Cognitive-behavioral Therapy For Generalized Anxiety Disorder Research Articles

Patients’ symptoms and strengths as predictors of long-term outcomes of CBT for generalized anxiety disorder – A three-level, multi-predictor analysis

Although cognitive behavioral therapy (CBT) is an effective treatment for generalized anxiety disorder (GAD), GAD often shows a chronic clinical course and common deterioration after treatment. Many trials have examined the efficacy of treatments in GAD, but little is known about intake predictors of long-term treatment outcomes. This study examined potential predictors of long-term treatment outcomes based on the individual’s symptom severity and strengths (behavioral, cognitive, interpersonal) at intake. Long-term outcomes were defined as worry at six-month follow-up (six-m FU) and worry decrease from intake and post-treatment to six-m FU. Data from 137 CBT outpatients with a GAD diagnosis from two randomized clinical trials were analyzed using three-level hierarchical linear modeling. Results revealed that worrying decreased up to the six-m FU. In single-predictor models, intake symptom severity and strength measures predicted worry at the six-m FU. In multi-predictor models, only behavioral strengths remained a significant predictor. Worry decrease from intake to the six-m FU was only predicted by behavioral strengths. These findings provide relevant information about intake predictors of long-term outcomes after CBT for GAD and underscore the potential relevance of assessing patients’ strengths for clinical practice.

Baseline overly accommodating interpersonal problems in relation to parsed alliance-outcome associations in cognitive behavioral therapy for generalized anxiety disorder

ABSTRACT Objective: Given its interpersonal underpinnings, relational factors may be salient in psychotherapy for generalized anxiety disorder (GAD). Supporting this point, research has indicated a positive total alliance-improvement correlation in cognitive behavioral therapy (CBT) for GAD. However, less research has disaggregated this correlation into within- and between-patient components, or examined theory-informed ways in which patient characteristics influence to these components. Thus, we first investigated parsed alliance-outcome associations in CBT for GAD. Second, consistent with theory that alliance may represent a direct interpersonal change correlate, we tested whether within-patient alliance improvements were especially therapeutic for patients with higher levels of an interpersonal problem prototypical of GAD—over accommodation. Also, consistent with theory that between-patient differences in overall alliance may be influenced by patients’ preexisting relational characteristics, we tested whether more overly accommodating patients reported poorer average alliances that, in turn, related to worse outcomes. Method: Sixty-nine patients received variants of CBT. Patients rated over accommodation at baseline, and alliance and outcome across treatment. Results: As hypothesized, within-patient alliance improvements correlated with subsequent anxiety reduction, and this association was stronger for more overly accommodating patients. All between-patient associations were nonsignificant. Conclusion: Results help clarify the nuanced role of alliance in CBT for GAD.

Interpersonal cognitions as a mechanism of change in cognitive behavioral therapy for generalized anxiety disorder? A multilevel dynamic structural equation model approach.

This study aimed to investigate the effects of changes in interpersonal cognitions on outcome during cognitive behavioral therapy (CBT) for generalized anxiety disorder (GAD) and how these effects are moderated by patients' interpersonal problems at intake. A sample of 80 adult patients diagnosed with GAD who were undergoing CBT within a randomized controlled trial completed a questionnaire concerning interpersonal problems at baseline as well as measures of changes in interpersonal and self-related cognitions and in worry severity session by session. We conducted dynamic structural equation modeling to estimate cross-lagged within-patient effects of changes in interpersonal cognitions on worry, adjusting for the effects of self-related cognitions. Furthermore, we included interpersonal problems as a moderator of the effects of changes in interpersonal cognitions. We found significant cross-lagged effects of changes in both interpersonal cognitions and self-related cognitions on subsequent worry levels. Greater changes in interpersonal cognitions and self-related cognitions in a given session were associated with lower worry levels at the beginning of the next session. When adjusting for self-related cognitions, the effects of changes in interpersonal cognitions on subsequent worry remained significant. However, there were no interactive effects of changes in interpersonal cognitions by patients' interpersonal problems on worry severity. The results present evidence supporting changes in interpersonal cognitions and self-related cognitions as relevant change mechanisms in CBT for GAD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Cognitive Behavioral Therapy for a Young Woman of Asian Heritage

Generalized anxiety disorder (GAD) is one of the most common anxiety disorders and is associated with significant impairments in academic, occupational, and social functioning. Cognitive behavioral therapy (CBT) has shown to be an effective treatment for GAD; however, little research has examined its effectiveness with individuals of Asian heritage. In fact, as a result of limited use of mental health services within the Asian population, there is little psychotherapy research for this population. The present case examined whether a well-established CBT protocol, Mastering Your Anxiety and Worry (MAW), can be tailored in a culturally responsive manner to consider factors and values that influence well-being and functioning. Treatment consisted of 27 sessions over a 6-month period, with outcome data demonstrating a significant decrease in anxiety symptoms at the end of treatment. Results revealed statistically reliable clinical change on the Depression, Anxiety, and Stress Scale–21 (DASS-21) using Western norms and norms for a Chinese sample. This case demonstrates the potential cross-cultural utility of CBT for GAD for individuals of Asian heritage.

Yoga for generalized anxiety disorder: design of a randomized controlled clinical trial

Generalized anxiety disorder (GAD) is a common disorder associated with significant distress and interference. Although cognitive behavioral therapy (CBT) has been shown to be the most effective form of psychotherapy, few patients receive or have access to this intervention. Yoga therapy offers another promising, yet under-researched, intervention that is gaining increasing popularity in the general public, as an anxiety reduction intervention. The purpose of this innovative clinical trial protocol is to investigate the efficacy of a Kundalini Yoga intervention, relative to CBT and a control condition. Kundalini yoga and CBT are compared with each other in a noninferiority test and both treatments are compared to stress education training, an attention control intervention, in superiority tests. The sample will consist of 230 individuals with a primary DSM-5 diagnosis of GAD. This randomized controlled trial will compare yoga (N=95) to both CBT for GAD (N=95) and stress education (N=40), a commonly used control condition. All three treatments will be administered by two instructors in a group format over 12 weekly sessions with four to six patients per group. Groups will be randomized using permuted block randomization, which will be stratified by site. Treatment outcome will be evaluated bi-weekly and at 6month follow-up. Furthermore, potential mediators of treatment outcome will be investigated. Given the individual and economic burden associated with GAD, identifying accessible alternative behavioral treatments will have substantive public health implications.

The Effectiveness of Cognitive Behavioral Therapy for Generalized Anxiety Disorder in a Frontline Service Setting

The goal of the current study was to test the generalizability of cognitive behavioral therapy (CBT) for generalized anxiety disorder (GAD) in a frontline service setting. Twenty‐nine patients who presented to treatment clinics with problematic worry were provided CBT for GAD. Among the intent‐to‐treat sample, there were no significant changes in worry or depression from pre‐ to posttreatment. Treatment completers showed significant pre‐ to posttreatment reductions on measures of worry and depression. The magnitude of change was smaller than has been reported in randomized control trials (RCTs). Although the frontline service setting differed from RCT settings in multiple ways, treatment completers nonetheless achieved moderate to large decreases in self‐reported worry and depression.

The assessment of treatment strategy in cognitive–behavior therapy: Using the pivotal topic measure

A new method of how to assess treatment strategy is presented. In a controlled clinical trial of cognitive–behavioral therapy (CBT) for generalized anxiety disorder (GAD), 12 therapists and 30 patients were asked, after each of 25 sessions, to write down what they viewed to be the most important topic of that particular session. A content analytic scheme for the classification of answers was developed and has good interrater reliability. In the initial sessions therapists focused on building a working alliance and on behavior analysis. They then progressed to psychoeducation and cognitive restructuring and coping. This sequence is paralleled by pivotal topics reported by the patients. At the beginning of treatment, patients placed greatest importance on the opportunity to talk, then realized that gaining insight and coping with anxiety were the central foci of treatment, and finally found that it required changing thoughts and learning competencies and self-confidence. Therapist and patient answers reflect central features of CBT for GAD in both content and sequence. Because similar topics are first mentioned by therapists and at a later point by patients, the assumption that the therapists lead the treatment process is supported. The Pivotal Topic Measure can be seen as a new way of assessing treatment strategy.