Worry Exposure versus Applied Relaxation in the Treatment of Generalized Anxiety Disorder

Abstract

Background: Worry exposure (WE) is a core element of cognitive-behavioral treatment for generalized anxiety disorder (GAD). Its efficacy as a stand-alone treatment method (without further cognitive-behavioral therapy interventions) has never been tested.We aimed to examine whether WE alone is as efficacious as the empirically supported stand-alone treatment for GAD, applied relaxation (AR). Methods: In a randomized controlled study, 73 outpatients meeting DSM-IV criteria for GAD as primary diagnosis were allocated to either WE or AR or a waiting list control group; in a 2nd randomization procedure the waiting list subjects were reallocated to WE or AR. The treatment was manualized (15 sessions with WE or AR), included 6-month and 1-year follow-ups, as well as last observation carried forward and completer analyses, and was controlled for allegiance effects.The Hamilton Anxiety Rating Scale and the State-Trait Anxiety Scale were used as primary outcome measures. Self-report scales of anxiety, worrying and depression including negative metacognition about worrying and thought suppression served as secondary outcome measures. Results: The dropout rate was moderate. The pre-/posttreatment effects were high for the Hamilton Anxiety Rating Scale (standardized mean difference >1) and for the State-Trait Anxiety Inventory (standardized mean difference >0.87). The proportion of patients reaching high end state functioning was 48% (WE) and 56% (AR). WE and AR did not differ with regard to dropout rate or treatment effects. The treatment effects were stable at 6 month and 1 year follow-up. Conclusion: This is the first study to show that a stand-alone exposure in sensu technique – WE – is efficacious in the treatment of GAD. Both AR and WE seem to represent effective principles of change in GAD.

Perinatal Generalized Anxiety Disorder: Assessment and Treatment

“…In another RCT, guided imagery and progressive muscle relaxation was found to be most effective in enhancing levels of relaxation and decreasing heart rate. 107 Hoyer et al 108 compared worry exposure with applied relaxation in the treatment of GAD and results showed that the treatments were equally effective. However, a recent meta-analysis indicated that CBT may be more effective in treatment of GAD than applied relaxation.…”

Generalized worry disorder: a review of DSM-IV generalized anxiety disorder and options for DSM-V

“…[44,47] Cognitive avoidance does show some symptom specificity in adults with clinical worry when compared to panic symptoms [54] and also decreases with effective CBT treatment. [55,56] In children and adolescents there has been little investigation into the use of avoidant strategies but Gosselin et al [57] did show that nonclinical adolescents who experience high worry (N 5 158, Penn State Worry Questionnaire (PSWQ) M(SD) 5 61.2(6.2)) engage in more cognitive avoidance strategies than those experiencing moderate worry (N 5 187, PSWQ M(SD) 5 43.8(2.1)). Avoidant strategies significantly predicted worry level, with avoidance of triggers, thought substitution, distraction, and thought suppression accounting for 19% of the variance in the youths' worry scores.…”

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

“…A lot of empirical work (i.e Rimm, 1979;Clark et al, 2003;Conrad &Roth, 2006;Goodwin &Montgomery, 2006;Hoyer et al, 2009) showed that muscle tension is related to anxiety and that an individual will experience comfort and decreased amount of anxiety if tense muscles can be made loose and comfortable. Relaxation is best when used within the context of self -management by the clients.…”

“…Further more Arakawa (1997) showed the efficacy of progressive muscle relaxation to reduce nausea, vomiting and anxiety induced by chemotherapy. Somewhat recently Hoyer et al (2009) investigated the efficacy of worry exposure and applied relaxation therapeutic techniques for the treatment of generalized anxiety disorder, while comparing with control group both were found to be effective.…”