The effects of relaxation training with cognitive or nondirective therapy and the role of relaxation-induced anxiety in the treatment of generalized anxiety.

Abstract

Thirty volunteers who met criteria for generalized anxiety disorder received 12 sessions of training in progressive muscular relaxation. Sixteen of the clients also were given cognitive therapy during 10 of those sessions, and the remaining 14 received nondirective therapy. Therapy was provided by 16 graduate student clinicians. The group as a whole showed substantial reductions in anxiety as measured by psychiatric assessor ratings, questionnaires, and daily self-monitoring, although relaxation plus cognitive therapy produced significantly greater improvement than relaxation plus nondirective therapy on several pretherapy-posttherapy questionnaires. Relaxation-induced anxiety, as measured by a questionnaire after each relaxation session, was significantly related to improvement in the total group: Oients who became anxious during relaxation training showed the least improvement.Behavior therapy techniques have shown considerable success with several of the anxiety disorders. Controlled trials have demonstrated the efficacy of exposure-based methods in treating simple phobia, agoraphobia, and obsessive-compulsive disorder and have demonstrated their general superiority over cognitive therapy (Foa & Kozak, 1985). Generalized anxiety has responded less successfully to this treatment. Because generalized anxiety disorder (GAD) is characterized by an apparent lack of external anxiety cues, exposure methods become more difficult in practice and the conditioning theory upon which they are based seems less relevant as an explanatory model. Thus, behavioral researchers have focused their attention on the possible role of internal (both cognitive and somatic) fear cues in understanding the process of the disorder (e.g., Barlow, 1985). Logical, therapeutic applications from this point of view have included relaxation and cognitive therapy in which new, somatically oriented or cognitively oriented coping strategies are learned in response to internal anxiety cues. Considerable re-

A metacognitive model and therapy for generalized anxiety disorder

“…Existing cognitive behavioural treatments of GAD appear to produce only modest effects (e.g. Butler et al, 1987Butler et al, , 1991Borkovec et al, 1987;Borkovec and Costello, 1993;Durham et al, 1994). The present model helps to explain the modest response rate for CBT interventions.…”

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

“…Moreover, comparisons with a ''psychological placebo'', a pill placebo or comparable control group conditions showed that CBT has not only unspecific psychotherapy effects, but also specific ingredients (Borkovec et al 1987;Borkovec and Costello 1993;Linden et al 2005;Power et al 1990;Stanley et al 2003). In one study, CBT for GAD was superior to a wait list, but was not more effective than a psychological placebo (Wetherell et al 2003).…”

The Effectiveness of Relaxation Therapy in the Reduction of Anxiety Related Symptoms (A Case Study)

“…Rokovec et al (1987) found that cognitive behavior therapy was superior to nondirective plus relaxation therapy in student sample, while Borkovec and Mathews (1988) found that the effects of two treatments were similar at posttest and 12 months follow up with clinical sample. Clients with generalized anxiety disorder frequently show symptoms of depression Chambless and Gillis (1996, p.122) compared three studies of different researchers and found CBT to have greater impact on depression than behavior therapy (Butler et al, 1991); CBT was superior to nondirective therapy but not to applied relaxation (Borkovec &Costello, 1993); further Borkovec et al(1987) showed that there were no significantly superior CBT effects for depression among treatment completers. Further more Arakawa (1997) showed the efficacy of progressive muscle relaxation to reduce nausea, vomiting and anxiety induced by chemotherapy.…”