Worry Reduction Research Articles

Effectiveness of Cognitive Behavior Therapy for Severe Mood Disorders in an Acute Psychiatric Naturalistic Setting: A Benchmarking Study

The current study examined the effectiveness of brief cognitive behavior therapy (CBT) for severe mood disorders in an acute naturalistic setting. The sample included 951 individuals with either major depressive disorder (n = 857) or bipolar disorder with depressed mood (n = 94). Participants completed a battery of self-report measures assessing depression, overall well-being, and a range of secondary outcomes both before and after treatment. We found significant reductions in depressive symptoms, worry, self-harm, emotional lability, and substance abuse, as well as significant improvements in well-being and interpersonal relationships, post-treatment. Comparable to outpatient studies, 30% of the sample evidenced recovery from depression. Comparison of findings to benchmark studies indicated that, although the current sample started treatment with severe depressive symptoms and were in treatment for average of only 10 days, the overall magnitude of symptom improvement was similar to that of randomized controlled trials. Limitations of the study include a lack of control group, a limitation of most naturalistic studies. These findings indicate that interventions developed in controlled research settings on the efficacy of CBT can be transported to naturalistic, “real world” settings, and that brief CBT delivered in a partial hospital program is effective for many patients with severe depressive symptoms.

Effectiveness of Online Self-Help for Suicidal Thoughts: Results of a Randomised Controlled Trial

BackgroundMany people with suicidal thoughts do not receive treatment. The Internet can be used to reach more people in need of support.ObjectiveTo test the effectiveness of unguided online self-help to reduce suicidal thoughts.Method236 adults with mild to moderate suicidal thoughts were randomised to the intervention (n = 116) or a waitlist control group (n = 120). Assessments took place at baseline, and 2, 4 and 6 weeks later. Primary outcome was suicidal thoughts. Secondary outcomes were depressive symptoms, anxiety, hopelessness, worry, and health status.ResultsThe intervention group showed a small significant effect in reducing suicidal thoughts (d = 0.28). Effects were more pronounced for those with a history of repeated suicide attempts. There was also a significant reduction in worry (d = 0.33). All other secondary outcomes showed small but non-significant improvements.ConclusionsAlthough effect sizes were small, the reach of the internet could enable this intervention to help many people reduce their suicidal thoughts.Trial RegistrationNetherlands Trial Register NTR1689

Mindfulness-based stress reduction for older adults with worry symptoms and co-occurring cognitive dysfunction.

Mindfulness-based stress reduction (MBSR) has the potential to reduce worry and improve cognitive functioning. In this treatment development project, we examined MBSR in older adults with worry symptoms and co-occurring cognitive dysfunction. We examined (i) acceptability of MBSR, (ii) whether MBSR needs to be lengthened providing more repetition, (iii) MBSR's benefits for worry reduction and cognitive improvements, and (iv) continued use of MBSR techniques during follow-up. Two sites (St. Louis and San Diego) enrolled individuals aged 65 years or older with significant anxiety-related distress plus subjective cognitive dysfunction, into traditional 8-session MBSR groups and 12-session groups that had the same content but more repetition of topics and techniques. We examined measures of mindfulness, worry, and a neuropsychological battery focused on memory and executive function before and after the MBSR program, and we followed up participants for 6 months after the completion of MBSR regarding their continued use of its techniques. Participants (N = 34) showed improvements in worry severity, increases in mindfulness, and improvements in memory as measured by paragraph learning and recall after a delay, all with a large effect size. Most participants continued to use MBSR techniques for 6 months post-instruction and found them helpful in stressful situations. There was no evidence that the extended 12-week MBSR produced superior cognitive or clinical outcomes, greater satisfaction, or greater continuation of MBSR techniques than 8-week MBSR. These preliminary findings are promising for the further testing and use of MBSR in older adults suffering from clinical worry symptoms and co-occurring cognitive dysfunction. These are common problems in a broad range of older adults, many of whom have anxiety and mood disorders; therefore, stress reduction intervention for them may have great public health value.

The Role of Cognitive Behaviour Therapy in Worry Reduction: A Case Study of an Outpatient with Post-Traumatic Stress Disorder

The purpose of this study was to examine the role of Cognitive Behaviour Therapy (CBT) on worry reduction in a 36-year-old female with posttraumatic stress disorder (PTSD). Sexual abuse and war exposure were the sources of PTSD for the patient. Using a manualized protocol, CBT techniques were tailored to the patient’s problems and content of symptoms within a case study. Self-rating scales were used to measure the role of CBT on worry reduction during pre-treatment, post-treatment and follow-up. Results showed the importance of CBT components for worry reduction in PTSD. Particular issues were encountered; the most notably were the designing and monitoring of out-session practices which involved careful planning. The treatment implications are discussed including the tailoring of therapy for personalized interventions and patient screening with regards to the construct of worry for clinicians.

Are Changes in Worry Associated with Treatment Response in Cognitive Behavioral Therapy for Insomnia?

Aim: Little is known about why some patients respond to cognitive behavioral therapy for insomnia, whereas other patients do not. To understand differences in treatment response, there is a dire need to examine processes of change. The purpose was to investigate the long-term association between insomnia-related worry and outcomes following cognitive behavior therapy for insomnia. Methods: Sixty patients with early insomnia (3–12 months duration) received group cognitive behavioral therapy for insomnia. At pretreatment and at a 1-year follow-up, the patients completed questionnaires indexing two domains of insomnia-related worry (sleeplessness and health), insomnia severity, anxiety, and depression as well as sleep diaries. Results: Decreases in the two worry domains were associated with improvements in all of the outcomes, except for sleep onset latency (SOL), at a medium to large level. Reductions in insomnia-related worry were associated with improvements in insomnia severity, wake after sleep onset (WASO), total sleep time (TST), and depression, but not in SOL or anxiety. While reductions in worry for sleeplessness were related to improvements in insomnia severity and TST, decreases in worry for health were associated with enhancements in WASO and depression. Conclusion: The findings suggest that reductions in insomnia-related worry might be one process route in which cognitive behavioral therapy operates to improve insomnia symptomatology. The results are discussed in relation to theory, clinical implications, and future research.

The interaction of affective with psychotic processes: A test of the effects of worrying on working memory, jumping to conclusions, and anomalies of experience in patients with persecutory delusions

Worry has traditionally been considered in the study of common emotional disorders such as anxiety and depression, but recent studies indicate that worry may be a causal factor in the occurrence and persistence of persecutory delusions. The effect of worry on processes traditionally associated with psychosis has not been tested. The aim of the study was to examine the short-term effects of a bout of worry on three cognitive processes typically considered markers of psychosis: working memory, jumping to conclusions, and anomalous internal experience. Sixty-seven patients with persecutory delusions in the context of a non-affective psychotic disorder were randomised to a worry induction, a worry reduction, or a neutral control condition. They completed tests of the cognitive processes before and after the randomisation condition. The worry induction procedure led to a significant increase in worry. The induction of worry did not affect working memory or jumping to conclusions, but it did increase a range of mild anomalous experiences including feelings of unreality, perceptual alterations, and temporal disintegration. Worry did not affect the occurrence of hallucinations. The study shows that a period of worry causes a range of subtle odd perceptual disturbances that are known to increase the likelihood of delusions. It demonstrates an interaction between affective and psychotic processes in patients with delusions.

Antidepressant Medication Augmented With Cognitive-Behavioral Therapy for Generalized Anxiety Disorder in Older Adults

OBJECTIVE Generalized anxiety disorder is common among older adults and leads to diminished health and cognitive functioning. Although antidepressant medications are efficacious, many elderly individuals require augmentation treatment. Furthermore, little is known about maintenance strategies for older people. The authors examined whether sequenced treatment combining pharmacotherapy and cognitive-behavioral therapy (CBT) boosts response and prevents relapse in older adults with generalized anxiety disorder. METHOD Participants were individuals at least 60 years of age with generalized anxiety disorder (N=73) who were recruited from outpatient clinics at three sites. Participants received 12 weeks of open-label escitalopram and were then randomly assigned to one of four conditions: 16 weeks of escitalopram (10-20 mg/day) plus modular CBT, followed by 28 weeks of maintenance escitalopram; escitalopram alone, followed by maintenance escitalopram; escitalopram plus CBT, followed by pill placebo; and escitalopram alone, followed by placebo. RESULTS Escitalopram augmented with CBT increased response rates on the Penn State Worry Questionnaire but not on the Hamilton Anxiety Rating Scale compared with escitalopram alone. Both escitalopram and CBT prevented relapse compared with placebo. CONCLUSIONS This study demonstrates effective strategies for treatment of generalized anxiety disorder in older adults. The sequence of antidepressant medication augmented with CBT leads to worry reduction in the short-term. Continued medication prevents relapse, but for many individuals, CBT would allow sustained remission without requiring long-term pharmacotherapy.

A randomized controlled trial of compassion cultivation training: Effects on mindfulness, affect, and emotion regulation

Compassion is a positive orientation towards suffering that may be enhanced through compassion training and is thought to influence psychological functioning. However, the effects of compassion training on mindfulness, affect, and emotion regulation are not known. We conducted a randomized controlled trial in which 100 adults from the community were randomly assigned to either a 9-week compassion cultivation training (CCT) or a waitlist (WL) control condition. Participants completed self-report inventories that measured mindfulness, positive and negative affect, and emotion regulation. Compared to WL, CCT resulted in increased mindfulness and happiness, as well as decreased worry and emotional suppression. Within CCT, the amount of formal meditation practiced was related to reductions in worry and emotional suppression. These findings suggest that compassion cultivation training effects cognitive and emotion factors that support psychological flexible and adaptive functioning.

Behavioural activation: A pilot trial of transdiagnostic treatment for excessive worry

Transdiagnostic interventions present pragmatic benefits in treatment dissemination and training of mental health professionals when faced with emotional disorders such as anxiety and depression. Excessive worry is a common feature across emotional disorders and represents an ideal candidate target for transdiagnostic intervention. The current pilot trial examined the efficacy of a behavioural activation treatment for worry (BAW) in a community population. 49 individuals experiencing excessive worry were randomised to waitlist or BAW receiving an 8 week group based intervention. Results demonstrated that BAW was successful in reducing excessive worry, depressive symptoms, cognitive avoidance, Intolerance of Uncertainty and improving problem solving orientation. Twice as many individuals showed clinically significant reductions in excessive worry after treatment compared to the waitlist control. Despite limitations to sample size and power, this study presents promising support for BAW as a practical transdiagnostic treatment for worry.

The Effect of Psychological Skills Training (PST) on Self-Regulation Behavior, Self-Efficacy, and Psychological Skill Use in Military Pilot-Trainees

Set within B. J. Zimmerman’s (1989, A social cognitive view of self-regulated academic learning, Journal of Educational Psychology, Vol. 81, pp. 329–339; and B. J. Zimmerman, 2000, Attaining self-regulation: A social-cognitive perspective, in M. Boekaerts, P. Pintrich, & M. Seidner, Eds., Self-Regulation: Theory, Research, and Applications, pp. 13–39, Orlando, Florida, Academic Press) cyclical model of self-regulation and social–cognitive theory, this study tested the hypothesis that multi-modal psychological skills training (PST) would increase self-regulation behavior, self-efficacy, and psychological skill use in military pilot-trainees experiencing course-related learning difficulties. From pre- to post-intervention, findings showed that specific self-regulation behavior increased linearly. Likewise, significant increases in self-efficacy and psychological skill use occurred, along with concomitant reductions in anxiety and worry. Changes were generally retained at 2-month follow-up. PST highlights potential in modifying pilot-trainee cognitive and behavioral strategies to underpin learning, improve individual/cohort responsiveness, and importantly, cost effectiveness in training provision.

Executive skills in older adults with GAD: Relations with clinical variables and CBT outcome

Although cognitive behavior therapy (CBT) is an effective intervention for treating generalized anxiety disorder (GAD) in older adults, researchers are now considering augmenting the therapy to enhance outcome. We are also long overdue in identifying moderators of CBT response (e.g., cognitive abilities) in late life anxiety. The goals of the current investigation were to examine performance on verbal versus nonverbal tests of executive skills (ES) and to test the relation between ES and clinical indices in older GAD patients. Hierarchical and logistic regression models identified baseline ES predictors of premature termination, homework compliance and quality, and indices of cognitive restructuring, an essential component of CBT. Although the analyses of response on symptom measures did not reveal any significant baseline predictors, an alternative ES grouping scheme showed that those whose ES improved during CBT also responded best in terms of worry reduction. These findings can be applied to the optimization of treatment for older anxiety patients, who are an underserved demographic group.

Mindfulness-Based Cognitive Therapy for Mental Health Professionals—a Pilot Study

We investigated the adherence of mental health professionals to a Mindfulness-Based Cognitive Therapy (MBCT) programme as well as the impact of MBCT on mindful awareness and attention, psychological well-being and distress, state and trait anxiety, worry and satisfaction with life. The design comprised of a prospective uncontrolled intervention study with pre- and post-measurements of meditation adherence and measures of psychological well-being. Twenty-seven mental health professionals participated in an 8-week MBCT programme for relapse prevention of depression, modified for healthy individuals. Their homework, mindful awareness and attention (Mindful Awareness and Attention Scale), general psychological well-being (General Health Questionnaire), state and trait anxiety (State-Trait Anxiety Inventory), satisfaction with life (Satisfaction with Life Scale), general psychopathology (Brief Symptom Inventory) as well as worry (Penn State Worry Questionnaire) were measured at week 1 and 8 during the intervention and at week 20 as follow-up. Twenty four of 27 (88 %) mental health professionals completed the course and were included in the analysis. Of these, 75 % (18 of 24) were female with a mean age of 36 years and a mean experience in cognitive behavioural therapy (CBT) of 6 years. Sixty-three per cent (15 of 24) reported continued practice at 20-week follow-up. A statistically significant improvement of mindful awareness and psychological well-being, with significant reduction in worry, trait anxiety and general psychopathology, was observed in participants who continued some form of meditation practice during the follow-up period. The majority of mental health professionals adhered to the MBCT meditation practice, and the more they practised mindfulness meditation, the more they experienced an increase in mindful awareness and attention, general psychological well-being and a decrease in general psychopathology, trait anxiety and worry.

A Randomized Controlled Trial of Telephone-Delivered Cognitive-Behavioral Therapy for Late-Life Anxiety Disorders

Older adults face a number of barriers to receiving psychotherapy, such as a lack of transportation and access to providers. One way to overcome such barriers is to provide treatment by telephone. The purpose of this study was to examine the effects of cognitive behavioral therapy delivered by telephone (CBT-T) to older adults diagnosed with an anxiety disorder. Randomized controlled trial. Participants' homes. Sixty participants age 60 and older with a diagnosis of generalized anxiety disorder, panic disorder, or anxiety disorder not otherwise specified. CBT-T versus information-only comparison. Coprimary outcomes included worry (Penn State Worry Questionnaire) and general anxiety (State Trait Anxiety Inventory). Secondary outcomes included clinician-rated anxiety (Hamilton Anxiety Rating Scale), anxiety sensitivity (Anxiety Sensitivity Index), depressive symptoms (Beck Depression Inventory), quality of life (SF-36), and sleep (Insomnia Severity Index). Assessments were completed prior to randomization, immediately upon completion of treatment, and 6 months after completing treatment. CBT-T was superior to information-only in reducing general anxiety (ES = 0.71), worry (ES = 0.61), anxiety sensitivity (ES = 0.85), and insomnia (ES = 0.82) at the posttreatment assessment; however, only the reductions in worry were maintained by the 6-month follow-up assessment (ES = 0.80). These results suggest that CBT-T may be efficacious in reducing anxiety and worry in older adults, but additional sessions may be needed to maintain these effects.

Applicability of a cognitive model of worry to children and adolescents

BackgroundIntolerance of uncertainly (IU), cognitive avoidance (CA) and positive beliefs about worry (PB) independently predict worry frequency in older adolescents and adults, and when targeted together in treatment produce significant reductions in both worry and anxiety in this age range. The present study addresses a gap in the literature by testing whether a cognitive model of excessive worry and anxiety incorporating these process variables is applicable to children and adolescents. MethodPrimary and secondary school students (n = 515; aged 7–19 years) completed modified self-report measures of worry frequency, anxiety, IU, CA and PB and a path analysis undertaken to test whether IU was a higher order variable for CA and PB and whether the relationship between IU/CA/PB and anxiety was mediated by worry frequency. ResultsSignificant (bivariate) correlations were observed between the measures of IU, PB, CA, worry and anxiety across the age range. However separate path models had to be fitted for children (aged 7–12 years) and adolescents (aged 13–19) with PB being dropped from the child model. CA was related to anxiety only through worry in children while IU showed direct paths to worry and anxiety in both children and adolescents. ConclusionsCognitive models of persistent worry in adults and older adolescents may, with some modification, have applicability to children. Further testing and refinement of these cognitive models of worry may lead to improvements in existing treatments for anxious youth.

Defusing the risk of borrowing: The psychology of payment protection insurance decisions

Consumers can defuse the financial risks of credit default by taking payment protection insurance (PPI). In two studies, predictions derived from Huber’s risk defusing operator theory of decision making were tested. We investigated the effects on PPI judgements and decisions of previous experience, cognitive appraisal, emotion and changes in PPI cost and level of cover. In Study 1, a randomized groups experiment, 241 high street bank customers were presented with scenarios in which they chose whether or not to purchase PPI. Logistic regression showed that previous experience, the anticipated worry reduction (peace of mind) afforded by PPI, and its perceived value for money, all had direct effects on PPI decisions. In addition, standard regression analysis found that: (1) PPI cost and level of cover significantly predicted the perceived value for money of PPI; and (2) the subjective probability of repayment difficulties predicted anticipated worry about repayment difficulties, which in turn predicted the anticipated worry reduction of PPI. In Study 2, a survey of 300 bank customers, the above direct and indirect effects on PPI decisions were further investigated by path modeling. The final path model was a good fit to the data and confirmed the main relationships described above. Thus, in addition to judgements of the value for money of PPI, worry concerning repayment difficulties, and its anticipated reduction, are strong determinants of consumer credit insurance decisions.

Use of Preoperative Hypnosis to Reduce Postoperative Pain and Anesthesia-Related Side Effects

The purpose of this pilot project was to test the feasibility of hypnosis as a preoperative intervention. The unique features of this study were: (a) use of a standardized nurse-delivered hypnosis protocol, (b) intervention administration immediately prior to surgery in the preoperative holding area, and (c) provision of hypnosis to breast cancer surgery patients receiving general anesthesia. A mixed-method design was used. Data collected from the intervention group and historical control group included demographics, symptom assessments, medication administration, and surgical, anesthesia, and recovery minutes. A semi-structured interview was conducted with the intervention group. A reduction in anxiety, worry, nervousness, sadness, irritability, and distress was found from baseline to postintervention while pain and nausea increased. The results support further exploration of the use of nurse-led preoperative hypnosis.

Mindfulness training increases momentary positive emotions and reward experience in adults vulnerable to depression: A randomized controlled trial.

To examine whether mindfulness-based cognitive therapy (MBCT) increases momentary positive emotions and the ability to make use of natural rewards in daily life. Adults with a life-time history of depression and current residual depressive symptoms (mean age = 43.9 years, SD = 9.6; 75% female; all Caucasian) were randomized to MBCT (n = 64) or waitlist control (CONTROL; n = 66) in a parallel, open-label, randomized controlled trial. The Experience Sampling Method was used to measure momentary positive emotions as well as appraisal of pleasant activities in daily life during 6 days before and after the intervention. Residual depressive symptoms were measured using the 17-item Hamilton Depression Rating Scale (Hamilton, 1960). MBCT compared to CONTROL was associated with significant increases in appraisals of positive emotion (b* = .39) and activity pleasantness (b* = .22) as well as enhanced ability to boost momentary positive emotions by engaging in pleasant activities (b* = .08; all ps < .005). Associations remained significant when corrected for reductions in depressive symptoms or for reductions in negative emotion, rumination, and worry. In the MBCT condition, increases in positive emotion variables were associated with reduction of residual depressive symptoms (all ps < .05). MBCT is associated with increased experience of momentary positive emotions as well as greater appreciation of, and enhanced responsiveness to, pleasant daily-life activities. These changes were unlikely to be pure epiphenomena of decreased depression and, given the role of positive emotions in resilience against depression, may contribute to the protective effects of MBCT against depressive relapse.

The impact of motivational interviewing on resistance in cognitive behavioural therapy for generalized anxiety disorder

The present study simultaneously examined observed resistance and homework compliance in Cognitive Behavioural Therapy (CBT) between those with severe generalized anxiety disorder who did (n =18) and did not (n =17) receive Motivational Interviewing (MI) prior to CBT. Large effects for reduced resistance early in CBT were observed in the MI pretreatment group relative to the no-pretreatment group. Moreover, receiving four sessions of MI was associated with significantly lower levels of resistance, compared to receiving four sessions of CBTalone. Using path analysis, resistance, but not homework compliance, was found to strongly and directly mediate the relationship between treatment group and worry reduction. Findings suggest that MI improves treatment outcomes when added to CBT for generalized anxiety by reducing client resistance to, and increasing client engagement with treatment.

The evolution of worry after breast cancer risk assessment: 6‐year follow‐up of the TRACE study cohort

There is little evidence regarding the long-term psychological implications of breast cancer risk assessment for women at moderate genetic risk. A follow-up study of a trial cohort was conducted to evaluate psychological outcomes and their predictors at 6-year follow-up. A further aim was to examine threshold scores for high cancer worry. Questionnaires were sent to 384 women assessed as moderate risk during a UK trial of genetic assessment (TRACE). Measures included cancer worry, perceived risk, health behaviours, general anxiety, psychological morbidity, optimism, and background variables assessed during TRACE and at 6-year follow-up. Reductions from baseline cancer worry and breast self-examination (BrSE) frequency were maintained 6 years after risk assessment, with relatively consistent levels over short- and long-term follow-up. Provision of risk information led to short-term reductions in perceived risk. During the 6-year period, 43% of women reported having made lifestyle changes and 27% had requested a mammogram. Baseline and post-risk cancer worry were the only significant predictors of long-term cancer worry. Greater worry at baseline predicted more frequent BrSE and higher perceived risk, but not lifestyle change or mammogram requests, at 6 years. Eighteen percent of women reported cancer worry above a threshold of 12.5 at long-term follow-up, compared with 30% at baseline. Overall reductions in cancer worry following moderate risk assessment were maintained in the long term. However, women at risk of sustained high cancer worry should be identified at an early stage in the risk assessment process for more intensive psycho-educational intervention. Copyright © 2010 John Wiley & Sons, Ltd.

Don't worry, be constructive: A randomized controlled feasibility study comparing behaviour therapy singly and combined with constructive worry for insomnia

Based on the lack of research on interventions targeting intrusive and worrisome thinking for insomnia, the aim was to examine whether a constructive worry (CW) intervention adds to the effects of behaviour therapy (BT). A randomized, controlled design was used. The design included a 2-week baseline, a 4-week intervention phase (sleep restriction and stimulus control [BT] or sleep restriction and stimulus control plus constructive worry [BT + CW]), and a 2-week follow-up. Twenty-two patients with primary insomnia participated. The primary outcome was the Anxiety and Preoccupation about Sleep Questionnaire (APSQ), and secondary endpoints were subjective sleep estimates, the Insomnia Severity Index (ISI), and the Work and Social Adjustment Scale (WSAS). Although both conditions produced significant improvements in subjective sleep estimates, no significant group differences over time were shown for total wake time (TWT) and total sleep time (TST). Both interventions resulted in reductions over time in insomnia severity, worry, and dysfunction. Compared to BT, BT + CW led to a larger decrease in insomnia severity at all three time points (controlled d= 1.10-1.68). In comparison with BT, BT + CW resulted in a larger reduction in worry at two of the time points (controlled d= 0.76-1.64). No significant differences between the two conditions were demonstrated for dysfunction. While more participants responded positively to treatment in the BT + CW (80-100%) than in the BT condition (18-27%), none of the participants remitted. The findings suggest that, compared to BT alone, CW might result in additional improvements in insomnia severity and worry. Given the small sample size and short follow-up, future studies are warranted.