Promoting walking as an adjunct intervention to group cognitive behavioral therapy for anxiety disorders: A pilot group randomized trial

Centre for Physical Activity and Health, School of Public Health, the University of Sydney, Camperdown, NSW, Australia.
Journal of Anxiety Disorders (Impact Factor: 2.96). 08/2008; 22(6):959-68. DOI: 10.1016/j.janxdis.2007.09.010
Source: PubMed


A group randomized trial of adding a home-based walking program to a standard group cognitive behavioral therapy (GCBT+EX) was compared with groups receiving GCBT and educational sessions (GCBT+ED). The study was implemented in an outpatient clinic providing GCBT for clients diagnosed with panic disorder, generalized anxiety disorder or social phobia. Pre- and post-treatment measures included the self-report depression, anxiety, and stress scale (DASS-21) and measures of physical activity. From January 2004 to May 2005, six groups were allocated to GCBT+EX (n=38) and five to GCBT+ED (n=36). Analysis of covariance for completed cases (GCBT+EX, n=21; GCBT+ED, n=20), adjusting for the group design, baseline DASS-21 scores, and anxiety diagnosis showed significant effect for GCBT+EX on depression, anxiety, and stress (regression coefficients=-6.21, -3.41, and -5.14, respectively, p<0.05) compared to the GCBT+ED. The potential of exercise interventions as adjunct to GCBT for anxiety disorder needs to be further explored.

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    • "Two clinical trials [41,42] found that patients suffering from different anxiety disorders achieved higher levels of PA and functional capacity through EX training [42], and that anxiety, depression, and perceived stress declined significantly more strongly in a combined CBT+EX treatment, compared to CBT alone [41]. Patients with social phobia were more likely to benefit from the EX enhancement, compared to patients suffering from other anxiety disorders. "
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    ABSTRACT: Several epidemiological studies have shown that exercise (EX) and physical activity (PA) can prevent or delay the onset of different mental disorders, and have therapeutic benefits when used as sole or adjunct treatment in mental disorders. This review summarizes studies that used EX interventions in patients with anxiety, affective, eating, and substance use disorders, as well as schizophrenia and dementia/mild cognitive impairment. Despite several decades of clinical evidence with EX interventions, controlled studies are sparse in most disorder groups. Preliminary evidence suggests that PA/EX can induce improvements in physical, subjective and disorder-specific clinical outcomes. Potential mechanisms of action are discussed, as well as implications for psychiatric research and practice.
    01/2013; 46 Suppl 1(Suppl 1):S12-21. DOI:10.3961/jpmph.2013.46.S.S12
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    • "To do this, we choose AE as a control condition for several reasons. Like MBSR, AE has been shown to improve both physical and mental health (Penedo and Dahn, 2005), especially symptoms of stress, depression, and anxiety (Petruzzello et al., 1991; Stich, 1998; Ströhle, 2009) in clinical samples of mixed anxiety (e.g., Merom et al., 2007), panic disorder (e.g., Broocks et al., 1998; Dratcu, 2001), and generalized anxiety disorder (e.g., Steptoe et al., 1989; McEntee and Halgin, 1999). As implemented in this study, we matched the amount of individual and group practice for MBSR and AE. "
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    ABSTRACT: Background: Social anxiety disorder (SAD) is characterized by distorted self-views. The goal of this study was to examine whether mindfulness-based stress reduction (MBSR) alters behavioral and brain measures of negative and positive self-views. Methods: Fifty-six adult patients with generalized SAD were randomly assigned to MBSR or a comparison aerobic exercise (AE) program. A self-referential encoding task was administered at baseline and post-intervention to examine changes in behavioral and neural responses in the self-referential brain network during functional magnetic resonance imaging. Patients were cued to decide whether positive and negative social trait adjectives were self-descriptive or in upper case font. Results: Behaviorally, compared to AE, MBSR produced greater decreases in negative self-views, and equivalent increases in positive self-views. Neurally, during negative self versus case, compared to AE, MBSR led to increased brain responses in the posterior cingulate cortex (PCC). There were no differential changes for positive self versus case. Secondary analyses showed that changes in endorsement of negative and positive self-views were associated with decreased social anxiety symptom severity for MBSR, but not AE. Additionally, MBSR-related increases in dorsomedial prefrontal cortex (DMPFC) activity during negative self-view versus case were associated with decreased social anxiety related disability and increased mindfulness. Analysis of neural temporal dynamics revealed MBSR-related changes in the timing of neural responses in the DMPFC and PCC for negative self-view versus case. Conclusion: These findings suggest that MBSR attenuates maladaptive habitual self-views by facilitating automatic (i.e., uninstructed) recruitment of cognitive and attention regulation neural networks. This highlights potentially important links between self-referential and cognitive-attention regulation systems and suggests that MBSR may enhance more adaptive social self-referential processes in patients with SAD.
    Frontiers in Human Neuroscience 11/2012; 6:295. DOI:10.3389/fnhum.2012.00295 · 3.63 Impact Factor
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    • "Further, aerobic exercise training was not statistically superior to relaxation when combined with either paroxetine or placebo in the treatment of patients with PD [99]. Other available pilot studies of structured exercise programs have demonstrated beneficial effects as individual or adjunctive therapies in patients with PTSD [100–102], SP [103] and OCD [104]. However, these studies generally suffer from methodological issues including lack of control groups and small sample sizes. "
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    ABSTRACT: Use of complementary medicines and therapies (CAM) and modification of lifestyle factors such as physical activity, exercise, and diet are being increasingly considered as potential therapeutic options for anxiety disorders. The objective of this metareview was to examine evidence across a broad range of CAM and lifestyle interventions in the treatment of anxiety disorders. In early 2012 we conducted a literature search of PubMed, Scopus, CINAHL, Web of Science, PsycInfo, and the Cochrane Library, for key studies, systematic reviews, and metaanalyses in the area. Our paper found that in respect to treatment of generalized anxiety or specific disorders, CAM evidence revealed current support for the herbal medicine Kava. One isolated study shows benefit for naturopathic medicine, whereas acupuncture, yoga, and Tai chi have tentative supportive evidence, which is hampered by overall poor methodology. The breadth of evidence does not support homeopathy for treating anxiety. Strong support exists for lifestyle modifications including adoption of moderate exercise and mindfulness meditation, whereas dietary improvement, avoidance of caffeine, alcohol, and nicotine offer encouraging preliminary data. In conclusion, certain lifestyle modifications and some CAMs may provide a beneficial role in the treatment of anxiety disorders.
    Evidence-based Complementary and Alternative Medicine 08/2012; 2012(420):809653. DOI:10.1155/2012/809653 · 1.88 Impact Factor
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