A Multiple-Baseline Evaluation of Acceptance and Commitment Therapy Focused on Repetitive Negative Thinking for Comorbid Generalized Anxiety Disorder and Depression.

Francisco J Ruiz,Verónica Cardona-Betancourt,Carmen Luciano,Juan C Suárez-Falcón,Cindy L Flórez

doi:10.3389/fpsyg.2020.00356

Abstract

Repetitive negative thinking (RNT) is a core feature of generalized anxiety disorder (GAD) and depression. Recently, some studies have shown promising results with brief protocols of acceptance and commitment therapy (ACT) focused on RNT in the treatment of emotional disorders in adults. The current study analyzes the effect of an individual, 3-session, RNT-focused ACT protocol in the treatment of severe and comorbid GAD and depression. Six adults meeting criteria for both disorders and showing severe symptoms of at least one of them participated in the study. A delayed multiple-baseline design was implemented. All participants completed a 5-week baseline without showing improvement trends in emotional symptoms (Depression Anxiety and Stress Scale – 21; DASS-21) and pathological worry (Penn State Worry Questionnaire; PSWQ). The ACT protocol was then implemented, and a 3-month follow-up was conducted. Five of the six participants showed clinically significant changes in the DASS-21 and the PSWQ. The standardized mean difference effect sizes for single-case experimental design were very large for emotional symptoms (d = 3.34), pathological worry (d = 4.52), experiential avoidance (d = 3.46), cognitive fusion (d = 3.90), repetitive thinking (d = 4.52), and valued living (d = 0.92 and d = 1.98). No adverse events were observed. Brief, RNT-focused ACT protocols for treating comorbid GAD and depression deserve further empirical tests.

Highlights

Comorbidity Between generalized anxiety disorder (GAD) and DepressionGeneralized anxiety disorder (GAD) and unipolar depression are the two psychological disorders most frequently seen in primary care and outpatient mental health services (Wittchen, 2002)
This study aims to build upon previous studies by testing the efficacy of the 3-session, Repetitive negative thinking (RNT)-focused ACT protocol used in Ruiz et al (2019) in participants suffering from comorbid GAD and depression
Sixty-three potential participants were rejected according to the initial inclusion and exclusion criteria: five individuals were younger than 18 years, 19 were entangled with thoughts, memories, and worries for less than 1 year, 7 were receiving psychological or psychiatric treatment, and 32 did not show severe scores on depression and/or anxiety

Summary

Introduction

Comorbidity Between GAD and DepressionGeneralized anxiety disorder (GAD) and unipolar depression are the two psychological disorders most frequently seen in primary care and outpatient mental health services (Wittchen, 2002). RNT-Focused ACT, Depression, and GAD is high variability across cultures (Kessler and Bromet, 2013). Both disorders lead to considerable disability, with depression alone being considered the first cause of disability worldwide (World Health Organization [WHO], 2017). Both GAD and depression are considered to be chronic disorders. The episode duration of depression is considerably shorter than in GAD, the recurrence of episodes is very high, with at least 50% of individuals who recover from the first one having more in their lifetime (Kupfer et al, 1996). The percentage of recurrence increases to 80% after a history of two depressive episodes (Burcusa and Iacono, 2007)

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