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Cognitive-behavioral therapy for generalized anxiety


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As a form of therapy, cognitive behavioral therapy (CBT) is more than a mere “toolbox.” CBT allows us to better understand how the human mind is functioning because it is based on neuroscience and experimental and scientific psychology. At the beginning, the Diagnostic and Statistical Manual of Mental Disorders (DSM) was “nontheoretical,” but nowadays (the most recent version being DSM-5), it is increasingly based on CBT paradigms (with the insertion of important notions such as cognitions and behaviors). This Brief Report presents what we currently know about generalized anxiety disorder (GAD) and how we can treat this condition by nonpharmaceutical means. In the last few years, GAD theories have evolved, becoming more precise about the cognitive functioning of GAD sufferers. Here, we look at current theoretical models and the main techniques of therapeutic care, as well as the advances in research about the “transdiagnostic” process and GAD in childhood. CBT is an effective treatment for GAD, typically leading to reductions in worry, and a study has shown that such therapy is equal to pharmaceutical treatment and more effective 6 months after study completion.
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Brief report
Current theoretical foundations
eneralized anxiety disorder (GAD) has been
regarded as a primary diagnosis since 1987 (Diagnostic
and Statistical Manual of Mental Disorders, third revi-
sion [DSM-III-R]). Previously, GAD had been consid-
ered an “anxiety neurosis.” Its specification as a singular
disorder has allowed the recognition of factors common
to anxiety disorders, for example, anxious anticipation,
cognitive biases, and excessive concern. Additionally,
GAD has specific factors that are not shared with other
anxiety disorders, such as intolerance of uncertainty,
and excessive concerns in several important areas. It
is therefore a diagnosis whose conceptualization has
much evolved over the last 2 decades, and recent stud-
ies on the subject suggest that the individualization of
GAD will continue into the future.1
Nowadays, DSM-52 defines GAD as “the presence
of excessive anxiety and worry about a variety of topics,
events, or activities. Worry occurs more often than not
for at least 6 months and is clearly excessive.” People
suffering from GAD have great difficulty in controlling
these worries. They may also present with edginess or
restlessness, difficulty sleeping, difficulty concentrating,
Keywords: child; cognitive behavioral therapy; generalized anxiety disorder;
practice; transdiagnostic process
Author affiliations: Psychologist in private practice, Eschau, France; Institu-
tion La Doctrine Chrétienne, Strasbourg, France; Strasbourg University, Stras-
bourg, France
Address for correspondence: 31A Rue du Couvent, 67114 Eschau, France
As a form of therapy, cognitive behavioral therapy (CBT)
is more than a mere “toolbox.” CBT allows us to bet-
ter understand how the human mind is functioning be-
cause it is based on neuroscience and experimental and
scientific psychology. At the beginning, the Diagnostic
and Statistical Manual of Mental Disorders (DSM) was
“nontheoretical,” but nowadays (the most recent ver-
sion being DSM-5), it is increasingly based on CBT para-
digms (with the insertion of important notions such as
cognitions and behaviors). This Brief Report presents
what we currently know about generalized anxiety
disorder (GAD) and how we can treat this condition by
nonpharmaceutical means. In the last few years, GAD
theories have evolved, becoming more precise about the
cognitive functioning of GAD sufferers. Here, we look
at current theoretical models and the main techniques
of therapeutic care, as well as the advances in research
about the “transdiagnostic” process and GAD in child-
hood. CBT is an effective treatment for GAD, typically
leading to reductions in worry, and a study has shown
that such therapy is equal to pharmaceutical treatment
and more effective 6 months after study completion.
© 2017, AICH – Servier Research Group Dialogues Clin Neurosci. 2017;19:203-207.
Cognitive-behavioral therapy for generalized
Lucas Borza, PsyM
and an increase in muscle aches or soreness. GAD suf-
ferers are generally burdened by the significant conse-
quences the disorder has on their relationships or on
their functioning.
In CBT, evaluation is crucial. Professionals rely on
their clinical judgment, but they will also use standard-
ized assessment tools to evaluate symptoms.3-7 Exces-
sive worry is the main symptom in GAD. Anxiety is
almost always present in the minds of patients. The
themes of concern are relatively similar to those of the
normal population but are experienced in more cata-
strophic ways. The surrounding world is perceived with
apprehension, vigilance, and pessimism (chronic feeling
of insecurity, loss of contact with the experiential).
The search for reassurance is the second core element.
Anxiety levels are therefore higher than in the normal
population, but they are less intense and more diffuse
than in a panic disorder, for example (Figure 1).
GAD affects approximately 6% of the general
population in France if one considers the entire lifes-
pan.7 The disorder is common and disabling. A recent
review of epidemiological studies in Europe suggests a
12-month prevalence of between 1.7% and 3.75% (be-
ing more common in old age), and the associated func-
tional impairment is similar to that observed with major
depression.8 Comorbidities may be frequent. Indeed,
66.3% of patients present with at least one concomitant
psychopathology9; in 60% of cases, major depression or
another anxious disorder is present10; and 90% of GAD
sufferers are suspected to have a secondary anxious dis-
order, such as social anxiety or panic disorder.11
Concerns described in GAD are considered as a suc-
cession of thoughts in verbal or pictorial form12-14 and not
as a feeling. The emotion of anxiety will be the conse-
quence of these worries and concerns. For instance, one
might think “if I get sick, I will not be able to work any-
more, I can lose my job and cannot support my family, we
will find ourselves on the street…” and so on.
In order to understand the pathology, cognitive psy-
chology attempts to represent the functioning of each
disorder through models. Here, we describe two of
these: Barlow’s model and the model of intolerance of
Barlow’s model15 describes a biological and psycho-
logical vulnerability to the negative elements of life.
Focusing attention on potential threats fosters this vul-
nerability and promotes a perceived inability to control
life events. Concerns have also been addressed as a way
to avoid a stronger emotion. This is important from a
therapeutic point of view. It explains how the disorder
can maintain itself over time (maintaining factors) and
which therapeutic techniques could be applied.
The model of intolerance of uncertainty16-18 is also
very important. The point here is to understand that it is
thought that anxiety is related to the difficulty to tolerate
doubt about future events and possible negative conse-
quences. However, why then don’t people who realize
that nothing bad happens end up worrying less? This
could be explained by the creation of “false beliefs” or
“positive beliefs” about worries. Indeed, worry is a cog-
nitive attempt to generate ways to prevent bad events
from happening and/or to prepare oneself for their oc-
currence. In addition, the goal of not feeling the “full”
emotion is reached. Patients do not question their beliefs
because they are happy that everything goes well. This
is explained in the avoidance model of worry.19-20 That
model also explains that in each situation, people seek
to eliminate an unpleasant thought, emotion, or memo-
ry. Most often, this leads to the anxious thought ending
up at the center of their attention. In addition, anxiety
promotes the avoidance of mental images that are as-
sociated with greater negative emotion. Thinking about
what could happen makes it possible to not suffer from
emotional images that are more emotionally intense.21
Safety behaviors are then set up (frequent calls to check
if everything goes well, hypervigilance about public an-
nouncement information, etc). So, whereas safety behav-
iors and cognitive avoidance will temporarily decrease
anxiety, they will reinforce worries over time.
Brief report
Time (min)
Emotion intensity
Panic disorder
5.0 -
4.5 -
4.0 -
3.5 -
3.0 -
2.5 -
2.0 -
1.5 -
1.0 -
0.5 -
0.0 - 1 3 5 10 15 20 25 30 35 40 45 50
Figure 1. Difference of emotion intensity evolution over time in panic
disorder versus generalized anxiety disorder. GAD, generalized
anxiety disorder.
CBT for generalized anxiety - Borza Dialogues in Clinical Neuroscience - Vol 19 . No. 2 . 2017
In summary, in the cognitive approach, worry can be
used as a coping strategy because people believe in its
usefulness. Indeed, some GAD sufferers affirm that it
would not be normal if they didn’t worry about their
family or their jobs, or even that it would increase the
risk that an accident would occur. Sometimes, magical
thoughts are present and very resistant to change.
It is fundamental to explore and evaluate the beliefs
about the function of concerns. They are powerful pre-
disposing and maintaining factors. It is the same with
patients’ perception of their own emotions, which are
often considered intolerable. They feel the need to sup-
press them as fast as they can (short-term strategy).22-26
Practical interventions
CBT as treatment for GAD includes the development
of a functional analysis, providing information through
psychoeducation, experimentation with new behaviors
and emotions (exposition, relaxation), and a cognitive
Functional analysis
Functional analysis makes it possible to specify where,
when, with what frequency, with what intensity, and
under what circumstances the anxious response is trig-
gered. It is performed with the patient and integrates
the factors maintaining the difficulties. This functional
analysis is crucial to the smooth running of therapy
because it gradually introduces important notions of
psychology. It makes it possible to visualize the mental
functioning of the person, which is already therapeutic
in and of itself.
Psychoeducation can easily be the next step. It is gener-
ally crucial because it makes it possible to understand
what the future therapeutic tools will be and facilitates
the increase in motivation to change. Patients begin to
think in a different way about which behaviors could be
the most useful.
The emotional and behavioral approach
The emotional and behavioral approach is generally fa-
vored. The therapist tries to teach relaxation in order to
instruct how to create positive emotions, not to manage
negative ones. There is a double effect as follows: (i) the
provision of a “psychological tool” to prepare for ex-
position exercises; relaxation allows desensitization of
anxiogenic situations; and (ii) a balancing of the gener-
al mood by adding “cognitive break times” in thoughts
and worries.
The behavioral dimension of CBT is the most im-
portant. Patients will be able to expose themselves
to their own emotions and so will be able to learn
how to fight maintaining factors and avoidance
behaviors that perpetuate the disorder. The cogni-
tive process that is sought is habituation. It is the
acceptance of thoughts as normal and nonblocking
that initiates cognitive work. An example of men-
tal exposition is the instruction “think the worst.
This strategy allows a rapid and effective reduction
in avoidance. Exposure to anxiety allows patients
to remain in the presence of images related to their
possible concerns (disturbing images that are usu-
ally avoided), in order to encourage emotional ha-
bituation. Patients can learn to tolerate their fears,
which will allow them to think less often and less
intensely about their worries.
The cognitive approach
The cognitive approach often begins with a self-ob-
servation that patients will carry out on their own
thoughts. Can the thoughts be spotted? Can patients
isolate them from emotions? The aim of the cognitive
work is to help patients take a step back from their
automatic thoughts and to be disjointed from those
worries. The third wave in CBT (mindfulness) adopted
this principle to create its therapeutic program with a
different form.
In a second step, therapy tends to modify the con-
tent of thoughts to reach a more objective evaluation
of situations. The goal is to struggle against cognitive
biases, such as overgeneralization or maximization of
danger. A second evaluation of situations is possible
by looking for objective indicators that allow relativiz-
ing. It is also possible to evaluate the consequences of
worry and to understand subtle avoidance. The thera-
pist tries to help patients to fully treat anxious antici-
pations, make them aware of danger patterns, and pro-
pose alternatives to catastrophism (overestimation of
risk). 27
Brief report
GAD in children and the
transdiagnostic process
Children, too, can be worried in a pathological way.
Anxieties are normal during development, but with poor
emotional management they can become problematic.
Always considering the “what if?” they ask a lot of ques-
tions to be sure and certain and sometimes they try to
predict every possible scenario. Attentional focus on
the threat appears to be a bias predisposing to GAD.28,29
Prompt treatment would seem important to prevent this
“cognitive habit” from becoming anchored because in-
tolerance of uncertainty can be the “fuel” of anxiety.30
Children with GAD show difficulty concentrating,
and they are always thinking about what’s next. They
need reassurance and approval for small steps and
avoid a lot of uncertain situations. They try to minimize
risks. They can present with perfectionism, a great fear
of making mistakes and a fear of criticism. They also
show metacognitive bias by thinking that worries will
prevent tragedies.
A child with GAD can look like he or she has de-
pression, whereas the real problem is closer to inhibi-
tion and resignation. Psychological work with children
and adolescents requires a lot of imagination. Clinicians
always need to create educational support and adapt
psychiatric classification to children.
CBT as a treatment for GAD has been established as
an excellent way to change pathological worries into
normal worries. A lot of research must still be done to
improve therapeutic tools that facilitate distancing one-
self from anxious thoughts. Current science has achieved
a good understanding of psychological mechanisms in
GAD, and further research in transdiagnostic fields may
provide new approaches to GAD treatment. o
Acknowledgments/Conflict of Interest: The author declares no conflict
of interest.
1. Haute Autorite de Santé. Affections psychiatriques de longue durée. Trou-
bles anxieux graves. Paris, France: HAS; 2007.
2. American Psychiatric Association. Diagnostic and Statistical Manual of
Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association;
3. Brown, TA, Barlow DH. Treatments That Work: Anxiety and Related Dis-
orders Interview Schedule for DSM-5. New York, NY: Oxford University Press;
4. First MB, Spitzer RL, Gibbon M, Williams JB. Structured Clinical Interview
for DSM-IV (SCID). New York, NY: Biometrics Research, New York State Psy-
chiatric Institute; 1998.
5. Silverman WK, Albano AM. Anxiety Disorders Interview Schedule for
DSM-IV: Child Version, Child And Parent Interview Schedules. San Antonio, TX:
Psychological Corporation; 1996.
6. Spitzer R, Kroenke K, Williams J, Lowe B. A brief measure for assess-
ing generalized anxiety disorder. Arch Intern Med. 2006;166(10):1092-1097.
7. Dugas MJ, Freeston MH, Lachance S, et al. The worry and anxiety
questionnaire: initial validation in nonclinical and clinical samples. Paper
presented at: World Congress of Behavioral and Cognitive Therapies; July
1995; Copenhagen, Denmark.
8. Agence Nationale d’Accréditationale d’Accréditation et d’Evalua-
tion en Santé. Diagnostic et prise en charge en ambulatoire du trouble
anxieux généralisé de l’adulte. Recomm Pour La Prat Clin. 2001:1-9.
9. Wittchen HU, Zhao S, Kessler RC, Eaton WW. DSM-III-R generalized
anxiety disorder in the National Comorbidity Survey. Arch Gen Psychiatry.
10. Nutt D, Argyropoulos S, Hood S, Potokar J. Generalized anxiety disor-
der: a comorbid disease. Eur Neuropsychopharmacol. 2006;16(suppl 2):S109-
11. Barlow DH, Rapee RM, Brown TA. Behavioral treatment of general-
ized anxiety disorder. Behav Ther. 1992;23(4):551-570.
12. Lader M. Generalized anxiety disorder. Encyclopedia Psychopharmacol.
13. Borkovec TD, Robinson E, Pruzinsky T, DePree JA. Preliminary ex-
ploration of worry: some characteristics and processes. Behav Res Ther.
14. Macleod AK, Williams JM, Bekerian DA. Worry is reasonable: the role
of explanations in pessimism about future personal events. J Abnorm Psy-
chol. 1991;100(4):478-486.
15. Barlow DH, Di Nardo PA. The diagnosis of generalized anxiety
disorder: development, current status, and future directions. In Rap-
ee RM, Barlow DH, eds. Chronic Anxiety: Generalized Anxiety Disorder,
and Mixed Anxiety–Depression. New York, NY: Guilford Press; 1991:95-
16. Mogg K, Mathews A, Weinman J. Memory bias in clinical anxiety. J
Abnorm Psychol. 1987;96(2):94-98.
17. Dugas MJ, Freeston MH, Ladouceur R. Intolerance of uncertainty and
problem orientation in worry. Cogn Ther Res. 1997;21(6):593-606.
18. Dugas MJ, Gagnon F, Ladouceur R, Freeston MH. Generalized anxi-
ety disorder: a preliminary test of a conceptual model. Behav Res Ther.
19. Borkovec TD. The nature, functions, and origins of worry. In Davey
GC, Tallis F, eds. Worrying: Perspectives on Theory, Assessment and Treatment.
Oxford, UK: Wiley; 1994:5-33.
20. Borkovec TD, Alcaine O, Behar ES. Avoidance theory of worry and
generalized anxiety disorder. In Heimberg R, Mennin D, Turk C, eds. Gen-
eralized Anxiety Disorder: Advances in Research and Practice. New York, NY:
Guilford press; 2004:77-108.
21. Hoyer J, Becker ES, Roth WT. Characteristics of worry in GAD patients,
social phobics, and controls. Depress Anxiety. 2001;13(2):89-96.
22. Mennin DS, Turk CL, Heimberg R, Carmin C. Focusing on the regula-
tion of emotion: a new direction for conceptualizing and treating gener-
alized anxiety disorder. In: Reinecke MA, Clark DA, eds. Cognitive Therapy
Across the Lifespan: Evidence and Practice. New York, NY: Cambridge Univer-
sity Press; 2004:60-89.
23. Cisler JM, Olatunji BO, Feldner MT, Forsyth JP. Emotion regulation
and the anxiety disorders: an integrative review. J Psycopathol Behav Assess.
CBT for generalized anxiety - Borza Dialogues in Clinical Neuroscience - Vol 19 . No. 2 . 2017
24. ThayerJF, Lane RD. A model of neurovisceral integration in emotion
regulation and dysregulation. J Affect Disord. 2000;61(3):201-216.
25. Dugas M, Ladouceur R. Treatment of GAD. Targeting intolerance
of uncertainty in two types of worry. Behav Modif. 2000;24(5):635-
26. Dugas MJ, Letarte H, Rhéaume J, et al. Worry and problem solv-
ing: evidence of a specific relationship. Cogn Ther Res. 1995;19:109-
27. Cottraux J. Les Thérapies Comportementales et Cognitives. 3rd ed. Paris,
France: Masson; 1998.
28. Waters AM, Bradley BP, Mogg K. Biased attention to threat in pae-
diatric anxiety disorders (generalized anxiety disorder, social phobia, spe-
cific phobia, separation anxiety disorder) as a function of “distress” versus
“fear” diagnostic categorization. Psychol Med. 2014;44(3)607-616.
29. Armstrong T, Zald DH, Olatunji BO. Attentional control in OCD and
GAD: specificity and associations with core cognitive symptoms. Behav Res
Ther. 2011;49(11):756-762.
30. Einstein, Danielle A. Extension of the transdiagnostic model to focus
on intolerance of uncertainty: a review of the literature and implications
for treatment. Clin Psychol Sci Pract. 2014;21(3):1468-2850.
Terapia cognitiva-conductual para la ansiedad
La terapia cognitiva-conductual (TCC), como una forma
de terapia, es más que una mera “caja de herramien-
tas”. La TCC permite una mejor comprensión de cómo
funciona la mente humana ya que se basa en las neu-
rociencias y en la psicología experimental y científica. El
Manual Diagnóstico y Estadístico de los Trastornos Men-
tales (DSM) inicialmente fue “ateórico”, pero actual-
mente (la versión más reciente, el DSM 5) se basa cada
vez más en paradigmas de TCC (con la inserción de im-
portantes nociones tales como cogniciones y conductas).
Este reporte breve presenta el conocimiento actual so-
bre el trastorno de ansiedad generalizada (TAG) y cómo
puede ser tratada esta condición a través de medios no
farmacológicos. En los últimos años, las teorías del TAG
han evolucionado, llegando a ser más precisas acerca
del funcionamiento cognitivo de quienes lo padecen.
En este artículo se revisan los modelos teóricos actuales
y las principales técnicas de manejo terapéutico, como
también los avances en la investigación sobre el proce-
so “transdiagnóstico” y el TAG en la niñez. La TCC es
un tratamiento efectivo para el TAG y lo característico
es que reduzca las preocupaciones. Un estudio ha mos-
trado que dicha terapia es equivalente al tratamiento
farmacológico y más efectiva a los seis meses de haber
completado el estudio.
La thérapie cognitivo-comportementale pour
l’anxiété généralisée
Mode de traitement, la thérapie cognitivo-comporte-
mentale (TCC) est plus qu’une simple «boîte à outils ».
Basée sur les neurosciences et sur la psychologie scien-
tifique et expérimentale, la TCC nous permet de mieux
comprendre le fonctionnement cognitif chez l’homme.
A ses débuts, le DSM (Diagnostic and Statistical Manual
of Mental Disorders) était “non théorique”, mais au-
jourd’hui (la version la plus récente étant le DSM-5), il
se base de plus en plus sur des modèles de TCC (avec
l’insertion de notions importantes comme la cognition
et le comportement). Nous présentons ici brièvement
nos connaissances actuelles sur l’anxiété généralisée
(AG) et ses moyens de traitement non médicamenteux.
Ces dernières années, les théories sur l’AG ont évolué
en se précisant sur le fonctionnement cognitif des per-
sonnes qui en souffrent. Nous examinons ici les modèles
théoriques actuels et les principales techniques de soin
thérapeutique, ainsi que les avancées de la recherche
sur le processus « transdiagnostique » et l’AG dans l’en-
fance. La TCC est un traitement efficace de l’AG, dimi-
nuant typiquement l’inquiétude excessive et une étude
a montré qu’un tel traitement est équivalent à un trai-
tement médicamenteux et plus efficace 6 mois après la
fin de l’étude.
... Interventions like yoga, Tai Chi, meditation and mindfulness are built on this evidence (National Center for Complementary and Integrative Health, n.d.; Robins et al., 2012;Woodyard, 2011). Also, building on this evidence are interventions including some variations of CBT programs where mind-body processes are incorporated (Borza, 2017;Lee & Cho, 2021). ...
... Furthermore, some variations of CBT were also included, e.g., mindfulness based cognitive therapy or when using the emotional and behavioral approach (e.g. patient learning relaxation), or the cognitive approach (mindfulness approach) (Borza, 2017;Lee & Cho, 2021). Studies were included regardless of intervention duration, type of publication, year of publication and publication status. ...
Background Living with atrial fibrillation (AF) has a negative impact on patients’ mental health, including their emotional, psychological and social well-being . This decrease in mental health can result in increased anxiety and worsening of physical symptoms demonstrating a mind-body connection. Mind-body interventions (MBIs) e.g., yoga, relaxation and some variants of cognitive behavioral therapy (CBT) are based on the perspective that mental and physical health affect each other, which is why MBIs potentially can have a positive effect on anxiety and poor mental health among patients with AF. Aim To investigate whether MBIs have an effect on mental health outcomes in adults with AF. Method We conducted a systematic review searching PubMed, Embase, Cochrane and CINAHL. The primary outcomes were mental health including anxiety. Secondary outcomes included health related quality of life (HRQoL) and physical factors. Results Five randomized clinical trials (three Swedish, one Chinese, one American) were included with a total of 431 participants. Interventions included two variants of CBT in two studies, yoga in two others, and a resiliency training Program in one. Yoga and CBT had a positive effect on mental health. CBT and a Relaxation Response Resiliency Program had no effect on anxiety. A positive effect of CBT on HRQoL and depression were found in all studies and on blood pressure and heart rate in one yoga study. Conclusion This review indicates that MBIs have a positive effect on mental health in patients with AF with no specific effects noted on anxiety. More research is needed.
... Cognitive behavior therapy (CBT), as a psychotherapeutic treatment, is considered the gold standard for treating GAD (7). CBT better demonstrates how the human mind functions because it is based on an experimental and scientific psychology (8). Hence, CBT for GAD involves cognitive therapy to address worry and cognitive biases and relaxation to handle tension and imaginal exposure to catastrophic images and stressful situations (9). ...
... It typically leads to reductions in worry. Such therapy is equal to pharmaceutical treatment and more effective 6 months after study completion (8). ...
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Objective The study aimed to ascertain the comparative efficacy of these two forms on reducing anxiety scores of scales in patients with a generalized anxiety disorder (GAD) by examining the available evidence for face-to-face cognitive behavior therapy (CBT) and internet-based cognitive behavior therapy (ICBT). Moreover, this study attempted to determine whether ICBT can obtain similar benefits as CBT for GAD patients during coronavirus disease 2019 (COVID-19) due to the quarantine policy and the requirement of social distance.Methods This meta-analysis was registered with the International Prospective Register of Systematic Reviews (PROSPERO) according to the guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement (registration number CRD42021241938). Therefore, a meta-analysis of randomized controlled trials (RCTs) examining CBT or ICBT was conducted in this study to treat GAD patients diagnosed with DMS-IV. The researchers searched PubMed, MEDLINE, Embase, PsycINFO, and the Cochrane Database of Systematic Reviews for relevant studies published from 2000 to July 5, 2022. Evidence from RCTs was synthesized by Review Manager 5.4 as mean difference (MD) for change in scores of scales through a random-effects meta-analysis.ResultsA total of 26 trials representing 1,687 participants were pooled. The results demonstrated that ICBT and CBT were very close in the effect size of treating GAD (MD = −2.35 vs. MD = −2.79). Moreover, they still exhibited a similar response (MD = −3.45 vs. MD = −2.91) after studies with active control were removed.Conclusion Regarding the treatment of GAD, ICBT can achieve a similar therapeutic effect as CBT and could be CBT's candidate substitute, especially in the COVID-19 pandemic era, since the internet plays a crucial role in handling social space constraints.Systematic Review Registration, identifier CRD42021241938.
... Cognitive Behavioural Therapy (CBT) • Exposure therapy • Medications (Source:Borza et al., 2017;McGuire et al., 2014) Definition of anxiety-related disorders. ...
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The study aims to develop an Anxiety-Related Disorders Jigsaw Puzzle (ADJP) as an intervention tool and to determine its effectiveness in enhancing children's mental health literacy on anxiety-related disorders. The ADJP contained four modules defining anxiety-related disorders, symptoms, risk factors, and prevention strategies. Seven subject-matter experts and participants evaluated these modules, and feedback was used to improve the tool further. A one-group pretest-posttest quasi-experimental design was then used to test the ADJP's efficacy in enhancing knowledge of anxiety-related disorders among primary school students (N=35). The results showed significant differences in anxiety literacy (A-Lit) scores between the intervention and control groups, implying that the ADJP intervention effectively enhanced the knowledge of anxiety-related disorders among study participants. Findings suggest the tool could be used as a mental health literacy resource for classroom activities to improve students' awareness of anxiety-related disorders.
... [29][30][31][32] CBT has been used to treat a variety of mental and somatic illnesses, including depression, anxiety disorders, chronic pain, eating disorders, schizophrenia, obsessive-compulsive disorders and post-traumatic stress disorder. 12,[33][34][35][36][37][38] A range of CBT interventions and therapy studies have been conducted to address other health issues such as insomnia and stress. 39,40 Behavioral strategies in CBT focus on overcoming avoidance, engaging in prosocial behavior and achieving selfcare. ...
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Heart failure (HF) remains a major cause of morbidity, mortality and healthcare costs, despite available treatments. Psychological issues such as depression, anxiety and poor self-care are prevalent in HF patients. Such issues adversely affect patients' daily lives and increase hospitalization and mortality rates; therefore, effective approaches to address these are needed. Cognitive-behavioral therapy (CBT) has been proposed as potentially useful for psychological comorbidities in HF patients, but its efficacy is not well-established. This narrative review aimed to summarize the evidence on the effectiveness of CBT for HF patients. A search was conducted using PubMed and Google Scholar for randomized controlled trials (RCTs) on CBT for HF patients. Ten studies (nine RCTs and one case study) were included in the review. CBT was found to be an effective intervention for managing depression, anxiety, low quality of life, and impaired social and physical functioning in HF patients. The results suggest that CBT can improve psychological well-being and enhance the benefits of rehabilitation programs. Face-to-face CBT appears to be superior to conventional therapy and can be implemented in cardiac rehabilitation settings. Further research is needed to evaluate the efficacy of internet-based CBT for cardiac patients and identify factors that promote treatment adherence.
... In cognitive behavioral theory, such relationships are understood in terms of the dynamic, cyclical interactions between emotional feelings of anxiety and their associated thoughts, somatic perceptions, and behaviors [26]. While correlation with anxiety disorder subtypes has not been examined in this study, evidence suggests that chronic, pervasive anxiety disorders such as generalized anxiety disorder are more common than anxiety disorders triggered acutely, such as panic disorder [27]. ...
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Background Anxiety disorders are the most prevalent mental disorders globally, with a substantial impact on quality of life. The prevalence of anxiety disorders has increased substantially following the COVID-19 pandemic, and it is likely to be further affected by a global economic recession. Understanding anxiety themes and how they change over time and across countries is crucial for preventive and treatment strategies. Objective The aim of this study was to track the trends in anxiety themes between 2004 and 2020 in the 50 most populous countries with high volumes of internet search data. This study extends previous research by using a novel search-based methodology and including a longer time span and more countries at different income levels. Methods We used a crowdsourced questionnaire, alongside Bing search query data and Google Trends search volume data, to identify themes associated with anxiety disorders across 50 countries from 2004 to 2020. We analyzed themes and their mutual interactions and investigated the associations between countries’ socioeconomic attributes and anxiety themes using time-series linear models. This study was approved by the Microsoft Research Institutional Review Board. ResultsQuery volume for anxiety themes was highly stable in countries from 2004 to 2019 (Spearman r=0.89) and moderately correlated with geography (r=0.49 in 2019). Anxiety themes were predominantly long-term and personal, with “having kids,” “pregnancy,” and “job” the most voluminous themes in most countries and years. In 2020, “COVID-19” became a dominant theme in 27 countries. Countries with a constant volume of anxiety themes over time had lower fragile state indexes (P=.007) and higher individualism (P=.003). An increase in the volume of the most searched anxiety themes was associated with a reduction in the volume of the remaining themes in 13 countries and an increase in 17 countries, and these 30 countries had a lower prevalence of mental disorders (P
... Cognitive function refers to the ability of the human brain to process, store, and extract information, including language information, intellectual skills, and cognitive strategies. Cognitive dysfunction includes language, perception, memory, calculation, comprehension, and judgment obstacles (5). POCD refers to patients who have no mental illness before surgery, and their cognitive function deteriorates slightly after surgical anesthesia, which is mainly manifested as learning difficulties, memory decline, and mental difficulties (6). ...
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The study aimed to explore the influence of Dexmedetomidine (Dex) on cognitive function and inflammatory factors in rats after cardiac surgery under cardiopulmonary bypass (CPB). For this purpose, 30 healthy male SD rats were reared in a quiet and clean environment with alternating light for 12 hours. They were rolled randomly into 3 groups, each with 10 rats, namely the control (Ctrl) group, the experimental group, and the Dex group. The rats in the Ctrl were not treated, and the rats in the experimental group were intraperitoneally injected with 50μg/kg saline. After that, cardiac surgery was performed under CPB. Rats in the Dex group were injected with 50 μg/kg Dex intraperitoneally and underwent cardiac surgery under CPB. The Morris water maze (MWM) experiment was performed to test the learning and memory abilities and spatial positioning abilities of SD rats. Enzyme-linked immunosorbent assay (ELISA method) was adopted to detect the contents of TNF-α, IL-6, and IL-1β. Fluorescence quantitative PCR was applied to determine the mRNA expression levels of TNF-α, IL-6, and IL-1β in the hippocampus. Results showed that in the MWM experiment, in contrast with the Ctrl, the escape latency of the experimental group and the Dex group after surgery were prolonged (P<0.05), and the times they crossed platforms reduced (P<0.05). In contrast with the experimental group, the escape latency of the Dex group shortened, and the times they crossed platforms increased. ELISA suggested that in contrast with the experimental group, the concentrations of TNF-α, IL-6, and IL-1β in the Ctrl decreased (P<0.05), and those in the Dex group decreased slightly. In the fluorescence quantitative PCR experiment, in contrast with the experimental group, the mRNA expression levels of TNF-α, IL-6, and IL-1β in the Ctrl increased, and those in the Dex group decreased slightly. Then Dex can improve the cognitive dysfunction of rats undergoing cardiac surgery under CPB, and its molecular mechanism may be to reduce the inflammation around the heart and hippocampus.
Conference Paper
We present ReWIND, a story-based serious game to help players learn cognitive behavioral therapy (CBT) strategies that are useful for tackling anxiety disorders. ReWIND artfully weaves CBT into the anxiety-relevant sub-stories encapsulated as quests in the game and implements game mechanics simulating CBT strategies such as cognitive restructuring. Finally, ReWIND reinforces learning of the CBT strategies through reflection dialogs, quest summaries and repetition of a CBT strategy across different quests. ReWIND offers a scalable framework to extend the game to cover many different anxiety scenarios and CBT strategies.
Although mental health conditions experienced by young athletes also present among nonathletes the prevalence of each disorder may differ in these populations. For each mental health concern, there are athlete-specific factors that may impress upon the athlete’s health, well-being, and performance, as well as athlete-specific treatment considerations. In this chapter, we outline a range of common mental health concerns, apply these to the athlete experience, and present a series of case studies. Topics of focus include mood and anxiety conditions and concerns, obsessive-compulsive and related presentations, trauma- and stressor-related concerns, dissociative experiences in athletic pursuits, feeding and eating conditions, neurodevelopmental conditions, substance-related concerns, and suicide and self-injurious behavior, with additional sections on minority stress experiences and psychological resilience. We describe how such concerns may be identified in athletes, how they impact performance, and how they may be best treated. With proper prevention, identification, and mental health support, athletes can reduce their vulnerability to mental health struggles and be more resilient so as to bounce back from all kinds of adversities, including their competitive sport environments, injuries, and beyond.KeywordsYoung athleteSport performancePsychological resilienceMental healthTraumaAnxietySubstance abuseNeurodevelopmental disordersSuicideSelf-injury
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Background Generalized Anxiety Disorder (GAD) causes a person's life to be full of worries by involving cognitive processes and not tolerating uncertainty and increasing worry and affecting the quality of sleep and attention of these people, and disrupting life functions. Objective This study investigated the effectiveness of cognitive-behavioral therapy (CBT) on anxiety, physical symptoms, worry, and attention deficits in people with GAD. Methods It was a quasi-experimental pre-test and post-test study with an experimental group and a control group. In this study, 30 women with GAD were selected using a voluntary sampling method. After matching, participants were randomly divided into experimental and control groups. The experimental group received CBT for 10 sessions, but the control group did not receive any treatment. The research instruments included the attention skills Questionnaire by Savari and Oraki and the Pennsylvania State Worry Scale. Results There was a significant difference in physical symptoms in the experimental group compared to the control group (P< 0.01, F = 65.28), while in the experimental group, there was a significant difference in worry compared to the control group. Moreover, there was a significant difference in attention deficit in the experimental group compared to the control group. Conclusion The results showed that CBT improved attention deficit and worry in women with GAD.
Behavioral pediatrics is a multidisciplinary field that involves many healthcare specialists revolving around the practicing pediatrician and primary care clinician; also, various additional, associated fields of training have developed such as developmental-behavioral pediatrics, neurodevelopmental pediatrics, pediatric psychodermatology and medical care for those of all ages with developmental disabilities (1-16). Experts in psychiatry and psychology work closely with pediatric clinicians in a variety of professional relationships, including co-located and non-co-located mental health settings (17-24). Pediatricians can provide a wide variety of care to children and adolescents with complex disorders, depending on their training as well as interests, and this book seeks to provide au courant perspectives in behavioral pediatrics (25-29). Behavioral health screening remains an important task of pediatricians and behavioral pediatricians as they evaluate their pediatric patients (30-40).
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This study reviews research on the construct of intolerance of uncertainty (IU). A recent factor analysis (Journal of Anxiety Disorders, 25, 2012, p. 533) has been used to extend the transdiagnostic model articulated by Mansell (2005, p. 141) to focus on the role of IU as a facet of the model that is important to address in treatment. Research suggests that individual differences in IU may compromise resilience and that individuals high in IU are susceptible to increased negative affect. The model extension provides a guide for the treatment of clients presenting with uncertainty in the context of either a single disorder or several comorbid disorders. By applying the extension, the clinician is assisted to explore two facets of IU, “Need for Predictability” and “Uncertainty Arousal.”
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review some of the empirically determined characteristics of worry / suggest theoretical perspectives that may account for the functions and origins of this ubiquitous process nature of worry [conceptual and imaginal cognitive activity, affective experience of worry, attentional activity and memory retrieval, behavioral responding, physiological activity] / functions of worry [cognitive avoidance of threat, inhibition of emotional processing] / origins of chronic worry and [generalized anxiety disorder] GAD [history of trauma, insecure attachment in childhood] (PsycINFO Database Record (c) 2012 APA, all rights reserved)
• A test-retest reliability study of the Structured Clinical Interview for DSM-III-R was conducted on 592 subjects in four patient and two nonpatient sites in this country as well as one patient site in Germany. For most of the major categories, ks for current and lifetime diagnoses in the patient samples were above.60, with an overall weighted k of.61 for current and.68 for lifetime diagnoses. For the nonpatients, however, agreement was considerably lower, with a mean k of.37 for current and.51 for lifetime diagnoses. These values for the patient and nonpatient samples are roughly comparable to those obtained with other structured diagnostic instruments. Sources of diagnostic disagreement, such as inadequate training of interviewers, information variance, and low base rates for many disorders, are discussed.
Background: Structural models of emotional disorders propose that anxiety disorders can be classified into fear and distress disorders. Sources of evidence for this distinction come from genetic, self-report and neurophysiological data from adults. The present study examined whether this distinction relates to cognitive processes, indexed by attention bias towards threat, which is thought to cause and maintain anxiety disorders. Method: Diagnostic and attention bias data were analysed from 435 children between 5 and 13 years of age; 158 had principal fear disorder (specific phobia, social phobia or separation anxiety disorder), 75 had principal distress disorder (generalized anxiety disorder, GAD) and 202 had no psychiatric disorder. Anxious children were a clinic-based treatment-seeking sample. Attention bias was assessed on a visual-probe task with angry, neutral and happy faces. Results: Compared to healthy controls, children with principal distress disorder (GAD) showed a significant bias towards threat relative to neutral faces whereas children with principal fear disorder showed an attention bias away from threat relative to neutral faces. Overall, children displayed an attention bias towards happy faces, irrespective of diagnostic group. Conclusions: Our findings support the distinction between fear and distress disorders, and extend empirically derived structural models of emotional disorders to threat processing in childhood, when many anxiety disorders begin and predict lifetime impairment.
deals first with the development of the DSM-III-R [Diagnostic and Statistical Manual of Mental Disorders—Revised] classification of GAD [generalized anxiety disorder] / revisions to GAD criteria currently under consideration by the DSM-IV Subgroup on GAD and Mixed Anxiety-Depression are reviewed recent research on the DSM-III-R GAD definition [reliability of the GAD diagnosis, reliability of GAD symptom ratings] (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Phenomenological features of worry such as thought content, subjective experience of worry, and efforts to control were investigated in the present interview study, as well as retrospective information about possible origins. To examine the clinical specificity of worrying in Generalized Anxiety Disorder (GAD), 36 GAD patients were compared to a normal control group (N = 30) and to a clinical control group (N = 22 social phobics). GAD patients differed from both groups in having higher frequency of worry, higher number of different worry topics, lower subjective controllability, more accompanying bodily symptoms, and more distress during worry. Thus, in general, our data confirm the central and specific role of worrying in GAD. Furthermore, in contrast to other topics, worrying about daily hassles was specific to GAD patients, which represents a lower threshold for starting to worry. Depression and Anxiety 13:89–96, 2001. © 2001 Wiley-Liss, Inc.
Worry, which is the central feature of generalized anxiety disorder (GAD), is now recognized as a truly important clinical phenomenon. The present study examines the relationship between intolerance of uncertainty and problem orientation in nonclinical worry. Subjects were 285 French-Canadian university students who completed a battery of questionnaires on a voluntary basis. The results indicate that intolerance of uncertainty and emotional problem orientation are strong predictors of trait worry, even when personal variables (age, sex) and mood state (level of anxiety, depression) have been partialed out. The findings also show that intolerance of uncertainty and emotional problem orientation both make common as well as a unique contributions to the prediction of worry. Implications for the treatment of worry are discussed and specific guidelines for reducing intolerance of uncertainty and intolerance of emotional arousal for different types of worries are suggested.
Recent studies suggest that worry is related to deficient problem-solving ability. This paper presents the relationship between worry and problem solving. Worry was measured with the Worry Domains Questionnaire (Tallis, Eysenck, & Mathews, 1992) and the Penn State Worry Questionnaire (Meyer, Miller, Metzger, & Borkovec, 1990); problem solving was assessed with the Social Problem-Solving Inventory (D'Zurilla & Nezu, 1990) and the Problem-Solving Inventory (Heppner & Petersen, 1982); and mood state was evaluated with the Beck Anxiety Inventory (Beck, Epstein, Brown, & Steer, 1988) and the Beck Depression Inventory (Beck, Rush, Shaw, & Emery, 1979). Subjects were 122 university students. The hypotheses were the following: (1) Worry would be negatively related to problem solving; and (2) cognitive and affective factors would play a more important role than behavioral deficits in limiting problem-solving ability. As both problem-solving scales are multidimensional, regression analyses predicted worry scores from the problem-solving scales. Results show that subscales describing theoretically sound problem-solving behaviors accounted for trivial or no variance in worry scores. On the other hand, even when mood state had been partialed out by hierarchical regression, subscales describing reactions to problematic situations predicted worry scores. Therefore, both hypotheses were confirmed. These results suggest that worry is related to problem orientation (i.e., immediate cognitive-behavioral-affective reactions to problematic situations) but not to problem-solving skills (i.e., articulating goals, generating solutions, making decisions, and implementing and verifying solutions). Clinical implications are discussed.