Cognitive Behavioral Treatments For Anxiety Disorders Research Articles

Barriers to and facilitators of using evidence-based, cognitive-behavioral anxiety interventions in integrated primary care practice.

Cognitive-behavioral treatment for anxiety disorders and symptoms remains underutilized in integrated primary care (IPC), in part because the many treatments developed for specialty care are not readily translated to this unique setting. The objective of this study was to identify barriers and facilitators to behavioral health providers (BHPs) delivering evidence-based cognitive--behavioral anxiety interventions within IPC practice. We conducted semistructured interviews with a national sample of 18 BHPs (50% psychologists, 33% social workers, 17% registered nurses) working in IPC in the Veterans Health Administration. We assessed barriers to and facilitators of using psychoeducation, exposure, cognitive therapy, relaxation training, mindfulness/meditation, Acceptance and Commitment Therapy-based interventions, and problem-solving therapy. Qualitative coding and conventional content analysis revealed barriers and facilitators at three levels: IPC, provider, and patient. Themes suggested key barriers of poor fit with the IPC model, BHP training deficits, and lack of patient buy-in, and key facilitators of good perceived fit of the intervention (e.g., scope, duration) with the IPC model, BHPs feeling well equipped, and utility for patients. BHPs select interventions based on fit for the individual patient. Some results were consistent with prior work from specialty care, but the IPC model itself introduces significant implementation challenges. BHPs would benefit from flexible intervention options and training on IPC treatment goals and how to deliver the essence of evidence-based interventions in small doses. Our findings will help to inform adaptation of behavioral anxiety interventions to better fit IPC practice and development of beneficial training and resources for BHPs to reduce implementation challenges. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Enhanced Cognitive-Behavioral Treatment for Anxiety Disorders in Children of Clinically Anxious Parents: Two Case Studies

Children with anxiety disorders are significantly less likely to recover following cognitive-behavioral therapy (CBT) if they have a parent with clinical anxiety. Despite this, prior research which has adapted CBT treatments to cater for this vulnerable clinical cohort of children is limited. In response to the identified need to optimize treatment outcomes for this particular group of children with anxiety disorders, an enhanced CBT intervention was recently developed, specifically to target anxiety maintenance factors in clinically anxious child–parent dyads. This dual case study presents the implementation of the enhanced intervention with two children with complex clinical presentations. Prior to treatment, both children met criteria for multiple anxiety disorders, as did their mothers. The presented case studies describe session-by-session treatment accounts, with a particular focus on the children’s experiences of individual and joint-observational exposure treatment components. Outcome data is provided for both children and their mothers, based on assessment measures collected at pre- and post-treatment, and during the intervention. At post-treatment, both children demonstrated symptom reduction and improved functioning across all diagnoses, including remission on a secondary diagnosis, although both still met criteria for their primary diagnoses. Additionally, self-reported outcomes on intervention acceptability measures were favorable. Results implied that the enhanced intervention provided a viable alternative treatment approach for children and their parents with co-occurring anxiety disorders. Recommendations are provided for clinicians delivering CBT to clinically anxious child–parent dyads.

Changes in positive affect in cognitive-behavioral treatment of anxiety disorders

ObjectiveThis study evaluated changes in positive affect within cognitive-behavioral treatments (CBT) for anxiety disorders. It was hypothesized that there would be significantly greater increases in positive affect in CBT conditions compared to the waitlist, and particularly higher in the Unified Protocol (UP) than the single disorder protocols (SDP) given the UP's focus on emotions (including positive emotions) rather than symptoms. MethodPatients with heterogeneous anxiety disorders (N = 223) were randomly assigned to the UP, SDP or waitlist. Linear mixed model regression (intent to treat) analyses were used to compare change in positive affect, quality of life, and savoring between patients in the treatment conditions (UP and SDP) versus waitlist conditions. Between condition effect sizes were calculated to assess the magnitude of difference within conditions at post-treatment. ResultsResults indicated a significant Group (treatment vs. waitlist) × Time (pre- post-treatment) interaction (F(1, 154.36) = 6.75; p = .01) for positive affect in which the treatment group showed significant improvements in positive affect pre- to post-treatment (ESsg = 0.37, SEsg = 0.09, 95% CI [0.20: 0.54]) and the waitlist condition did not. There were no differences between UP and SDP conditions in positive affect at baseline or at post-treatment. ConclusionsThese results suggest CBT, which typically focuses on reductions in negative affect, may also improve positive affect. The importance of future research evaluating, targeting, and improving positive affect in CBT trials is discussed.Clinicaltrials.gov Identifier: NCT01243606

Strengths and Limitations of Internet-Based Cognitive-Behavioral Treatments for Anxiety Disorders

This commentary discusses the strengths and limitations of internet-based cognitive-behavioral treatments (ICBT) for anxiety disorders, as highlighted by the case studies described in Ciuca, Berger, and Miclea (2017), and in Schulz, Vincent, and Berger (2017). In comparing the course of treatment for patients with contrasting clinical outcomes, the authors offer insights into the many benefits and challenges of ICBT. Suggestions for improving ICBT interventions for anxiety disorders, implications for implementation and dissemination, and ethical considerations are discussed.

37.3 Cognitive-Behavioral Treatment for Anxiety Disorders in Children and Adolescents With Autism Spectrum Disorder

The goal of this session is to provide evidence-based recommendations for the effective CBT of anxiety disorders in children and adolescents with autism spectrum disorder (ASD). This presentation will include a discussion of common challenges faced by clinicians working with this population, important modifications to CBT when applied to youth with ASD, and possible mechanisms of treatment effect.

Bridging the Gaps Between Basic Science and Cognitive-Behavioral Treatments for Anxiety Disorders in Routine Care

Abstract. As a core component of cognitive-behavioral therapies (CBT), behavioral exposure is an effective treatment for anxiety disorders. Still, recent treatment studies demonstrate relatively high rates of treatment dropout, nonresponse, and relapse, indicating a substantial need for optimizing and personalizing existing treatment procedures. In the present article, we aim to address current challenges and future demands for translational research in CBT for the anxiety disorders, including (a) a better understanding of those mechanisms conferring behavioral change, (b) identifying important sources of individual variation that may act as moderators of treatment response, and (c) targeting practical barriers for dissemination of exposure therapy to routine care. Based on a recursive process model of psychotherapy research we will describe distinct steps to systematically translate basic and clinical research “from bench to bedside” to routine care, but also vice versa. Some of these aspects may stimulate the future roadmap for evidence-based psychotherapy research in order to better target the treatment of anxiety disorders as one core health challenge of our time.

Disorder-specific versus generic cognitive-behavioral treatment of anxiety disorders in children and young people: a systematic narrative review of evidence for the effectiveness of disorder-specific CBT compared with the disorder-generic treatment, Coping Cat.

Coping Cat (CC), a generic cognitive-behavioral intervention for anxiety disorders in children and young people, is recommended in the United Kingdom for social anxiety disorder (SAD), generalized anxiety disorder, separation anxiety (SA), and specific phobias (SP), with disorder-specific approaches generally favored in treatment of anxiety disorders in adults. To compare CC with disorder-specific cognitive-behavioral therapy (CBT) interventions based on anxiety-related treatment outcomes. Primary research articles describing treatment of children and young people aged 7-17 for SAD, generalized anxiety disorder, SA, and SP, using CC or disorder-specific CBT. Ten studies implemented CC and four implemented disorder-specific CBT. One study compared CC with a disorder-specific approach. There was a lack of data to support use of CC in treatment of SPs. However, CC was equally effective as disorder-specific treatments for SA and SAD. A lack of data exists for disorder-specific CBT interventions compared to CC.

Keep Your Eye on the Target: Safety Behavior Reduces Targeted Threat Beliefs Following a Behavioral Experiment

This study examined the effect of safety behavior on belief change during a behavioral experiment. Highly spider fearful participants (N = 126) evaluated a targeted negative belief about spiders during a brief behavioral experiment with a live tarantula. Participants were randomly assigned either to use or not use safety gear during the session. Results demonstrated that after the behavioral experiment, targeted negative beliefs were significantly lower in the safety gear condition than in the control condition. Both conditions benefited from comparable improvements across a broader constellation of negative spider-related beliefs. Safety gear facilitated closer approach to the spider during the session; however, participants who did not use safety gear experienced greater improvement in perceived control. These findings suggest that safety behavior need not impair corrective learning during cognitive-behavioral interventions and that it might indeed enhance it. Results are discussed in terms of cognitive-behavioral treatments for anxiety disorders and of the role of safety behavior therein.

Threat reappraisal as a mediator of symptom change in cognitive-behavioral treatment of anxiety disorders: A systematic review.

Identifying mediators of therapeutic change is important to the development of interventions and augmentation strategies. Threat reappraisal is considered a key mediator underlying the effects of cognitive-behavioral therapy (CBT) for anxiety disorders. The present study systematically reviewed the evidence for the threat reappraisal mediation hypothesis. In our review, we included studies that (a) investigated the threat reappraisal mediation hypothesis; (b) included adults with an anxiety disorder diagnosis; (c) used a longitudinal design; and (d) did not report on previously published findings (to avoid the inclusion of multiple reports of the same data). After data extraction, we made review-specific quality judgments for each study using the following a priori criteria informed by mediation theory: (a) demonstrated statistical mediation; (b) demonstrated that CBT caused threat reappraisal; (c) demonstrated that threat reappraisal caused anxiety reduction; and (d) demonstrated specificity of the threat reappraisal-anxiety reduction relation. Of the 2,296 studies we identified, 25 met inclusion criteria. Of these studies, 56% tested and 52% established statistical mediation, 52% tested and 28% established CBT as a cause of threat reappraisal, 28% tested and 24% established threat reappraisal as a cause of anxiety reduction, and 44% tested and 36% established specificity of the threat reappraisal-anxiety reduction relation. While threat reappraisal is related to anxiety symptom improvement with CBT, there are few extant studies that meet most of the criteria necessary to conclusively demonstrate that it causes symptom improvement in CBT and that it is not a proxy for other third variables. Recommendations for future research in this area are discussed.

What Makes a Quality Therapy? A Consideration of Parsimony, Ease, and Efficiency

Evaluations of psychotherapy have traditionally focused on symptom reduction as the primary standard by which their value is determined. This has contributed to the appearance of equivalence between many therapies that may differ considerably in complexity, feasibility, amount of homework and therapist contact required, expected cost, speed of symptom decline, and transdiagnostic utility. In the current paper, I make the case that these are fundamental features related to quality that should be considered in psychotherapy development, randomized controlled trials, and dissemination efforts. Empirically supported treatments for different disorders are evaluated based on these criteria, and special consideration is given to cognitive-behavioral treatments for anxiety disorders. Specific recommendations for a quality-oriented clinical research agenda are also provided.

A Human Model That Suggests a Role for Sleep in the Cognitive Neuropsychology of PTSD and Recovery

A Human Model That Suggests a Role for Sleep in the Cognitive Neuropsychology of PTSD and Recovery

From the lab to the clinic: Effectiveness of cognitive-behavioral treatments for anxiety disorders.

A controversy exists over whether results of randomized controlled trials of psychological treatment methods generalize to routine clinical practice. To examine the generalizability of cognitive–behavioral interventions for anxiety disorders, a meta-analysis of 11 effectiveness studies was conducted. Only studies that closely approximated real-world clinical practice were included in the present meta-analysis (e.g., studies were conducted in a nonuniversity setting, practitioners had regular caseloads, clients were not excluded if they had comorbid conditions). Cognitive–behavioral interventions were associated with significant improvement in anxiety symptoms at the end of treatment (dw 1.35) and again at follow-up (dw 1.14). On the basis of these results, it seems that cognitive–behavioral interventions for anxiety disorders generalize to real-world clinical practice.

Group and Individual Cognitive-Behavioral Treatments for Youth With Anxiety Disorders: 1-Year Follow-Up

This study reports the 1-year follow-up of a cognitive-behavioral treatment for anxiety disorders in children and adolescents. Thirty-seven anxiety-disordered youth (aged 8–14 years at the time of treatment) were randomly assigned to individual cognitive-behavioral treatment (ICBT), group cognitive-behavioral treatment (GCBT), or a waitlist control (WLC) condition. Previously reported posttreatment results demonstrated significant reductions in anxiety whereas children in the WLC failed to demonstrate changes in report of anxiety or in diagnostic status. At the present 1-year follow-up, 81% of ICBT and 77% of GCBT children no longer met criteria for their primary anxiety disorder. Multivariate analyses of variance demonstrated maintenance of treatment gains for both ICBT and CGBT but failed to reveal differences between the conditions. Results not only suggest the nondifferential efficacy of individual and group cognitive-behavioral treatments for anxiety-disordered children but also add to the evidence suggesting GCBT as a “probably efficacious treatment.”

Patients' perceptions of pharmacological and cognitive-behavioral treatments for anxiety disorders

Cognitive-behavioral therapy (CBT) and pharmacotherapy are the most well-established treatments for anxiety disorders. This study examined how treatment-seeking anxiety disorder patients (N = 103) perceive the acceptability, believability, and effectiveness of these treatments. While both treatments were perceived favorably, CBT was rated as more acceptable and more likely to be effective in the long-term. Most patients also rated CBT as their treatment of choice. Patients taking medication reported equally favorable views of both treatments, whereas unmedicated patients rated CBT more favorably than medication. Psychotherapy history was less strongly related to treatment perceptions. Our results suggest that despite their favorable views of both treatments, patients tend to prefer CBT to medication for the treatment of anxiety disorders. Directions for future research are discussed.

Therapist Alliance-Building Behavior Within a Cognitive-Behavioral Treatment for Anxiety in Youth.

Explored the specific behavior of therapists contributing to a child client's perception of a therapeutic alliance with youth (n = 56) who received a manualized cognitive-behavioral treatment for anxiety disorders. The first 3 sessions were coded for 11 therapist behaviors hypothesized to predict ratings of alliance. Child, therapist, and observer alliance ratings were gathered after the 3rd and 7th therapy sessions. "Collaboration" positively predicted early child ratings of alliance, and "finding common ground" and "pushing the child to talk" negatively predicted early child ratings of alliance. Although no coded therapist behaviors predicted early therapist ratings of alliance, "collaboration" and "not being overly formal" positively predicted therapist alliance ratings by Session 7. Child, observer, and therapist ratings of alliance were significantly correlated. Results are discussed with regard to the identified behavior of the therapist as a step toward the identification of empirically supported strategies for building a stronger child-therapist alliance.

Update on and Advances in Assessment and Cognitive-Behavioral Treatment of Anxiety Disorders in Children and Adolescents.

Most child psychologists would agree that treating anxiety disorders in children is extremely challenging at times but also rewarding. This article provides an updated look at assessment strategies and promising psychosocial treatment techniques for children with 3 common anxiety disorders: separation anxiety disorder, social phobia, and generalized anxiety disorder. The need for comprehensive diagnostic evaluations is highlighted through information on the wide range of assessment procedures and instruments available to practicing psychologists interested in treating anxious youth. In addition, a treatment approach shown to be empirically efficacious for treating anxious children, cognitive-behavioral therapy, is described. We provide practical examples of assessment and treatment techniques for clinical practice. Tables are included that can serve as useful quick references for the 3 areas covered.

Computer-supported cognitive behavioral treatment of anxiety disorders.

This article reviews the empirical literature pertaining to the use of computer-supported cognitive-behavioral treatment of anxiety disorders, including palmtop computers, virtual reality exposure therapy, and personal computer software programs. The advantages and disadvantages unique to each type of technology are described. The review concludes with a discussion of ethical issues, barriers to the use of technology by clinicians, and suggestions for a process by which scientists and practitioners can conceptualize how technology can advance our understanding of anxiety and our dissemination of effective treatments.

Cognitive-behavioral treatment of anxiety disorders in children: Long-term (6-year) follow-up.

Cognitive-behavioral treatment of anxiety disorders in children: Long-term (6-year) follow-up.

Training in empirically validated treatments: What are clinical psychology students learning?

Directors of clinical training (83%) and directors of internships with American Psychological Asso-ciation approval (55%) responded to a survey concerning empirically validated psychological treat-ments in which their students received training. Most programs provided supervised clinical experi-ence in a number of these treatments. However, over 20% of doctoral training programs failed toprovide minimal coverage of empirically validated treatments in didactic courses, and internshipprograms typically did not require that students be competent in any of these treatments beforecompletion of the program. The absence of didactic and clinical training in empirically validatedpsychodynamic therapies and interpersonal therapy was most marked. These findings suggest thatprograms need to be more attentive to teaching data-based treatments.PAUL CRITS-CHRISTOPH received his PhD in clinical psychology fromYale University in 1984. He is currently associate professor of psychol-ogy in psychiatry and director of the Center for Psychotherapy Researchat the University of Pennsylvania. At present he is studying the effects ofbrief dynamic psychotherapy and cognitive therapy for cocaine addic-tion and for generalized anxiety disorder and is examining the processof interpersonal psychotherapy and cognitive therapy for depression.ELLEN FRANK received her PhD from the University of Pittsburgh in1979. She is professor of psychiatry and psychology in the Departmentof Psychiatry at the University of Pittsburgh School of Medicine. Shedirects the Depression and Manic-Depression Prevention Program atWestern Psychiatric Institute and Clinic. Her treatment research hasfocused on the prophylaxis of recurrent mood disorders using interper-sonal psychotherapy, pharmacotherapy, and their combination.DIANNE L. CHAMBLESS received her PhD in clinical psychology fromTemple University in 1979. She is currently professor of psychology atThe American University. She conducts research on the psychopathol-ogy and cognitive-behavioral treatment of anxiety disorders and is par-ticularly interested in psychotherapy integration and the impact of in-terpersonal relationships on anxiety.CINDY BRODY received her BA in psychology from the University ofPennsylvania in 1991 and for 3 years was a research assistant at theCenter for Psychotherapy Research. She is currently a doctoral studentin clinical psychology at The American University. Her major researchinterests are in coping, interpersonal problems, and psychotherapy pro-cess and outcome.JORDAN F. KARP received his BA in psychology from Emory University in1992. He completed 2 years as a research associate in the Depression andManic-Depression Prevention Program at Western Psychiatric Instituteand Clinic. He is currently a medical student at the University ofPittsburgh.WE THANK David Barlow, Barry Wolfe, and Division 12 for assistance

A critique of cognitive therapy for anxiety disorders

Progress in the cognitive-behavioral treatment of anxiety disorders is reviewed. Significant advances have been made in treating panic disorders and there are promising signs of an expansion of cognitive theory and therapy to other disorders, notably hypochondriasis, obsessional disorders and circumscribed phobias. Nevertheless, some difficult obstacles have emerged to present serious problems for the prevailing cognitive theory.