Confronting panic in the real world
Clark researchers aid the local mental health community by "bridging the gap"
Learn how Clark students helped with Professor Addis' research
Imagine a tiger is lunging
at you with bared teeth and extended claws.
Your heart races, adrenaline flows, you fear you won't be able to breathe,
and your nerves jump out of control.
Now imagine there is no tiger but your body
and mind respond just the same. Many people experience spontaneous attacks
that feel just like this; danger seems imminent and yet there is no apparent
trigger to the full-fledged panic reaction.
For those suffering with panic disorder, a
common mental health problem, the attacks can
be debilitating as they try to avoid any cues that might set off a panic
reaction. Some may remain imprisoned in their houses. Others may continually
rush to the emergency room because they think they are dying.
Thanks to Clark researchers, help may soon be on the way. Assistant professor
of psychology Michael Addis is leading a study designed to "bridge the gap
between research and practice" by applying promising treatments developed in
controlled research environments to real-life cases.
"Therapists in full-time practice don't have time to think about research.
And researchers have been relatively out of touch with the realities of
mental health practice," he says. "This study bridges the gap between the
ivory tower and the community."
Funded by a $350,000 five-year National Institute of Mental Health grant and
started in 1998, the study tracks 100 patients suffering from panic disorder
who are treated by 10 mental health therapists in the Worcester area. Five of
the therapists are trained by Clark researchers in "cognitive behavioral"
treatment, while the rest treat their patients as they have in the past,
which is called "treatment as usual."
Few standards of practice
Unlike the medical industry, there are few specifically recommended
treatments for common mental health problems. Individual therapists often
treat their patients as they see fit, usually basing their treatment on what
appears to have worked with similar patients.
"This is a very common disorder that therapists see, and very few know how to
treat it effectively without medication or long-term therapy," says Addis.
"This is one of the first studies to evaluate what happens when stat
e-of-the-art treatments are brought to clinical practice. Effective
treatments developed in academic settings may not reach front-line
practitioners unless we can forge research-practice partnerships like this
one."
The local therapists receiving the training in this study are grateful for
the new knowledge. "They love it," Addis says of the therapists. "They
describe it (the training sessions) as the highlight of their week. They feel
like they are continuing to learn."
An 87 percent solution
Addis and his team are training the therapists to use a variety of "cognitive
behavioral treatment" called "Panic Control Therapy," developed by Dr. David
Barlow at Boston University. In controlled research studies, 87 percent of
people treated this way were "panic free" at the end of six to 12 sessions.
"The treatment involves educating people on the nature of panic," says
Addis. "We teach them about the role of their own thoughts, behaviors and
physiology in panic reactions." Eventually the patient is gradually exposed
to feared situations, and the fear of future panic attacks decreases. When
success is achieved, the quality of the patient's life can improve
dramatically, Addis says.
The short and the long term
The study will look at the short-term success of patients, and their
well-being over a two-year period following treatment. The first two years of
the study were devoted to developing partnerships between the research team
and the mental health community. Addis' team, which consists of four graduate
students and several undergraduates, works closely with Fallon Community
Health Care and the Boston Road Clinic, a large mental health care provider.
Another key part of the study is to evaluate costs—the cost to the patient,
the cost of training the therapists, and the costs of alternative treatments
such as medication. Panic and other anxiety disorders are not only costly to
people suffering from them, but to the health-care industry as well.
"I worked with a patient who went to the emergency room every day for five
years because he was convinced he was having a heart attack during panic
episodes," says Addis. "Effective treatment is a win-win for the patient and
the health-care industry."
Conducting research in the real world, as opposed to a controlled setting,
has its drawbacks, Addis says. Patients must deal with the world of managed
care, and may drop out of the study for financial reasons, for example.
Therapists change jobs, or don't follow the treatment protocol. But despite
the problems, the conclusions will be more relevant for the mental-health
community.
"When science partners with the real world, great things can happen for many
people," says Addis.
Professor Addis' study is a prime example of Clark's
special learning environment: faculty, graduate students
and undergraduates working together. Graduate students Christina Hatgis,
Aaron Krasnow, Karen Jacob and Inna Khazan help train therapists, provide
consultation and
monitor data collection. Several undergraduates help at
all levels, especially in data collection.
Professor Addis has received the New Researcher
Award from the Association for the Advancement of
Behavior Therapy, as well as Clark's Hodgkins Award and
the Hayden Junior Faculty Fellowship for excellence in research and teaching.
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