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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
Jonathan R. T. Davidson, MD
Joe (Chunsheng) Wang, MD, PhD
Staff:
Levis Erik Churchill
Nabila Lateef
Ann S. Tamariz
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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). For further information, please contact
Ann Tamariz at (919) 684-5401.
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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.
These scales are available for use free-of-charge for work in clinical
practice and not for profit research activities. If you are interested
in using one of these instruments in for-profit research or another
commercial enterprise, please contact Ann Tamariz at (919) 684-5401.
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, along with links to related publications
and copies of the scales.
Mini-SPIN
Then Mini-SPIN is 3-item self-rated scale
derived from the Social Phobia Inventory (SPIN, see below). 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.
[Mini-SPIN – English]
[Mini-SPIN – Spanish]
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].
[SPRINT – English]
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.
[SPIN – English]
[SPIN – Chinese ROC]
[SPIN – Chinese PROC]
[SPIN – Dutch]
[SPIN – Finnish]
[SPIN – French Canadian]
[SPIN – German]
[SPIN – Indian Hindi]
[SPIN – Indian Marathi]
[SPIN – Japanese]
[SPIN – Latvian]
[SPIN – Portuguese]
[SPIN – Spanish]
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
Tel (919) 684-5645
Fax (919) 684-8866
Email:
wei.zhang@duke.edu
Ann S. Tamariz
Program Coordinator
(919) 684-5401
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