A randomized controlled trial of cognitive-behavioral therapy for generalized anxiety disorder with integrated techniques from emotion-focused and interpersonal therapies.

Abstract

Objective-Recent models suggest that generalized anxiety disorder (GAD) symptoms may be maintained by emotional processing avoidance and interpersonal problems.Method-This is the first randomized controlled trial to test directly whether cognitivebehavioral therapy (CBT) could be augmented with the addition of a module targeting interpersonal problems and emotional processing. Eighty-three primarily White participants (mean age = 37) with a principle diagnosis of GAD were recruited from the community. Participants were assigned randomly to CBT plus supportive listening (n = 40) or to CBT plus interpersonal and emotional processing therapy (n = 43) within a study using an additive design. Doctoral-level psychologists with full-time private practices treated participants in an outpatient clinic. Using blind assessors, participants were assessed at pretreatment, posttreatment, 6-month, 1-year, and 2-year follow-up with a composite of self-report and assessor-rated GAD symptom measures (the Penn Results-Mixed models analysis of all randomized participants showed very large withintreatment effect sizes for both treatments , d = 1.86) with no significant differences at post .07], d = .07) or 2-year follow-up (CI = [-.01, .01]), d = .12). There was also no statistical difference between compared treatments on clinically significant change based on chi-square analysis.State Conclusions-Interpersonal and emotional processing techniques may not augment CBT for all GAD participants.Keywords generalized anxiety disorder; emotional processing; emotional avoidance; interpersonal problems; cognitive-behavioral therapy On the basis of several clinical trials (see , cognitive-behavioral therapy (CBT) presently stands as the only psychotherapy to meet criteria as an empirically supported treatment for generalized anxiety disorder (GAD; Chambless & Ollendick, 2001 NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptNonetheless, significant room for improvement exists. A marked percentage of clients continue to experience clinically significant anxious symptoms after treatment (Borkovec & Ruscio, 2001) and fail to demonstrate sustained reduction in GAD symptoms (Westen & Morrison, 2001).Failure to achieve and/or maintain gains from CBT for GAD might be due to the omission of techniques to address variables that may be maintaining the disorder. Among such variables, both emotional processing avoidance and interpersonal problems are prevalent in people with GAD, and researchers have provided well-developed models for their roles in the maintenance of worry and GAD (e.g., Borkovec, Alcaine, & Behar, 2004;Newman & Erickson, 2010). In one of these models, worry, the central feature of GAD, is hypothesized to be a means to avoid emotional processing . In line with this model, the predominantly verbal-linguistic nature of worrisome thinking (and its lessened concrete imagery) inhibit cardiovascular response to feared material, leading to a dampening of emotional learning and a maintenance of worrisome thinki...

Gender Difference in Attentional Bias Toward Negative and Positive Stimuli in Generalized Anxiety Disorder

“…Participant characteristics are presented in Table 3 and are similar to other GAD samples (e.g., Newman et al, 2011). Men and women did not differ in their STAI, HARS, or BDI-II scores.…”

The relationship between depression and generalized anxiety during intensive psychological and pharmacological treatment

“…Randomized clinical trials have demonstrated that pharmacotherapy and psychotherapy interventions for MDD reduce anxiety symptoms and such interventions for GAD reduce depressive symptoms (Gorman, 2002;Leichsenring et al, 2009;Newman et al, 2011;Rivas-Vazquez, 2001). However, little is known about the temporal relationship between symptoms of MDD and GAD along the course of treatment and it remains unclear how targeting one disorder results in change in symptoms of the other.…”

Adaptation, validity and reliability of the Leahy Emotional Schema Scale Turkish version based on Turkish university students and workers / Üniversite öğrencileri ve çalışanları örnekleminde Leahy Duygusal Şema Ölçeği’nin Türkçe uyarlaması, geçerlilik ve güvenilirliği

“…Emotion concept has been getting more importance in evidence-based psychotherapy in recent years (1)(2)(3). Especially in cognitive-behavioral psychotherapy process, it is being thought that schemas and attitudes towards emotions may cause resistance to change of client (4).…”