Treatment Of Worry Research Articles

Examining the latent structure of worry and generalized anxiety in a clinical sample

Generalized anxiety disorder (GAD) is characterized by “pathological” worry, suggesting that GAD worriers differ qualitatively from non-GAD worriers. However, results from taxometric studies of worry in undergraduate and community samples have been mixed and to date, no studies have utilized clinical samples. The current study examined the latent structure of worry and GAD symptoms in a diagnostically heterogeneous clinical sample. Indicators were selected from the Penn State Worry Questionnaire-Abbreviated (n=1175) and the GAD-7 (n=638) and submitted to three taxometric procedures: MAXCOV, MAMBAC, and L-Mode. Results from all three procedures suggested that both worry and generalized anxiety are best conceptualized as dimensional constructs. Findings also indicated that ongoing conceptualization, assessment, and treatment of worry and GAD may be hampered by the application of a categorical framework.

Cross-Sectional and Longitudinal Relations between Working Memory Performance and Worry

Whereas past theorizing has posited that worrying disrupts working memory, the present study aimed to explore the idea that working memory deficits may contribute to the tendency to worry, and perhaps the etiology of Generalized Anxiety Disorder (GAD). College students (N = 198) completed questionnaire measures of worry and anhedonic depression, a clinical interview to assess symptoms of GAD, and two working memory tasks: the n-back task and the operation span (OSPAN) task. Also, a subset of these participants (n = 38) reported their levels of worry and anhedonic depression during the past week again at the end of the academic semester. Initial levels of worry and symptoms of GAD were negatively associated with n-back (but not OSPAN) performance. Furthermore, n-back performance predicted levels of recent worry at follow-up, even after controlling for baseline worry. In contrast, anhedonic depression was not significantly associated with task performance (cross-sectionally or prospectively). Potential implications of these findings for theories and treatment of worry are discussed.

Guided Self-Help for the Management of Worry in Parkinson's Disease: A Pilot Study

Anxiety disorder and anxiety symptomatology are common in Parkinson's disease (PD), with up to 25% patients experiencing significant worry. There is no systematic evidence base for the management of anxiety or anxiety related symptoms such as worry in PD. To investigate whether cognitive therapy, delivered as bibliotherapy, is an effective intervention for worry in PD. 54 participants were randomly allocated to a guided reading group and a control group. The guided reading group were given a CBT based self-help resource called What? Me Worry!?! to work through over eight weeks, with telephone support at two week intervals. Controls were given information about worry only, and one phone call. Measures of worry, intolerance of uncertainty, metacognitions and health status were taken at baseline and after 3 months. Analysable data were obtained for 15 controls and 17 from the guided reading group. Worry and intolerance of uncertainty were significantly reduced in the guided reading group. However, no significant differences were found for the follow up measures between the groups. Bibliotherapy has the potential to be useful and cost effective as a management strategy for the treatment of worry in people with PD.

The effects of reducing worry in patients with persecutory delusions: study protocol for a randomized controlled trial

BackgroundOur approach to advancing the treatment of psychosis is to focus on key single symptoms and develop interventions that target the mechanisms that maintain them. In our theoretical research we have found worry to be an important factor in the development and maintenance of persecutory delusions. Worry brings implausible ideas to mind, keeps them there, and makes the experience distressing. Therefore the aim of the trial is to test the clinical efficacy of a cognitive-behavioral intervention for worry for patients with persecutory delusions and determine how the worry treatment might reduce delusions.Methods/DesignAn explanatory randomized controlled trial - called the Worry Intervention Trial (WIT) - with 150 patients with persecutory delusions will be carried out. Patients will be randomized to the worry intervention in addition to standard care or to standard care. Randomization will be carried out independently, assessments carried out single-blind, and therapy competence and adherence monitored. The study population will be individuals with persecutory delusions and worry in the context of a schizophrenia spectrum diagnosis. They will not have responded adequately to previous treatment. The intervention is a six-session cognitive-behavioral treatment provided over eight weeks. The control condition will be treatment as usual, which is typically antipsychotic medication and regular appointments. The principal hypotheses are that a worry intervention will reduce levels of worry and that it will also reduce the persecutory delusions. Assessments will be carried out at 0 weeks (baseline), 8 weeks (post treatment) and 24 weeks (follow-up). The statistical analysis strategy will follow the intention-to-treat principle and involve the use of linear mixed models to evaluate and estimate the relevant between- and within-subjects effects (allowing for the possibility of missing data). Both traditional regression and newer instrumental variables analyses will examine mediation. The trial is funded by the UK Medical Research Council (MRC)/NHS National Institute of Health Research (NIHR) Efficacy and Mechanism Evaluation (EME) Programme.DiscussionThis will be the first large randomized controlled trial specifically focused upon persecutory delusions. The project will produce a brief, easily administered intervention that can be readily used in mental health services.Trial registrationCurrent Controlled Trials ISRCTN23197625

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.

Examining the Role of Emotional Avoidance in the Relationship Between Posttraumatic Stress Disorder Symptom Severity and Worry

A growing body of literature suggests that worry is a cognitive activity functioning to avoid unpleasant internal experiences such as negative thoughts, emotions, and somatic responses. Given the highly aversive internal events associated with posttraumatic stress disorder (PTSD), individuals experiencing PTSD symptoms following exposure to a traumatic event may be particularly motivated to engage in avoidant regulation strategies such as worry. Surprisingly, however, few studies to date have examined the relationship between PTSD and worry as well as potential factors that might explain this association. Therefore, the goal of this study was to examine the association between PTSD symptom severity and worry and the extent to which emotional avoidance explains this relationship. To this end, 207 college students with a history of traumatic exposure (meeting Criterion A for a PTSD diagnosis) completed a series of questionnaires assessing history of exposure to potentially traumatic events, PTSD symptom severity, emotional avoidance tendencies, and worry. Results demonstrated that PTSD symptom severity was positively associated with worry and emotional avoidance. Further, emotional avoidance was found to fully account for this relationship, providing support for the proposed emotionally avoidant function of worry. The implications of these findings for future research and the treatment of worry among individuals with a history of traumatic exposure are discussed.

A randomised controlled trial of a worry intervention for individuals with persistent persecutory delusions

Recent research has shown that worry is associated with distressing paranoia. Therefore, the aim was to target worry in a therapeutic intervention for individuals with delusions. It was predicted that a worry intervention would reduce levels of worry and paranoia distress. Twenty-four individuals with persistent persecutory delusions and high levels of worry were randomly assigned to receive a four session cognitive-behavioural worry intervention (W-CBT) or treatment as usual (TAU). The worry intervention was specifically designed not to target the content of delusions. In this open-label evaluation, assessments of worry and paranoia were conducted at baseline, at one month (end of treatment) and at two months. The worry intervention achieved a statistically significant reduction in worry which was maintained at two month follow up. A significant reduction in delusional distress was also reported. There was an indication that the worry intervention may also reduce the frequency of paranoid thoughts but this was not statistically significant. In the first trial specifically for persecutory delusions, a brief worry intervention was shown to have benefits. The results support a causal role for worry in paranoid experience.

Enhancing current treatments for anxiety disorders.

Although there continue to be new developments in cognitive behavioral treatments for anxiety disorders, most of these advances have focused on refining existing treatments, rather than on developing new techniques. Many of the fundamental strategies that are successfully used for treating anxiety disorders today (e.g., cognitive restructuring, in vivo exposure, interoceptive exposure, imaginal exposure, relaxation training, response prevention, skills training) have been established for some time now. Instead of developing novel treatments for anxiety disorders, the focus of recent research has been on improving existing treatments and disseminating empirically supported interventions. Examples of recent innovations have included (a) using existing cognitive-behavioral therapy (CBT) techniques for new anxiety-based problems, such as hypochondriasis (Clark et al., 1998; Visser & Bouman, 2001), (b) using CBT in new settings, such as primary care (Power, Simpson, Swanson, & Wallace, 1990; Price, Beck, Nimmer, & Bensen, 2000), (3) delivering existing treatments in new ways, such as incorporating new technology (Newman, Consoli, & Taylor, 1999; Rothbaum, Hodges, & Smith, 1999), (4) delivering treatments more quickly (e.g., Clark et al., 1999), and (5) broadening cognitive and behavioral treatments to include aspects of other approaches, such as family therapies (Daiuto, Baucom, Epstein, & Dutton, 1998; Van Noppen, Steketee, McCorkle, & Pato, 1997). Roemer and Orsillo’s proposed treatment (this issue) for generalized anxiety disorder (GAD) is an example of how traditional CBT can be modified and (ideally) improved upon for a particular problem. The treatment described by the authors is exciting for a number of reasons. First, GAD is often considered to be among the most treatment resistant of the anxiety disorders, suggesting that existing treatments are not as effective as they could be. Adding mindfulness and acceptance-based strategies to standard GAD treatments makes practical sense in light of the fact that these approaches appear to be useful for a number of other conditions previously thought to be resistant to long-term change (e.g., borderline personality disorder; substance use disorders). More important, as reviewed by Roemer and Orsillo, the proposed treatment makes theoretical sense in the context of recent research on the nature and treatment of worry and GAD. Still, Roemer and Orsillo’s article (this issue) gives rise to a number of important issues and questions regarding which strategies should be most helpful for treating anxiety disorders, based on current theory and research; what common and unique elements exist across various psychological treatments for anxiety-based problems; and what directions should be taken as existing treatments continue to be refined and improved upon. The remainder of this commentary provides a brief summary of these issues.

Worry: An electrocortical analysis

Worry has been described as uncontrollable verbally-mediated analytic cognitive activity, or thoughts, concerning future events. To date, worry and the treatment of worry have been assessed primarily by self-report of cognitive activity. The current study assessed worriers and nonworriers during worry and a brief relaxation treatment using EEG alpha and beta measures. Worry was found to be associated with high, overall cortical activation as well as relatively greater left hemisphere activation. Progressive relaxation was associated with attenuation of worriers' left hemisphere asymmetric EEG activation. EEG alpha measures indicated less activation during and after progressive muscular relaxation than during a self-relaxation condition. Implications for theory and assessment of cognitive anxiety are discussed.