Treatment Of Generalized Anxiety Disorder Research Articles

Behavioral Experiments for Intolerance of Uncertainty: A Randomized Clinical Trial for Adults With Generalized Anxiety Disorder

Sophisticated multicomponent treatments for adults with generalized anxiety disorder (GAD) have been developed over the past three decades. Although these comprehensive treatments have produced encouraging results, they appear to be less efficacious than treatments for other anxiety disorders. The goal of this randomized controlled trial is to test a newly developed, highly focused treatment for adults with GAD: Behavioral Experiments for Intolerance of Uncertainty. Sixty (60) participants (51 women, 9 men), with a mean age of 34.60 years (range: 19 to 67 years), were randomized to either treatment (n = 30) or wait-list control (n = 30). Treatment consisted of 12 weekly 1-hour sessions in which participants learned to use behavioral experiments to test their catastrophic beliefs about uncertainty. Assessments were conducted at pre-, mid- and postcondition, and at 6- and 12-month follow-up. The primary outcome was the severity of GAD, and secondary outcomes were worry, depression, somatic anxiety, and intolerance of uncertainty. Using growth curve modeling, we found that (1) the treatment group was superior to the wait-list group in terms of change from pre- to posttest on all outcomes; (2) the combined sample (once wait-listed participants received treatment) evidenced large and significant decreases on all outcomes; and (3) treatment gains were either maintained or increased over the 12-month follow-up period of the study. The new treatment is a promising treatment option for adults with GAD considering that it may be as efficacious as more comprehensive evidence-based psychological treatments for GAD.

Intolerance of uncertainty and information-seeking behavior: Experimental manipulation of threat relevance

Prospective intolerance of uncertainty (IU) involves fear and anxiety in anticipation of future uncertainty and is especially related to worry and generalized anxiety disorder (GAD). Individuals high in IU appraise uncertain situations as threatening and thus may engage in excessive information-seeking behavior to decrease uncertainty. This study aimed to examine the links between prospective IU and information-seeking. Participants (N = 174) high and low in prospective IU completed an ostensible aptitude test (threat stimulus), which was supposedly either excellent (high relevance condition) or poor (low relevance condition) at predicting future outcomes. Thus, the test itself presented an immediate threat, and the awaited test results generated uncertainty. Following the relevance manipulation, participants were given the opportunity to engage in information-seeking behavior by asking questions about the ostensible test and by requesting feedback about the test results. Results indicated that in the high-relevance condition, individuals high and low in IU evidenced similar levels of information-seeking behavior. Conversely, in the low-relevance condition, individuals low in IU evidenced less information-seeking than did individuals high in IU. Furthermore, cognitive appraisals of ambiguous situations were associated with the extent of information-seeking behavior. The implications of these findings for the treatment of GAD are discussed.

Remote cognitive-behavioral therapy for generalized anxiety disorder: A preliminary meta-analysis.

Generalized anxiety disorder (GAD) is a chronic mental health condition that results in significant individual, societal, and economic burden. While cognitive behavioral therapy (CBT) is well established as an efficacious treatment for GAD, individuals have identified several logistical barriers to accessing face-to-face CBT. Remotely delivered treatments address many of these treatment barriers. The aim of the current study was to synthesize the current literature on the efficacy of remote CBT for GAD using a meta-analytic approach. Relevant articles were identified through an electronic database search and 10studies (with 11 remote conditions and 1071 participants) were included in the meta-analysis. Within-group findings indicate that remote CBT for GAD results in large effect sizes from pretreatment to posttreatment (g = 1.30; 95% confidence interval[CI]: 1.03-1.58). Both low intensity and high intensity remote CBT interventions were found to result in large effect sizes (g = 1.36; 95% CI: 1.11-1.61 and g = 0.83; 95% CI: 0.20-1.47, respectively), with no significant differences between the treatment formats (Q1 = 2.28, p = 0.13). Between-group effect sizes were medium in size at posttreatment (g = 0.76; 95% CI: 0.47-1.06). These findings have potential implications for the delivery of evidence-based treatment for GAD and the inclusion of remote methods in stepped care treatment approaches.

A comparison of emotion-focused therapy and cognitive-behavioral therapy in the treatment of generalized anxiety disorder: Results of a feasibility randomized controlled trial.

Generalized anxiety disorder (GAD) is a chronic mental health difficulty typically present in primary care settings. Cognitive-behavioral therapy (CBT) is the psychological intervention with the best evidence for its efficacy for GAD. The development of other psychological interventions can increase client choice. This feasibility trial examined an initial assessment of the efficacy of EFT in comparison to CBT in the treatment of GAD in the context of an Irish public health service. The trial provided information on recruitment, therapist training/adherence, and client retention relevant for a potential noninferiority trial. A randomized controlled trial compared the efficacy of EFT versus CBT for GAD. Both therapies were offered in a 16-20 sessions format. Therapists (n = 8) were trained in both conditions and offered both therapies. Clients were randomly assigned to the two therapies EFT (n = 29) and CBT (n = 29). Outcomes were assessed using several measures, with the Generalized Anxiety Disorder-7 (GAD-7) being the primary outcome. Clients were assessed at baseline, week 16, end of therapy, and at 6-month follow-up. Therapists were able to learn the two models after a short training and showed moderate levels of adherence. Although not statistically significant, the drop out from treatment was 10% for EFT and 27% for CBT. The two therapies showed large pre-post change and similar outcomes across all measures, with these benefits retained at 6-month follow-up. Results suggest that EFT is a potentially promising treatment for GAD. Further investigation is indicated to establish its potential to expand the available psychological therapies for GAD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The relationship between repetitive negative thinking, sleep disturbance, and subjective fatigue in women with Generalized Anxiety Disorder.

ObjectivesFatigue is a prominent symptom of Generalized Anxiety Disorder (GAD). However, the pathways contributing to elevated fatigue in GAD are poorly understood. Sleep disturbance, also prominent in GAD, only partially explains elevated fatigue in GAD. Repetitive negative thinking (RNT) is a cognitive feature of both GAD and sleep disturbance, and RNT has recently also been associated with elevated fatigue. Therefore, this study assessed whether elevated fatigue in GAD is accounted for by a combination of sleep quality and RNT.DesignBetween‐group, correlational design in 64 primarily university‐educated women with and without a GAD diagnosis.MethodsWomen completed self‐report questionnaires assessing RNT experienced in the past few days, previous night’s sleep quality, and current physical and mental fatigue. Hierarchical linear regressions were conducted to assess whether the relationship between GAD status and fatigue is accounted for by RNT and sleep quality.ResultsWomen with GAD reported lower sleep quality, and higher RNT and physical and mental fatigue, compared to women without GAD. Sleep quality partly accounted for group differences in both types of fatigue (β’s > −0.4), whereas RNT fully accounted for group differences in both types of fatigue (β’s > 0.29). The relationship between RNT and both types of fatigue was fully accounted for by sleep quality (β’s > −0.39).ConclusionsThese findings indicate that heightened RNT amongst women with GAD may be associated with elevated physical and mental fatigue via its detrimental effects on sleep quality. Interventions that reduce RNT may help to alleviate fatigue symptoms in women with GAD.Practitioner points Women with Generalized Anxiety Disorder (GAD) have elevated fatigue and repetitive negative thinking (RNT), and poorer self‐reported sleep quality, relative to women without GAD.Whereas sleep quality only partially accounts for elevated fatigue in GAD, RNT fully accounts for elevated fatigue, and the relationship between RNT and fatigue is fully accounted for by sleep quality.These findings provide novel evidence that women with GAD may have elevated fatigue because of the detrimental effects of RNT on sleep.These findings suggest that targeting RNT in treatment for GAD may help to reduce fatigue in GAD, by improving sleep quality.

UK Medical Cannabis Registry: an analysis of clinical outcomes of medicinal cannabis therapy for generalized anxiety disorder

ABSTRACT Objectives Anxiety disorders are one of the most common reasons for seeking treatment with cannabis-based medicinal products (CBMPs). Current pharmacological treatments are variable in efficacy and the endocannabinoid system has been identified as a potential therapeutic target. This study aims to detail the changes in health-related quality-of-life (HRQoL) and clinical safety following CBMP therapy for generalized anxiety disorder. Methods A case series from the UK Medical Cannabis Registry was performed. Primary outcomes included changes from baseline in patient-reported outcome measures (the General Anxiety Disorder Scale (GAD-7), EQ-5D-5L (a measure of health-related quality of life), and Sleep Quality Scale (SQS)) at 1, 3 and 6 months. Statistical significance was defined as p<0.050. Results Sixty-seven patients were treated for generalized anxiety disorder. Statistically significant improvements were observed in GAD-7, EQ-5D-5L Index Value, EQ5D Visual Analog Scale, and SQS scores at 1, 3 and 6 months (p<0.050). Twenty-five (39.1%) patients reported adverse events during the follow-up period. Conclusion This study suggests that CBMPs may be associated with improvements in HRQoL outcomes when used as a treatment for generalized anxiety disorder. These findings must be treated with caution considering limitations of study design; however this data may help inform future clinical studies and practice. Plain Language Summary Anxiety disorders are the most prevalent psychiatric illness type in the United Kingdom, with 8.2 million cases reported in 2010. Generalized anxiety disorder (GAD), the most common anxiety disorder, debilitates, and so reduces the quality of life of those who suffer from the condition. The efficacy of current treatments for GAD varies greatly from person-to-person. The endocannabinoid system in the human body is currently attracting a lot of attention in the scientific community as it can be targeted by chemicals in the cannabis plant to produce therapeutic effects in order to treat GAD. There is, however, a lack of studies investigating the effects of medicinal cannabis in GAD, and so this study aims to explore the drug’s effect on quality of life in patients suffering from GAD. Sixty-seven patients who attended the Sapphire Clinics for medicinal cannabis treatment for GAD were included in the study. The results from this study highlight that medicinal cannabis may improve generalized anxiety disorder, general health-related quality of life, and sleep-specific outcomes at 1, 3, and 6 months after starting treatment. There was also a low number of severe, disabling, and life-threatening adverse events experienced by patients. Although this study explores the effects of medicinal cannabis in a real clinical setting, the results were not compared to other types of treatment. Future studies with a comparator are therefore needed before concluding the true effects of medicinal cannabis in patients with GAD.

Meaning in life, psychological hardiness and death anxiety: individuals with or without generalized anxiety disorder (GAD).

Generalized anxiety disorder (GAD) is a widespread psychiatric disorder. According to the transdiagnostic approach, death anxiety can underpin predominantly somatic manifestations of GAD. Personal resilience factors such as a sense of a meaningful life, and psychological hardiness, which can protect people from developing clinical symptoms, may be lower in individuals with GAD. So far, there has been no study examining the role of meaning in life dimensions, death anxiety, and hardiness in individuals with GAD in Turkey. Thus, we aimed to investigate to what extent the GAD sample differs from the non-anxious control group in terms of death anxiety, meaning in life dimensions, and hardiness. Secondly, we examined how conceptually predicted death anxiety by meaning in life dimensions and hardiness regardless of diagnosis, age, and gender. Just before the spread of the Covid-19 pandemic, we could only recruit 38 individuals with GAD and 31 non-anxious control subjects. The Death Anxiety Scale, The Meaning in Life Questionnaire and the Psychological Hardiness Scale were administered to all the participants. The one-way MANOVA results with Bonferroni adjustment revealed that individuals with GAD significantly differed from the control group in every way. Hierarchical regression analysis displayed that the presence of meaning made the most significant contribution in predicting death anxiety. In conclusion, existential issues such as death anxiety, hardiness, and meaningful life can be emphasized for the treatment of GAD, and the presence of meaning is the most crucial antidote to avoid death anxiety in all individuals.

Agomelatine for the treatment of generalized anxiety disorder: focus on its distinctive mechanism of action.

Generalized anxiety disorder (GAD), the most frequently diagnosed form of anxiety, is usually treated by cognitive-behavioural approaches or medication; in particular, benzodiazepines (acutely) and serotonin or serotonin/noradrenaline reuptake inhibitors (long term). Efficacy, compliance, and acceptability are, however, far from ideal, reinforcing interest in alternative options. Agomelatine, clinically employed in the treatment of major depression, expresses anxiolytic properties in rodents and was effective in the treatment of GAD (including severely ill patients) in several double-blind, short-term (12 weeks) and relapse-prevention (6 months) studies. At active doses, the incidence of adverse effects was no higher than for placebo. Agomelatine possesses a unique binding profile, behaving as a melatonin (MT1/MT2) receptor agonist and 5-HT2C receptor antagonist, yet recognizing neither monoamine transporters nor GABAA receptors. Extensive evidence supports a role for 5-HT2C receptors in the induction of anxious states, and their blockade likely plays a primary role in mediating the anxiolytic actions of agomelatine, including populations in the amygdala and bed nucleus of stria terminalis, as well as the hippocampus. Recruitment of MT receptors in the suprachiasmatic nucleus, thalamic reticular nucleus, and hippocampus appears to fulfil a complimentary role. Downstream of 5-HT2C and MT receptors, modulation of stress-sensitive glutamatergic circuits and altered release of the anxiogenic neuropeptides, corticotrophin-releasing factor, and vasopressin, may be implicated in the actions of agomelatine. To summarize, agomelatine exerts its anxiolytic actions by mechanisms clearly distinct from those of other agents currently employed for the management of GAD.Plain Language Summary How agomelatine helps in the treatment of anxiety disorders Introduction:• Anxiety disorders have a significant negative impact on quality of life.• The most common type of anxiety disorder, called generalized anxiety disorder (GAD), is associated with nervousness and excessive worry.• These symptoms can lead to additional symptoms like tiredness, sleeplessness, irritability, and poor attention.• GAD is generally treated through either cognitive-behavioural therapy or medication. However, widely used drugs like benzodiazepines and serotonin reuptake inhibitors have adverse effects.• Agomelatine, a well-established antidepressant drug, has shown anxiety-lowering (‘anxiolytic’) properties in rats and has been shown to effectively treat GAD with minimal side effects.• However, exactly how it acts on the brain to manage GAD is not yet clear.• Thus, this review aims to shed light on agomelatine’s mechanism of action in treating GAD.Methods:• The authors reviewed studies on how agomelatine treats anxiety in animals.• They also looked at clinical studies on the effects of agomelatine in people with GAD.Results:• The study showed that agomelatine ‘blocks’ a receptor in nerve cells, which plays a role in causing anxiety, called the 5-HT2C receptor.• Blocking this receptor, especially in specific brain regions such as nerve cells of the amygdala, bed nucleus of stria terminalis, and hippocampus, produced the anxiety reduction seen during agomelatine treatment.• Agomelatine also activates the melatonin (MT) receptor, which is known to keep anxiety in check, promote sleep, and maintain the sleep cycle.• Agomelatine should thus tackle sleep disturbances commonly seen in patients with GAD.• Beyond 5-HT2C and MT receptors, signalling molecules in nerve cells that are known to be involved in anxiety disorders (called ‘neurotransmitters’ and ‘neuropeptides’) are also affected by agomelatine.Conclusion:• Agomelatine’s anxiolytic effects are caused by mechanisms that are distinct from those of other medications currently used to treat GAD.• This explains its therapeutic success and minimal adverse side effects.

Role of Primary Care Physician in Management of Generalized Anxiety Disorder

Individual survival would be impossible without anxiety, which is a natural and important emotion. Anxiety is considered a disease that requires treatment when it occurs in the absence of a threat, or in a disproportionate proportion to a threat, as well as when it prevents the affected individual from leading a normal life. Generalized Anxiety Disorder (GAD) is a widespread mental disorder characterized by excessive and difficult-to-control anxiety and concerns. as well as a variety of psychological and physical symptoms. Patients with GAD frequently visit primary care, and it is widely acknowledged that the majority of patients should be treated in this environment. Clinical practice guidelines advocate pharmacological (e.g., SSRIs and venlafaxine) or cognitive behavior therapy as first-line therapies for GAD. There are several proposed etiological explanations for GAD, including Freud's psychoanalytic theory, Stack's interpersonal theory, and the Stress Diathesis Model. The exact pathophysiological process of the disease is not fully understood. Patients with GAD frequently visit primary care, and it is widely acknowledged that the majority of patients should be treated in this environment. Clinical practice guidelines advocate pharmacological (e.g., SSRIs and venlafaxine) or cognitive behavior therapy as first-line therapies for GAD. In this article, we’ll be discussing GAD epidemiology, etiology, evaluation, and treatment.

Efficacy of manual acupuncture versus placebo acupuncture for generalized anxiety disorder (GAD) in perimenopause women: study protocol for a randomized controlled trial

BackgroundGeneralized anxiety disorder (GAD) is common among perimenopausal women. Acupuncture may be an effective treatment for GAD, but evidence is limited. The pathogenesis of GAD is not yet clear, but it is related to the hypothalamic-pituitary-adrenal axis and its excretion, cortisol (CORT), and adrenocorticotropic hormone (ACTH). The object of this study is to evaluate the efficacy of manual acupuncture (MA) versus placebo acupuncture (PA) for perimenopausal women with GAD.MethodsThis study is a single-center, randomized, single-blind clinical trial that will be conducted in the First Affiliated Hospital of Guangzhou University of Chinese Medicine. A total of 112 eligible GAD patients will be randomly assigned (1:1) to receive MA (n=56) or PA (n=56) three times per week for 4 weeks. The primary outcome measure will be the HAMA score. The secondary outcome measures will be the GAD-7 and PSQI scores and the levels of CORT and ACTH. The evaluation will be executed at baseline, 2 weeks, the end of the treatment, and a follow-up 3-month period. All main analyses will be carried out based on the intention-to-treat (ITT) principle.DiscussionThis study intends to compare the efficacy between MA and PA in the treatment of perimenopausal women with GAD and to further study the mechanisms underlying the effect.Trial registrationChinese Clinical Trial Registry ChiCTR2100046604. Registered on 22 May 2021.

Cognitive Behavior Therapy Targeting Intolerance of Uncertainty Versus Selective Serotonin Reuptake Inhibitor for Generalized Anxiety Disorder: A Randomized Clinical Trial

AbstractGiven the high prevalence and adverse outcomes associated with generalized anxiety disorder (GAD), development and expansion of effective treatment modalities are important. The present study compared the effectiveness of cognitive behavior therapy targeting intolerance of uncertainty (CBT-IU) and selective serotonin reuptake inhibitors (SSRIs) for treating GAD. A total of 30 Iranian patients with GAD (Mage = 25.16 ± 6.73) were randomised to receive either CBT-IU (n = 15) or SSRI (n = 15). Measures included the Structured Clinical Interview for DSM-5 (SCID-5), Penn State Worry Questionnaire (PSWQ), Why Worry-II (WW-II), Intolerance of Uncertainty Scale (IUS), and Negative Problem Orientation Questionnaire (NPOQ). Repeated measures analysis of variance tested differential treatment outcomes. The results of intention-to-treat (ITT) analysis indicated that although both CBT-IU and SSRI were effective treatments for GAD, CBT-IU produced significantly better results than SSRI at post-treatment. This clinical trial provides preliminary cross-cultural support for the treatment of GAD using CBT-IU, with findings suggesting that this non-medication intervention reduces GAD symptoms.

Determining the Efficacy of Electronic Cognitive Behavioral Therapy for Generalized Anxiety Disorder Compared to Pharmaceutical Interventions: Protocol for a Quasi-Experimental Study.

BackgroundGeneralized anxiety disorder (GAD) is an extremely prevalent and debilitating mental health disorder. Currently, the gold standard treatment for GAD is cognitive behavioral therapy (CBT) and/or pharmacotherapy. The most common medications used to treat GAD are selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors. While CBT is the gold standard treatment for GAD, it is costly, time-consuming, and often inaccessible. Fortunately, the electronic delivery of CBT (e-CBT) has emerged as a promising solution to address these barriers. e-CBT has shown to offer comparable results to in-person CBT while improving accessibility for patients and time efficiency for clinicians.ObjectiveThis study aims to investigate the treatment efficacy of e-CBT compared to and in conjunction with pharmacotherapy for GAD.MethodsThis study will use a quasi-experimental design to allow patients the freedom to choose which treatment modality they would like to receive. Participants with a diagnosis of GAD will be enrolled in 1 of 3 possible treatment arms: (1) e-CBT, (2) medication, or (3) a combination of e-CBT and medication. The e-CBT program will include a 12-week psychotherapy program delivered through the Online Psychotherapy Tool—a secure, cloud-based, digital mental health platform. The treatment efficacy of e-CBT will be compared with that of medication alone and medication in combination with e-CBT.ResultsThe study received ethics approval in April 2019 and participant recruitment began in June 2019. Participant recruitment has been conducted through social media advertisements, physical advertisements, and physician referrals. To date, 146 participants (e-CBT: n=53; medication: n=49; combination: n=44) have been recruited. Data collection is expected to conclude by June 2021, and data analysis is expected to be completed by October 2021. Linear regression (for continuous outcomes) and binomial regression (for categorical outcomes) analysis will be conducted using interpretive qualitative methods.ConclusionsIf either the efficacy of e-CBT is shown to be comparable to that of medication or the effects of both treatments are augmented when used in tandem, these findings could have major implications on the mental health care system. e-CBT is a more accessible and affordable treatment that could increase mental health care capacity 4-fold if proven viable.Trial RegistrationClinicalTrials.gov NCT04478526; https://clinicaltrials.gov/ct2/show/NCT04478526International Registered Report Identifier (IRRID)DERR1-10.2196/27772

Cognitive-Behavioral Treatment for Generalized Anxiety Disorder: Theoretical Foundations and Empirically Supported Strategies

Cognitive-behavioral therapy (CBT) is the most extensively studied psychotherapy for generalized anxiety disorder (GAD) and has demonstrated large effect sizes compared to waitlist and placebo control. CBT for GAD treatment protocols is based on several cognitive-behavioral models of the disorder that emphasize the role of worry as an avoidance strategy to escape from distressing internal experiences, such as negative emotions, uncomfortable physical sensations, and intrusive images. Cognitive-behavioral models also posit that positive and negative beliefs about worry are instrumental in maintaining the worry process. Common cognitive-behavioral treatment strategies to target these causal mechanisms include psychoeducation, self-monitoring of worry episodes, relaxation techniques, mindfulness exercises, cognitive reappraisal, behavioral experiments to test beliefs about worry, imaginal exposure to core fears, and commitment to valued actions. In this article, we provide an overview of cognitive-behavioral models of GAD and describe the evidence-based treatment strategies that emerged from these models. [ Psychiatr Ann . 2021;51(5):210–215.]

Individualized Homeopathic Medicines in the Treatment of Generalized Anxiety Disorder: A Double-Blind, Randomized, Placebo-Controlled, Pilot Trial

Introduction: Evidence favoring homeopathy in generalized anxiety disorder (GAD) remains scarce. The objective of this pilot trial was to test feasibility of a definitive trial in future. We also experimented whether individualized homeopathic medicines (IH) plus psychological counseling (PC) can produce significantly different effects beyond placebo plus PC in the treatment of GAD. Methods: A double-blind, randomized, placebo-controlled, parallel arm, pilot trial was conducted on 62 GAD patients at the National Institute of Homoeopathy, India. GAD-7 questionnaire and Hamilton Anxiety Scale (HAM-A) were used as the primary and secondary outcomes, respectively, measured at baseline and 3 months. Patients received either IH plus PC (n = 31) or identical-looking placebo plus PC (n = 31). Intention-to-treat sample was analyzed to detect group differences using unpaired t tests. Results: Recruitment and retention rates were 56 and 90%, respectively. Mean age was 31.5 years; 56.5% were male. GAD-7 reductions were non-significantly higher in IH than placebo (p = 0.122). Group differences on HAM-A favored IH significantly (p = 0.018). Effect sizes were small to medium. Calcarea carbonica was the most frequently indicated medicine. No serious adverse events happened. Conclusions: A small but positive direction of anxiolytic effect was observed favoring homeopathy over placebo. A definitive trial appeared feasible in future.

Change talk and sustain talk in treatment of generalized anxiety disorder: A secondary analysis of cognitive behavioral therapy and metacognitive therapy in adult outpatients

Background and objectivesMeasures of patient motivation have proven elusive, showing inconsistent results in relation to psychotherapy outcome. How patients talk about change is an alternative measure of motivation, with potential value in predicting treatment outcome. This study had two aims: (1) to examine if change talk and sustain talk (including its subcategories) predicted reduction in worry levels at post-treatment and 2-year follow-up, and (2) if there were differences between the cognitive behavioral therapy (CBT) and metacognitive therapy (MCT) conditions with respect to change talk. MethodsThis study investigated 24 patients receiving CBT and 27 patients receiving MCT for generalized anxiety disorder (GAD), and coded patients’ utterances in sessions 1 and 4. ResultsChange talk was significantly associated with lower worry levels at post-treatment and 2-year follow-up, beyond initial worry severity and treatment condition. Change talk in session 4, and reduction in sustain talk from session 1 to 4, was positively associated with improvement, whilst sustain talk in session 4 showed a negative relationship. More specifically, commitment statements in session 1 and expressing signs of taking steps at session 4 were associated with reduction in worry levels. Moreover, patients in the MCT condition argued more both for and against change during session 1, but not session 4. LimitationsThe sample size was relatively small. ConclusionsThese results indicate that change talk sustain talk could be important in the treatment of GAD.

Uso de plantas medicinais no tratamento de ansiedade no ambiente acadêmico

Introdução: O Transtorno de Ansiedade Generalizada (TAG) se caracteriza pelos sentimentos vagos desagradáveis e de preocupações excessivas, um mal-estar psíquico, relacionado ao medo, a apreensão e a incerteza, provocando uma tensão e/ou um desconforto antecipado do desconhecido. Algumas plantas medicinais são utilizadas para o tratamento do TAG, como por exemplo, à Matricaria recutita, Valeriana officinalis, Passiflora incarnata e Piper methysticum. Objetivo: O objetivo deste estudo foi delinear a prevalência de sintomatologia de TAG, avaliar as variáveis demográficas, o conhecimento e uso de plantas medicinais no tratamento de TAG no contexto acadêmico. Metodologia: Trata-se de um estudo observacional do tipo transversal, realizado em cursos da área da saúde da Universidade Anhembi Morumbi (UAM) em São Paulo-SP, Brasil. Para esta pesquisa, foram considerados elegíveis os candidatos matriculados em cursos da Escola da Saúde e Bem estar, devidamente matriculados entre o primeiro e sexto ano, com idade igual ou maior que 18 anos. Resultados: Apenas 13,3% dos participantes não se consideram ansiosos, contudo, foi constatado que, mesmo o participante levando em consideração não ser ansioso, se queixou de alguns sintomas físicos, psicológicos ou ambos relacionados a quadros de ansiedade. A pesquisa identificou que 31,6% dos participantes relataram que já fizeram uso de medicamentos alopáticos e 31,1% relataram o uso de plantas medicinais para tratamento de TAG. Conclusão: Mesmo no ambiente acadêmico nota-se que 38,9% dos universitários não possuem conhecimento sobre as terapias alternativas

The effectiveness of Internet-delivered treatment for generalized anxiety disorder: An updated systematic review and meta-analysis.

BackgroundGeneralized anxiety disorder (GAD) is a highly prevalent, chronic disorder associated with impaired quality of life, societal burden, and poor treatment rates. Internet‐delivered interventions may improve the accessibility of treatments and are increasingly being used. This study aimed to update a previous meta‐analysis to determine the effectiveness of available Internet‐delivered interventions in treating symptoms of GAD.MethodSystematic literature searches were conducted (through April 2020) using Embase, PubMed, PsychINFO, and Cochrane to find randomized controlled trials of Internet‐delivered interventions for GAD. Risk of bias was evaluated, and Hedge's g was calculated at posttreatment and follow‐up.ResultsTwenty studies met eligibility criteria and were included in the meta‐analysis. Random‐effect models detected large effect sizes for primary outcomes of anxiety (g = 0.79) and worry (g = 0.75), favoring treatment. Effect sizes for depression, functional impairment, and quality of life were moderate to large. Maintenance of effects at follow‐up seems likely.ConclusionsResults support the effectiveness of Internet‐delivered treatments for GAD. Considerable heterogeneity between studies appeared moderated by variability in the interventions themselves, highlighting the importance of further investigation into the characteristics that may optimize treatment outcomes. Overall, Internet‐delivery appears to be a viable mode of treatment for GAD with potential to relieve existing gaps in the provision of treatment.

Comparative Remission Rates and Tolerability of Drugs for Generalised Anxiety Disorder: A Systematic Review and Network Meta-analysis of Double-Blind Randomized Controlled Trials.

Background: Generalized anxiety disorder (GAD) is one of the most common psychiatric disorders associated with substantial dysfunction and socioeconomic burden. Pharmacotherapy is the first choice for GAD. Remission [Hamilton Anxiety Scale (HAM-A) score ≤7] is regarded as a crucial treatment goal for patients with GAD. There is no up-to-date evidence to compare remission rate and tolerability of all available drugs by using network meta-analysis. Therefore, the goal of our study is to update evidence and determine the best advantageous drugs for GAD in remission rate and tolerability profiles. Method: We performed a systematic review and network meta-analysis of double-blind randomized controlled trials (RCTs). We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, wanfang data, China Biology Medicine and ClinicalTrials.gov from their inception to March 2020 to identify eligible double-blind, RCTs reporting the outcome of remission in adult patients who received any pharmacological treatment for GAD. Two reviewers independently assessed quality of included studies utilizing the Cochrane Collaboration’s risk of bias tool as described in Cochrane Collaboration Handbook and extracted data from all manuscripts. Our outcomes were remission rate (proportion of participants with a final score of seven or less on HAM-A) and tolerability (treatments discontinuations due to adverse events). We calculated summary odds ratios (ORs) and 95% confidence intervals (CIs) of each outcome via pairwise and network meta-analysis with random effects. Results: Overall, 30 studies were included, comprising 32 double-blind RCTs, involving 13,338 participants diagnosed as GAD by DSM-IV criteria. Twenty-eight trials were rated as moderate risk of bias, four trials as low. For remission rate, agomelatine (OR 2.70, 95% CI 1.74–4.19), duloxetine (OR 1.88, 95% CI 1.47–2.40), escitalopram (OR 2.03, 95% CI 1.48–2.78), paroxetine (OR 1.74, 95% CI 1.25–2.42), quetiapine (OR 1.88, 95% CI 1.39–2.55), and venlafaxine (OR 2.28, 95% CI 1.69–3.07) were superior to placebo. For tolerability, sertraline, agomelatine, vortioxetine, and pregabalin were found to be comparable to placebo. However, the others were worse than placebo in terms of tolerability, with ORs ranging between 1.86 (95% CI 1.25–2.75) for tiagabine and 5.98 (95% CI 2.41–14.87) for lorazepam. In head-to-head comparisons, agomelatine, duloxetine, escitalopram, quetiapine, and venlafaxine were more efficacious than tiagabine in terms of remission rate, ORs from 1.66 (95% CI 1.04–2.65) for duloxetine to 2.38 (95% CI 1.32–4.31) for agomelatine. We also found that agomelatine (OR 2.08, 95% CI 1.15–3.75) and venlafaxine (OR 1.76, 95% CI 1.08–2.86) were superior to vortioxetine. Lorazepam and quetiapine were poorly tolerated when compared with other drugs. Conclusions: Of these interventions, only agomelatine manifested better remission with relatively good tolerability but these results were limited by small sample sizes. Duloxetine, escitalopram, venlafaxine, paroxetine, and quetiapine showed better remission but were poorly tolerated.

Repetitive Transcranial Magnetic Stimulation (rTMS): A Large-Scale Retrospective Clinical Data Analysis Indicating rTMS as Effective Treatment for Generalized Anxiety Disorder (GAD)

Background: Typical success rates of rTMS reported in the literature indicate remission and response rates of approximately 45% and 68%, respectively, for Major Depressive Disorder (MDD) (Dunner, Aaronson, Sackeim, Janicak, Carpenter, Boyadjis, & Lanocha, 2014). To date, rTMS is FDA-cleared only for MDD and Obsessive Compulsive Disorder (OCD). This report aims to compare patient response rates reported in the literature to those of a multi-location organization consisting of three clinics, and demonstrates the efficacy of rTMS in treating not only MDD but also GAD. Comorbitiy of the two disorders is so prevalent that some authors suggest that GAD and MDD should be conceived and treated as a single disorder, while others suggest the two disorders should remain as distinct diagnoses, and one a comorbidity of the other (MacNamara, Kotov, & Hajcak 2015). GAD occurs prior to MDD in 54% of cases (Galyamina, Kovalenko, Smagin, & Kudryavtseva, 2017) causing impairment by causing feelings of excessive worry, irritability or restlessness and may include somatic responses such as nausea, palpitations, and insomnia. Methods: A total of 401 patients with a clinical diagnosis of MDD were treated with rTMS at the dorsolateral prefrontal cortex. Remission rates and response magnitudes were compared using an evaluative case report design, and patient data spanning the three clinical locations. Left hemisphere targets received either high-frequency rTMS (120% of MT, 10 Hz for 18 minutes) or intermittent Theta-Burst (120% of MT, 5 Hz for 3:08 minutes). Right hemisphere targets received rTMS (110% or 120% of MT, 1 Hz for 15 minutes) or continuous Theta-Burst (110% of MT. 5 Hz for 39 seconds). Bilateral treatment protocols varied in combinations of standard rTMS and Theta-Burst. Patient progress was monitored using the Patient Health Questionnaire-9 (PHQ-9) for depression and Generalized Anxiety Disorder-7 (GAD-7) for anxiety. Results: In standard with this organization's clinical definitions, patients were considered in remission for scores of 5 or lower for PHQ-9 and GAD-7, for MDD and GAD respectively. For remission rates, 40.40% of patients reported a PHQ-9 score of 5/27 or lower according to the PHQ-9, and 44.03% of patients reported 5/21 or lower, according to the GAD-7. Conversely, response rates (indicated by a fifty percent or greater decrease in scores) were 59.71% for GAD7, and 67.42% for PHQ-9. Conclusion: In this retrospective analysis of three clinics’ outcomes, remission and response outcomes for GAD were similar to outcomes for MDD, indicating that rTMS shows significant efficacy for GAD treatment. A large, sham-controlled, randomized clinical trial controlling for protocols, and demographics is needed to determine TMS for GAD is an effective treatment. Conflicts of Interest: All data was collected from clinics belonging to NeuroStim TMS Centers. Funding: Funding for this study was provided by NeuroStim TMS Centers. References Dunner, D. L., Aaronson, S. T., Sackeim, H. A., Janicak, P. G., Carpenter, L. L., Boyadjis, T., & Lanocha, K. (2014). A multisite, naturalistic, observational study of transcranial magnetic stimulation for patients with pharmacoresistant major depressive disorder: durability of benefit over a 1-year follow-up period. The Journal of clinical psychiatry, 75(12), 1394-1401. Galyamina, A. G., Kovalenko, I. L., Smagin, D. A., & Kudryavtseva, N. N. (2017). Interaction of Depression and Anxiety in the Development of Mixed Anxiety/Depression Disorder. Experimental Studies of the Mechanisms of Comorbidity (review). Neuroscience and Behavioral Physiology, 47(6), 699–713. https://doi.org/10.1007/s11055-017-0458-3 MacNamara, A., Kotov, R., & Hajcak, G. (2015). Diagnostic and Symptom-Based Predictors of Emotional Processing in Generalized Anxiety Disorder and Major Depressive Disorder: An Event-Related Potential Study. Cognitive Therapy and Research, 40(3), 275–289. https://doi.org/10.1007/s10608-015-9717-1

Efficacy of a two-session repetitive negative thinking-focused acceptance and commitment therapy (ACT) protocol for depression and generalized anxiety disorder: A randomized waitlist control trial.

This parallel randomized controlled trial aimed to evaluate the effect of acceptance and commitment therapy (ACT) focused on disrupting repetitive negative thinking (RNT) versus a waitlist control (WLC) in the treatment of depression and generalized anxiety disorder (GAD). Forty-eight participants with a main diagnosis of depression and/or GAD were allocated by means of simple randomization to a 2-session RNT-focused ACT intervention or to the WLC. The primary outcomes were emotional symptoms as measured by the Depression, Anxiety, and Stress Scales-21. Process outcomes included ACT- and RNT-related measures: general RNT, experiential avoidance, cognitive fusion, values, and generalized pliance. At the 1-month follow-up, linear mixed effects models showed that the intervention was efficacious in reducing emotional symptoms (d = 2.42, 95% confidence interval [1.64, 3.19]), with 94.12% of participants in the RNT-focused ACT condition showing clinically significant change in the Depression, Anxiety, and Stress Scales-21 total scores versus 9.09% in the WLC condition (70% vs. 8% in intention-to-treat analysis). The intervention effects were maintained at the 3-month follow-up. No adverse events were found. A very brief RNT-focused ACT intervention was highly effective in the treatment of depression and GAD. (PsycInfo Database Record (c) 2020 APA, all rights reserved).