Behavioral Therapy For Anxiety Disorders Research Articles

Treating Low-Income and Minority Women With Posttraumatic Stress Disorder

Twenty-one female psychiatric outpatients with chronic posttraumatic stress disorder (PTSD) are randomly assigned to prolonged exposure (PE; n = 9) for PTSD or treatment as usual (TAU; n = 12). Participants are predominantly low income and African American with complex trauma and psychiatric histories. Treatment is delivered by community therapists with no prior training in behavior therapy for anxiety disorders. Clients who completed PE show a greater improvement in PTSD symptoms, general anxiety, and depression than clients who completed TAU. These findings provide preliminary evidence suggesting that PE is an effective treatment for core PTSD symptoms, even when delivered by community therapists in a front-line services clinic.

Cognitive behavior therapy for anxiety disorders: 40 years of progress

Cognitive–behavior therapies (CBT) have been evaluated in randomized controlled studies (RCT) and anxiety disorders since 1966 and for each disorder there are at least two CBT methods that are considered evidence based (empirically supported) today. Numerous meta-analyses have evaluated the efficacy of these methods against various control conditions. However, none has looked at whether modern CBT studies lead to better treatment effects than were obtained 10–40 years ago. The aim of this paper is to present a meta-analysis focusing on the mean extent of change achieved by the CBT treatments across decades (from the 1970s onwards). Database searches yielded a total of 432 RCTs for the anxiety disorders combined and 364 of these allowed calculation of within-group effect size (ES) or percentage clinical improvement. Separate ESs were calculated for three central measures: independent assessor rating, self-report and behavioral approach test. The results showed that in most instances there was no significant change in ES across time. In a few instances, the treatment effects were greater in modern studies. However, it was more common with a negative development, or a mixed development (first positive then negative or vice versa). There was no significant change in proportion of clinical improvement. Treatment time and attrition either increased or remained stable. If the single studies that gave the highest ES each decade were compared, all anxiety disorders besides panic disorder and obsessive–compulsive disorder showed a positive development. Possible explanations to the results are discussed.

Summary of ‘Cognitive behavioural therapy for anxiety disorders in children and adolescents’

AbstractThis is a summary of a Cochrane review, published in this issue of EBCH, first published as: James A, Soler A, Weatherall R. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD004690. DOI: 10.1002/14651858. CD004690.pub2.Further information for this Cochrane review is available in this issue of EBCH in the accompanying Commentary and Characteristics and Key Findings Tables articles. Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration

Commentaries on ‘Cognitive behavioural therapy for anxiety disorders in children and adolescents’, with response from the author

AbstractThese are commentaries on a Cochrane review, published in this issue of EBCH, first published as: James A, Soler A, Weatherall R. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD004690. DOI: 10.1002/14651858.CD004690.pub2.Further information for this Cochrane review is available in this issue of EBCH in the accompanying EBCH Summary and Characteristics and Key Findings Tables articles. Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration

Cochrane review: Cognitive behavioural therapy for anxiety disorders in children and adolescents

AbstractBackgroundChildhood and adolescent anxiety disorders are relatively common, occurring in between 5‐18% of all children and adolescents. They are associated with significant morbidity and impairment in social and academic functioning, and when persistent, there is a risk of depression, suicide attempts and substance abuse in adulthood. There is accumulating evidence for the efficacy of cognitive behavioural therapy (CBT), with a number of randomised controlled trials (RCTs) suggesting benefit.ObjectivesTo determine whether CBT is an effective treatment for childhood and adolescent anxiety disorders in comparison to waiting list or attention controls.Search strategySearch of the Cochrane Register of Controlled Trials and the Cochrane Depression, Anxiety and Neurosis Group Register, which includes relevant randomised controlled trials from the bibliographic databases ‐ The Cochrane Library ( to January 2004), EMBASE, (1970‐2004) MEDLINE (1970‐2004) and PsycINFO (1970‐2004). We also searched the references of all included studies and relevant textbooks, and contacted authors in order to identify further trials.Selection criteriaEach identified study was assessed for possible inclusion by two reviewers independently.Inclusion criteria consisted of randomised controlled trials of CBT versus waiting list/attention controls in children (more than six years of age) and adolescents (under the age of 19 years) with a DSM (Diagnostic Statistical Manual) or ICD (International Classification of Diseases) anxiety diagnosis; and excluding simple phobia, obsessive compulsive disorder and post‐traumatic stress disorder. Each study was required to conform to the principles of CBT through use of a protocol and comprising at least eight sessions of CBT.Data collection and analysisThe methodological quality of included trials was assessed by two reviewers independently. The dichotomous outcome of remission of anxiety diagnosis was pooled using relative risk (RR) with 95% confidence intervals. Means and standard deviations of anxiety symptom continuous scores were pooled using the standardised mean difference (SMD). Heterogeneity was assessed and intention‐to‐treat (ITT) analyses undertaken. The presence of publication bias was assessed using funnel plots.Main resultsThirteen studies with 498 subjects and 311 controls met the inclusion criteria and were included in the analyses. The studies involved community or outpatient subjects only, with anxiety of only mild to moderate severity. ITT analyses showed a response rate for remission of any anxiety diagnosis of 56% for CBT versus 28.2% for controls (RR 0.58,95%CI 0.50 to 0.67), with no evidence of heterogeneity. The number needed to treat (NNT) was 3.0 (95%CI 2.5 to 4.5). For reduction in anxiety symptoms, the SMD was ‐0.58 (95% CI ‐0.76 to ‐0.40) with no significant heterogeneity indicated. Post hoc analyses suggest that individual, group and family/parental formats of CBT produced fairly similar outcomes.Authors' conclusionsCognitive behavioural therapy appears an effective treatment for childhood and adolescent anxiety disorders in comparison to waiting list or attention control. There was no evidence for a difference between an individual, group or parental/family format. CBT can be recommended for the treatment of childhood and anxiety disorders, although with only just over half improving, there is a need for further therapeutic developments.Plain language summaryCognitive behavioural therapy appears an effective treatment for childhood and adolescent anxiety disorders in comparison to waiting list or an attention control.Cognitive behavioural therapy has been adapted for the treatment of anxiety disorders in adolescents and children over the age of six years. This psychological treatment can be delivered in various formats: individual, group and family /parent. Cognitive behavioural therapy appears effective in just over 50% of cases. There is no difference between formats.

Characteristics and key findings for ‘Cognitive behavioural therapy for anxiety disorders in children and adolescents’

AbstractThese are the characteristics and key findings for a Cochrane review published in this issue of EBCH, first published as James A, Soler A, Weatherall R. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD004690. DOI: 10.1002/14651858.CD004690.pub2.Further information for this Cochrane review is available in this issue of EBCH in the accompanying EBCH Summary and Commentary articles. Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration

Promoting walking as an adjunct intervention to group cognitive behavioral therapy for anxiety disorders—A pilot group randomized trial

A group randomized trial of adding a home-based walking program to a standard group cognitive behavioral therapy (GCBT + EX) was compared with groups receiving GCBT and educational sessions (GCBT + ED). The study was implemented in an outpatient clinic providing GCBT for clients diagnosed with panic disorder, generalized anxiety disorder or social phobia. Pre- and post-treatment measures included the self-report depression, anxiety, and stress scale (DASS-21) and measures of physical activity. From January 2004 to May 2005, six groups were allocated to GCBT + EX ( n = 38) and five to GCBT + ED ( n = 36). Analysis of covariance for completed cases (GCBT + EX, n = 21; GCBT + ED, n = 20), adjusting for the group design, baseline DASS-21 scores, and anxiety diagnosis showed significant effect for GCBT + EX on depression, anxiety, and stress (regression coefficients = −6.21, −3.41, and −5.14, respectively, p < 0.05) compared to the GCBT + ED. The potential of exercise interventions as adjunct to GCBT for anxiety disorder needs to be further explored.

Is stepped care the right format for internet delivered cognitive behavioural therapy for anxiety disorders and depression?

Is stepped care the right format for Internet delivered cognitive behaviour therapy for anxiety disorders and depression?

Cognitive Behavioural Therapy for Anxiety Disorders in Children and Adolescents: A Meta-Analysis.

We conducted a meta-analysis using 20 randomised controlled studies of cognitive behavioural therapy (CBT) for anxiety disorders in children and adolescents. The mean pre-post effect size was d = 0.94, which was maintained at follow-up. The mean effect size when comparing the CBT and control group was d = 0.61. Within the CBT group, the mean effect size of university clinics (d = 0.77) was larger than that of other clinics (d = 0.37). The difference in effect sizes was hardly noticeable when comparing CBT with family or parents and CBT with child only (d = 0.03). Further studies are required to examine the effectiveness of family CBT versus child CBT.

Efficacy and utility of computer-assisted cognitive behavioural therapy for anxiety disorders

Despite the efficacy of cognitive behavioural treatment for anxiety disorders, more than 70% of individuals with anxiety disorders go untreated every year. This is partially due to obstacles to treatment including limited access to mental health services for rural residents, the expense of treatment and the inconvenience of attending weekly therapy sessions. Computer-assisted therapy may be a means of providing cost-effective psychological services to individuals experiencing barriers to treatment. To date, computers have been applied to therapy for anxiety disorder using various formats including Internet treatment, virtual reality treatment, videoconferencing and more standard computer-assisted or computer-guided packages that are implemented on palmtop computers or desktop computers. The current paper reviews trials evaluating the efficacy of these technology-based treatments for anxiety disorders and discusses implications for future research.

The use of homework in behavior therapy for anxiety disorders.

In this article, the authors discuss the role of homework in behavior therapyfor the anxiety disorders. First, the authors describe the essential componentsof behavior therapy that include exposure to feared consequences andcessation of all avoidance behaviors. Then, the authors briesy review theliterature on the relationship between homework compliance and treatmentoutcome. Next, the authors discuss the way that homework is used in termsof self-monitoring and exposure exercises during the course of treatment.Finally, the authors discuss the practicalities of encouraging homeworkcompliance and managing noncompliance.Behavior therapy is an empirically based treatment approach that hasdemonstrated efÞcacy across the anxiety disorders (see Hersen & Bellack,1999, for discussions of behavior therapy in panic disorder, obsessiveÐcompulsive disorder, social phobia and posttraumatic stress disorder, or forspeciÞc treatment manuals including suggestions for homework assign-ments see Oxford University Press/Graywind Publications manuals). Inaddition to the empirical stance taken by researchers of behavior therapy,clinicians and patients are also encouraged to take the stance of scientistsin the context of treatment. SpeciÞcally, treatment involves testing beliefsthat they have about particular situations during treatment sessions and ontheir own through the use of homework assignments.Behavior therapy for the anxiety disorders focuses primarily on havingpatients confront situations that that they are avoiding. Avoidance can beovert (e.g., a person with social phobia who refuses to do any public

Neuroimaging and the functional neuroanatomy of psychotherapy

Studies measuring the effects of psychotherapy on brain function are under-represented relative to analogous studies of medications, possibly reflecting historical biases. However, psychological constructs relevant to several modalities of psychotherapy have demonstrable neurobiological correlates, as indicated by functional neuroimaging studies in healthy subjects. This review examines initial attempts to measure directly the effects of psychotherapy on brain function in patients with depression or anxiety disorders. Fourteen published, peer-reviewed functional neuroimaging investigations of psychotherapy were identified through a MEDLINE search and critically reviewed. Studies were compared for consistency of findings both within specific diagnostic categories, and between specific modalities of psychotherapy. Results were also compared to predicted neural models of psychotherapeutic interventions. Behavioral therapy for anxiety disorders was consistently associated with attenuation of brain-imaging abnormalities in regions linked to the pathophysiology of anxiety, and with activation in regions related to positive reappraisal of anxiogenic stimuli. In studies of major depressive disorder, cognitive behavioral therapy and interpersonal therapy were associated with markedly similar changes in cortical-subcortical circuitry, but in unexpected directions. For any given psychiatric disorder, there was only partial overlap between the brain-imaging changes associated with pharmacotherapy and those associated with psychotherapy. Despite methodological limitations, initial neuroimaging studies have revealed convergent and mechanistically sensible effects of psychotherapy on brain function across a range of psychiatric disorders. Further research in this area may take advantage of emerging neuroimaging techniques to explore a broader range of psychotherapies, with the ultimate goal of improving clinical decision-making and treatment.

Influences of beliefs and personality disorders on treatment outcome in anxiety patients.

The present study investigated the effects of personality disorders (PDs) and specific PD-related beliefs on the results of (cognitive-)behavioral therapy for anxiety disorders in a sample of 398 outpatients. The authors used a prospective design in which relationships between PD variables before treatment and outcome measures at posttest and follow-up were evaluated with multilevel analyses. People with PDs and PD-related beliefs reported higher symptom levels at outcome. However, these effects were not as strong as might be expected on the basis of prevailing clinical thought in this area. Dropout rates were not influenced by the presence of 1 or more PDs or PD-related beliefs. Results indicate that treatment of anxiety disorders in patients with concomitant one or more PDs is appropriate.

The Kutcher Adolescent Depression Scale (KADS)

Free AccessThe Kutcher Adolescent Depression Scale (KADS)Sarah BrooksSarah BrooksSearch for more papers by this authorPublished Online:June 2005https://doi.org/10.1521/capn.9.5.4.52044PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutReferencesBeck , A.T., Ward, C., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for depression. Archives of General Psychiatry, 4, 561–571. Crossref, Google ScholarBirleson , P. (1981). The validity of depressive disorder in childhood and the development of a self-rating scale: A research report. Journal of Child Psychol Psychiatry, 22, 73–88. Crossref, Google ScholarBrooks , S.J., & Kutcher, S. (2001). Diagnosis and measurement of adolescent depression: A review of commonly utilized instruments. Journal of Child and Adolescent Psychopharmacology, 11, 341–376. Crossref, Google ScholarBrooks , S.J., Krulewicz, S., & Kutcher, S. (2003). The Kutcher Adolescent Depression Scale: Assessment of its evaluative properties over the course of an 8-week pediatric pharmacotherapy trial. Journal of Child and Adolescent Psychopharmacology, 13, 337–349. Crossref, Google ScholarCostello , E.J., & Angold, A. (1988). Scales to assess child and adolescent depression: Checklists, screens, and nets. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 726–737. Crossref, Google ScholarFendrich , M., Weissman, M.M., & Warner, V. (1990). Screening for depressive disorder in children and adolescents: validating the Center for Epidemiologic Studies Depression Scale for Children. American Journal of Epidemiology, 131, 538–551. Crossref, Google ScholarKovacs, M. (1992). The Children's Depression Inventory. North Tonawanda (NY), Mental Health Systems. Google ScholarLeBlanc , J.C., Almudevar, A., Brooks, S.J., & Kutcher, S. (2002). Screening for adolescent depression: comparison of the Kutcher Adolescent Depression Scale with the Beck Depression Inventory. Journal of Child and Adolescent Psychopharmacology, 12, 113–126. Crossref, Google ScholarPoznanski, E.O., & Mokros, H.B. (1996). Children's Depression Rating Scale Revised (CDRS-R). Los Angeles, CA, Western Psychological Services. Google ScholarRadloff , L.S. (1977). A CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401. Crossref, Google ScholarReynolds, W.M. (1987). Reynolds Adolescent Depression Scale Professional Manual. Odessa, Florida, Psychological Assessment Resources. Google ScholarReynolds , W.M., & Coats, K.I. 1986: A comparison of cognitive-behavioral therapy and relaxation training for the treatment of depression in adolescents. Journal of Consulting Clinical Psychology, 54, 653–660. Crossref, Google Scholar Previous article Next article FiguresReferencesRelatedDetails Cited byCited by1. Sexual and gender minority ( SGM ) adolescents' disordered eating: Exploring general and SGM‐specific factorsOnline publication date: 9 May 2022. Go to citation Crossref Google Scholar2. Do social phobia and depression go hand in hand? A cross-sectional study among school-going adolescents of Northern region of IndiaOnline publication date: Go to citation Crossref Google Scholar3. Specialist Applications of Cognitive Behavioral Therapy for Anxiety Disorders and DepressionOnline publication date: Go to citation Crossref Google Scholar4. Adapting CBT for Children and Adolescents with Anxiety Disorders and DepressionOnline publication date: Go to citation Crossref Google Scholar5. Validation of the Major Depressive Disorder Subscale (MDDS) of the Revised Child Anxiety & Depression Scale (RCADS) in a Sample of Jamaican and Barbadian Elementary School Children Validation of the Major Depressive Disorder Subscale (MDDS) of the Revised Child Anxiety & Depression Scale (RCADS) in a Sample of Jamaican and Barbadian Elementary School ChildrenOnline publication date: 8 May 2021. Go to citation Crossref Google Scholar6. Relationship of verbal aggresiveness with self-esteem and depression in verbally aggressive adolescents at public middle schoolOnline publication date: Go to citation Crossref Google Scholar7. Measurement invariance and psychometric analysis of Kutcher Adolescent Depression Scale across gender and marital statusOnline publication date: Go to citation Crossref Google Scholar8. Psychometric properties of two adolescent depression scales in a colombian community sample: ADRS and RCADS -major depressionOnline publication date: 19 January 2019. Go to citation Crossref Google Scholar9. Validation of the Kutcher Adolescent Depression Scale in a Caribbean student sampleOnline publication date: 5 July 2018. Go to citation Crossref Google Scholar10. Rural America and Evidence-Based Assessment: The Potential for a Happy MarriageOnline publication date: 23 September 2017. Go to citation Crossref Google Scholar11. Prevention strategies for adolescent depressionOnline publication date: 2 January 2018. Go to citation Crossref Google Scholar Volume 9Issue 5Aug 2004 Information© The Guilford PressPDF download

The Costs of Anxiety Disorders and their Treatment: A Commentary.

Abstract aim of this article is to comment on two review papers (Koemer et al., 2004 and Roberge et al., 2004): one examining the economic burden of anxiety disorders, and the other the economic benefit of cognitive behaviour therapy for anxiety disorder. It is evident from both these papers that Canadian data on the direct and indirect costs of treating and not treating anxiety disorders are lacking and sorely needed, in addition to demonstrating the importance of addressing cost-related isues in Canadian mental health research, the authors of these papers present basic concepts of economic evaluation. They also identify the areas more in need of cost analysis and discuss the implications of the Canadian findings for health-care policy and research in Canada. Overall, the two articles have the potential of convincing Canadian psychologists to become more active in cost research and, thus, to contribute to advocacy efforts for better mental health services in Canada. Escalating costs represent, without a doubt, one of the major problems facing Canada's public health-care system. All provincial/territorial health plans are presently under immense financial strain. This is a consequence of several factors, including the cost of mental disorders. One estimate of the economic cost of mental disorders in was $14.4 billion in 1998, a little more than 25% of the total invested in public health care that year (Bland, 1998). Despite this, our public system continues to invest disproportionately in the treatment of physical diseases, particularly those associated with death. Why is that? What can Canadian psychology do about it? When I was President of the Canadian Psychological Association (CPA), I became quite interested in advocacy. John Service and I developed a guide to help Canadian psychologists in their advocacy efforts (Gauthier & Service, 1999). One of the critical things that I learned early in the process was to rely on data to convince Members of Parliament that investing in psychology would improve both health and medical outcomes. Such an investment would ultimately result in cost savings. Without data, Members of Parliament would not not be convinced. As a scientist and a practitioner interested in anxiety disorders and as a co-president of a provincial association for anxiety disorders (Association/Troubles Anxieux du Quebec - ATAQ), I welcome the initiative taken by Canadian Psychology/Psychologic canadienne to publish two review papers dealing with the economic cost of anxiety disorders and their treatment. I also thank the Editor of Canadian Psychology /Psychologie canadienne for inviting me to comment on these papers. It is an honour and a privilege for me to do so. I now turn to the review papers. In each instance, I make general and specific comments. I present these comments in the order in which the relevant issues appear in each paper. Thus, the order of my comments does not reflect their level of importance. Paper by Koerner et al. I begin with the paper entitled The Economic Burden of Anxiety Disorders in Canada by Koerner, Dugas, Savard, Gaudet, Tttrcotte, and Marchand. title of their paper suggests that the main focus of the paper is the costs of anxiety disorders. However, generalized anxiety' disorder (GAD) is the only anxiety disorder that these authors examined closely. Introduction. authors are clearly aware of what is happening in the political arena. They refer to the final report of the Commission on the Future of Health Care in chaired by Romanow (Canada, 2002) and the Canadian Psychological Association's advocacy effort in the inquiry. They also highlight the fact that the recommendations put forth in the final report did not show a great deal of concern for mental health problems in Canada. I agree with the authors that one of the major reasons for GPA's limited impact on the Romanow Royal Commission may have been its reliance on evidence derived, for the most part, from research conducted in the United States - in the absence of Canadian data - to demonstrate the relationship between mental and physical health, and the costs associated with psychological disorders. …

Irrational cognitions and the fear of flying

In order to test the hypothesis that the fear of flying is associated with irrational evaluative beliefs, as postulated by Rational Emotive Behavior Therapy for anxiety disorders, 15 fearful flyers and 7 non-fearful flyers participated in the Articulated Thoughts during Simulated Situations procedure. Six experimental scenes depicting some basic fears associated with the fear of flying and six supposedly non-anxiety provoking flight-related control scenes were used. The fear of flying group displayed significantly more irrational thoughts and significantly higher subjective ratings of anxiety on all experimental and five control scenes compared to the non-fearful flyers. Their negative cognitions were predominantly characterized by awfulizing and low frustration tolerance. The results are interpreted as offering support for the cognitive view that anxiety, and the fear of flying, are associated with negative cognitions characterized by a preoccupation with danger and with an overestimation of the seriousness of the perceived threat (awfulizing) and an underestimation of coping abilities (low frustration tolerance).