Generalized Anxiety Disorder: A Comparison of Symptom Change in Adults Receiving Cognitive-Behavioral Therapy or Applied Relaxation

Department of Psychology, Concordia University, Montreal, Quebec, Canada.
Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 04/2012; 80(3):490-6. DOI: 10.1037/a0028132
Source: PubMed


Generalized anxiety disorder (GAD) is characterized by excessive worry and somatic symptoms of anxiety (e.g., restlessness, muscle tension). Several psychological treatments lead to significant reductions in GAD symptoms by posttreatment. However, little is known about how GAD symptoms change over time. Our main goal was to examine how GAD symptoms changed in relation to one another during 2 distinct but efficacious psychological treatments: cognitive-behavioral therapy (CBT) and applied relaxation (AR). Specifically, we asked whether change in worry accounted for change over time in somatic anxiety (or the reverse) to the same degree in CBT and AR.
We examined data from 57 individuals with GAD enrolled in a randomized controlled trial. Self-report measures of worry and somatic anxiety were obtained daily during treatment.
Although the direction of influence between changes in worry and somatic anxiety was bidirectional to some extent in both treatments, a significant difference was also observed: Change in worry accounted for subsequent change in somatic anxiety to a greater extent in CBT than in AR.
These findings allowed us to identify differences in a mechanism of change in GAD symptoms during 2 treatments and to provide some support for the idea that similarly efficacious treatments may produce symptom change via different mechanisms in a manner that is consistent with the theoretical rationales on which the treatments are based.

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    • "This allowed us to assess whether the levels of the mechanism variables predicted subsequent symptomatic levels throughout treatment and follow - up , con - trolling for prior levels of symptoms ( Bolger and Laurenceau , 2013 ; Collins and Sayer , 2001 ) . At Level 1 of the models ( within - subject ) , we predicted the outcome at Time tþ 1 from each mechanism variable at Time t , and the symptomatic levels at Time t ( Donegan and Dugas , 2012 ) . To assess whether the type of treatment quali - fied these effects , we added an interaction with treatment condi - tion . "
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    ABSTRACT: Background The goal of the study was to examine two central theory-driven mechanisms of change, causal attributions and relational representations, to account for symptomatic improvement in psychodynamic treatment and supportive clinical management, combined with either pharmacotherapy or placebo, in a randomized control trial (RCT) for depression. Method We used data from an RCT for depression, which reported non-significant differences in outcome among patients (N=149) who received supportive-expressive psychotherapy (SET), clinical management combined with pharmacotherapy (CM+MED), or clinical management with placebo pill (CM+PBO) (Barber et al., 2012). Mechanism and outcome measures were administered at intake, mid-treatment, end of treatment, and at a 4-month follow-up. Results Improvements in causal attributions and in relational representations were found across treatments. Changes in causal attributions did not predict subsequent symptomatic level when controlling for prior symptomatic level. In contrast, decrease in negative relational representations predicted subsequent symptom reduction across all treatments, and increase in positive relational representations predicted subsequent symptom reduction only in SET. Limitations The study is limited by its moderate sample size. Additional studies are needed to examine the same questions using additional treatment orientations, such as cognitive treatments. Conclusions Findings demonstrate that changes in negative relational representations may act as a common mechanism of change and precede symptom reduction across psychodynamic therapy and supportive case management combined with either pharmacotherapy or placebo, whereas an increase in positive relational representation may be a mechanism of change specific to psychodynamic therapy.
    Full-text · Article · Dec 2015 · Journal of Affective Disorders
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    • "Hence, it would be important to determine what happens specifi cally in the case of ADs and whether the presence of some specifi c technique can be associated with an increase of therapy duration. Among the techniques with greater empirical support of effi cacy and effectiveness most frequently used, are the techniques of psychoeducation, exposure, cognitive restructuring, or relaxation techniques (Donegan & Dugas, 2012; Hoyer, Beesdo, Gloster, Runge, Höfl er, & Becker, 2009; Öst, Svensson, Hellström, & Lindwall, 2001). Therefore, it is important to study the value of these techniques with regard to treatment duration. "
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    ABSTRACT: Anxiety disorders are one of the disorders most frequently requested for psychological attention. The purpose of this study is to identify the factors that can explain a longer duration of psychological treatment for anxiety disorders. 202 patients from the University Psychology Clinic of the Complutense University of Madrid were analyzed. Multivariate regression analysis showed that the presence of obsessive-compulsive disorder and the application of arousal control techniques followed by modeling and other specific techniques were the best predictors of treatment duration. Reducing as much as possible the number of techniques applied without reducing intervention efficacy is suggested. In some disorders that produce a greater life disorganization, it may be useful to try to organize the patient´s life either as a first goal or at the same time as the intervention program, so as to increase its effectiveness and reduce the number of sessions.
    Full-text · Article · May 2015 · Psicothema
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    • "Two studies of mindfulness-based treatment for depression also found that decreased levels of worry and rumination (change scores) mediated the effect of treatment on depression outcome (Van Aalderen et al., 2012). Similarly, changes in worry (measured daily) have been shown to partially mediate the effect of time on decreased anxiety in CBT and applied relaxation for GAD (Donegan & Dugas, 2012). To the authors' knowledge, there is only one study that has examined changes in content independent RNT and treatment outcome. "
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    ABSTRACT: Repetitive negative thinking (RNT) is a common symptom across depression and anxiety disorders and preliminary evidence suggests that decreases in rumination and worry are related to improvement in depression and anxiety symptoms. However, despite its prevalence, relatively little is known about transdiagnostic RNT and its temporal associations with symptom improvement during treatment. The current study was designed to examine the influence of RNT on subsequent depression and anxiety symptoms during treatment. Participants (n = 131; 52% female; 93% White; M = 34.76 years) were patients presenting for treatment in a brief, cognitive behavior therapy based, partial hospitalization program. Participants completed multiple assessments of depression (Center for the Epidemiological Studies of Depression-10 scale), anxiety (the 7-item Generalized Anxiety Disorder Scale), and repetitive negative thinking (Perseverative Thinking Questionnaire) over the course of treatment. Results indicated statistically significant between and within person effects of RNT on depression and anxiety, even after controlling for the effect of time, previous symptom levels, referral source, and treatment length. RNT explained 22% of the unexplained variability in depression scores and 15% of the unexplained variability in anxiety scores beyond that explained by the control variables. RNT may be an important transdiagnostic treatment target for anxiety and depression. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Mar 2015 · Behaviour Research and Therapy
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