Michel J. Dugas’s research while affiliated with Université du Québec en Outaouais and other places

Background Sudden gains are significant symptom improvements occurring between therapy sessions. Approximately 20% of individuals with generalized anxiety disorder (GAD) experience sudden gains during psychotherapy (Deschênes and Dugas in Cogn Ther Res 37:805–811, 2013. https://doi.org/10.1007/s10608-012-9504-1; Flückiger et al. in J Consult Clin Psychol 89(5):454, 2021. https://doi.org/10.1037/ccp0000639). This study explores the frequency and impact of sudden gains during a novel cognitive-behavioral treatment (CBT) for GAD—Behavioral Experiments for Intolerance of Uncertainty (Dugas et al. in Behav Ther 53(6):1147–1160, 2022. https://doi.org/10.1016/j.beth.2022.05.003)—a treatment designed to reduce intolerance of uncertainty via behavioral experiments that expose individuals to uncertainty-inducing situations and help them develop more adaptive beliefs and emotional reactions toward uncertainty (Robichaud et al. in Cognitive behavioral treatment for generalized anxiety disorder: from science to practice, Routledge, London, 2019). Methods The study tested three hypotheses: (1) at least 20% of participants would experience a sudden gain, (2) participants with sudden gains would demonstrate greater progress during treatment, and (3) these improvements would persist at 6-month follow-up. Forty-eight (48) adults with primary GAD completed 12 sessions of CBT. Sudden gains were identified using the Penn State Worry Questionnaire—Past Week (PSWQ-PW; Stöber and Bittencourt in Behav Res Ther 36(6):645–656, 1998. https://doi.org/10.1016/S0005-7967(98)00031-X), which was administered weekly during treatment. GAD symptoms were assessed with the Worry and Anxiety Questionnaire (WAQ; Dugas et al. in Journal de Thérapie Comportementale et Cognitive 11:31–36, 2001) administered at baseline, post-treatment, and 6-month follow-up to track symptom changes over time. Results Fifteen participants (31.25%) experienced a sudden gain. Mixed ANOVAs revealed that participants with sudden gains achieved significantly greater symptom reductions from pre- to post-treatment (WAQ [F(1,46) = 4.51, p =.039, partial η² =.09]). These improvements were sustained at 6-month follow-up (WAQ [F(2,82) = 4.91, p =.01, partial η² =.11]). Conclusions Sudden gains during CBT for GAD are both frequent and impactful. In the context of Behavioral Experiments for Intolerance of Uncertainty, these gains contribute to superior outcomes observed at post-treatment and sustained over the long term. Their mechanisms of action and implications for enhancing treatment efficacy warrant further investigation.

Background/objectives: Several factors have been shown to play a role in the development and maintenance of generalized anxiety disorder (GAD), including intolerance of uncertainty and emotion dysregulation. Although the individual contribution of both of these factors is well documented, their combined effect has yet to be studied in a clinical population with GAD. The aim of the present study was to examine the relative contribution of intolerance of uncertainty and emotion dysregulation to the prediction of worry and GAD severity in adults with GAD. Methods: The sample consisted of 108 participants diagnosed with GAD. The participants completed measures of worry, GAD severity, depressive symptoms, intolerance of uncertainty, and emotion dysregulation. Results: Multiple regression indicated that both intolerance of uncertainty and emotion dysregulation significantly contributed to both worry and GAD severity, over and above the contribution of depressive symptoms. Of note, the model explained 36% of the variance in GAD severity scores. Conclusions: The present results provide preliminary evidence of complementarity among dominant models of GAD, and point to the potential role of integrative conceptualizations and treatment strategies for GAD.

In the original publication [...]

Introduction : Les abandons thérapeutiques constituent une problématique non négligeable en contexte de pratique clinique et de recherche. Objectif : Explorer les variables cliniques pouvant contribuer à l'abandon durant une séance d'exposition en réalité virtuelle de 15 minutes pour la peur des araignées. Hypothèses : Les participants qui abandonnent rapporteront une peur des araignées plus sévère, des symptômes dépressifs plus sévères et une perception d'efficacité personnelle face aux araignées moins grande. Parmi ces variables cliniques, la perception d'efficacité personnelle fera une contribution unique significative à la prédiction de l'abandon. Méthode : Trente-neuf adultes ayant peur des araignées ont complété les questionnaires de l'étude avant l'exposition. Six participants ont abandonné durant la séance d'exposition. Résultats : Les participants qui se sont retirés de l'exposition rapportaient une peur des araignées plus sévère (t(19,09) = 3,51, p = 0,01), des symptômes dépressifs plus sévères (t(37) = 2,55, p = 0,02) et une perception d'efficacité personnelle face aux araignées plus faible (t(37) = 2,66, p = 0,01). Lorsque toutes ces variables ont été considérées simultanément, seule l'intensité des symptômes dépressifs faisait une contribution unique à la prédiction de l'abandon (B =-0,30, SE = 0,15, Wald = 4,15, p = 0,04). Conclusion : Les résultats suggèrent que les symptômes dépressifs pourraient avoir un impact particulièrement important sur l'abandon en contexte d'exposition.

Because the diagnostic criteria of generalized anxiety disorder (GAD) are not tied to specific worry domains (worry is “generalized”), research on the content of worry in GAD is lacking. To our knowledge, no study has addressed vulnerability for specific worry topics in GAD. The goal of the current study, a secondary analysis of data from a clinical trial (Dugas et al., 2022, Behavior Therapy), is to explore the relationship between pain catastrophizing and worry about health in a sample of 60 adults with primary GAD. All data for this study were collected at pretest, prior to randomization to experimental condition in the larger trial. The hypotheses were that (1) pain catastrophizing would be positively related to the severity of GAD, (2) the relationship between pain catastrophizing and the severity of GAD would not be explained by intolerance of uncertainty and psychological rigidity, and (3) pain catastrophizing would be greater in participants reporting worry about health compared to those not reporting worry about health. All hypotheses were confirmed, suggesting that pain catastrophizing may be a threat‐specific vulnerability for health‐related worry in GAD. The implications of the current findings include a better understanding of the ideographic content of worry, which could help focus treatment interventions for individuals with GAD.

In this study, we combined the results of two controlled trials and examined the relationships between working alliance, telepresence, cognitive change, and treatment outcome. Sixty‐five participants with a primary diagnosis of generalized anxiety disorder (GAD) or panic disorder with agoraphobia (PDA) received cognitive behavior therapy delivered via videoconference. Participants completed measures of working alliance and telepresence after three psychotherapy sessions. They also completed measures of treatment outcome and dysfunctional beliefs (cognitive change) specific to PDA and GAD at pretreatment and posttreatment. Results revealed that telepresence at the fifth session moderated the relationship between the working alliance at the first and fifth sessions. As telepresence increased, its impact on the working alliance diminished. Cognitive change mediated the relationship between the working alliance at the fifth session and treatment outcome.

Delivering psychotherapy by videoconference has been studied in a number of clinical trials, but no large controlled trial has involved generalized anxiety disorder (GAD). This multicenter randomized controlled non-inferiority trial was conducted to test if cognitive-behavior psychotherapy delivered by videoconference (VCP) is as effective as cognitive-behavior psychotherapy delivered face-to-face, using a strict margin of tolerance for non-inferiority. A total of 148 adults received a 15-session weekly manualized program. The treatment was based on the intolerance of uncertainty model of GAD. The impact of treatment was assessed using primary (GAD severity), secondary (worry, anxiety, and intolerance of uncertainty) and tertiary (general functioning) variables measured before and after treatment and at 6-month and 12-month follow-ups. Results showed that: (a) the treatment was effective; (b) VCP for GAD was statistically non-inferior to face-to-face psychotherapy on primary, secondary and tertiary measures at all assessment points; (c) change in intolerance of uncertainty significantly predicted change in the primary outcome measure over and above important clinical factors common to all psychotherapies (motivation, working alliance, perceived therapist competence, and client satisfaction). These findings support the use of VCP as a promising treatment option for adults with GAD. Clinical trial registry: ISRCTN#12662027.

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 one-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.

The cognitive model of compulsive checking (Rachman, 2002) proposes that perceptions of responsibility, seriousness of harm and probability of harm interact to promote checking behaviour. We examined these factors in an ecologically valid experimental paradigm. Two groups of participants (participants with OCD who compulsively check and undergraduate controls) were assigned to a high or low responsibility condition, and then checked objects representing: (a) high seriousness of harm (stove burners), (b) low seriousness of harm (light bulbs), (c) high probability of harm (functional burners and bulbs), and (d) low probability of harm (non-functional burners and bulbs). In general, a diagnosis of OCD, as well as conditions of increased severity/likelihood of harm, and to a lesser degree, increased responsibility, led to a greater period of time spent checking. Implications for the cognitive-behavioural model of and treatment for compulsive checking are discussed.

Background: Previous meta-analyses have shown a significant relationship between working alliance and treatment outcome in general. Some studies have examined the relationship between working alliance and treatment outcome during telepsychotherapy, but to the best of our knowledge, no study has examined the mediating role of individual components of the working alliance. Objective: As part of a clinical trial of cognitive behavioral therapy (CBT) for generalized anxiety disorder (GAD) delivered by videoconference (VC), the aim of this study is to examine the mediating role of intolerance of uncertainty on the relationship between the components of the working alliance and treatment outcome. Methods: A sample of 46 adults with primary GAD received 15 sessions of CBT for GAD delivered over VC. Participants completed the measure of working alliance immediately after the fifth therapy session. The degree of change in intolerance of uncertainty (a key psychological process) was assessed from pre- to posttreatment. Treatment outcome was assessed via changes in GAD symptoms from pretreatment to the 6-month follow-up. Results: The results revealed that the therapeutic bond did not predict treatment outcome (r=-0.23; P=.12). However, agreement on therapeutic goals and tasks did predict treatment outcome (r=-0.42; P=.004 and r=-0.37; P=.01, respectively). In addition, the relationship between consensus on therapeutic tasks and treatment outcome was completely mediated by changes in intolerance of uncertainty (unstandardized β=-0.03; r2=0.12), whereas consensus relative to treatment goals had a direct impact on treatment outcome. Conclusions: These results provide a better understanding of the differential role of the components of the working alliance in telepsychotherapy as a facilitative factor for changes in key cognitive processes, leading to therapeutic change. Trial registration: International Standard Randomized Controlled Trial Number (ISRCTN): 12662027; http://www.isrctn.com/ISRCTN12662027.