Behavioral Experiments for Intolerance of Uncertainty: A Randomized Clinical Trial for Adults With Generalized Anxiety Disorder

Dugas, Michel J.; Sexton, Kathryn A.; Hebert, Elizabeth A.; Bouchard, Stéphane; Gouin, Jean‐Philippe; Shafran, Roz

doi:10.1016/j.beth.2022.05.003

Cited by 28 publications

(38 citation statements)

References 34 publications

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“…The analyses were performed on the intent-to-treat sample and were essentially replicated using the treatment completers sample. Although the results of the current study were somewhat expected given previous findings [ 16 , 17 , 18 , 19 , 20 , 21 ], the efficacy of CBT-IU had yet to be conclusively documented with VCP.…”

Section: Discussionsupporting

confidence: 44%

“…The CBT protocol used in this study focused on intolerance of uncertainty, was based on the 6-module version of CBT-IU, used cognitive restructuring and exposure strategies, and lasted 15 weeks. Can these findings be generalized to variations in CBT for GAD, for example a treatment based on a different theoretical model, e.g., acceptance-based behavior therapy [ 85 ], without a problem-solving module, using mostly behavioral experiments [ 18 ], or shorter in duration? Empirical findings and replications are always important [ 86 ], but the key question is why these variations would be influenced by delivering CBT by videoconference.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, participants were all motivated to engage in psychotherapy, which may not always be the case in routine clinical practice. The CBT-IU treatment protocol [ 74 ] used has evolved over the years to focus more specifically on intolerance of uncertainty [ 18 ], and treatment strategies such as problem-solving are no longer germane to the protocol. The treatment was delivered by graduate students in clinical psychology, which is a population that has been shown to be able to successfully use VCP to deliver evidence-based treatment [ 97 ].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, individuals who received a secondary diagnosis of bipolar disorder, borderline personality disorder, intellectual disability, psychotic disorder, schizophrenia, substance-related disorder, or who presented firm suicidal intentions or a physical condition making participation in the study inadvisable (e.g., hearing impaired, visual impairment, epilepsy) were ineligible for participation. These eligibility criteria are similar to those used in recent efficacy trials of CBT for GAD [ 18 ].…”

Section: Methodsmentioning

confidence: 99%

“…Based on this model, Dugas and colleagues developed a cognitive-behavioral treatment for GAD that is focused on intolerance of uncertainty (IU) and is now commonly referred to as CBT-IU [ 15 ]. Several randomized controlled trials have demonstrated the efficacy of CBT-IU for GAD [ 16 , 17 , 18 , 19 , 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

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A Multisite Non-Inferiority Randomized Controlled Trial of the Efficacy of Cognitive-Behavior Therapy for Generalized Anxiety Disorder Delivered by Videoconference

Bouchard

Dugas

Belleville

et al. 2022

JCM

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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.

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Section: Discussionsupporting

confidence: 44%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Multisite Non-Inferiority Randomized Controlled Trial of the Efficacy of Cognitive-Behavior Therapy for Generalized Anxiety Disorder Delivered by Videoconference

Bouchard

Dugas

Belleville

et al. 2022

JCM

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Psychotherapies for Generalized Anxiety Disorder in Adults

Papola,

Miguel,

Mazzaglia

et al. 2024

JAMA Psychiatry

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ImportanceGeneralized anxiety disorder (GAD) is one of the most common mental disorders in adults. Psychotherapies are among the most recommended treatments for GAD, but which should be considered as first-line treatment needs to be clarified.ObjectiveTo use a network meta-analysis to examine the short- and long-term associations of different psychotherapies with outcomes of effectiveness and acceptability in adults with GAD.Data SourcesMEDLINE, Embase, PsycINFO, and the Cochrane Register of Controlled Trials were searched from database inception to January 1, 2023, to identify randomized clinical trials (RCTs) of psychotherapies for adults with GAD.Study SelectionRCTs comparing any type of psychotherapy against another or with a control condition for the treatment of adults (≥18 years, both sexes) with a primary diagnosis of GAD were eligible for inclusion.Data Extraction and SynthesisThis study followed Cochrane standards for extracting data and assessing data quality and used the PRISMA guideline for reporting. Risk of bias of individual studies was assessed using the second version of the Cochrane risk of bias tool, and the Confidence in Network Meta-Analysis was used to rate the certainty of evidence for meta-analytical results.Main Outcomes and MeasuresEight psychotherapies were compared against one another and with 2 control conditions. Primary outcomes were severity of GAD symptoms and acceptability of the psychotherapies. Random-effects model pairwise and network meta-analyses were conducted. For effectiveness, standardized mean differences (SMDs) were pooled, and for acceptability, relative risks with 95% CIs were calculated.ResultsData from 66 RCTs were included. Effect size estimates on data from 5597 participants (mean [SD], 70.9% [11.9%] women; mean [SD] age, 42.2 [12.5] years) suggested that third-wave cognitive behavior therapies (CBTs) (SMD, −0.78 [95% CI, −1.19 to −0.37]; certainty, moderate), CBT (SMD, −0.68 [95% CI, −1.05 to −0.32]; certainty, moderate), and relaxation therapy (SMD, −0.54 [95% CI, −1.04 to −0.05]; certainty, low) were associated with reduced GAD symptoms vs treatment as usual. Relative risks for all-cause discontinuation (indication of acceptability) signaled no differences compared with treatment as usual for all psychotherapies (eg, relative risk, 1.07 [95% CI, 0.73-1.57] for CBT vs treatment as usual). When excluding studies at high risk of bias, relaxation therapy lost its superiority over treatment as usual (SMD, −0.40; 95% CI, −1.15 to 0.34). When considering anxiety severity at 3 to 12 months after completion of the intervention, only CBT remained significantly associated with greater effectiveness than treatment as usual (SMD, −0.58; 95% CI, −0.93 to −0.23).Conclusions and RelevanceGiven the evidence in this systematic review and network meta-analysis for its associations with both acute and long-term effectiveness, CBT may represent the first-line therapy of GAD. Third-wave CBTs and relaxation therapy were associated with short-term effectiveness and may also be offered.

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Pain catastrophizing and worry about health in generalized anxiety disorder

Dugas

Marchal

Cormier

et al. 2023

Clin Psychology and Psychoth

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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, 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.

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Behavioral Experiments for Intolerance of Uncertainty: A Randomized Clinical Trial for Adults With Generalized Anxiety Disorder

Cited by 28 publications

References 34 publications

A Multisite Non-Inferiority Randomized Controlled Trial of the Efficacy of Cognitive-Behavior Therapy for Generalized Anxiety Disorder Delivered by Videoconference

A Multisite Non-Inferiority Randomized Controlled Trial of the Efficacy of Cognitive-Behavior Therapy for Generalized Anxiety Disorder Delivered by Videoconference

Psychotherapies for Generalized Anxiety Disorder in Adults

Pain catastrophizing and worry about health in generalized anxiety disorder

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