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Näsling J, Åström E, Jacobsson L, Ljungberg JK. Effect of Psychotherapy on Intolerance of Uncertainty: A Systematic Review and Meta-Analysis. Clin Psychol Psychother 2024; 31:e3026. [PMID: 39036833 DOI: 10.1002/cpp.3026] [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: 11/14/2023] [Revised: 06/20/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024]
Abstract
Intolerance of uncertainty (IU) is the tendency to react negatively on affective, cognitive and behavioural levels to uncertain situations and to harbour negative beliefs about the implications of uncertainty. IU has been linked to psychopathology and shown to impact treatment outcomes. This study systematically reviewed the literature and performed a meta-analysis of the effects of psychotherapy on IU. A total of 22 studies (1491 participants) were identified in online searches and included in the meta-analyses. Analyses were performed on studies with passive and active control conditions. The pooled effect on IU from studies with passive control was large (g = -0.94 [95% CI -1.25 to -0.62]) but with significant heterogeneity. Pooled effects on IU from studies with active controls were not significant. Moderator analysis showed that among studies with a passive control condition, studies that recruited participants from clinical care facilities produced smaller effect sizes. Among studies with an active control condition, study quality significantly moderated the results, with higher quality leading to a larger effect size. These results indicate that changes in IU may be difficult to reliably achieve in psychotherapy and leave many questions about the effect of psychotherapy on IU unanswered, such as what active components produced the observed changes in studies with passive control.
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Affiliation(s)
- John Näsling
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
- Department of Primary Care, Region Norrbotten (Swedish public healthcare), Luleå, Sweden
| | | | - Lars Jacobsson
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
- Department of Primary Care, Region Norrbotten (Swedish public healthcare), Luleå, Sweden
- Department of Health Sciences, University of Lund, Lund, Sweden
| | - Jessica K Ljungberg
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
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2
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Stavropoulos L, Cooper DDJ, Champion SM, Keevers L, Newby JM, Grisham JR. Basic processes and clinical applications of mental imagery in worry: A systematic review. Clin Psychol Rev 2024; 110:102427. [PMID: 38640775 DOI: 10.1016/j.cpr.2024.102427] [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: 03/27/2023] [Revised: 12/17/2023] [Accepted: 04/04/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND In this systematic review, we aimed to synthesise existing research on the phenomenology of mental imagery among high worriers compared to healthy individuals, and to characterise the nature and effectiveness of existing imagery-related interventions in treatment of worry. METHODS PsycInfo, CENTRAL, EMBASE, Medline, Medline Epub, and PubMed were searched for studies examining the relationship between worry/GAD and mental imagery, or interventions using imagery in treatment of worry/GAD. We assessed study quality and used qualitative narrative synthesis to comprehensively map study results. RESULTS The search yielded 2589 abstracts that were assessed for eligibility independently by two authors. From this, 183 full texts were screened and 50 qualitatively synthesised. Twenty-seven reported an association between worry/GAD and an aspect of mental imagery. Here, overactive negative and worry imagery, and diminished positive future imagining, were associated with worry/GAD. Twenty-three studies reported an intervention. This literature suggested mixed findings regarding efficacy, including for imaginal exposure as an independent technique for GAD. CONCLUSIONS Findings support dysfunctional negative imagining and diminished positive prospective imagery in GAD. General imagining abilities remain intact, which is promising for efforts to utilise imagery in treatment. Further research is warranted to develop innovative clinical applications of imagery in treatment of GAD.
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Affiliation(s)
- Lauren Stavropoulos
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia.
| | - David D J Cooper
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Sophie M Champion
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Luke Keevers
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Jill M Newby
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia; Black Dog Institute, UNSW, Hospital Road, Randwick, Sydney 2022, Australia
| | - Jessica R Grisham
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
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Stavropoulos L, Briggs N, Grisham JR. Self-guided imagery rescripting for worry images: A preliminary experimental investigation. J Clin Psychol 2024; 80:1213-1230. [PMID: 38356250 DOI: 10.1002/jclp.23660] [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: 11/08/2022] [Revised: 07/30/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Mental images of feared events are overactive and intrusive in generalized anxiety disorder (GAD). Imagery rescripting involves integration of positive or neutral imagery and corrective information into images to facilitate emotional processing, reduce imagery intrusions, and re-structure underlying schema. Yet only one known study has applied the technique to treatment of worry. The present study aimed first to examine the relationship between trait worry and properties of future-oriented worry images, and second to examine the efficacy of a self-guided imagery rescripting intervention in improving individuals' response to their worries. METHODS Participants recruited through Amazon Mechanical Turk (N = 365) identified their major worry and wrote the script of a worst-case scenario mental image. Participants were randomized to three conditions: re-writing the same worry image script (exposure), or writing scripts of either one or three positive alternative future-oriented images (rescripting conditions). RESULTS In preliminary analyses, trait worry negatively predicted participants' ratings of worry images, including valence and ability to cope, and positively predicted distress, anticipated cost, and belief in their negative meaning. In experimental analyses, linear mixed-effects models revealed anxious response and cognitive appraisal of the threat were significantly lower among participants allocated to rescripting relative to exposure. There was no effect of rescripting type. CONCLUSIONS This investigation demonstrated the impact of a future-oriented imagery rescripting task on anxiety and cognitive biases associated with real worries in an unselected sample. Results may contribute to the development of imagery rescripting interventions for GAD.
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Affiliation(s)
| | - Nancy Briggs
- Stats Central, Mark Wainwright Analytical Centre, University of New South Wales, Sydney, Australia
| | - Jessica R Grisham
- School of Psychology, University of New South Wales, Sydney, Australia
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Fracalanza K, Raila H, Avanesyan T, Rodriguez CI. Written Imaginal Exposure for Hoarding Disorder: A Preliminary Pilot Study. J Nerv Ment Dis 2024; 212:289-294. [PMID: 38598729 PMCID: PMC11008768 DOI: 10.1097/nmd.0000000000001719] [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] [Indexed: 04/12/2024]
Abstract
ABSTRACT Hoarding disorder (HD) is marked by difficulty discarding possessions. Many refuse treatment or drop out, which may be due to treatment's incorporation of in-home decluttering, which is feared and avoided. Thus, strategies to prepare patients for decluttering/discarding are needed. Imaginal exposure (IE), or imagining one's worst fears about discarding, could be one such strategy. This pilot preliminarily tested a short-duration IE intervention compared with a control intervention. Over 3 days, adults diagnosed with HD (n = 32) were randomly assigned to either write about and imagine their worst fears about discarding (IE condition) or a neutral topic (control writing [CW] condition). The IE condition showed significant improvements in HD symptoms from preintervention to 1-week follow-up, with medium to large effects; however, the CW condition did as well. Comparing change scores between conditions, the IE condition's improvements were not significantly different than the CW condition's. Overall, IE was helpful in improving HD symptoms, but this pilot did not indicate that it was more helpful than CW. This raises important questions about possible demand characteristics, placebo effects, or regression to the mean, and it has implications for the design and methodology of other studies assessing IE's utility.
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Affiliation(s)
- Katie Fracalanza
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Hannah Raila
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
- Department of Psychology, University of California Santa Cruz, Santa Cruz, CA, USA
| | - Tatevik Avanesyan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Carolyn I. Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
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Newman MG, Basterfield C, Erickson TM, Caulley E, Przeworski A, Llera SJ. Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts. Expert Rev Neurother 2022; 22:751-770. [PMID: 36107159 PMCID: PMC9754763 DOI: 10.1080/14737175.2022.2125800] [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: 04/23/2022] [Accepted: 09/14/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Generalized anxiety disorder (GAD) is common and disabling. Different versions of cognitive behavioral therapy (CBT) have been tested, but no treatment works for everyone. Therefore, researchers have attempted approaches to enhance CBT. AREAS COVERED The current narrative review examines meta-analyses and individual trials of CBT-based treatments for GAD. We focus on CBT and its cognitive and behavioral components as well as efforts to enhance CBT and its dissemination and generalizability. Enhancement efforts included interpersonal and emotional processing therapy, mindfulness-based CBT, emotion regulation therapy, intolerance of uncertainty therapy, the unified protocol, metacognitive therapy, motivational interviewing, and contrast avoidance targeted treatment. Emerging strategies to enhance dissemination have focused on technologically based treatments. Attempts at generalizability have included examination of efficacy within diverse racial and ethnic groups. EXPERT OPINION We conclude that CBT is efficacious, and a number of enhancement efforts have shown some promise in improving upon CBT in single trials. However, more research is needed, particularly efforts to determine which enhancements work best for which individuals and what are the mechanisms of change. Furthermore, few technological interventions have been compared to active treatments. Finally, much more attention needs to be paid to ethnic and racial diversity in randomized controlled trials.
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Affiliation(s)
- Michelle G Newman
- Department of Psychology, The Pennsylvania State University, Park, PA, USA
| | | | - Thane M Erickson
- Department of Psychology, Seattle Pacific University, Seattle, Washington, USA
| | - Evan Caulley
- Department of Psychology, Seattle Pacific University, Seattle, Washington, USA
| | - Amy Przeworski
- Department of Psychology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sandra J Llera
- Department of Psychology, Towson University, Baltimore, Maryland, USA
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Disengagement Training for the Treatment of Pathological Worry: A Preliminary Test. Behav Ther 2021; 52:86-98. [PMID: 33483127 DOI: 10.1016/j.beth.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/23/2020] [Accepted: 02/26/2020] [Indexed: 11/23/2022]
Abstract
Pathological worry is characterized by an inability to distract or disengage from worry, and this uncontrollability is the defining feature of generalized anxiety disorder (GAD). The present study assessed a novel computerized strategy that targets these attention difficulties. Worry Disengagement Training (WDT), which involves alternating between writing about one's worry and positive topics, was evaluated in a sample with elevated worry (N = 50), most of whom met for GAD diagnosis (66%). Compared to waitlist, WDT led to increased ability to disengage from in vivo worry on a breath focus task, resulting in fewer negative intrusions (β = -.29, p = .02; sr2 = .08). Relative to waitlist, WDT also led to lower self-reported general worry (β = -.36, p = .001, sr2 = .14) and depressive symptoms (β = -.25, p = .02, sr2 = .07). These effects remained in the subset of participants meeting criteria for GAD. WDT did not impact anxious arousal, suggesting some specificity of effects. These findings provide preliminary support for WDT as an effective strategy to increase disengagement ability and reduce worry and depression. Limitations and future directions are discussed.
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de Almeida Sampaio TP, Jorge RC, Martins DS, Gandarela LM, Hayes-Skelton S, Bernik MA, Lotufo-Neto F. Efficacy of an acceptance-based group behavioral therapy for generalized anxiety disorder. Depress Anxiety 2020; 37:1179-1193. [PMID: 32333486 DOI: 10.1002/da.23021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 03/17/2020] [Accepted: 03/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Generalized anxiety disorder (GAD) shows the weakest treatment response among anxiety disorders. This study aimed at examining whether an acceptance-based group behavioral therapy (ABBT) for patients in a Brazilian anxiety disorders program, combining mindfulness and exposure strategies, can improve clinical outcome when compared with a standard nondirective supportive group therapy (NDST). METHODS Ninety-two individuals diagnosed with GAD were randomized to receive 10 sessions of either ABBT or NDST. Assessments at pretreatment, midtreatment, posttreatment, and 3-month follow-up comprised the following outcome measures: Hamilton Anxiety Rating Scale (HAM-A), Penn State Worry Questionnaire (PSWQ), Depression Anxiety and Stress Scale (DASS), and the Clinical Global Impressions (CGI). The World Health Organization Quality of Life (WHOQOL) was administered at pretreatment and posttreatment. RESULTS The mixed-effects regression models for DASS-stress, Hamilton Anxiety Interview, and CGI showed a significant effect for Time and the Time × Treatment effect, but not for the Treatment main effect. Similarly, there was a significant Time × Treatment effect for the PSWQ, but not main effects of Time or Treatment. Altogether, these data indicate that symptoms decreased in both conditions across treatment and follow-up, and that the rate of change was more rapid for those participants in the ABBT condition. We found no differences between groups from pretreatment to posttreatment in DASS-anxiety or any secondary outcome measure, but for the physical health domain of WHOQOL, which was faster in ABBT. CONCLUSIONS Both groups showed good clinical outcomes, but in general, participants of the ABBT group improved faster than those in the NDST group.
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Affiliation(s)
- Thiago Pacheco de Almeida Sampaio
- Department of Clinical Psychology, Institute of Psychology, University of São Paulo, São Paulo, Brazil.,Department of Psychiatry, Anxiety Disorders Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Renê Cabral Jorge
- Department of Psychiatry, Anxiety Disorders Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Daniel Santos Martins
- Department of Clinical Psychology, Institute of Psychology, University of São Paulo, São Paulo, Brazil.,Department of Psychiatry, Anxiety Disorders Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Lucas Marques Gandarela
- Department of Psychiatry, Anxiety Disorders Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Sarah Hayes-Skelton
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts
| | - Márcio Antonini Bernik
- Department of Psychiatry, Anxiety Disorders Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Francisco Lotufo-Neto
- Department of Clinical Psychology, Institute of Psychology, University of São Paulo, São Paulo, Brazil.,Department of Psychiatry, Anxiety Disorders Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
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Whiteside SPH, Brennan E, Biggs BK, Vickers K, Hathaway J, Seifert SJ, Kramer KM, Hofschulte DR. The feasibility of verbal and virtual reality exposure for youth with academic performance worry. J Anxiety Disord 2020; 76:102298. [PMID: 32937260 DOI: 10.1016/j.janxdis.2020.102298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/28/2020] [Accepted: 08/30/2020] [Indexed: 12/17/2022]
Abstract
With exposure emerging as a key ingredient in anxiety treatment for childhood anxiety disorders (CADs), expansion of exposure techniques is a promising avenue for improving treatment efficacy. The present study examined use of imaginal exposure (IE), a technique understudied in the treatment of CADs. Specifically, the study tested whether two forms of exposure to worries (verbal IE and virtual reality exposure therapy, VRET) would be effective and acceptable forms of exposure with youth. Twenty youth with fears of academic failure completed both types of worry exposure, presented in randomized order. Regardless of order of presentation, both verbal IE and VRET elicited moderate anxiety that decreased to mild over the span of the exposures. Both were found to be acceptable by youth and neither was associated with negative side effects. Youth found VRET to be slightly more interesting and novel, but noted that verbal IE was more realistic and individualized. The present study supports the use of standalone worry exposure as an effective and acceptable treatment for general worries in youth and suggests VRET could be more effective with improved realism.
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Affiliation(s)
| | - Elle Brennan
- Department of Psychiatry and Psychology, Mayo Clinic, United States
| | - Bridget K Biggs
- Department of Psychiatry and Psychology, Mayo Clinic, United States
| | - Kristin Vickers
- Department of Psychiatry and Psychology, Mayo Clinic, United States; Office of Patient Education, Mayo Clinic, United States
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Tallon K, Ovanessian MM, Koerner N, Dugas MJ. Mental imagery in generalized anxiety disorder: A comparison with healthy control participants. Behav Res Ther 2020; 127:103571. [PMID: 32087392 DOI: 10.1016/j.brat.2020.103571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 12/15/2019] [Accepted: 01/23/2020] [Indexed: 11/26/2022]
Abstract
Mental imagery plays a prominent role across psychopathology. However, its quality and role in generalized anxiety disorder (GAD) have not been examined as extensively as in other disorders. The goal of the present study was to obtain a better understanding of general imagery processes and individual differences in people with GAD. Adults with GAD (N = 31) were compared to a Healthy Control (HC) group (N = 32) across mental imagery domains as per Pearson, Deeprose, Wallace-Hadrill, Heyes, and Holmes (2013)'s framework: cognitive, general use/experience, and clinical. No differences were found between the GAD and HC groups on cognitive aspects of imagery. Both groups were also similar in their ability to imagine experiences across sensory modalities. No differences were found between groups in their spontaneous use of imagery in everyday situations, or in vividness of sensory-perceptual imagery. For clinical aspects of imagery, between-group differences emerged in the experience of prospective imagery; those with GAD reported greater "pre-experiencing" ("intrusive, prospective, personally-relevant imagery"; Deeprose & Holmes, 2010), rated imagined future negative scenarios as more vivid, more likely, and more personally relevant, and evaluated the experience of these images as more intense than did HCs. Taken together, findings suggest that the presence of intrusive mental imagery distinguishes individuals with GAD from those without psychopathology. Findings could help improve interventions utilizing imagery techniques.
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Affiliation(s)
| | | | - Naomi Koerner
- Department of Psychology, Ryerson University, Canada.
| | - Michel J Dugas
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Canada
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A Feasibility Open Trial of a Brief Internet-Delivered Written Exposure Therapy for Worry. Behav Cogn Psychother 2019; 47:462-477. [DOI: 10.1017/s1352465818000693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: Cognitive exposure, a treatment of choice for hypothetical fears, involves listening repeatedly to a recorded scenario of one's worst hypothetical fear. A major limitation, however, is that the script cannot be easily modified. Aims: The current study assessed the feasibility of a brief guided internet-based written exposure therapy (iWET) for hypothetical fears, Mind at Peace. Method: Fifty-three adults presenting clinical levels of anxiety (GAD-7 ≥ 8) and worry (PSWQ ≥ 45) were recruited. A single group pre-test/post-test design including a 3-month follow-up was used. Mind at Peace is a 6-week iWET consisting of psychoeducation and five 30-minute weekly writing exposure sessions. Feasibility outcome measures included treatment adherence, attrition, treatment acceptability and preliminary efficacy. Primary outcome measures were the Generalized Anxiety Disorder-7 (GAD-7) and the Penn State Worry Questionnaire (PSWQ). Results: Attrition was higher (57%) and adherence lower (28%) than expected. Intent-to-treat repeated measures ANOVAs revealed significant and large improvements on the GAD-7 (ƞp2 = 0.36) and the PSWQ (ƞp2 = 0.23) with similar findings among study completers. Remission rates were higher on the GAD-7 than on the PSWQ, suggesting that Mind at Peace may primarily target general symptoms of generalized anxiety. Rates of acceptability varied, but nearly all study completers reported that they would recommend this treatment to a friend. Conclusions: This study provided valuable information on Mind at Peace. Methodological changes are proposed to improve its feasibility. A more definitive trial incorporating suggested methodological improvements is recommended.
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Malivoire BL, Marcos M, Pawluk EJ, Tallon K, Kusec A, Koerner N. Look before you leap: the role of negative urgency in appraisals of ambiguous and unambiguous scenarios in individuals high in generalized anxiety disorder symptoms. Cogn Behav Ther 2018; 48:217-240. [PMID: 30230425 DOI: 10.1080/16506073.2018.1508247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Negative interpretation bias, the propensity to make threatening interpretations of ambiguous information, is associated with symptoms of generalized anxiety disorder (GAD). Apart from its relationship with intolerance of uncertainty (IU), little is known about what explains the presence of this cognitive bias in GAD. One factor may be negative urgency (NU), the tendency to take rash action when distressed, which is related to GAD symptoms and to cognitive biases in nonclinical populations. The aim of the present study was to examine the relationship between NU and interpretation bias in individuals high in GAD symptoms (N = 111). IU, trait anxiety, and other forms of impulsivity were examined concurrently as competing correlates of interpretation bias. Greater NU and IU were found to be unique correlates of greater threatening interpretations of ambiguous scenarios. Greater NU was also a unique correlate of greater threatening interpretations of negative and positive scenarios. No other forms of impulsivity were uniquely related to interpretation bias. The findings suggest that greater NU may have a role in the tendency for individuals high in GAD symptoms to make threatening interpretations in response to ambiguous scenarios, overtly threatening situations, and situations without indication of threat or danger. Theoretical implications of these findings are discussed.
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Affiliation(s)
| | - Michelle Marcos
- a Department of Psychology , Ryerson University , Toronto , Canada
| | | | - Kathleen Tallon
- a Department of Psychology , Ryerson University , Toronto , Canada
| | - Andrea Kusec
- a Department of Psychology , Ryerson University , Toronto , Canada
| | - Naomi Koerner
- a Department of Psychology , Ryerson University , Toronto , Canada
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Andersson E, Hedman E, Wadström O, Boberg J, Andersson EY, Axelsson E, Bjureberg J, Hursti T, Ljótsson B. Internet-Based Extinction Therapy for Worry: A Randomized Controlled Trial. Behav Ther 2017; 48:391-402. [PMID: 28390501 DOI: 10.1016/j.beth.2016.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 07/11/2016] [Accepted: 07/17/2016] [Indexed: 11/26/2022]
Abstract
Worry is a common phenotype in both psychiatric patients and the normal population. Worry can be seen as a covert behavior with primary function to avoid aversive emotional experiences. Our research group has developed a treatment protocol based on an operant model of worry, where we use exposure-based strategies to extinguish the catastrophic worry thoughts. The aim of this study was to test this treatment delivered via the Internet in a large-scale randomized controlled trial. We randomized 140 high-worriers (defined as > 56 on the Penn State Worry Questionnaire [PSWQ]) to either Internet-based extinction therapy (IbET) or to a waiting-list condition (WL). Results showed that IbET was superior to WL with an overall large between-group effect size of d = 1.39 (95% confidence interval [1.04,1.73]) on the PSWQ. In the IbET group, 58% were classified as responders. The corresponding figure for WL participants was 7%. IbET was also superior to the WL on secondary outcome measures of anxiety, depression, meta-cognitions, cognitive avoidance, and quality of life. Overall treatment results were maintained for the IbET group at 4- and 12-month follow-up. The results from this trial are encouraging as they indicate that worry can be targeted with an accessible and novel intervention for worry. Replication trials with active control group are needed.
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Koerner N, Mejia T, Kusec A. What's in a name? Intolerance of uncertainty, other uncertainty-relevant constructs, and their differential relations to worry and generalized anxiety disorder. Cogn Behav Ther 2016; 46:141-161. [PMID: 27684470 DOI: 10.1080/16506073.2016.1211172] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A number of studies have examined the association of intolerance of uncertainty (IU) to trait worry and generalized anxiety disorder (GAD). However, few studies have examined the extent of overlap between IU and other psychological constructs that bear conceptual resemblance to IU, despite the fact that IU-type constructs have been discussed and examined extensively within psychology and other disciplines. The present study investigated (1) the associations of IU, trait worry, and GAD status to a negative risk orientation, trait curiosity, indecisiveness, perceived constraints, self-oriented and socially prescribed perfectionism, intolerance of ambiguity, the need for predictability, and the need for order and structure and (2) whether IU is a unique correlate of trait worry and of the presence versus absence of Probable GAD, when overlap with other uncertainty-relevant constructs is accounted for. N = 255 adults completed self-report measures of the aforementioned constructs. Each of the constructs was significantly associated with IU. Only IU, and a subset of the other uncertainty-relevant constructs were correlated with trait worry or distinguished the Probable GAD group from the Non-GAD group. IU was the strongest unique correlate of trait worry and of the presence versus absence of Probable GAD. Indecisiveness, self-oriented perfectionism and the need for predictability were also unique correlates of trait worry or GAD status. Implications of the findings are discussed, in particular as they pertain to the definition, conceptualization, and cognitive-behavioral treatment of IU in GAD.
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Affiliation(s)
- Naomi Koerner
- a Department of Psychology , Ryerson University , Toronto , M5B 2K3 , Canada
| | - Teresa Mejia
- a Department of Psychology , Ryerson University , Toronto , M5B 2K3 , Canada
| | - Andrea Kusec
- a Department of Psychology , Ryerson University , Toronto , M5B 2K3 , Canada
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