André Marchand

By Theodora E. Katerelos, Claude Bélanger, Marie-Christine Payette, Ghassan El-Baalbaki, André Marchand and Michel Perreault

For more than 60 years, researchers have been interested in determining the impact of expectations on treatment outcome. Earlier studies mostly focused on two types of expectations: prognostic and process expectations. Aims: To review how four different types of expectations (prognostic, process, anxiety expectancy and anxiety sensitivity) contribute to psychotherapy outcome, and to the development of clinical disorders, especially anxiety. Conclusions: First, the role of process and prognostic expectancies in clinical disorders and psychotherapy outcome should be clarified by addressing the methodological flaws of the earlier expectancy studies. Second, studies, especially those on anxiety disorders, may benefit from evaluating the four different types of expectations to determine their relative impact on outcome, and on the development and maintenance of these disorders. Third, possible links with other clinical disorders should be further explored. Finally, expectancies should be assessed prior to treatment and after several sessions to determine the extent to which the treatment's failure in modifying initial low expectancies contribute to a poor outcome.

Part of the book: A Fresh Look at Anxiety Disorders

By Katia Levrier, Carolyn Leathead, Delphine-Émilie Bourdon, Sophie Lacerte, André Marchand and Geneviève Belleville

Post-traumatic nightmares (PTNMs) can be treatment resistant to conventional treatments for post-traumatic stress disorder (PTSD). New cognitive and behavioral treatments (CBTs) for nightmares (NM) and pharmacological treatments, such as Prazosin, have been developed to directly reduce PTNMs. Objectives: The first objective was to evaluate the impact of CBTs for NM and Prazosin on the reduction of PTNMs in an adult population. A second aim was to explore the impact of these treatments in general PTSD symptoms and sleep. Method: A systematic search of English and French clinical studies on any CBTs and Prazosin treatments for PTNMs published from 1980 to 2012 was conducted in PsycINFO, MedLine, PILOTS,and ProQuest Dissertations and Theses. Results: The final sample was composed of 26 studies. The combined effect size (ES) for Prazosin was g = 1.30, 95% CI [0.61, 2.00], and for CBTs, it was g = 0.55, 95% CI [0.38, 0.72]. Conclusions: Prazosin had a large impact on PTNM reduction, while CBTs had a moderate impact. Specific NM treatments (Prazosin or CBTs) contribute to PTNM reduction and reduce PTSD and sleep symptoms. These findings are significant to the literature on PTSD and future studies should consider them. Several recommendations are proposed.

Part of the book: A Multidimensional Approach to Post-Traumatic Stress Disorder

By Stéphane Guay, Myra Gravel-Crevier, Richard Boyer and André Marchand

Violent crimes represent a societal problem, and victims, namely women, often develop posttraumatic stress disorder (PTSD). Previous studies have identified acute stress disorder (ASD) as a predictor of PTSD, as well as dissociation. However, there are some inconsistencies regarding which cluster or symptom has better predictive power, and the impact of gender is still unknown in victims of violent crimes. The aim of this study was to determine the predictive power of full and partial ASD diagnosis, clusters, and symptoms according to gender. To do so, 39 women and 36 men were evaluated using validated semi-structured clinical interviews within 30 days post crime for ASD and 2 months later for PTSD. Results showed that 52% of individuals had full ASD and 20% has partial ASD, 40% had full PTSD and 17% had partial PTSD. Both full and partial ASD diagnoses, as well as all clusters, and most symptoms, were good predictors of PTSD. No gender differences were observed concerning the predictive power of ASD clusters and symptoms. The decreased emphasis on dissociative reactions in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5) to establish an ASD diagnosis appears relevant to better identify women and men at risk of PTSD after a violent crime, and to deliver appropriate early preventive interventions.

Part of the book: A Multidimensional Approach to Post-Traumatic Stress Disorder

By Katia Levrier, André Marchand, Valérie Billette, Stéphane Guay and Geneviève Belleville

In cases of post-traumatic stress disorder (PTSD), nightmares can often persist, even after a cognitive behavioral therapy (CBT) for this disorder. Imagery rehearsal therapy (IRT) is a CBT that targets the treatment of nightmares directly. Objectives: the present study describes the feasibility and the efficacy of combining IRT with first-line, trauma-focused CBT for PTSD. Method: two individuals with PTSD took part in this experimental case study protocol. The efficacy of the combined treatment was evaluated using semi-structured interviews, self-report questionnaires, and daily self-monitoring diaries. Results: after three IRT sessions for Participant 1 and five IRT sessions for Participant 2, combined with CBT for PTSD, both participants experienced a slight decrease in sleep difficulties and in the intensity of their PTSD symptoms post-treatment. More particularly, one participant demonstrated a significant decrease in the level of distress associated with his post-traumatic nightmares (PTNM). Conclusions: these results demonstrate that it is possible and promising to combine IRT with CBT for PTSD.

Part of the book: Cognitive Behavioral Therapy and Clinical Applications