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Anxiety and Traumatic
Stress Program |
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Anxiety and Traumatic Stress Program
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Program Overview
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Anxiety and Traumatic Stress Faculty
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Evaluation and Treatment
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Clinical Research
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Training Opportunities in Anxiety and Traumatic Stress
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Instruments Developed by the Program
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Contact Information
Program Overview
The Anxiety and Traumatic Stress Program (ATSP),
under the direction of Dr. Wei Zhang, is an adult outpatient program
which provides both clinical and research services. Attendings,
fellows, and residents specialize in the evaluation and treatment of the
full range of anxiety disorders and mood disorders, including:
Generalized anxiety disorder (GAD)
Obsessive compulsive disorder (OCD)
Panic disorder
Posttraumatic stress disorder (PTSD)
Social anxiety disorder (SAD; also known as social phobia)
Specific phobia
Depressive disorders
The ATSP provides services to over 500
adults outpatients annually. The program serves as a major referral
center in the local community and elsewhere in the Southeastern United
States. Since its inception in 1987, under the direction of Dr.
Jonathan Davidson, the Program has demonstrated continued growth and
development and is now recognized as one of the leading programs of its
kind in the US. Ongoing research through the Program serves as an
umbrella under which a large number of clinical investigators conduct
important and innovative research, with opportunities for collaborative
work with other clinicians in the Department, the Program in Integrative
Medicine, other departments within the Medical Center, and the Duke
Clinical Research Institute (DCRI). Investigators at Duke also
have an excellent record of collaboration with colleagues at other
institutions.
The ATSP is comprised of a staff of
clinicians, coordinators, data processing and management personnel,
statisticians, and support staff who participate in research pertaining
to anxiety and mood disorders. Such activities include clinical
treatment trials, epidemiologic studies, development and validation of
rating scales, and archival data analyses.
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Anxiety and Traumatic
Stress Faculty
Anxiety and Traumatic Stress Program
Department of Psychiatry and Behavioral Sciences
Duke University Medical Center
Director: Wei Zhang, MD, PhD
Staff:
Administrative Assistant Levis Erik Churchill
(919) 681-5750
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Evaluation and Treatment
Through the program, patients receive a
comprehensive clinical and diagnostic evaluation. Diagnostic and
psychopharmacological consultations are also available. A full
range of treatments are available, including pharmacologic and
psychosocial treatments, including but not limited to cognitive
behavioral therapy, virtual reality therapy, and other psychotherapeutic
approaches, and mind body skills training (e.g., meditation and other
mindfulness-based stress reduction practices).
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Clinical
Research
Clinical studies performed by the group
cover the full range of anxiety disorders, as well as major depression.
For more information on research studies currently being conducted by
the Program, click here.
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Instruments
Developed by the Program
Since 1987, the Program has developed a
variety of psychometrically validated rating instruments. These
tools may be used to facilitate screening and diagnosis of anxiety
disorders and assessment of illness severity and response to treatment
over time. The scales described below are available in
English, with several of the scales also available in other languages.
Below are brief descriptions of the instruments available. The SARA,
SIP, SOS, TQ and TOP-8 are available for general non-commercial use,
subject to acknowledgement of copyright, which is identical for English
and translated forms. The SPIN, MINI-SPIN and SPRINT are not in the
public domain and permission for use should be obtained from the
copyright holder, Dr. Davidson, at
david011@mc.duke.edu.
The Mini-SPIN is 3-item self-rated scale
derived from the Social Phobia Inventory. The
Mini-SPIN is may be used as a screening tool to help identify
individuals at increased risk for having social phobia (or social
anxiety disorder). Using a cutoff score of 6 or greater, the Mini-SPIN
demonstrated 90% accuracy (efficiency) in diagnosing the presence or
absence of GSAD in a managed care population and those in need of
further evaluation.
Connor KM, Kobak KA, Churchill LE,
Katzelnick D, Davidson JR. Mini-SPIN: a brief screening assessment
for generalized social anxiety disorder. Depression and Anxiety
2001; 14:137-140.
Self-Assessment of Resilience and Anxiety
(SARA)
The SARA is an 8-item self-rating including
questions designed to measure calmness, mental clarity, confidence,
physical wellbeing, sociability, and resilience. In a study of an herbal
anxiolytic in patients with generalized anxiety disorder (GAD), the SARA
scale was responsive to symptom change over time and correlated with
comparable GAD symptom measures. The SARA scale demonstrated solid
psychometric properties in this sample, however its performance has not
been assessed outside of GAD nor conventional treatment modalities.
Barnett SD, Connor KM, Davidson JR.
The self-assessment of resilience and anxiety: psychometric properties.
CNS Spectrums 2001; 6:854-857.
[SARA – English]
Short PTSD Rating Interview (SPRINT)
The SPRINT provides a brief global
assessment for PTSD, as well as for each of the individual symptom
clusters associated with the disorder (i.e., intrusion and
re-experiencing; avoidance and numbing; hyperarousal). The SPRINT
is responsive to symptom change over time and correlates with comparable
PTSD symptom measures. In victims of trauma, a score of 14-17 is
associated with 96% diagnostic accuracy, whereas in those with PTSD,
highest efficiency corresponded to a range of 11-13. The SPRINT
demonstrates solid psychometric properties and can serve as a reliable,
valid and homogeneous measure of PTSD illness severity and of global
improvement.
Connor KM, Davidson JR. SPRINT: a
brief global assessment of post-traumatic stress disorder.
International Clinical Psychopharmacology 2001; 16:279-284.
Vaishnavi S, Payne, V, Connor, K, Davidson
JR. A comparison of the SPRINT and CAPS assessment scales for
posttraumatic stress disorder. Depression and Anxiety 2006; Jul 13
[Epub ahead of print].
Social Phobia Inventory (SPIN)
The SPIN is a 17-item self-rating for social
anxiety disorder (or social phobia). The scale is rated over the
past week and includes items assessing each of the symptom domains of
social anxiety disorder (fear, avoidance, and physiologic arousal).
A total score of 19 distinguished between social phobia subjects and
controls. The SPIN demonstrates solid psychometric properties and
shows promise as a measurement for the screening and treatment response
of social phobia.
Connor KM, Davidson JR, Churchill LE,
Sherwood A, Foa E, Weisler RH. Psychometric properties of the
Social Phobia Inventory (SPIN). New self-rating scale. British Journal
of Psychiatry 2000; 176:379-386.
Structured Interview for PTSD (SIP)
The SIP was developed to be used in any
individual who has experienced a traumatic event when the objective is
to assess posttraumatic symptom severity or diagnosis. The rater
administered scale is comprised of 17 items which assess each of the 3
PTSD symptom clusters: re-experiencing; avoidance and numbing; and
hyperarousal. Note 2 items assessing survivor and behavior guilt
are also included, representing holdovers from the original DSM-III
criteria. Each item is rated from 0-4 and represents a composite
assessment of frequency, severity, and functional impairment.
Optimal diagnostic sensitivity is attained at a cutoff score of 20.
While originally developed to DSM-III defined PTSD, the scale was
modified in 1995 to reflect DSM-IV criteria for PTSD.
Davidson JR, Malik MA, Travers J.
Structured Interview for PSTD (SIP): psychometric validation for DSM-IV
criteria. Depression and Anxiety 1997; 5:127-129.
Davidson JRT. Smith RD, Kudler HS.
Validity and reliability of the DSM-III criteria for posttraumatic
stress disorder. Journal of Nervous and Mental Disease 1989;
177:366-341.
[SIP – English]
[SIP – Spanish]
Symptom Occurrence Scale (SOS)
The SOS is a self-rating developed by our
group to evaluate treatment emergent-side effects in clinical trials of
anxiety and mood disorders. The scale is also useful in clinical
practice to assist in monitoring medication tolerability.
Connor KM, Davidson JR, Churchill LE.
Adverse-effect profile of kava. CNS Spectrums 2001; 6:848,
850-853.
[SOS – English]
Trauma Questionnaire (TQ)
The TQ provides an assessment of lifetime
history of trauma exposure. The scale includes assessment of a
wide range of traumatic experiences, including age of the event,
frequency of occurrence, and, if more than one trauma was experienced,
identification of the worst trauma. The TQ was originally
developed and validated in an adult inpatient mood disorders population,
however it has subsequently been widely used by our group an others in
clinical research and practice. The TQ may be administered by an
clinician or other rater or self-rated.
Escalona R, Tupler LA, Saur CD, Krishnan KR,
Davidson JR. Screening for trauma history on an inpatient
affective-disorders unit: a pilot study. Journal of Traumatic
Stress 1997; 10:299-305.
[TQ – English]
[TQ – Chinese ROC]
[TQ – Spanish]
Treatment Outcome PTSD scale (TOP-8)
The TOP-8 scale was developed as a brief,
clinician-administered scale for use in assessing responses to treatment
in patients with post-traumatic stress disorder. The instrument
was developed from a larger post-traumatic stress disorder evaluation
scale (SIP, see above) based on items which occurred frequently in the
population and which responded substantially to treatment across time.
The 8 resultant items were drawn from all three symptom clusters for
post-traumatic stress disorder, and showed an improved ability to detect
drug versus placebo differences in comparison with the original scale.
Connor KM, Davidson JR. Further
psychometric assessment of the TOP-8: a brief interview-based measure of
PTSD. Depression and Anxiety 1999; 9:135-137.
Davidson JR, Colket JT. The eight-item
treatment-outcome post-traumatic stress disorder scale: a brief measure
to assess treatment outcome in post-traumatic stress disorder.
International Clinical Psychopharmacology 1997; 12:41-45.
[TOP-8 – English]
[TOP-8 –
Spanish]
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Contact Information
Anxiety and Traumatic Stress Program
Department of Psychiatry and Behavioral Sciences
Duke University Medical Center
Box 3812
Durham, North Carolina 27710
Dr. Wei Zhang
Director, Anxiety and Traumatic Stress Program
Administrative Assistant
Levis Erik Churchill
Tel (919) 681-5750
Fax (919) 684-8866
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