Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-26T08:32:56.144Z Has data issue: false hasContentIssue false
  • English
  • Français

A cognitive behavioural group therapy for bipolar disorder using daily mood monitoring

Published online by Cambridge University Press:  22 April 2020

H.T. Henken Open the ORCID record for H.T. Henken [Opens in a new window] ,
R.W. Kupka ,
S. Draisma ,
J. Lobbestael ,
K. van den Berg ,
S.M.A. Demacker  and
E.J. Regeer
H.T. Henken*
Affiliation:
Department of Medical Psychology, Máxima Medical Centre, Veldhoven, The Netherlands
R.W. Kupka
Affiliation:
Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
S. Draisma
Affiliation:
Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, Amsterdam, The Netherlands
J. Lobbestael
Affiliation:
Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
K. van den Berg
Affiliation:
Early Intervention Team Psychosis, GGzE Eindhoven, The Netherlands Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
S.M.A. Demacker
Affiliation:
Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
E.J. Regeer
Affiliation:
Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
*
*Corresponding author. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background and aim:

This study investigated the effects of group cognitive behavioural therapy (CBT) for patients with bipolar disorder. The development of CBT for this disorder is relatively under-explored.

Method:

Participants with bipolar I or II disorder were treated with group CBT in addition to treatment as usual. The effectiveness of the protocol was explored through sequence analysis of daily mood monitoring prior to, during and after the intervention. Also, a repeated measures design was used assessing symptomatology, dysfunctional attitudes, sense of mastery, psychosocial functioning, and quality of life at start and end of intervention, and at follow-up 2 and 12 months later.

Results:

The results indicate that variation in mood states diminished over the course of the intervention. Also, there was a change from depressive states to more euthymic states. Greater number of reported lifetime depressive episodes was associated with greater diversity of mood states. There was an increase in overall psychosocial functioning and self-reported psychological health following the intervention. Improvement continued after treatment ended until follow-up at 2 months, and measured 1 year later, for outcomes representing depression, general psychosocial functioning and self-reported psychological health. Due to small sample size and the lack of a control group the results are preliminary.

Conclusions:

The results of this pilot study suggest that both offering CBT in group interventions and sequence analysis of time series data are helpful routes to further explore when improving standard CBT interventions for patients suffering from bipolar disorder.

Keywords

bipolar disordergroup cognitive behavioural therapyrepeated measures analysissequence analysistreatment outcome
Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 48 , Issue 5 , September 2020 , pp. 515 - 529
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akkerhuis, G., Van Groenestijn, M., & Nolen, W. (2005). Questionnaire for Bipolar Illness-NL 2.0 Short Form.Google Scholar
Alloy, L., Reilly-Harrington, N., Fresco, D., & Zechmeister, J. (1999). Cognitive styles and life events in subsyndromal unipolar and bipolar disorders: stability and prospective prediction of depressive and hypomanic mood swings. Journal of Cognitive Psychotherapy, 13, 21–40.CrossRefGoogle Scholar
Altman, E., Hedeker, D., Peterson, J., & Davis, J. (1997). The Altman self-rating mania scale. Society of Biological Psychiatry, 42, 948–955.CrossRefGoogle ScholarPubMed
Amick, H. R., Gartlehner, G., Gaynes, B. N., Forneris, C., Asher, G. N., Morgan, L. C., … & Lohr, K. N. (2015). Comparative benefits and harms of second generation antidepressants and cognitive behavioral therapies in initial treatment of major depressive disorder: systematic review and meta-analysis. British Medical Journal, 351, 1–10. https://doi.org/10.1136/bmj.h6019Google ScholarPubMed
Arntz, A., Sofi, D., & van Breukelen, G. (2013). Imagery rescripting as treatment for complicated PTSD in refugees: a multiple baseline case series study. Behaviour Research and Therapy, 51, 274–283. https://doi.org/10.1016/j.brat.2013.02.009CrossRefGoogle ScholarPubMed
Ball, J., Mitchell, P., Corry, J., Skillecorn, A., Smith, M., & Malhi, G. (2006). A randomized controlled trial of cognitive therapy for bipolar disorder: focus on long-term change. Journal of Clinical Psychiatry, 67, 277–286. Retrieved from: http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L43357475CrossRefGoogle ScholarPubMed
Barlow, D., Nock, M., & Hersen, M. (2009). Single-Case Experimental Designs.Strategies for Studying Behaviour Change (3rd edn). Boston, MA, USA: Allyn & Bacon.Google Scholar
Basco, M., & Rush, A. (2007). Cognitive-Behavioral Therapy for Bipolar Disorder (2nd revise). New York, USA: Guilford Press.Google Scholar
Beck, J. (2011). Cognitive Behavior Therapy: Basics and Beyond. New York, USA: Guilford Press.Google Scholar
Bisson, J., Roberts, N., Andrew, M., Cooper, R., & Lewis, C. (2013). Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews (12).CrossRefGoogle Scholar
Bockting, C. (2003). Cognitieve therapie bij depressie. Atelier Rijksbouwmeester.Google Scholar
Bockting, C. (2009a). Niet meer depressief. Werkboek voor patienten. Bohn Stafleu van Loghum.CrossRefGoogle Scholar
Bockting, C. (2009b). Preventieve cognitieve training bij terugkerende depressie. Bohn Stafleu van Loghum.CrossRefGoogle Scholar
Borckardt, J. J., Nash, M. R., Murphy, M. D., Moore, M., Shaw, D., & O’Neil, P. (2008). Clinical practice as natural laboratory for psychotherapy research: a guide to case-based time-series analysis. The American Psychologist, 63, 77–95. https://doi.org/10.1037/0003-066X.63.2.77CrossRefGoogle ScholarPubMed
Brady, T. (2003). Measures of self-efficacy, helplessness, mastery and control: the Arthritis Helplessness Index (AHI)/Rheumatology Attitudes Index (RAI), Arthritis Self-Efficacy Scale (ASES), Children’s Arthritis Self-Efficacy Scale (CASE), Generalized Self-Efficacy Scale. Arthritis & Rheumatism, 49, S147–S164.CrossRefGoogle Scholar
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences (2nd edn). New York, USA: Academic Press.Google Scholar
Corruble, E., Legrand, J., Duret, C., Charles, G., & Guelfi, J. (1999a). IDS-C and IDS-SR: psychometric properties in depressed in-patients. Journal of Affective Disorders, 56, 95–101.CrossRefGoogle ScholarPubMed
Corruble, E., Legrand, J., Zvenigorowski, H., Duret, C., & Guelfi, J. (1999b). Concordance between self-report and clinician’s assessment of depression. Journal of Psychiatric Research, 33, 457–465.CrossRefGoogle ScholarPubMed
De Beurs, E., & Zitman, F. (2006). De Brief Symptom Inventory (BSI): de betrouwbaarheid en validiteit van een handzaam alternatief voor de SCL-90. [The Brief Symptom Inventory: the reliability and validity of a brief alternative of the SCL-90]. Maandblad Geestelijke Volksgezondheid, 61, 120–141.Google Scholar
De Graaf, R., Ten Have, M., Van Gool, C., & Van Dorsselaer, S. (2012). Prevalence of mental disorders and trends from 1996 to 2009. Results from the Netherlands Mental Health Survey and Incidence Study-2. Social Psychiatry and Psychiatric Epidemiology. https://doi.org/10.1007/s00127-010-0334-8CrossRefGoogle ScholarPubMed
Denicoff, K., Leverich, G., Nolen, W., Rush, A., McElroy, S., Keck, P., … & Post, R. (2000). Validation of the prospective NIMH-Life-Chart Method (NIMH-LCM TM-p) for longitudinal assessment of bipolar illness. Psychological Medicine, 30, 1391–1397.CrossRefGoogle Scholar
Derogatis, L. (1975). The Brief Symptom Inventory. Baltimore, MD, USA: Clinical Psychometric Research.Google Scholar
Derogatis, L., & Melisaratos, N. (1983). The Brief Symptom Inventory: an introductory report. Psychological Medicine, 13, 595–605.CrossRefGoogle Scholar
Field, A. (2013). Discovering Statistics Using IBM SPSS Statistics (4th edn). Sage Publications Ltd.Google Scholar
First, M., Spitzer, R., Gibbon, M., & Williams, J. (1996). User’s guide for the Structured Clinical Interview for DSM-IV-TR Axis I Disorders – research version.CrossRefGoogle Scholar
Gabadinho, A., Ritschard, G., Müller, N. S., & Studer, M. (2011). Analyzing and visualizing state sequences in R with TraMineR. Journal of Statistical Software, 40, 1–37. Retrieved from: http://archive-ouverte.unige.ch/unige:16809CrossRefGoogle Scholar
Gitlin, M. J., Mintz, J., Sokolski, K., Hammen, C., & Altshuler, L. L. (2011). Subsyndromal depressive symptoms after symptomatic recovery from mania are associated with delayed functional recovery. Journal of Clinical Psychiatry, 72, 692–697. https://doi.org/10.4088/JCP.09m05291greCrossRefGoogle ScholarPubMed
Goodwin, G. M., Haddad, P. M., Ferrier, I. N., Aronson, J. K., Barnes, T. R. H., Cipriani, A., … & Young, A. H. (2016). Evidence-based guidelines for treating bipolar disorder: revised third edition recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology, 30, 495–553. https://doi.org/10.1177/0269881116636545CrossRefGoogle ScholarPubMed
Hales, S. A., Di Simplicio, M., Iyadurai, L., Blackwell, S. E., Young, K., Fairburn, C. G., … & Holmes, E. A. (2018). Imagery-focused cognitive therapy (ImCT) for mood instability and anxiety in a small sample of patients with bipolar disorder: a pilot clinical audit. Behavioural and Cognitive Psychotherapy, 46, 706–725. https://doi.org/10.1017/S1352465818000334CrossRefGoogle Scholar
Henry, C., Van den Bulke, D., Bellivier, F., Roy, I., Swendsen, J., M’Bailara, K., … & Leboyer, M. (2008). Affective lability and affect intensity as core dimensions of bipolar disorders during euthymic period. Psychiatry Research, 159, 1–6. https://doi.org/10.1016/j.psychres.2005.11.016CrossRefGoogle ScholarPubMed
Hirschfeld, R. (2007). Guideline Watch: Practice Guideline for the Treatment of Patients with Bipolar Disorder (2nd edn). APA Practice Guidelines for the Treatment of Psychiatric Disorders: Comprehensive Guidelines and Guideline Watches (November), 1–9. https://doi.org/10.1176/appi.books.9780890423363.148430CrossRefGoogle Scholar
Hirschfeld, R., Bowden, C. L., Gitlin, M. J., Keck, P. E., Perlis, R. H., Suppes, T., … & Yager, J. (2002). Practice guideline for the treatment of patients with bipolar disorder (revision). American Journal of Psychiatry, 159, 1–50. https://doi.org/10.1176/foc.1.1.64Google Scholar
Holmes, E. A., Bonsall, M. B., Hales, S. A., Mitchell, H., Renner, F., Blackwell, S. E., … & Di Simplicio, M. (2016). Applying time-series analysis to mood fluctuations in bipolar disorder to promote treatment innovation: a case series. Translational Psychiatry, 6, 1–10. https://doi.org/10.1038/tp.2015.207CrossRefGoogle Scholar
Jang, Y., Haley, W., Small, B., & Mortimer, J. (2002). The role of mastery and social resources in the associations between disability and depression in later life. The Gerontologist, 42, 807–813.CrossRefGoogle ScholarPubMed
Johnson, S. L., & Tran, T. (2007). Bipolar disorder: what can psychotherapists learn from the cognitive research? Journal of Clinical Psychology, 63, 425–432. https://doi.org/10.1002/jclp.20361CrossRefGoogle ScholarPubMed
Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Servier Research Group Dialogues in Clinical Neuroscience, 17, 337–346.Google ScholarPubMed
Kelly, R. E., Dodd, A. L., & Mansell, W. (2017). ‘When my moods drive upward there is nothing i can do about it’: a review of extreme appraisals of internal states and the bipolar spectrum. Frontiers in Psychology, 8, 1–16. https://doi.org/10.3389/fpsyg.2017.01235CrossRefGoogle Scholar
Kessing, L., Hansen, M., & Andersen, P. (2004a). Course of illness in depressive and bipolar disorders. Naturalistic study, 1994–1999. British Journal of Psychiatry, 185, 372–377. https://doi.org/10.1192/bjp.185.5.372CrossRefGoogle ScholarPubMed
Kessing, L., Hansen, M., Andersen, P., & Angst, J. (2004b). The predictive effects of episodes on the risk of recurrence in depressive and bipolar disorders – a life-long perspective. Acta Psychiatrica Scandinavica, 109, 339–344. https://doi.org/10.1007/s11920-005-0061-0CrossRefGoogle Scholar
Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. U. (2012). Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research. https://doi.org/10.1002/mpr.1359CrossRefGoogle ScholarPubMed
Kupka, R. W., Goossens, P., & van Bendegem, M. (2015). Multidisciplinaire richtlijn bipolaire stoornissen, 1–326.Google Scholar
Lam, D. H., Burbeck, R., Wright, K., & Pilling, S. (2009). Psychological therapies in bipolar disorder: the effect of illness history on relapse prevention – a systematic review. Bipolar Disorders. https://doi.org/10.1111/j.1399-5618.2009.00724.xCrossRefGoogle ScholarPubMed
Lam, D. H., Jones, S. H., & Hayward, P. (2010). Cognitive Therapy for Bipolar Disorder: A Therapist’s Guide to Concepts, Methods and Practice (2nd edn). New York, USA: John Wiley and Sons Ltd. https://doi.org/10.1002/9780470970256CrossRefGoogle Scholar
Lam, D., Wright, K., & Smith, N. (2004). Dysfunctional assumptions in bipolar disorder. Journal of Affective Disorders, 79, 193–199. https://doi.org/10.1016/S0165-0327(02)00462-7CrossRefGoogle ScholarPubMed
Leverich, G., Nolen, W., Rush, A., McElroy, S., Keck, P., Denicoff, K., … & Post, R. (2001). The Stanley Foundation Bipolar Treatment Outcome Network. I. Longitudinal methodology. Journal of Affective Disorders, 67, 33–44.CrossRefGoogle ScholarPubMed
Leverich, G., & Post, R. (1998). Life charting of affective disorders. CNS Spectrums, 3, 21–37.CrossRefGoogle Scholar
Marangell, L. B., Dennehy, E. B., Miyahara, S., Wisniewski, S. R., Bauer, M. S., Rapaport, M. H., & Allen, M. H. (2009). The functional impact of subsyndromal depressive symptoms in bipolar disorder: data from STEP-BD. Journal of Affective Disorders, 114, 58–67. https://doi.org/10.1016/j.jad.2008.07.006CrossRefGoogle ScholarPubMed
Marshall, G., & Lang, E. (1990). Optimism, self-matery, and symptoms of depression in women professionals. Social Psychology, 59, 132–139.Google ScholarPubMed
McMahon, K., Herr, N. R., Zerubavel, N., Hoertel, N., & Neacsiu, A. D. (2016). Psychotherapeutic treatment of bipolar depression. Psychiatric Clinics of North America. https://doi.org/10.1016/j.psc.2015.09.005CrossRefGoogle ScholarPubMed
Merikangas, K., Jin, R., He, J., Kessler, R., Lee, S., Sampson, N., … & São Paulo, P. (2011). Prevalence and correlates of bipolar spectrum disorder in the World Mental Health Survey Initiative. Archives of General Psychiatry, 68, 241–251. https://doi.org/10.1001/archgenpsychiatry.2011.12CrossRefGoogle ScholarPubMed
NICE (2006). Bipolar Disorder, 1–592. https://doi.org/10.1002/yd.23319925408CrossRefGoogle Scholar
Oud, M., Mayo-Wilson, E., Braidwood, R., Schulte, P., Jones, S. H., Morriss, R., … & Kendall, T. (2016). Psychological interventions for adults with bipolar disorder: systematic review and meta-analysis. British Journal of Psychiatry. https://doi.org/10.1192/bjp.bp.114.157123CrossRefGoogle ScholarPubMed
Pearlin, L. I., Lieberman, M. A., Menaghan, E. G., & Mullan, J. T. (1981). The stress process. Journal of Health and Social Behavior, 22, 337–356. https://doi.org/10.2307/2136676CrossRefGoogle ScholarPubMed
Pearlin, L. I., & Schooler, C. (1978). The structure of coping. Journal of Health and Social Behavior, 19, 2–21. https://doi.org/10.2307/2136319CrossRefGoogle ScholarPubMed
Raes, F., Hermans, D., Van den Broeck, K., & Eelen, P. (2005). Kort instrumenteel: de Nederlandstalige versie van de Dysfunctional Attitude Scale – vorm A (DAS-A-NL) [The Dutch version of the Dysfunctional Attitude Scale – form A (DAS-A-NL)]. Gedragstherapie, 38, 285–294.Google Scholar
Reinares, M., Sanchez-Moreno, J., & Fountoulakis, K. N. (2014). Psychosocial interventions in bipolar disorder: what, for whom, and when. Journal of Affective Disorders, 156.CrossRefGoogle ScholarPubMed
Rosa, A., Sanchez-Moreno, J., Martinez-Aran, A., Salamero, M., Torrent, C., Reinares, M., … & Vieta, E. (2007). Validity and reliability of the Functioning Assessment Short Test (FAST) in bipolar disorder. Clinical Practice and Epidemiology in Mental Health, 3, 1–8. https://doi.org/10.1186/1745-0179-3CrossRefGoogle Scholar
Rush, A., Giles, D., Schlesser, M., Fulton, C., Weissenburger, J., & Burns, C. (1986). The Inventory of Depressive Symptomatology (IDS): preliminary findings. Psychiatry Research, 18, 65–87.CrossRefGoogle ScholarPubMed
Rush, A., Gullion, C., Basco, M., Jarrett, R., & Trivedi, M. (1996). The Inventory of Depressive Symptomatology (IDS): psychometric properties. Psychological Medicine, 26, 477–486.CrossRefGoogle ScholarPubMed
Salcedo, S., Gold, A. K., Sheikh, S., Marcus, P. H., & Nierenberg, A. A. (2016). Empirically supported psychosocial interventions for bipolar disorder: current state of the research. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2016.05.018CrossRefGoogle Scholar
Sanchez-Moreno, J., Martinez-Aran, A., Tabares-Seisdedos, R., Torrent, C., Vieta, E., & Ayuso-Mateos, J. (2009). Functioning and disability in bipolar disorder: an extensive review. Psychotherapy and Psychosomatics, 78, 285–297.CrossRefGoogle Scholar
Saunders, K. E. A., Cipriani, A., Rendell, J., Attenburrow, M. J., Nelissen, N., Bilderbeck, A. C., … & Geddes, J. R. (2016). Oxford Lithium Trial (OxLith) of the early affective, cognitive, neural and biochemical effects of lithium carbonate in bipolar disorder: study protocol for a randomised controlled trial. Trials, 17, 1–5. https://doi.org/10.1186/s13063-016-1230-7CrossRefGoogle ScholarPubMed
Scheier, M., Carver, C., & Bridges, M. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): e reevaluation of the Life Orientation Test. Journal of Personality and Social Psychology, 67, 1063–1078.CrossRefGoogle Scholar
Scott, J. (2010). Overcoming Mood Swings. A Self-Help Guide using Cognitive Behavioral Techniques. Little Brown UK.Google Scholar
Scott, J., Paykel, E., Morriss, R., Bentall, R., Kinderman, P., Johnson, T., … & Hayhurt, H. (2006). Cognitive-behavioural therapy for severe and recurrent bipolar disorders. British Journal of Psychiatry, 188, 313–320.CrossRefGoogle ScholarPubMed
Searson, R., Mansell, W., Lowens, I., & Tai, S. (2012). Think Effectively about Mood Swings (TEAMS): a case series of cognitive-behavioural therapy for bipolar disorders. Journal of Behavior Therapy and Experimental Psychiatry, 43, 770–779. https://doi.org/10.1016/j.jbtep.2011.10.001CrossRefGoogle ScholarPubMed
Solomon, D. A., Leon, A. C., Coryell, W. H., Endicott, J., Li, C., Fiedorowicz, J. G., … & Keller, M. B. (2010). Longitudinal course of bipolar I disorder: duration of mood episodes. Archives of General Psychiatry, 67, 339–347. https://doi.org/10.1001/archgenpsychiatry.2010.15CrossRefGoogle ScholarPubMed
Stange, J. P., Sylvia, L. G., Magalha, Da Silvaes, P. V., Miklowitz, D. J., Otto, M. W., Frank, E., … & Deckersbach, T. (2013). Extreme attributions predict the course of bipolar depression: results from the STEP-BD randomized controlled trial of psychosocial treatment. Journal of Clinical Psychiatry, 74, 249–255. https://doi.org/10.4088/JCP.12m08019CrossRefGoogle ScholarPubMed
Suppes, T., Leverich, G., Keck, P., Nolen, W., Denicoff, K., Altshuler, L., … & Post, R. (2001). The Stanley Foundation Bipolar Treatment Outcome Network. II. Demographics and illness characteristics of the first 261 patients. Journal of Affective Disorders, 67, 45–59.CrossRefGoogle ScholarPubMed
The WHOQOL Group (1996). WHOQOL-BREF: Introduction, Administration, Scoring and Generic Version of the Assessment. Programme on Mental Health (December), 16. https://doi.org/10.1037/t01408-000CrossRefGoogle Scholar
Trompenaars, F. J., Masthoff, E. D., Van Heck, G. L., Hodiamont, P. P., & De Vries, J. (2005). Content validity, construct validity, and reliability of the WHOQOL-Bref in a population of Dutch adult psychiatric outpatients. Quality of Life Research, 14, 151–160. https://doi.org/10.1007/s11136-004-0787-xCrossRefGoogle Scholar
Van Groenestijn, M., Akkerhuis, G., Kupka, R., Schneider, N., & Nolen, W. (1998). Gestructureerd klinisch interview voor de vaststelling van DSM-IV As-I stoornissen.Google Scholar
Weismann, A. (1979). Dysfunctional Attitude Scale: A Validation Study. Unpublished doctoral dissertation, University of Pennsylvania, Philadelphia.Google Scholar
Weismann, A., & Beck, A. (1978). Development and validation of the dysfunctional attitude scale. Paper presented at the Annual meeting of the Association for the Advanced Behavior Therapy, Chicago, November.Google Scholar
Zaretsky, A. E., Velyvis, V. P., & Parikh, S. V. (2004). Dysfunctional Attitudes in Bipolar Disorder. Poster presentation on behalf of the PE/CBT Study Consortium, 4.Google Scholar
Zhu, Z., Zhang, L., Jiang, J., Li, W., Cao, X., Zhou, Z., … & Li, C. (2014). Comparison of psychological placebo and waiting list control conditions in the assessment of cognitive behavioral therapy for the treatment of generalized anxiety disorder: a meta-analysis. Shanghai Archives of Psychiatry, 26, 319–331. https://doi.org/10.11919/j.issn.1002-0829.214173Google ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.