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Sporrer JK, Johann A, Chumbley J, Robinson OJ, Bach DR. Induced worry increases risk aversion in patients with generalized anxiety. Behav Brain Res 2024; 474:115192. [PMID: 39127128 DOI: 10.1016/j.bbr.2024.115192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 07/28/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024]
Abstract
Generalized anxiety disorder is characterized by disruptions in decision-making, including an enhanced aversion to uncertain outcomes (i.e., risk aversion), which is not specific to negative outcomes (i.e., no loss aversion). It is unknown if this uncertainty bias is a trait-like causal factor contributing to anxiety symptoms, or a state-like feature triggered by anxiety symptoms such as worry chains. Here, in-patients with Major Depression Disorder (MDD), with (N = 16) or without (N = 24) Generalized anxiety (GA) symptoms, and healthy controls (N = 23), completed an economic decision-making task before and after worry induction. They were asked to choose between a certain monetary payoff, and an uncertain gamble, allowing for estimation of risk and loss aversion through a computational prospect-theoretic model. There were no significant differences in risk and loss aversion between any of the three groups at baseline. After worry induction, patients with GA symptoms, compared to those without, showed increased risk aversion. This increase was modulated by the severity of anxiety symptoms. These findings suggest that decision-making disruptions in anxiety disorder may be driven by anxiety symptoms such as worry, rather than causing them. This could shape etiological models, motivate standardization of emotional state in research on decision-making in anxiety disorders, support treatment strategies primarily aimed at worry management, and could guide novel interventions focusing on uncertainty exposure across aversive and appetitive domains.
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Affiliation(s)
- Juliana K Sporrer
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, and Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Alexandra Johann
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Justin Chumbley
- Biostatistics and Research Decision Sciences, MSD, Zürich, Switzerland; Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Oliver J Robinson
- Institute of Cognitive Neuroscience and Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Dominik R Bach
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, and Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry Hospital, University of Zurich, Zurich, Switzerland; University of Bonn, Transdisciplinary Research Area "Life and Health", Hertz Chair for Artificial Intelligence and Neuroscience, Bonn, Germany.
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Kelso KC, Gros DF. Intolerance of uncertainty on distress and impairment: The mediating role of repetitive negative thinking. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2024; 2024. [PMID: 39246301 PMCID: PMC11378962 DOI: 10.1007/s10862-024-10157-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2024] [Indexed: 09/10/2024]
Abstract
Repetitive negative thinking and intolerance of uncertainty are risk and maintenance factors for emotional disorders. Although emerging evidence suggests that intolerance of uncertainty predicts increases in distress through repetitive negative thinking, these relationships have yet to be investigated among veterans. The present study examines if repetitive negative thinking mediates the relationships of intolerance of uncertainty with stress, disordered symptoms and impairment among a mixed clinical sample of veterans. Two hundred and forty-four treatment-seeking veterans with diagnoses of major depressive disorder, panic disorder, or posttraumatic stress disorder completed measures of intolerance of uncertainty, repetitive negative thinking, stress, impairment, depression, panic, and posttraumatic stress prior to receiving treatment. Mediation models revealed indirect effects of intolerance of uncertainty through repetitive negative thinking on stress and impairment in the full sample, and on disordered symptoms in subsamples with major depressive disorder and posttraumatic stress disorder. Conversely, intolerance of uncertainty did not have direct or indirect effects on disordered symptoms in a panic disorder subsample. Findings suggest that repetitive negative thinking and intolerance of uncertainty uniquely contribute to stress, impairment, and disordered symptoms, but repetitive negative thinking, may, in part, drive intolerance of uncertainty's contribution to emotional disorders. Interventions for repetitive negative thinking might improve the efficacy of existing transdiagnostic treatment protocols. Cross-sectional data is a limitation of the present study. Prospective designs in civilian samples can better establish the temporality of these relationships and if they are generalizable to the larger population.
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Affiliation(s)
- Kerry C Kelso
- Mental Health Service, Durham Veterans Affairs Healthcare System
| | - Daniel F Gros
- Mental Health Service, Ralph H. Johnson Veterans Affairs Healthcare System, and the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
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Black MH, Greenwood DL, Hwa JCC, Pivac J, Tang J, Clarke PJF. What Are You Worried About? Content and Extent of Worry in Autistic Adults. J Autism Dev Disord 2024; 54:2040-2054. [PMID: 36988767 PMCID: PMC10052250 DOI: 10.1007/s10803-023-05963-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 03/30/2023]
Abstract
Autistic adults commonly experience anxiety and worry, although knowledge on how worry presents and the content, extent, and experiences among autistic adults is limited. A convergent parallel mixed-methods approach was used to explore the presentation and experiences of worry in autistic and non-autistic adults. Quantitative surveys were used to compare the content and extent of worry in autistic adults to non-autistic adults, with semi-structured interviews also conducted with autistic adults to gain a deeper understanding of the experiences, impacts and content of worry in autistic adults. Findings indicated that autistic adults demonstrated clinically significant levels of worry which were substantially higher than non-autistic adults. Autistic adults described worry as a cycle of negative thoughts impacting their daily life. Findings indicate that autistic adults may worry more than non-autistic adults, impacting on participation in activities of daily living, sleep, and mental health.
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Affiliation(s)
- Melissa H Black
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia.
| | - Dana L Greenwood
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | | | - Jacqueline Pivac
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Jessica Tang
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Patrick J F Clarke
- enAble Institute, Curtin University, Perth, WA, Australia
- Cognition and Emotion Research Group, Curtin University, Perth, WA, Australia
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Yang X, Fang Y, Wang Y, Liu S, Cai J, Li H, Chen Z. Multidimensional stressors and depressive and anxiety symptoms in adolescents: A network analysis through simulations. J Affect Disord 2024; 347:364-374. [PMID: 38007108 DOI: 10.1016/j.jad.2023.11.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Existing research has established associations between various stressors and adolescent mental health, primarily from a variable-level perspective. However, a symptom-level understanding about which stressors and symptoms might play a important role is scarce. METHODS The sample consisted of 15,570 adolescents aged 10 to 19. Participants completed questionnaires which assessed multidimensional stressors, depressive symptoms, anxiety symptoms, and demographic information. Network analysis was conducted to explore the relationships between stressors and depressive and anxiety symptoms. Additionally, to identify effective targets for the treatment and prevention of adolescent mental health issues, symptom-specific intervention simulations were performed on the network to investigate changes in symptom values in response to the alleviation and aggravation of specific stressors and symptoms. RESULTS Findings revealed that academic stressors exhibited stronger associations with anxiety symptoms than other stressors, particularly nervousness. Family relationships were more closely linked to depressive symptoms than other stressors, particularly suicidal ideation. Academic stressors emerged as an effective intervention target, and uncontrollable worry as an important prevention target. With the exception of academic stressors, simulating aggravation interventions on symptoms resulted in more changes in overall symptom activation than alleviation interventions. LIMITATIONS A cross-sectional design did not uncover network changes over time and the sample was non-clinical. CONCLUSIONS This study highlights the importance of addressing academic stressors to alleviate adolescents' depressive and anxiety symptoms and reveals that uncontrollable worry is a key prevention target. The findings are helpful for clinicians and educators to develop effective strategies to protect adolescents' mental health.
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Affiliation(s)
- Xiaoman Yang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 101408, China
| | - Yuan Fang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China.
| | - Yaxin Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
| | - Shaoran Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
| | - Jimin Cai
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 101408, China
| | - Haoyu Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 101408, China
| | - Zhiyan Chen
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China.
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Stickley A, Shirama A, Sumiyoshi T. Financial debt, worry about debt and mental health in Japan. BMC Psychiatry 2023; 23:761. [PMID: 37848860 PMCID: PMC10580597 DOI: 10.1186/s12888-023-05235-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/29/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Financial debt has been linked to poorer mental health. However, most research has been undertaken in western countries. This study examined the association between financial debt, worry about debt, and mental health in Japan, where there has been little specific focus on debt and its effects on mental health. METHODS Data were analyzed from 3717 respondents collected in an online survey in 2023. Information on financial debt and worry about debt was collected with single-item questions. The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scale were used to respectively collect information on depression and anxiety symptoms, while a single-item measure was used to obtain information on a recent history of suicidal ideation. Logistic regression was used to assess associations. RESULTS Both financial debt (17.7%) and worry about debt (14.8%) were prevalent in the study sample. In fully adjusted analyses, compared to those with no debt and worry about debt, individuals who were worried about debt but had no debt, or who had debts and were worried about debt had significantly higher odds for suicidal ideation and depressive symptoms. In contrast, having debt but not being worried about debt was not associated with any of the mental health outcomes. CONCLUSION The results of this study suggest that worrying about debt is strongly associated with poorer mental health among Japanese adults. Interventions to address debt and its associated worries may be important for improving public mental health in Japan.
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Affiliation(s)
- Andrew Stickley
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo, 187-8553, Japan.
| | - Aya Shirama
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo, 187-8553, Japan
| | - Tomiki Sumiyoshi
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo, 187-8553, Japan
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Vîslă A, Probst GH, Flückiger C. Symptom severity in daily life, early response and posttreatment changes in anxiety and depressive symptoms in generalized anxiety disorder. Clin Psychol Psychother 2023; 30:907-912. [PMID: 36869583 DOI: 10.1002/cpp.2847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 02/10/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Meta-analytic research shows early response to psychotherapy to predict depression and anxiety outcomes posttreatment. However, little is known about which variables explain differences in early response. Moreover, for patients with generalized anxiety disorder (GAD), there is limited research on whether early response predicts longer-term changes in symptoms. In this study, we used anxiety and controllability beliefs assessed in daily life at intake to predict early response to treatment (until session 5), and we further examined if early response predicts longer-term changes in symptoms (until posttreatment, when adjusting for intake symptom severity) in patients with GAD. METHODS Forty-nine individuals with GAD reported their anxiety and controllability beliefs using event-based (participant-initiated) ecological momentary assessment (EMA) for 7 days at intake. Symptoms were measured at pretreatment, session 5, session 10, and posttreatment. RESULTS Results show anxiety levels reported during EMA to be associated with a higher reduction in both anxiety and depressive symptoms early in treatment. Moreover, higher controllability beliefs during EMA were associated with less early response. When predicting change in symptoms until posttreatment, results showed an early change to significantly predict change in symptoms until posttreatment. CONCLUSIONS Given that we found early response to psychotherapy in patients with GAD to be a prognostic factor for long-term response, it is recommended to monitor response early in treatment and pay special attention to those patients showing less early response.
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Affiliation(s)
| | - Greta Helene Probst
- University of Zurich, Zurich, Switzerland
- University of Kassel, Kassel, Germany
| | - Christoph Flückiger
- University of Zurich, Zurich, Switzerland
- University of Kassel, Kassel, Germany
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Strand ER, Hjemdal O, Anyan F, Nordahl H, Nordahl HM. Change in interpersonal problems and metacognitive beliefs as predictors of improvement in patients with generalized anxiety disorder. Clin Psychol Psychother 2023; 30:842-851. [PMID: 36797996 DOI: 10.1002/cpp.2841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Generalized anxiety disorder (GAD) is characterized by persistent worry and anxiety, often with a chronic course. We tested the role of two suggested underlying factors in GAD, interpersonal problems and negative metacognitive beliefs, as predictors of trait-worry and trait-anxiety. METHODS The sample consisted of 56 patients with a primary diagnosis of GAD from a randomized controlled trial. We first estimated the proportion of variance lying between the higher level of the data structure to account for potential therapists' effects. Two hierarchical regression analyses were conducted testing change in interpersonal problems and negative metacognitive beliefs as predictors of change in trait-worry and trait-anxiety following treatment. Change in depression and anxiety symptoms was controlled. RESULTS Change in negative metacognitive beliefs was the strongest predictor of improvement of both trait-worry and trait-anxiety. Change in interpersonal problems was not a unique predictor of change in trait-worry but did make a significant and unique contribution to trait-anxiety. CONCLUSIONS Negative metacognitive beliefs may be important targets to improve trait-worry and trait-anxiety in GAD. Interpersonal problems may be relevant for trait-anxiety but could also be a surface marker of higher order vulnerability factors. Implications for treatment are discussed.
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Affiliation(s)
- Eivind R Strand
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Nidaros DPS, St. Olavs Hospital, Trondheim, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Frederick Anyan
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Henrik Nordahl
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hans M Nordahl
- Østmarka, Division of Psychiatry, St. Olav's Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
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Llera SJ, Newman MG. Incremental validity of the contrast avoidance model: A comparison with intolerance of uncertainty and negative problem orientation. J Anxiety Disord 2023; 95:102699. [PMID: 36958137 PMCID: PMC10166139 DOI: 10.1016/j.janxdis.2023.102699] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 02/23/2023] [Accepted: 03/15/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND This study examined the incremental validity of the Contrast Avoidance Model (CAM) in predicting generalized anxiety disorder (GAD) symptoms when compared against well-established constructs in the GAD literature: intolerance of uncertainty (IU) and negative problem orientation (NPO). METHOD In this study, 185 students (108 of whom endorsed clinical levels of GAD symptoms) completed questionnaires to assess for all constructs. GAD symptoms were regressed on measures of contrast avoidance (CA; Contrast Avoidance-General Emotion and Contrast Avoidance-Worry Questionnaires; Llera & Newman, 2017) tendencies in addition to measures of IU and NPO in separate analyses. Commonality analyses explored the unique versus overlapping contributions of each factor in explaining GAD symptoms. RESULTS In all models, CA was a significant predictor after controlling for demographic variables (age, gender, race, and ethnicity) and both IU and NPO. This was also true when excluding CA items referencing worry. All variables contributed unique explanatory power in the prediction of GAD. CONCLUSION Results provide evidence of the incremental validity of the CAM as a model of GAD.
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Affiliation(s)
- Sandra J Llera
- Towson University, Department of Psychology, 8000 York Rd., Towson, MD 21252, USA.
| | - Michelle G Newman
- Penn State University, Department of Psychology, 371 Moore Building, University Park, PA 16802, USA
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Erickson TM, Lewis JA, Crouch TA, Singh NB, Cummings MH. Interpersonal contrast avoidance as a mechanism for the maintenance of worry. J Anxiety Disord 2023; 94:102678. [PMID: 36773485 DOI: 10.1016/j.janxdis.2023.102678] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023]
Abstract
Despite consistent links between interpersonal problems and worry, mechanisms explaining this relationship remain unknown. The Contrast Avoidance Model (CAM; Newman & Llera, 2011) posits that individuals at risk for chronic worry and generalized anxiety disorder (GAD) fear sudden negative mood shifts, using worry to perpetuate negative moods and avoid these negative emotional contrasts. We propose interpersonal (IP) contrast avoidance (e.g., acting friendly to prevent others from causing mood shifts) as a novel explanation for interpersonal dysfunction in worriers. This study investigated IP contrast avoidance and worry in two samples. A nonclinical sample ranging in GAD symptoms (Study 1; N = 92) reported IP problems at baseline then IP contrast avoidance and worry over eight weeks (637 diaries). As expected, baseline IP problems prospectively predicted worry indirectly through chronic IP contrast avoidance. Affiliative, submissive, cold, and total IP contrast avoidance strategies predicted same-week and lagged next-week worry increases; affiliative, submissive, and total strategies also predicted maintenance of worry over eight weeks in growth models. Lastly, Study 2 showed the relevance of IP contrast avoidance strategies in a treatment-seeking clinical sample (N = 40), correlating with interpersonal problems and worry. Overall, results provide proof-of-concept for extending the CAM to the interpersonal domain.
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Affiliation(s)
- Thane M Erickson
- Department of Clinical Psychology, Seattle Pacific University, 3307 3rd Ave. W., Suite 107, Seattle, WA 98119, USA.
| | - Jamie A Lewis
- Department of Clinical Psychology, Seattle Pacific University, 3307 3rd Ave. W., Suite 107, Seattle, WA 98119, USA
| | - Tara A Crouch
- Department of Clinical Psychology, Seattle Pacific University, 3307 3rd Ave. W., Suite 107, Seattle, WA 98119, USA
| | - Narayan B Singh
- Department of Clinical Psychology, Seattle Pacific University, 3307 3rd Ave. W., Suite 107, Seattle, WA 98119, USA
| | - Mackenzie H Cummings
- Department of Clinical Psychology, Seattle Pacific University, 3307 3rd Ave. W., Suite 107, Seattle, WA 98119, USA
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Vîslă A, Allemand M, Flückiger C. Within- and between-patients associations between self-efficacy, outcome expectation, and symptom change in cognitive behavioral therapy for generalized anxiety disorder. J Clin Psychol 2023; 79:86-104. [PMID: 35781807 PMCID: PMC10084306 DOI: 10.1002/jclp.23407] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/05/2022] [Accepted: 06/23/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES There is limited information on how a change in patients' expectations over time results in symptom change in psychotherapy. This study aimed to investigate the changes in patients' expectations and symptoms during treatment and across follow-up as well as to determine the within- and between-patient relationships between two types of patient expectations, that is, self-efficacy and outcome expectation, and symptom change. METHODS Participants (80 participants × 6 repeated measures; 480 observations) with generalized anxiety disorder were treated using cognitive behavioral therapy and the within- and between-patient scores of self-efficacy and outcome expectation were evaluated in multilevel models as predictors of symptom change. RESULTS Patients' self-efficacy and outcome expectation increased, whereas severity of their symptoms reduced during and after treatment. At the within-patient (WP) level, an increase in self-efficacy was associated with a decrease in worry and depressive symptoms, and an increase in outcome expectation was associated with a decrease in depressive symptoms. The between-patient (BP) effect, however, was contrary to the WP effect, that is, self-efficacy was positively correlated with worry and outcome expectation was positively correlated with depressive symptoms CONCLUSION: These results highlight the importance of disaggregating the WP variability from BP variability in psychotherapy process-outcome research as they exhibit different associations at the within- and between-patient levels. Clinical Trial Registration: ClinicalTrial.gov (NCT03079336).
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Affiliation(s)
- Andreea Vîslă
- Department of Psychology, University of Zürich, Zürich, Switzerland
| | - Mathias Allemand
- Department of Psychology, University of Zürich, Zürich, Switzerland
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