2020-26-6-612-619. (In. Russ.)

15. Shertok L. Gipnoz : teoriya, praktika i tekhnika [Hypnosis: theory, practice and technique]. Moscow. 1992. 224 p. (In. Russ.)

16. Yagudina R.I., Kulikov A.Yu., Litvinenko M.M. QALY: istoriya, metodologiya i budushchee metoda [QALY: history, methodology and future of the method]. Farmakoekonomika. Sovremennaya farmakoekonomika i farmakoepidemiologiya [Pharmacoeconomics. Modern pharmacoeconomics and pharmacoepidemiology]. 2010; 3(1):7–11. (In. Russ.)

17. Cramer H., Sellin C., Schumann D., Dobos G. Yoga in Arterial Hypertension. Dtsch. Arztebl. Int. 2018; 115(50):833– 839. DOI: 10.3238/arztebl.2018.0833.

18. Dhungana R.R., Pedisic Z., Joshi S. [et al.]. Effects of a health worker-led 3-month yoga intervention on blood pressure of hypertensive patients: a randomised controlled multicentre trial in the primary care setting. BMC Public Health. 2021; 21(1):550. DOI: 10.1186/s12889-021-10528-y.

19. Fechner G.T. Elemente der psychophysik. Leipzig : Breitkopf und Härtel. 1860. Vol. 1. 362 p.

20. Khan A., Khan S.R., Shankles E.B., Polissar N.L. Relative sensitivity of the Montgomery-Asberg Depression Rating Scale, the Hamilton Depression rating scale and the Clinical Global Impressions rating scale in antidepressant clinical trials. Int. Clin. Psychopharmacol. 2002; 17(6):281–285. DOI: 10.1097/00004850-200211000-00003.

21. Leon A.C., Shear M.K., Klerman G.L. [et al.]. A comparison of symptom determinants of patient and clinician global ratings in patients with panic disorder and depression. J. Clin. Psychopharmacol. 1993; 13(5):327–331.

22. Sartory G. Some Psychophysiological Issues in Behavioural Psychotherapy. Behavioural and Cognitive Psychotherapy. 1981; 9(3):215–230. DOI: 10.1017/S0141347300007503.

23. Van der Helm PA. Weber-Fechner behavior in symmetry perception? Atten Percept Psychophys. 2010; 72(7):1854– 1864. DOI: 10.3758/APP.72.7.1854.

24. Maloney R.K., Mitchison G.J., Barlow H.B. Limit to the detection of Glass patterns in the presence of noise. J. Opt. Soc. Am. 1987: 4(12):2336–2341. DOI: 10.1364/josaa.4.002336.