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Barry TJ, Sewart AR, Arch JJ, Craske MG. DEFICITS IN DISENGAGING ATTENTION FROM THREAT PREDICT IMPROVED RESPONSE TO COGNITIVE BEHAVIORAL THERAPY FOR ANXIETY. Depress Anxiety 2015; 32:892-9. [PMID: 26372291 DOI: 10.1002/da.22421] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 08/05/2015] [Accepted: 08/16/2015] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Pretreatment biases in attending toward threat have been shown to predict greater symptom reduction following cognitive behavioral therapy (CBT) for anxiety. Findings to date do not extend to clinical severity of diagnoses and they assess treatment response immediately posttreatment and not at follow-up. Research in this area has also not examined components of vigilance (e.g., engagement, disengagement) or whether these effects are confined to external attention and not attention to internal symptoms of anxiety. METHODS In the present investigation, 96 adults with a range of anxiety disorders completed a dot probe task to assess threat-related attention biases before and after 12 sessions of CBT. RESULTS Pretreatment deficits in disengaging attention from external and internal threats, and not the speed of engagement with threat, predicted reductions in clinical severity of diagnoses that were maintained 2 years later. The presence of posttreatment attention biases was not associated with increased clinical severity after treatment. CONCLUSIONS Pretreatment deficits in disengaging attention from threat may promote better and more durable response to CBT for a range anxiety disorders.
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Affiliation(s)
- Tom J Barry
- Centre of Learning Psychology and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Amy R Sewart
- UCLA Anxiety Disorders Research Centre, Department of Psychology, University of California Los Angeles, California
| | - Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado at Boulder, Colorado
| | - Michelle G Craske
- UCLA Anxiety Disorders Research Centre, Department of Psychology, University of California Los Angeles, California
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Wolitzky-Taylor K, Zimmermann M, Arch JJ, De Guzman E, Lagomasino I. Has evidence-based psychosocial treatment for anxiety disorders permeated usual care in community mental health settings? Behav Res Ther 2015; 72:9-17. [DOI: 10.1016/j.brat.2015.06.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/20/2015] [Accepted: 06/22/2015] [Indexed: 11/16/2022]
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Arch JJ, Mitchell JL. An Acceptance and Commitment Therapy (ACT) group intervention for cancer survivors experiencing anxiety at re-entry. Psychooncology 2015; 25:610-5. [PMID: 26130586 DOI: 10.1002/pon.3890] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 04/28/2015] [Accepted: 05/27/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Joanna J Arch
- University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO, USA
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Schneider RL, Arch JJ, Wolitzky-Taylor KB. The state of personalized treatment for anxiety disorders: A systematic review of treatment moderators. Clin Psychol Rev 2015; 38:39-54. [DOI: 10.1016/j.cpr.2015.02.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 02/11/2015] [Accepted: 02/13/2015] [Indexed: 11/26/2022]
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Davies CD, Niles AN, Pittig A, Arch JJ, Craske MG. Physiological and behavioral indices of emotion dysregulation as predictors of outcome from cognitive behavioral therapy and acceptance and commitment therapy for anxiety. J Behav Ther Exp Psychiatry 2015; 46:35-43. [PMID: 25199454 DOI: 10.1016/j.jbtep.2014.08.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 06/27/2014] [Accepted: 08/14/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND OBJECTIVES Identifying for whom and under what conditions a treatment is most effective is an essential step toward personalized medicine. The current study examined pre-treatment physiological and behavioral variables as predictors and moderators of outcome in a randomized clinical trial comparing cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for anxiety disorders. METHODS Sixty individuals with a DSM-IV defined principal anxiety disorder completed 12 sessions of either CBT or ACT. Baseline physiological and behavioral variables were measured prior to entering treatment. Self-reported anxiety symptoms were assessed at pre-treatment, post-treatment, and 6- and 12-month follow-up from baseline. RESULTS Higher pre-treatment heart rate variability was associated with worse outcome across ACT and CBT. ACT outperformed CBT for individuals with high behavioral avoidance. Subjective anxiety levels during laboratory tasks did not predict or moderate treatment outcome. LIMITATIONS Due to small sample sizes of each disorder, disorder-specific predictors were not tested. Future research should examine these predictors in larger samples and across other outcome variables. CONCLUSIONS Lower heart rate variability was identified as a prognostic indicator of overall outcome, whereas high behavioral avoidance was identified as a prescriptive indicator of superior outcome from ACT versus CBT. Investigation of pre-treatment physiological and behavioral variables as predictors and moderators of outcome may help guide future treatment-matching efforts.
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Affiliation(s)
- Carolyn D Davies
- Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
| | - Andrea N Niles
- Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Andre Pittig
- Department of Psychology, University of Mannheim, Mannheim, Germany
| | - Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado, Boulder, Boulder, CO, USA
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
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Niles AN, Burklund LJ, Arch JJ, Lieberman MD, Saxbe D, Craske MG. Cognitive mediators of treatment for social anxiety disorder: comparing acceptance and commitment therapy and cognitive-behavioral therapy. Behav Ther 2014; 45:664-77. [PMID: 25022777 PMCID: PMC4842179 DOI: 10.1016/j.beth.2014.04.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 03/08/2014] [Accepted: 04/23/2014] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To assess the relationship between session-by-session mediators and treatment outcomes in traditional cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for social anxiety disorder. METHOD Session-by-session changes in negative cognitions (a theorized mediator of CBT) and experiential avoidance (a theorized mediator of ACT) were assessed in 50 adult outpatients randomized to CBT (n=25) or ACT (n=25) for DSM-IV social anxiety disorder. RESULTS Multilevel modeling analyses revealed significant nonlinear decreases in the proposed mediators in both treatments, with ACT showing steeper decline than CBT at the beginning of treatment and CBT showing steeper decline than ACT at the end of treatment. Curvature (or the nonlinear effect) of experiential avoidance during treatment significantly mediated posttreatment social anxiety symptoms and anhedonic depression in ACT, but not in CBT, with steeper decline of the Acceptance and Action Questionnaire at the beginning of treatment predicting fewer symptoms in ACT only. Curvature of negative cognitions during both treatments predicted outcome, with steeper decline of negative cognitions at the beginning of treatment predicting lower posttreatment social anxiety and depressive symptoms. CONCLUSIONS Rate of change in negative cognitions at the beginning of treatment is an important predictor of change across both ACT and CBT, whereas rate of change in experiential avoidance at the beginning of treatment is a mechanism specific to ACT.
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Craske MG, Niles AN, Burklund LJ, Wolitzky-Taylor KB, Vilardaga JCP, Arch JJ, Saxbe DE, Lieberman MD. Randomized controlled trial of cognitive behavioral therapy and acceptance and commitment therapy for social phobia: outcomes and moderators. J Consult Clin Psychol 2014; 82:1034-48. [PMID: 24999670 DOI: 10.1037/a0037212] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cognitive behavioral therapy (CBT) is an empirically supported treatment for social phobia. However, not all individuals respond to treatment and many who show improvement do not maintain their gains over the long-term. Thus, alternative treatments are needed. METHOD The current study (N = 87) was a 3-arm randomized clinical trial comparing CBT, acceptance and commitment therapy (ACT), and a wait-list control group (WL) in participants with a diagnosis of social phobia based on criteria of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994). Participants completed 12 sessions of CBT or ACT or a 12-week waiting period. All participants completed assessments at baseline and posttreatment, and participants assigned to CBT and ACT also completed assessments 6 and 12 months following baseline. Assessments consisted of self-report measures, a public-speaking task, and clinician ratings. RESULTS Multilevel modeling was used to examine between-group differences on outcomes measures. Both treatment groups outperformed WL, with no differences observed between CBT and ACT on self-report, independent clinician, or public-speaking outcomes. Lower self-reported psychological flexibility at baseline was associated with greater improvement by the 12-month follow-up in CBT compared with ACT. Self-reported fear of negative evaluation significantly moderated outcomes as well, with trends for both extremes to be associated with superior outcomes from CBT and inferior outcomes from ACT. Across treatment groups, higher perceived control and extraversion were associated with greater improvement, whereas comorbid depression was associated with poorer outcomes. CONCLUSIONS Implications for clinical practice and future research are discussed.
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Affiliation(s)
| | | | | | | | | | - Joanna J Arch
- Department of Psychology, University of Colorado at Boulder
| | - Darby E Saxbe
- Department of Psychology, University of Southern California
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Arch JJ. Cognitive behavioral therapy and pharmacotherapy for anxiety: treatment preferences and credibility among pregnant and non-pregnant women. Behav Res Ther 2013; 52:53-60. [PMID: 24326075 DOI: 10.1016/j.brat.2013.11.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 10/16/2013] [Accepted: 11/13/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND Relatively little is known about women's anxiety-related treatment preferences and no studies have examined potential differences between pregnant versus non-pregnant women. Treatment credibility and willingness are particularly important to understand regarding exposure-based cognitive behavioral therapy (CBT) and pharmacotherapy, the leading evidence-based treatments. METHODS A large U.S. sample of pregnant (n = 377) and matched non-pregnant (n = 399) women (total N = 776) rated overall treatment preferences and treatment credibility, concerns, and willingness to have CBT and pharmacotherapy if suffering from anxiety. RESULTS Women preferred anxiety-related treatment that included psychotherapy. Preference for psychotherapy alone was stronger among pregnant (74%) than non-pregnant (47%) women, p < .001. In response to treatment descriptions, both groups rated CBT more favorably than pharmacotherapy on treatment willingness, credibility, and concerns, ps < .001, with the magnitude of this preference significantly greater among pregnant than non-pregnant women, ps < .001. Pregnancy status was unrelated to CBT ratings. Treatment credibility and to a lesser extent total concerns mediated the relationship between pregnancy status and pharmacotherapy willingness. CONCLUSIONS Non-pregnant and especially pregnant women rated exposure-based CBT for anxiety more favorably than pharmacotherapy. Pregnancy status predicted general treatment preferences and pharmacotherapy, but not CBT, ratings.
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Affiliation(s)
- Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado, 345 UCB Muenzinger, Boulder, CO 80309-0345, USA.
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Arch JJ, Ayers CR. Which treatment worked better for whom? Moderators of group cognitive behavioral therapy versus adapted mindfulness based stress reduction for anxiety disorders. Behav Res Ther 2013; 51:434-42. [PMID: 23747582 DOI: 10.1016/j.brat.2013.04.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 04/09/2013] [Accepted: 04/11/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Identifying treatment moderators facilitates treatment matching and personalized medicine. No previous studies have investigated treatment moderators for a mindfulness-based versus traditional cognitive behavioral therapy (CBT) for anxiety disorders to determine for whom each is most effective. The current study examined three putative moderators of principal anxiety disorder severity outcomes for adapted mindfulness based stress reduction (MBSR) and group CBT - baseline depression symptoms, anxiety sensitivity, and diagnostic severity. METHOD Seventy-one patients with a DSM-IV anxiety disorder were randomized to adapted MBSR or group CBT and assessed at baseline, post-treatment, and 3-month follow up. RESULTS CBT outperformed adapted MBSR among those with no to mild depressive symptoms and, at post-treatment only, among those with very high anxiety sensitivity. At follow up, adapted MBSR outperformed CBT among those with moderate to severe depressive symptoms and among those with average anxiety sensitivity (for this sample). Baseline severity affected post-treatment outcomes differently in CBT than in adapted MBSR. CONCLUSION Baseline levels of depression, anxiety sensitivity, and to some extent diagnostic severity, differentially moderated outcomes in CBT and adapted MBSR for anxiety disorders. Recommendations and clinical implications are discussed.
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Affiliation(s)
- Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB Muenzinger, Boulder, CO 80309-0345, USA.
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Arch JJ. Pregnancy-specific anxiety: which women are highest and what are the alcohol-related risks? Compr Psychiatry 2013; 54:217-28. [PMID: 22943960 DOI: 10.1016/j.comppsych.2012.07.010] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 06/06/2012] [Accepted: 07/06/2012] [Indexed: 10/27/2022] Open
Abstract
In a national US sample of pregnant women (n=311), we investigated the question of who becomes highly anxious about pregnancy by examining putative sociodemographic, pregnancy- and mental health-related predictors of pregnancy anxiety. We also assessed the contribution of pregnancy anxiety to the risk of significant alcohol consumption during pregnancy. English-speaking pregnant women aged 18+years were recruited online. Results indicated that sociodemographic factors (younger age, white, unmarried, lower education, lower household income, no previous children), feelings about current pregnancy (unwanted), and general anxiety (higher general and state anxiety) predicted higher pregnancy-related anxiety, whereas age, religiosity, number of weeks pregnant, unplanned pregnancy, and maternal depressive symptoms did not. Pregnancy anxiety was the single strongest predictor of alcohol drinking risk during pregnancy (p<.001, ∆R(2)=.10) a relationship that held after controlling for other significant predictors. Pregnancy anxiety also represented the strongest predictor of screening positively for drinking risk during pregnancy at the total T-ACE (an alcohol risk screener for pregnancy) level of 3+ (odds ratio 95% CI=1.61-4.14, p<.001), though not at the level of 2+ (odds ratio 95% CI=0.98-1.68, p=.07). We discuss implications for the link between maternal mental health and birth/ child outcomes.
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Affiliation(s)
- Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB Muenzinger, Boulder, CO 80309-0345, USA.
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Arch JJ, Ayers CR, Baker A, Almklov E, Dean DJ, Craske MG. Randomized clinical trial of adapted mindfulness-based stress reduction versus group cognitive behavioral therapy for heterogeneous anxiety disorders. Behav Res Ther 2013; 51:185-96. [PMID: 23419887 DOI: 10.1016/j.brat.2013.01.003] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 12/18/2012] [Accepted: 01/09/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare a mindfulness-based intervention with cognitive behavioral therapy (CBT) for the group treatment of anxiety disorders. METHOD One hundred five veterans (83% male, mean age=46 years, 30% minority) with one or more DSM-IV anxiety disorders began group treatment following randomization to adapted mindfulness-based stress reduction (MBSR) or CBT. RESULTS Both groups showed large and equivalent improvements on principal disorder severity thru 3-month follow up (ps<.001, d=-4.08 for adapted MBSR; d=-3.52 for CBT). CBT outperformed adapted MBSR on anxious arousal outcomes at follow up (p<.01, d=.49) whereas adapted MBSR reduced worry at a greater rate than CBT (p<.05, d=.64) and resulted in greater reduction of comorbid emotional disorders (p<.05, d=.49). The adapted MBSR group evidenced greater mood disorders and worry at Pre, however. Groups showed equivalent treatment credibility, therapist adherence and competency, and reliable improvement. CONCLUSIONS CBT and adapted MBSR were both effective at reducing principal diagnosis severity and somewhat effective at reducing self-reported anxiety symptoms within a complex sample. CBT was more effective at reducing anxious arousal, whereas adapted MBSR may be more effective at reducing worry and comorbid disorders.
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Affiliation(s)
- Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB Muenzinger, Boulder, CO 80309-0345, USA.
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Abstract
Anxiety disorders during pregnancy are highly prevalent and associated with serious and enduring consequences for both mother and child. Exposure-based cognitive behavioral (CBT) and behavioral therapies (BT) represent the most empirically supported psychosocial treatments for anxiety disorders in general adult samples. Pregnant women, however, generally have been excluded from this body of research. Evidence that pregnant women inhabit a unique biological context combined with untested assumptions that exposure would unduly stress or harm the fetus have likely prohibited inquiry. This paper seeks to remedy this gap by integrating findings from obstetric, psychiatric, and psychological research to inform central questions regarding exposure-based treatment of anxiety disorders during pregnancy. Based on available evidence, we consider the potential risks and benefits of CBT/BT for anxiety disorders during pregnancy relative to other currently available treatment options. From a multidisciplinary research perspective, we argue that exposure-based therapies are likely to be safe during pregnancy, particularly relative to the alternatives. However, we also highlight critical questions for future research to directly test the biopsychological impact of exposure-based therapies among pregnant women.
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Affiliation(s)
- Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO 80309-0345, USA.
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Pittig A, Arch JJ, Lam CWR, Craske MG. Heart rate and heart rate variability in panic, social anxiety, obsessive-compulsive, and generalized anxiety disorders at baseline and in response to relaxation and hyperventilation. Int J Psychophysiol 2012; 87:19-27. [PMID: 23107994 DOI: 10.1016/j.ijpsycho.2012.10.012] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Revised: 10/18/2012] [Accepted: 10/21/2012] [Indexed: 02/07/2023]
Abstract
It remains unclear if diminished high frequency heart rate variability (HF-HRV) can be found across anxiety disorders. HF-HRV and heart rate (HR) were examined in panic (PD), generalized anxiety (GAD), social anxiety (SAD), and obsessive-compulsive disorder (OCD) relative to healthy controls at baseline and during anxiety stressors. All disorders evidenced diminished baseline HF-HRV relative to controls. Baseline HRV differences were maintained throughout relaxation. For hyperventilation, PD and GAD demonstrated greater HR than controls. Psychotropic medication did not account for HF-HRV differences except in OCD. Age and sex evidenced multiple main effects. Findings suggest that low baseline HF-HRV represents a common index for inhibitory deficits across PD, GAD, and SAD, which is consistent with the notion of autonomic inflexibility in anxiety disorders. Elevated HR responses to hyperventilation, however, are specific to PD and GAD.
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Affiliation(s)
- Andre Pittig
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
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Arch JJ, Eifert GH, Davies C, Plumb Vilardaga JC, Rose RD, Craske MG. Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders. J Consult Clin Psychol 2012; 80:750-65. [PMID: 22563639 PMCID: PMC4718567 DOI: 10.1037/a0028310] [Citation(s) in RCA: 214] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Randomized comparisons of acceptance-based treatments with traditional cognitive behavioral therapy (CBT) for anxiety disorders are lacking. To address this gap, we compared acceptance and commitment therapy (ACT) to CBT for heterogeneous anxiety disorders. METHOD One hundred twenty-eight individuals (52% female, mean age = 38, 33% minority) with 1 or more DSM-IV anxiety disorders began treatment following randomization to CBT or ACT; both treatments included behavioral exposure. Assessments at pre-treatment, post-treatment, and 6- and 12-month follow-up measured anxiety-specific (principal disorder Clinical Severity Ratings [CSRs], Anxiety Sensitivity Index, Penn State Worry Questionnaire, Fear Questionnaire avoidance) and non-anxiety-specific (Quality of Life Index [QOLI], Acceptance and Action Questionnaire-16 [AAQ]) outcomes. Treatment adherence, therapist competency ratings, treatment credibility, and co-occurring mood and anxiety disorders were investigated. RESULTS CBT and ACT improved similarly across all outcomes from pre- to post-treatment. During follow-up, ACT showed steeper linear CSR improvements than CBT (p < .05, d = 1.26), and at 12-month follow-up, ACT showed lower CSRs than CBT among completers (p < .05, d = 1.10). At 12-month follow-up, ACT reported higher AAQ than CBT (p = .08, d = 0.42; completers: p < .05, d = 0.56), whereas CBT reported higher QOLI than ACT (p < .05, d = 0.42). Attrition and comorbidity improvements were similar; ACT used more non-study psychotherapy at 6-month follow-up. Therapist adherence and competency were good; treatment credibility was higher in CBT. CONCLUSIONS Overall improvement was similar between ACT and CBT, indicating that ACT is a highly viable treatment for anxiety disorders.
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Affiliation(s)
- Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado-Boulder, CO, USA
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Arch JJ, Wolitzky-Taylor KB, Eifert GH, Craske MG. Longitudinal treatment mediation of traditional cognitive behavioral therapy and acceptance and commitment therapy for anxiety disorders. Behav Res Ther 2012; 50:469-78. [DOI: 10.1016/j.brat.2012.04.007] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 04/20/2012] [Accepted: 04/23/2012] [Indexed: 10/28/2022]
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Wolitzky-Taylor KB, Arch JJ, Rosenfield D, Craske MG. Moderators and non-specific predictors of treatment outcome for anxiety disorders: A comparison of cognitive behavioral therapy to acceptance and commitment therapy. J Consult Clin Psychol 2012; 80:786-99. [DOI: 10.1037/a0029418] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Arch JJ, Craske MG. Laboratory stressors in clinically anxious and non-anxious individuals: The moderating role of mindfulness. Behav Res Ther 2010; 48:495-505. [DOI: 10.1016/j.brat.2010.02.005] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 01/15/2010] [Accepted: 02/19/2010] [Indexed: 11/27/2022]
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Abstract
In this article, the authors assess the successes, remaining challenges, and new developments in cognitive behavioral therapy (CBT) for anxiety disorders. They define CBT, examine treatment components, review treatment efficacy, and discuss the challenges of attrition, long-term follow-up, co-occurring/comorbid disorders, limited treatment comparisons, treatment mediators, and broader implementation. In addition, they present recent developments in cognitive behavioral therapy for anxiety disorders, including linking exposure therapy to basic science, mindfulness and acceptance-based treatments, and unified or transdiagnostic treatment protocols.
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Affiliation(s)
- Joanna J Arch
- Department of Psychology, University of California Los Angeles, 1285 Franz Hall, Los Angeles, CA 90095-1563, USA.
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Arch JJ, Craske MG. Acceptance and commitment therapy and cognitive behavioral therapy for anxiety disorders: Different treatments, similar mechanisms? ACTA ACUST UNITED AC 2008. [DOI: 10.1111/j.1468-2850.2008.00137.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Arch JJ, Craske MG. Implications of naturalistic use of pharmacotherapy in CBT treatment for panic disorder. Behav Res Ther 2007; 45:1435-47. [PMID: 17343821 DOI: 10.1016/j.brat.2007.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2006] [Revised: 12/19/2006] [Accepted: 01/04/2007] [Indexed: 11/25/2022]
Abstract
This study examined naturalistic medication use and cognitive behavioral therapy (CBT) treatment outcomes in 105 patients meeting DSM-IV criteria for panic disorder (PD), assessed by structured clinical interview. The association between pre- and post-treatment use of SSRIs, benzodiazepines (BZs), and any anti-anxiety or anti-depressant (A/D) medication were investigated for three indicators of treatment outcome (PD severity, presence of agoraphobia (AG), anxiety sensitivity) at post-treatment and 6-month follow-up. Controlling for pre-treatment severity, pre-treatment SSRI use was associated with worse outcomes for AG (p=.04) and anxiety sensitivity (p=.047); post-treatment SSRI use was associated with delayed improvements in PD severity (p=.05). Pre-treatment use of A/D was associated with poorer PD severity outcomes (p=.04). Post-treatment use of A/D was associated with higher anxiety sensitivity scores across post-treatment and 6-month follow-up (p=.03). BZ use was not associated with significantly worse outcomes. However, there was a decrease in the number of patients using BZs from pre-treatment to post-treatment (p=.06) and follow-up (p=.006). In conclusion, controlling for pre-treatment severity, pre- and post-treatment use of SSRIs and A/D was associated with poorer outcomes, particularly for PD severity and anxiety sensitivity.
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Affiliation(s)
- Joanna J Arch
- Department of Psychology, Franz Hall, University of California, Los Angeles, CA 90095-1563, USA.
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Arch JJ, Craske MG. Mechanisms of mindfulness: Emotion regulation following a focused breathing induction. Behav Res Ther 2006; 44:1849-58. [PMID: 16460668 DOI: 10.1016/j.brat.2005.12.007] [Citation(s) in RCA: 394] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2005] [Revised: 12/12/2005] [Accepted: 12/14/2005] [Indexed: 11/21/2022]
Abstract
The current study investigated whether a 15 min recorded focused breathing induction in a normal, primarily undergraduate population would decrease the intensity and negativity of emotional responses to affectively valenced picture slides and increase willingness to remain in contact with aversive picture slides. The effects of the focused breathing induction were compared with the effects of 15 min recorded inductions of unfocused attention and worrying. The focused breathing group maintained consistent, moderately positive responses to the neutral slides before and after the induction, whereas the unfocused attention and worry groups responded significantly more negatively to the neutral slides after the induction than before it. The focusing breathing group also reported lower negative affect and overall emotional volatility in response to the post-induction slides than the worry group, and greater willingness to view highly negative slides than the unfocused attention group. The lower-reported negative and overall affect in response to the final slide blocks, and greater willingness to view optional negative slides by the focused breathing group may be viewed as more adaptive responding to negative stimuli. The results are discussed as being consistent with emotional regulatory properties of mindfulness.
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Affiliation(s)
- Joanna J Arch
- Department of Psychology, University of California, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA.
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Arch JJ, Craske MG, Stein MB, Sherbourne CD, Roy-Byrne PP. Correlates of alcohol use among anxious and depressed primary care patients. Gen Hosp Psychiatry 2006; 28:37-42. [PMID: 16377363 DOI: 10.1016/j.genhosppsych.2005.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2005] [Revised: 08/19/2005] [Accepted: 08/22/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study is to determine the patterns of alcohol use for primary care patients with anxiety disorders and/or major depression in three urban university-affiliated outpatient clinics. METHOD A waiting room sample of adults was screened for anxiety disorders and major depression. Six hundred fourteen screened patients were assessed using the Composite International Diagnostic Interview [World Health Organization. Composite International Diagnostic Interview (CIDI) 2.1. Geneva: World Health Organization, 1997] and frequency-quantity alcohol use questions. Adjusted for age and gender, logistic regression analyses were used to determine associations between panic disorder, social phobia, PTSD, major depression and typical heavy (three drinks/two or more times a week) and frequent (four or more times a week) alcohol use. RESULTS Of the patients, 6.19% (38/614) reported typical heavy drinking and 8.31% (51/614) reported frequent drinking in the preceding 3 months. PTSD was associated with heavy drinking (adjusted OR = 3.1; 95% CI, 1.3-7.3). Panic disorder was associated with frequent alcohol use (adjusted OR = 2.2; 95% CI, 1.2-4.2) but reduced heavy drinking (adjusted OR = 0.4; 95% CI, 0.2-0.9). There was no significant relationship between alcohol use and the co-occurrence of two or more anxiety and/or mood disorders. CONCLUSION In an examination of primary care patients diagnosed, the majority of whom were with at least one anxiety disorder and/or major depression; current heavy and frequent alcohol use was associated with specific individual anxiety disorders and/or major depression.
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Affiliation(s)
- Joanna J Arch
- Department of Psychology, University of California, Los Angeles, 90095-1563, USA.
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