Interpersonal cognitions as a mechanism of change in cognitive behavioral therapy for generalized anxiety disorder? A multilevel dynamic structural equation model approach.

Abstract

Objective: This study aimed to investigate the effects of changes in interpersonal cognitions on outcome during cognitive behavioral therapy (CBT) for generalized anxiety disorder (GAD) and how these effects are moderated by patients' interpersonal problems at intake. Method: A sample of 80 adult patients diagnosed with GAD who were undergoing CBT within a randomized controlled trial completed a questionnaire concerning interpersonal problems at baseline as well as measures of changes in interpersonal and self-related cognitions and in worry severity session by session. We conducted dynamic structural equation modeling to estimate cross-lagged within-patient effects of changes in interpersonal cognitions on worry, adjusting for the effects of self-related cognitions. Furthermore, we included interpersonal problems as a moderator of the effects of changes in interpersonal cognitions. Results: We found significant crosslagged effects of changes in both interpersonal cognitions and self-related cognitions on subsequent worry levels. Greater changes in interpersonal cognitions and self-related cognitions in a given session were associated with lower worry levels at the beginning of the next session. When adjusting for self-related cognitions, the effects of changes in interpersonal cognitions on subsequent worry remained significant. However, there were no interactive effects of changes in interpersonal cognitions by patients' interpersonal problems on worry severity. Conclusions: The results present evidence supporting changes in interpersonal cognitions and self-related cognitions as relevant change mechanisms in CBT for GAD.What is the public health significance of this article? Changes in interpersonal cognitions during cognitive behavioral therapy for generalized anxiety disorder were associated with greater outcome, even when taking into account and adjusting for changes in self-related cognitions. Therapists might benefit from enhancing these changes by engaging patients in a clarification of their interpersonal motives and relational patterns. The relevance of changes in interpersonal cognitions seems to be homogenous across patients with different levels of interpersonal problems at baseline.

Psychological Outcomes and Mechanisms of Mindfulness-Based Training for Generalised Anxiety Disorder: A Systematic Review and Meta-Analysis

“…The current narrative review also found that interpretation bias was not a significant mediator of the relationship between increased trait mindfulness and reductions in anxiety symptoms following MBSR (Hoge et al, 2020 ). Moreover, changes in negative cognitions appear to be particularly relevant mechanisms of anxiety reduction following CBT (e.g., Gallagher et al, 2020 ; Gómez Penedo et al, 2021 ; Kladnistki et al, 2022 ). The current findings may support the possibility that, in GAD, mindfulness exerts its effects through practice of adopting a mindful, non-judgemental, and distanced relationship with one’s thoughts and feelings, rather than challenging maladaptive thinking, as in other Cognitive Therapy approaches (Baer, 2003 ; Kabat-Zinn, 2003 ; Wells, 2002 ).…”

“…In future work, inclusion of ‘stand-alone’ interventions and evidence-based treatment controls (i.e., CBT) would help to delineate the distinct therapeutic mechanisms of mindfulness-based programs. CBT-based cognitive techniques may be integral in targeting key maladaptive cognitive biases involved in GAD and worry symptoms (Dugas et al, 2007 ; Gómez Penedo et al, 2021 ; Kladnistki et al, 2022 ). However, specific mindfulness techniques may hold promise as treatment adjuncts.…”

Using machine learning algorithms to predict the effects of change processes in psychotherapy: Toward process-level treatment personalization.

“…Thus, to estimate the processes effects on outcome, we followed recent literature that applied DSEM, computing separate models for each process (Gómez Penedo, Schwartz, et al, 2022; Gómez Penedo et al, 2021; Rubel et al, 2019). In these models, at the within-patient level, variations in outcome in a given session are predicted by outcome variations in the previous session (i.e., autoregressive effects) and process variations in the previous session (i.e., cross-lagged effects).…”

“…All participants signed a written informed consent form. Full methods of the study were documented at the Open Science Framework (OSF; https://osf.io/mv7kd; Go ´mez Penedo, Meglio, et al, 2022).…”

Do Patient's Interpersonal Problems Improve Following Metacognitive Therapy? A Systematic Review and Meta‐Analysis

“…2011). Furthermore, a recent meta‐analysis found interpersonal problems to be significantly related to worse treatment outcomes across depressive and anxiety disorders (Gómez Penedo and Flückiger 2023). This underlines the need for further treatment development in relation to interpersonal problems with an aim to increase and broaden treatment effects.…”