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Auva'a-Alatimu T, Alefaio-Tugia S, Ioane J. Understanding the impact of digital therapeutic engagement in promoting mental wellbeing for Pacific youth in Aotearoa New Zealand: an exploration of the literature. Int J Ment Health Syst 2024; 18:22. [PMID: 38844998 PMCID: PMC11157858 DOI: 10.1186/s13033-024-00633-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 03/25/2024] [Indexed: 06/09/2024] Open
Abstract
The Pacific population in Aotearoa New Zealand is youthful, with the majority (55%) being under the age of 25 (Statistics New Zealand, 2014). It is vital that youth mental health for Pacific is understood in relation to their overall wellbeing (Paterson et al., 2018). In parallel to this, the World Health Organization (2022) accentuates the need to protect and promote mental wellbeing for young people globally. Specifically, Pacific youth were far more likely than Aotearoa New Zealand European counterparts to have poorer mental health and higher numbers of suicidality and self-harming behaviours (Ataera-Minster & Trowland, 2018; Fa'alili-Fidow et al., 2016). Moreover, research confirms that Pacific people aged 15-24 years have higher levels of psychological distress of 38% compared to 35% of Pacific adults aged 45-64 years (Ataera-Minster & Trowland, 2018). There is a lack of evidence-based psychological approaches that are culturally appropriate and applicable for Pacific people in Aotearoa New Zealand. Considerably, substantial evidence supports the need to provide more accessible resources and interventions that are flexible, culturally adaptable and cost-effective for Pacific youth. This review aims to (1) provide an insight into Pacific people in Aotearoa New Zealand, (2) have an understanding of Pacific worldview & wellbeing, (3) highlight mental health for Aotearoa New Zealand youth & globally (4) identify therapeutic approaches, including digital mental health globally and in Aotearoa New Zealand.Understanding the perspectives of Pacific youth is a significant first step. Therefore, this article will examine the therapeutic approaches, specifically in the digital space, that are proven effective when promoting wellness for Pacific youth.
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Affiliation(s)
| | | | - Julia Ioane
- Massey University, School of Psychology, Auckland, New Zealand
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Chen SZ, Zainal NH, Newman MG. Elevated depression and anxiety predict future patterns of individualistic and collectivistic cultural values: A cross-lagged longitudinal network analysis. J Affect Disord 2024; 349:310-320. [PMID: 38181844 PMCID: PMC10950001 DOI: 10.1016/j.jad.2023.12.083] [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: 07/13/2023] [Revised: 12/04/2023] [Accepted: 12/27/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Specific components of independent and interdependent self-construal have been associated with psychopathology. However, most studies on this topic have been cross-sectional, precluding causal inferences. We used contemporaneous and temporal cross-lagged network analysis to establish weak causal effects in understanding the association between self-construal and psychopathology components. METHODS Middle-aged and older community-dwelling adults (n = 3294) participated in the Midlife Development in the United States study across two time-points, spaced nine years apart. Six self-construal (interdependence: connection to others, commitment to others, receptiveness to influence; independence: behavioral consistency, sense of difference from others, self-reliance) and three psychopathology nodes (major depressive disorder (MDD), generalized anxiety disorder (GAD), and panic disorder (PD) symptom severity) were examined. All network analyses controlled for age, sex, race, and number of chronic illnesses as covariates. RESULTS Contemporaneous and temporal networks yielded relations between elevated MDD and PD and increased receptiveness to influence. Heightened GAD symptom severity was associated with future increased difference from others and decreased connection to others, commitment to others, and receptiveness to influence. Higher MDD, GAD, and PD severity were associated with future lower self-reliance. Network comparison tests revealed no consistent network differences across sex and race. LIMITATIONS DSM-III-R measures of MDD, GAD, and PD were used. Results may not generalize to culturally diverse racial groups. CONCLUSIONS Changes in self-construal may result from increased MDD, GAD, and PD severity. Findings suggest the importance of targeting common mental health symptoms to positively influence how individuals view the self and others in various social contexts.
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Affiliation(s)
- Serena Z Chen
- The Pennsylvania State University, United States of America.
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Papola D, Miguel C, Mazzaglia M, Franco P, Tedeschi F, Romero SA, Patel AR, Ostuzzi G, Gastaldon C, Karyotaki E, Harrer M, Purgato M, Sijbrandij M, Patel V, Furukawa TA, Cuijpers P, Barbui C. Psychotherapies for Generalized Anxiety Disorder in Adults: A Systematic Review and Network Meta-Analysis of Randomized Clinical Trials. JAMA Psychiatry 2024; 81:250-259. [PMID: 37851421 PMCID: PMC10585589 DOI: 10.1001/jamapsychiatry.2023.3971] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/02/2023] [Indexed: 10/19/2023]
Abstract
Importance Generalized anxiety disorder (GAD) is one of the most common mental disorders in adults. Psychotherapies are among the most recommended treatments for GAD, but which should be considered as first-line treatment needs to be clarified. Objective To use a network meta-analysis to examine the short- and long-term associations of different psychotherapies with outcomes of effectiveness and acceptability in adults with GAD. Data Sources MEDLINE, Embase, PsycINFO, and the Cochrane Register of Controlled Trials were searched from database inception to January 1, 2023, to identify randomized clinical trials (RCTs) of psychotherapies for adults with GAD. Study Selection RCTs comparing any type of psychotherapy against another or with a control condition for the treatment of adults (≥18 years, both sexes) with a primary diagnosis of GAD were eligible for inclusion. Data Extraction and Synthesis This study followed Cochrane standards for extracting data and assessing data quality and used the PRISMA guideline for reporting. Risk of bias of individual studies was assessed using the second version of the Cochrane risk of bias tool, and the Confidence in Network Meta-Analysis was used to rate the certainty of evidence for meta-analytical results. Main Outcomes and Measures Eight psychotherapies were compared against one another and with 2 control conditions. Primary outcomes were severity of GAD symptoms and acceptability of the psychotherapies. Random-effects model pairwise and network meta-analyses were conducted. For effectiveness, standardized mean differences (SMDs) were pooled, and for acceptability, relative risks with 95% CIs were calculated. Results Data from 65 RCTs were included. Effect size estimates on data from 5048 participants (mean [SD], 70.9% [11.9%] women; mean [SD] age, 42.2 [12.5] years) suggested that third-wave cognitive behavior therapies (CBTs) (SMD, -0.76 [95% CI, -1.15 to -0.36]; certainty, moderate), CBT (SMD, -0.74 [95% CI, -1.09 to -0.38]; certainty, moderate), and relaxation therapy (SMD, -0.59 [95% CI, -1.07 to -0.11]; certainty, low) were associated with reduced GAD symptoms vs treatment as usual. Relative risks for all-cause discontinuation (indication of acceptability) signaled no differences compared with treatment as usual for all psychotherapies (eg, relative risk, 1.04 [95% CI, 0.64-1.67] for CBT vs treatment as usual). When excluding studies at high risk of bias, relaxation therapy lost its superiority over treatment as usual (SMD, -0.47; 95% CI, -1.18 to 0.23). When considering anxiety severity at 3 to 12 months after completion of the intervention, only CBT remained significantly associated with greater effectiveness than treatment as usual (SMD, -0.60; 95% CI, -0.99 to -0.21). Conclusions and Relevance Given the evidence in this systematic review and network meta-analysis for its associations with both acute and long-term effectiveness, CBT may represent the first-line therapy of GAD. Third-wave CBTs and relaxation therapy were associated with short-term effectiveness and may also be offered.
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Affiliation(s)
- Davide Papola
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Clara Miguel
- Section of Clinical Psychology, Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Mariacristina Mazzaglia
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Pamela Franco
- Department of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sara A. Romero
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Anushka R. Patel
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Giovanni Ostuzzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Chiara Gastaldon
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Eirini Karyotaki
- Section of Clinical Psychology, Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Department of Health Sciences, Technical University Munich, Munich, Germany
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marit Sijbrandij
- Section of Clinical Psychology, Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Toshi A. Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Pim Cuijpers
- Section of Clinical Psychology, Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Nic Giolla Chomhaill C, Ward J, Dowling M. Fear of recurrence in women with ovarian cancer: A qualitative evidence synthesis. Eur J Oncol Nurs 2024; 68:102487. [PMID: 38113769 DOI: 10.1016/j.ejon.2023.102487] [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: 09/08/2023] [Revised: 11/16/2023] [Accepted: 12/08/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE Approximately 80% of ovarian cancers recur after first-line treatments. Women with ovarian cancer (OC) are therefore particularly vulnerable to experiencing fear of cancer recurrence (FCR). This study aimed to synthesise experiences of fear of cancer recurrence among women living with ovarian cancer. METHOD A qualitative evidence synthesis (QES) was conducted in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. A systematic search of seven databases was undertaken to identify all available qualitative research exploring fear of cancer recurrence in women with OC. Thematic synthesis of extracted data from included studies was undertaken and managed in NVivo. RESULTS Twenty-two papers reporting on eighteen studies were included in the synthesis. Three main themes were developed (triggers, responses, and coping) and included ten subthemes. FCR was triggered by factors relating to awareness of prognosis, treatment, and negative communication. Women responded to FCR by performing body checking and protecting their families. FCR led to adverse effects on women's wellbeing as it exacerbated uncertainty about their future. Women attempted to cope with FCR through seeking support, regaining control, and redirecting negative thoughts and actions. CONCLUSIONS Women use a variety of approaches to manage their fear of recurrence. Further research on the most appropriate interventions for FCR tailored specifically to the needs of women with OC is needed.
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Affiliation(s)
| | - Jana Ward
- Occupational Therapy Department, Galway University Hospital, Ireland.
| | - Maura Dowling
- School of Nursing and Midwifery, University of Galway, Ireland.
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McCleery A, Wynn JK, Novacek DM, Reavis EA, Senturk D, Sugar CA, Tsai J, Green MF. The impact of psychological strengths on Veteran populations' mental health trajectories during the COVID-19 pandemic. Soc Psychiatry Psychiatr Epidemiol 2024; 59:111-120. [PMID: 37314492 PMCID: PMC10719422 DOI: 10.1007/s00127-023-02518-9] [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: 03/16/2023] [Accepted: 06/07/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE Mental health trajectories during the COVID-19 pandemic have been examined in Veterans with tenuous social connections, i.e., those with recent homelessness (RHV) or a psychotic disorder (PSY), and in control Veterans (CTL). We test potential moderating effects on these trajectories by psychological factors that may help individuals weather the socio-emotional challenges associated with the pandemic (i.e., 'psychological strengths'). METHODS We assessed 81 PSY, 76 RHV, and 74 CTL over 5 periods between 05/2020 and 07/2021. Mental health outcomes (i.e., symptoms of depression, anxiety, contamination concerns, loneliness) were assessed at each period, and psychological strengths (i.e., a composite score based on tolerance of uncertainty, performance beliefs, coping style, resilience, perceived stress) were assessed at the initial assessment. Generalized models tested fixed and time-varying effects of a composite psychological strengths score on clinical trajectories across samples and within each group. RESULTS Psychological strengths had a significant effect on trajectories for each outcome (ps < 0.05), serving to ameliorate changes in mental health symptoms. The timing of this effect varied across outcomes, with early effects for depression and anxiety, later effects for loneliness, and sustained effects for contamination concerns. A significant time-varying effect of psychological strengths on depressive symptoms was evident in RHV and CTL, anxious symptoms in RHV, contamination concerns in PSY and CTL, and loneliness in CTL (ps < 0.05). CONCLUSION Across vulnerable and non-vulnerable Veterans, presence of psychological strengths buffered against exacerbations in clinical symptoms. The timing of the effect varied across outcomes and by group.
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Affiliation(s)
- Amanda McCleery
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, 52242, USA.
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.
| | - Jonathan K Wynn
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- VA Rehabilitation R&D Center on Enhancing Community Integration for Homeless Veterans, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Derek M Novacek
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- VA Rehabilitation R&D Center on Enhancing Community Integration for Homeless Veterans, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Eric A Reavis
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- VA Rehabilitation R&D Center on Enhancing Community Integration for Homeless Veterans, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Damla Senturk
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Biostatistics, University of California, Los Angeles, CA, USA
| | - Catherine A Sugar
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Biostatistics, University of California, Los Angeles, CA, USA
| | - Jack Tsai
- VA National Center on Homelessness Among Veterans, Washington, DC, USA
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Michael F Green
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- VA Rehabilitation R&D Center on Enhancing Community Integration for Homeless Veterans, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Apostol AE, Mohamed B, Thomas C, Williams T, Mahon S, Fisher M, Lewis-Morton R. CBT for Generalized Anxiety Disorder in Parkinson's Disease: A Case Study. Clin Gerontol 2024; 47:352-361. [PMID: 37668529 DOI: 10.1080/07317115.2023.2254311] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
OBJECTIVES To examine the use of cognitive behavioral therapy (CBT) in a case of co-occurring generalized anxiety disorder (GAD) and Parkinson's disease (PD). METHODS This case study refers to a male aged 75 years with a diagnosis of Idiopathic Parkinson's disease. It focuses on applying a CBT model to address the psychological difficulties with PD and GAD. RESULTS This case study reveals key aspects in presentation, diagnosis, and psychological treatment between PD and GAD, and is one of few studies published in this area. CONCLUSIONS Symptoms of anxiety in an older adult with PD decreased during a course of CBT. The implications of the treatment outcome of this study and further considerations of treatment plans for comorbid PD and anxiety have been discussed. CLINICAL IMPLICATIONS Using CBT could positively impact non-motor symptoms of Parkinson's, such as sleep difficulties and speech impediments. Using CBT for the catastrophic thinking and worry content in GAD seems to act as a complementary therapy for psychological/non-motor symptoms of PD.
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Affiliation(s)
- Alina Elena Apostol
- Cardiff and Vale University Health Board, Parkinson's Disease Service, University Hospital Llandough, Llandough, UK
| | - Biju Mohamed
- Cardiff and Vale University Health Board, Parkinson's Disease Service, University Hospital Llandough, Llandough, UK
| | - Christopher Thomas
- Cardiff and Vale University Health Board, Parkinson's Disease Service, University Hospital Llandough, Llandough, UK
| | - Tracy Williams
- Cardiff and Vale University Health Board, Parkinson's Disease Service, University Hospital Llandough, Llandough, UK
| | - Sandra Mahon
- Cardiff and Vale University Health Board, Parkinson's Disease Service, University Hospital Llandough, Llandough, UK
| | - Miriam Fisher
- Cardiff and Vale University Health Board, Parkinson's Disease Service, University Hospital Llandough, Llandough, UK
| | - Ruth Lewis-Morton
- Cardiff and Vale University Health Board, Parkinson's Disease Service, University Hospital Llandough, Llandough, UK
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Miller ML, McGuire JF. Targeting intolerance of uncertainty in treatment: A meta-analysis of therapeutic effects, treatment moderators, and underlying mechanisms. J Affect Disord 2023; 341:283-295. [PMID: 37657623 DOI: 10.1016/j.jad.2023.08.132] [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: 06/22/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Anxiety-related disorders are among the most prevalent psychiatric conditions and cause significant impairment. Intolerance of uncertainty (IU) contributes to the emergence, maintenance, and symptom severity of anxiety-related disorders, yet information regarding treatment-related changes in IU is limited. This systematic review and meta-analysis examined the efficacy of evidence-based treatments for anxiety-related disorders on IU, explored factors moderating treatment effects of IU, and examined whether therapeutic improvement in IU corresponded with improvements in anxiety symptom severity. METHODS PubMED and PsycINFO were searched for randomized controlled trials (RCTs) using the terms "intolerance of uncertainty" AND "treatment" OR "therapy." Data for pre and post-treatment measures and patient, intervention, and trial-level characteristics were extracted from 28 RCTs. Separate random effects models examined the treatment efficacy of interventions on IU and symptom severity. Moderators of therapeutic effects were analyzed via method-of-moments meta-regression or an analog to the analysis of variance. RESULTS Across RCTs, interventions exhibited a large therapeutic effect on IU compared to control conditions (g = 0.89). Treatment effects on IU positively corresponded with improved symptom severity and accounted for 36 % of the variance. Interestingly, comorbid depression and certain treatment approaches were associated with larger improvements in IU. CONCLUSION Evidence-based treatments are effective in improving IU, highlighting the importance of IU in the treatment of anxiety-related disorders. Moderator analyses identified patient and intervention-level factors to inform approaches to improve therapeutic effects on IU. Future research is needed to optimize interventions targeting IU and evaluate long-term efficacy of interventions on IU for anxiety-related disorders.
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Affiliation(s)
- Michelle L Miller
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Joseph F McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
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Yang Y, Gorka SM, Pennell ML, Weinhold K, Orchard T. Intolerance of Uncertainty and Cognition in Breast Cancer Survivors: The Mediating Role of Anxiety. Cancers (Basel) 2023; 15:3105. [PMID: 37370715 DOI: 10.3390/cancers15123105] [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] [Received: 05/15/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Cancer-related cognitive impairment (CRCI) is one of the most prevalent symptoms that breast cancer survivors experience. While cancer treatments are established contributors to CRCI, inter-individual differences in CRCI are not well understood. Individual differences in sensitivity to uncertainty are potential contributors to CRCI; however, no prior studies have attempted to examine this link in the context of breast cancer. To address the gap, we used preliminary findings from an ongoing cross-sectional study. A total of 38 women with stage I-III breast cancer (1-4 years post-treatment) were included in this study. Intolerance of uncertainty (IU) was assessed using the Intolerance of Uncertainty Scale. Self-reported cognitive function was assessed with the Neuro-QoL questionnaire. Anxiety was assessed using the Patient-Reported Outcomes Measurement System Bank. From this study, we found that anxiety mediates the association between IU and cognitive function of survivors. In other words, among post-menopausal breast cancer survivors, those with higher IU showed higher anxiety and consequently had lower cognitive function. This finding suggests that assessing IU may help predict the risk of CRCI. This study expands the current knowledge that addresses the importance of IU as a factor associated with cognitive health.
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Affiliation(s)
- Yesol Yang
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center-James, 406 W 10th Avenue, Columbus, OH 43210, USA
| | - Stephanie M Gorka
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, 370 W 9th Avenue, Columbus, OH 43210, USA
- Institute for Behavioral Medicine Research, The Ohio State University, 460 Medical Center Drive, Columbus, OH 43210, USA
| | - Michael L Pennell
- Division of Biostatistics, College of Public Health, The Ohio State University, 1841 Neil Ave., Columbus, OH 43210, USA
| | - Kellie Weinhold
- Human Nutrition Program, Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH 43210, USA
| | - Tonya Orchard
- Human Nutrition Program, Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH 43210, USA
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Berg H, Akeman E, McDermott TJ, Cosgrove KT, Kirlic N, Clausen A, Cannon M, Yeh HW, White E, Thompson WK, Choquette EM, Sturycz-Taylor CA, Cochran G, Ramirez S, Martell CR, Wolitzky-Taylor KB, Craske MG, Abelson JL, Paulus MP, Aupperle RL. A randomized clinical trial of behavioral activation and exposure-based therapy for adults with generalized anxiety disorder. JOURNAL OF MOOD AND ANXIETY DISORDERS 2023; 1:100004. [PMID: 38384390 PMCID: PMC10881118 DOI: 10.1016/j.xjmad.2023.100004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Objective Exposure-based therapy (EXP) and behavioral activation (BA) are empirically-supported behavioral intervention techniques that target avoidance and approach behavior to alleviate symptoms. Although EXP is an established treatment for generalized anxiety disorder (GAD), the effectiveness of BA for GAD has not been directly tested or compared with that of EXP. This study examined the efficacy of EXP and BA for adults with GAD. Method In a randomized clinical trial (clinicaltrials.gov: NCT02807480) with partial blinding in Tulsa, OK, 102 adults with GAD were allocated to manualized, 10-session EXP or BA between April 2016-April 2021. Primary analyses were intention-to-treat and included the 94 (46 EXP, 48 BA) participants who started treatment. The GAD-7 self-report scale was the primary outcome measure. Results Similar GAD-7 declines were observed at post-treatment for EXP (d=-0.97 [95% CI -1.40 to -0.53]) and BA (d=-1.14 [95% CI -1.57 to -0.70]), and were maintained through 6-month follow-up (EXP: d=-2.13, BA: d=-1.98). Compared to EXP, BA yielded more rapid declines in anxiety and depression scores during therapy (d=0.75-0.77), as well as lower anxiety and depression scores (d=0.13-0.14) and greater participant-rated improvement (d=0.64) at post-treatment. Bayesian analyses indicated 74-99% probability of greater change in BA than EXP at post-treatment. Conclusions BA and EXP are both effective in treating GAD, and BA may confer greater benefit during treatment. Future research is warranted to inform personalized treatment approaches.
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Affiliation(s)
- Hannah Berg
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Elisabeth Akeman
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Timothy J. McDermott
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
- Department of Psychology, University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Kelly T. Cosgrove
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
- Department of Psychology, University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Namik Kirlic
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Ashley Clausen
- St. Vincent Hospital, Billings, 1233 N 30th St, Billings, MT 59101, USA
| | - Mallory Cannon
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Hung-Wen Yeh
- Health Services & Outcomes Research, Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108, USA
| | - Evan White
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
- Department of Community Medicine, University of Tulsa, 1215 South Boulder Ave W, Tulsa, OK 74119, USA
| | - Wesley K. Thompson
- Family Medicine and Public Health, UC San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Emily M. Choquette
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | | | - Gabe Cochran
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Sam Ramirez
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Christopher R. Martell
- Department of Psychological and Brain Sciences, University of Massachusetts–Amherst, 135 Hicks Way, Amherst, MA 01003, USA
| | - Kate B. Wolitzky-Taylor
- Psychology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA 90077, USA
| | - Michelle G. Craske
- Psychology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA 90077, USA
| | - James L. Abelson
- Department of Psychiatry, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Martin P. Paulus
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
- Department of Community Medicine, University of Tulsa, 1215 South Boulder Ave W, Tulsa, OK 74119, USA
| | - Robin L. Aupperle
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
- Department of Community Medicine, University of Tulsa, 1215 South Boulder Ave W, Tulsa, OK 74119, USA
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10
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Wilson EJ, Abbott MJ, Norton AR. The impact of psychological treatment on intolerance of uncertainty in generalized anxiety disorder: A systematic review and meta-analysis. J Anxiety Disord 2023; 97:102729. [PMID: 37271039 DOI: 10.1016/j.janxdis.2023.102729] [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: 08/18/2022] [Revised: 04/03/2023] [Accepted: 05/18/2023] [Indexed: 06/06/2023]
Abstract
Research has demonstrated a strong link between intolerance of uncertainty and generalized anxiety disorder (GAD). The current systematic review and meta-analysis aimed to evaluate how effective evidence-based psychological treatments are at reducing intolerance of uncertainty for adults with GAD. An extensive literature search identified 26 eligible studies, with a total of 1199 participants with GAD. Psychological treatments (k = 32 treatment groups) yielded large significant within-group effect size from pre- to post-treatment and pre-treatment to follow-up for intolerance of uncertainty (g = 0.88; g = 1.05), as well as related symptoms including worry (g = 1.32; g = 1.45), anxiety (g = 0.94; g = 1.04) and depression (g = 0.96; g = 1.00). Psychological treatment also yielded a large significant between-group effect on intolerance of uncertainty (g = 1.35). Subgroups analysis found that CBT that directly targeted intolerance of uncertainty (CBT-IU) throughout treatment was significantly more effective than general CBT at reducing intolerance of uncertainty (p < 0.01) and worry (p < 0.01) from pre- to post treatment, however, this result was not maintained at follow-up. Meta-regression analyses supported this finding as increases in the amount of time spent directly targeting intolerance of uncertainty, significantly increased the effect size for both intolerance of uncertainty (z = 2.01, p < 0.01) and worry (z = 2.23, p < 0.01). Overall, these findings indicate that psychological treatments are effective at reducing IU, and related symptom measures of GAD.
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Affiliation(s)
- Emily J Wilson
- Graduate School of Health, University of Technology Sydney, Australia
| | - Maree J Abbott
- School of Psychology, The University of Sydney, Australia.
| | - Alice R Norton
- Graduate School of Health, University of Technology Sydney, Australia; School of Psychology, The University of Sydney, Australia
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11
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Fang S, Ding D. The differences between acceptance and commitment therapy (ACT) and cognitive behavioral therapy: A three-level meta-analysis. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023. [DOI: 10.1016/j.jcbs.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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12
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Psychological interventions for generalized anxiety disorder: Effects and predictors in a naturalistic outpatient setting. PLoS One 2023; 18:e0282902. [PMID: 36897860 PMCID: PMC10004605 DOI: 10.1371/journal.pone.0282902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/25/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE Numerous randomized controlled trials (RCTs) demonstrate the efficacy of cognitive behavioral therapy (CBT), metacognitive therapy (MCT), and methods to reduce intolerance of uncertainty (IU-CBT) in the treatment of generalized anxiety disorder (GAD). However, few studies have investigated these treatments under conditions of routine clinical care. The main objective of this study was to investigate the effectiveness of psychotherapy for GAD in an outpatient setting and to identify factors influencing treatment outcome. METHODS Fifty-nine GAD patients received naturalistic CBT (including MCT and IU-CBT) in an outpatient clinic and postgraduate training center for psychotherapy. Patients completed self-report questionnaires at the beginning and end of therapy regarding the main outcome worry as well as metacognitions, intolerance of uncertainty, depression, and general psychopathology. RESULTS Worry, negative metacognitions, intolerance of uncertainty, depression, and general psychopathology decreased significantly (p's < .001) with large effect sizes for all symptoms (d = 0.83-1.49). A reliable change in the main outcome worry was observed in 80% of patients, and recovery occurred in 23%. Higher worry scores at posttreatment were predicted by higher pretreatment scores, female sex, and less change in negative metacognitive beliefs during treatment. CONCLUSIONS Naturalistic CBT for GAD appears to be effective in routine clinical care for worry as well as depressive symptoms, with particular benefits associated with altering negative metacognitions. However, a recovery rate of only 23% is lower than the rates reported in RCTs. Treatment needs to be improved, especially for patients with more severe GAD and for women.
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13
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Trenoska Basile V, Newton-John T, Wootton BM. Internet videoconferencing delivered cognitive behavior therapy for generalized anxiety disorder: protocol for a randomized controlled trial. Trials 2022; 23:592. [PMID: 35871088 PMCID: PMC9308270 DOI: 10.1186/s13063-022-06520-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 07/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background Generalized anxiety disorder (GAD) is a chronic mental health condition that results in a significant individual and societal burden. While cognitive behavioral therapy (CBT) is well established as an efficacious treatment for GAD, many patients experience logistical barriers when accessing face-to-face CBT. Remotely delivered treatments remove many of these barriers. Despite emerging evidence demonstrating the efficacy of remotely delivered CBT for GAD, studies examining the efficacy of remote methods for GAD that are analogous to standard face-to-face treatment, in particular synchronous treatments such as CBT delivered via online videoconferencing (VCBT), are needed. Methods The authors propose a two-group randomized controlled trial comparing the efficacy of VCBT for GAD against a waitlist control group. The recruitment target will be 78 adults with primary GAD of at least moderate severity. The manualized high-intensity VCBT intervention will be delivered weekly over a 10-week period. After treatment completion, waitlist participants will receive the same VCBT delivered in a brief format (i.e., weekly over a 5-week period). Treatment for both groups will be delivered in real time via an online teleconferencing platform. Outcome measures will be administered at baseline, mid-treatment, post-treatment, and 3-month follow-up. Discussion This trial will report findings on the efficacy of a remote synchronous high-intensity VCBT intervention for GAD. The results have the potential to contribute towards advancing our knowledge on the evidence base for GAD, as well as increase the dissemination of VCBT for GAD. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12621000786897. Registered on 22 June 2021
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14
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Dugas MJ, Sexton KA, Hebert EA, Bouchard S, Gouin JP, Shafran R. Behavioral Experiments for Intolerance of Uncertainty: A Randomized Clinical Trial for Adults With Generalized Anxiety Disorder. Behav Ther 2022; 53:1147-1160. [PMID: 36229113 DOI: 10.1016/j.beth.2022.05.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 11/28/2022]
Abstract
Sophisticated multicomponent treatments for adults with generalized anxiety disorder (GAD) have been developed over the past three decades. Although these comprehensive treatments have produced encouraging results, they appear to be less efficacious than treatments for other anxiety disorders. The goal of this randomized controlled trial is to test a newly developed, highly focused treatment for adults with GAD: Behavioral Experiments for Intolerance of Uncertainty. Sixty (60) participants (51 women, 9 men), with a mean age of 34.60 years (range: 19 to 67 years), were randomized to either treatment (n = 30) or wait-list control (n = 30). Treatment consisted of 12 weekly 1-hour sessions in which participants learned to use behavioral experiments to test their catastrophic beliefs about uncertainty. Assessments were conducted at pre-, mid- and postcondition, and at 6- and 12-month follow-up. The primary outcome was the severity of GAD, and secondary outcomes were worry, depression, somatic anxiety, and intolerance of uncertainty. Using growth curve modeling, we found that (1) the treatment group was superior to the wait-list group in terms of change from pre- to posttest on all outcomes; (2) the combined sample (once wait-listed participants received treatment) evidenced large and significant decreases on all outcomes; and (3) treatment gains were either maintained or increased over the 12-month follow-up period of the study. The new treatment is a promising treatment option for adults with GAD considering that it may be as efficacious as more comprehensive evidence-based psychological treatments for GAD.
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Affiliation(s)
| | | | | | | | | | - Roz Shafran
- Great Ormond Street Institute of Child Health, University College London
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15
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Laposa JM, Katz DE, Lisi DM, Hawley LL, Quigley L, Rector NA. Longitudinal changes in intolerance of uncertainty and worry severity during CBT for generalized anxiety disorder. J Anxiety Disord 2022; 91:102623. [PMID: 35994883 DOI: 10.1016/j.janxdis.2022.102623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 06/17/2022] [Accepted: 08/11/2022] [Indexed: 10/15/2022]
Abstract
Intolerance of uncertainty (IU) is a key construct in generalized anxiety disorder (GAD), but little is known about the concurrent and temporal patterns of associations between IU and GAD symptom severity during treatment. In addition, most of the extant literature focuses on IU as a unidimensional construct, whereas some researchers conceptualize IU as being comprised of two dimensions, inhibitory and prospective IU. Ninety individuals with GAD completed measures of IU and worry severity at pre-treatment, session 4, session 8, and end of treatment (session 12), during group-based cognitive behavior therapy (CBT) for GAD. Longitudinal multilevel modeling showed that IU predicted worry severity concurrently, but not prospectively over time; this pattern of associations was found with the total IUS score and the inhibitory (but not prospective) subscale score. Further, the relationship between IU total scores and worry severity became stronger over time. The relationship between inhibitory (but not prospective) IU and worry also became stronger over time. When the order of the variables in the model was reversed, worry severity also predicted concurrent but not future IU. Therefore, change in IU is associated with change in worry throughout the course of CBT, particularly as treatment progresses, though its directional association as a cause and/or effect remains unclear.
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Affiliation(s)
- Judith M Laposa
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, 100 Stokes St., Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada.
| | - Danielle E Katz
- Forest Hill Centre for Cognitive Behavioural Therapy, 439 Spadina Road, Toronto, Ontario, Canada
| | - Diana M Lisi
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, Canada
| | - Lance L Hawley
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, Canada
| | - Leanne Quigley
- Ferkauf Graduate School of Psychology, 1165 Morris Park Ave, The Bronx, NY, United States
| | - Neil A Rector
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, Canada
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16
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Popa CO, Sava FA, Muresan S, Schenk A, Cojocaru CM, Muntean LM, Olah P. Standard CBT versus integrative and multimodal CBT assisted by virtual-reality for generalized anxiety disorder. Front Psychol 2022; 13:1008981. [PMID: 36248526 PMCID: PMC9554655 DOI: 10.3389/fpsyg.2022.1008981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/14/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Generalized Anxiety Disorder (GAD) is a prevalent emotional disorder associated with increased dysfunctionality, which has a lasting impact on the individual’s quality of life. Besides medication, Cognitive-Behavioral Therapy (CBT) represents the golden standard psychotherapeutic approach for GAD, integrating multilevel techniques and various delivery formats that enable the development of tailored treatment protocols. The objective of this study was to compare the efficiency of a standard CBT protocol targeting worries, dysfunctional beliefs, and intolerance of uncertainty with an integrative and multimodal CBT intervention augmented with Virtual Reality (VR). Materials and methods This study included 66 participants (Mage = 22.53 years; SD = 2.21) with moderate GAD symptoms that were randomized to the standard CBT group (CBTs; N = 32) and the Integrative and Multimodal CBT augmented with VR (IM-VRCBT; N = 34) group. The interventions comprised 10 weekly sessions conducted by trained CBT therapists, including cognitive restructuring, problem-solving, behavioral exposure, and relaxation techniques. Baseline and post-assessments were conducted with both groups. Primary outcome measures included the Hamilton Anxiety Rating Scale (HARS) and Penn-State Worry Questionnaire (PSWQ) to evaluate the severity of GAD symptoms and worries, respectively. Secondary outcomes involved the administration of Automatic Thoughts Questionnaire (ATQ), Dysfunctional Attitudes Scale (DAS) and Unconditional Self-Acceptance Questionnaire (USAQ). Results Both interventions determined statistically significant effects on both primary and secondary outcomes (ps < 0.001) in the expected direction. However, CBTs was associated with higher effect sizes for anxiety (Cohen’s d = 2.76) and worries (Cohen’s d = 1.85), in contrast to IM-VRCBT. Also, secondary analyses revealed positive correlations between changes in anxiety and worries level and the reduction of dysfunctional cognitive processes. Conclusion This research emphasized the effectiveness of CBT interventions for treating adults with moderate GAD symptomatology. Specifically, both interventions were efficient for reducing anxiety symptomatology present at individuals with GAD. However, regarding cognitive dysfunctions like worries, the standard CBT protocol performed better, as compared to the IM-VRCBT. In addition, we conclude that VR could be integrated within CBT interventions in a single protocol for GAD treatment.
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Affiliation(s)
- Cosmin Octavian Popa
- Department of Ethics and Social Sciences, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu-Mures, Romania
| | - Florin Alin Sava
- Department of Psychology, West University of Timișoara, Timișoara, Romania
| | - Simona Muresan
- Department of Internal Medicine IV, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu-Mures, Romania
- *Correspondence: Simona Muresan,
| | - Alina Schenk
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu-Mures, Romania
| | - Cristiana Manuela Cojocaru
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu-Mures, Romania
- Cristiana Manuela Cojocaru,
| | - Lorena Mihaela Muntean
- Department of Psychiatry, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu-Mures, Romania
| | - Peter Olah
- Department of Medical Informatics and Biostatistics, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu-Mures, Romania
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17
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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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18
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Soltani S, Noel M, Neville A, Birnie KA. Intolerance of Uncertainty in Pediatric Chronic Pain: Dyadic Relationships Between Youth and Parents. THE JOURNAL OF PAIN 2022; 23:1581-1593. [PMID: 35470088 DOI: 10.1016/j.jpain.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/27/2022] [Accepted: 04/09/2022] [Indexed: 06/14/2023]
Abstract
The current study used a dyadic analytic approach (actor-partner interdependence models) to assess the stability and interrelationships of intolerance of uncertainty (IU) among a cohort of youth with chronic pain and their parents (n = 156 dyads). Relationships between parent and youth IU, parent and youth pain interference, and parent and youth internalizing mental health symptoms were examined. At baseline and follow-up, youth and parents completed psychometrically-sound questionnaires to assess their respective IU, pain characteristics, and clinical outcomes (pain interference, anxiety, depressive, and posttraumatic stress symptoms). Our findings support the construct stability of IU over time, as well as intrapersonal (ie, actor) effects of IU on follow-up youth pain interference and mental health symptoms and parents' mental health symptoms (but not parent pain interference). There were no interpersonal (ie, partner) effects over time between youth and parent IU or between youth and parent IU and pain interference or mental health symptoms. These findings align with previous research evidencing IU as a transdiagnostic risk factor for a range of mental health concerns and extend previous findings by showing the stability of parent and youth IU over time and its potential predictive relevance to outcomes in a clinical sample of youth with chronic pain. PERSPECTIVE: This article presents dyadic analyses assessing intrapersonal and interpersonal associations between intolerance of uncertainty (IU) and pain and mental health symptoms in youth with chronic pain and their parents. Analyses evidenced short-term construct stability of IU and intrapersonal (but not interpersonal) effects of IU on pain and mental health symptoms.
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Affiliation(s)
- Sabine Soltani
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada.
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Mathison Centre for Mental Health Research & Education, Calgary, Alberta, Canada
| | - Alexandra Neville
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn A Birnie
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Mathison Centre for Mental Health Research & Education, Calgary, Alberta, Canada; Department of Anesthesiology, Perioperative, and Pain Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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19
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Parker SC, Ahrens AH. (Just Thinking of) Uncertainty Increases Intolerance of Uncertainty. JOURNAL OF INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1027/1614-0001/a000376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Intolerance of uncertainty is a far-reaching – yet not widely examined – construct with clinical and nonclinical associations. The current study implemented a brief reflection on uncertainty hypothesized to increase tolerance of uncertainty. The group who engaged in the reflection ( n = 50) was compared to an active control condition ( n = 50). Results demonstrated the opposite of the primary hypothesis: simply reflecting on uncertainty significantly increased intolerance of uncertainty (vs. tolerance of uncertainty). Results also demonstrated that those higher in mindfulness were higher in tolerance of uncertainty, with the “nonreactivity” factor of mindfulness contributing unique variance. These findings suggest multiple factors that might contribute to both tolerance and intolerance of uncertainty. This study indicates that investigations of interventions that include training in mindfulness and its component of nonreactivity might be particularly warranted.
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Affiliation(s)
- Suzanne C. Parker
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
- Department of Psychology, American University, Washington, DC, USA
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20
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Luo R, Li Q, Meng G, Zheng Y, Hu K, Zhang X, Dai B, Liu X. The association between intolerance of uncertainty and Internet addiction during the second wave of the coronavirus disease 2019 pandemic: A multiple mediation model considering depression and risk perception. Psych J 2022; 11:383-391. [PMID: 35385213 PMCID: PMC9088591 DOI: 10.1002/pchj.545] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/16/2022] [Accepted: 02/28/2022] [Indexed: 12/14/2022]
Abstract
Repeated outbreaks of coronavirus disease 2019 (COVID‐19) have forced people to shift most of their work and life activities from offline to online, leading to a growing problem of Internet dependence and even Internet addiction. However, the mechanism of the association between COVID‐19‐related intolerance of uncertainty (COVID‐19 IU) and Internet addiction during the second wave of COVID‐19 is still unclear. The current study explored the association between COVID‐19 IU and Internet addiction as mediated by depression and risk perception based on the Uncertainty‐Depression‐Perception‐Addiction model (UDPA). A total of 1,137 adult participants were recruited, and COVID‐19 IU, depression, risk perception, Internet addiction, and demographic variables were analyzed. The results showed that COVID‐19 IU was significantly and positively associated with Internet addiction and that this relationship was mediated in parallel by depression and risk perception. Our findings further extend the Interaction of Person‐Affect‐Cognition‐Execution (I‐PACE) model from the perspective of applicability in the unique context of COVID‐19. Furthermore, the study suggests that individuals could decrease their dependence on the Internet to prevent Internet addiction during the second wave of the pandemic through effective interventions that include lowering COVID‐19 IU, improving emotion regulation, and developing reasonable perceptions of risk.
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Affiliation(s)
- Ronglei Luo
- Department of Psychiatry and Psychology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Qi Li
- Beijing Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, China
| | - Guangteng Meng
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Ya Zheng
- Department of Psychology, Dalian Medical University, Dalian, China
| | - Kesong Hu
- Department of Psychology, Lake Superior State University, Sault St. Marie, Michigan, USA
| | - Xiaoya Zhang
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Bibing Dai
- Department of Psychiatry and Psychology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Xun Liu
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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21
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Liu C, Ren L, Li K, Yang W, Li Y, Rotaru K, Wei X, Yücel M, Albertella L. Understanding the Association Between Intolerance of Uncertainty and Problematic Smartphone Use: A Network Analysis. Front Psychiatry 2022; 13:917833. [PMID: 35898626 PMCID: PMC9309646 DOI: 10.3389/fpsyt.2022.917833] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/23/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Existing research has demonstrated that intolerance of uncertainty (IU) is associated with problematic smartphone use (PSU). However, little is known about how different IU components such as uncertainty-related beliefs, emotions, and behaviors may impact on different PSU symptoms. METHODS Extending previous research, the current study examined the specific associations between IU components and PSU symptoms via a symptom-level network approach. A regularized partial correlation network consisting of different IU components and PSU symptoms was estimated among 1,849 Chinese university students. We examined pathways and influential nodes (i.e. central components/symptoms and bridge components/symptoms) within the IU-PSU network. RESULTS The strongest pathway linking IU and PSU was between emotional reactions to uncertainty and coping-motivated smartphone use. Importantly, emotional reactions toward not having enough information (a reflection of emotional reactions to uncertainty) may act as both a central and a bridge component in maintaining the whole IU-PSU network. CONCLUSIONS The results are in line with the I-PACE model and highlight that PSU may be a coping response for negative emotions derived from uncertainty. Finally, the current findings highlight the potential of interventions targeting intolerance of uncertainty for reducing PSU.
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Affiliation(s)
- Chang Liu
- BrainPark, Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Lei Ren
- Military Medical Psychology School, Fourth Military Medical University, Xi'an, China
| | - Kuiliang Li
- School of Psychology, Army Medical University, Chongqing, China
| | - Wei Yang
- Psychological Counseling Center, Xijing University, Xi'an, China
| | - Ye Li
- Psychological Counseling Center, Xijing University, Xi'an, China
| | - Kristian Rotaru
- BrainPark, Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia.,Department of Accounting, Monash Business School, Monash University, Caulfield, VIC, Australia
| | - Xinyi Wei
- Department of Psychology, Renmin University of China, Beijing, China
| | - Murat Yücel
- BrainPark, Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Lucy Albertella
- BrainPark, Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC, Australia
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22
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Zhang W, Du Y, Yang X, Wang E, Fang J, Liu Z, Wu S, Liu Q, Hu Y. Comparative efficacy of face-to-face and internet-based cognitive behavior therapy for generalized anxiety disorder: A meta-analysis of randomized controlled trial. Front Psychiatry 2022; 13:832167. [PMID: 35966496 PMCID: PMC9366007 DOI: 10.3389/fpsyt.2022.832167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 07/11/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The study aimed to ascertain the comparative efficacy of these two forms on reducing anxiety scores of scales in patients with a generalized anxiety disorder (GAD) by examining the available evidence for face-to-face cognitive behavior therapy (CBT) and internet-based cognitive behavior therapy (ICBT). Moreover, this study attempted to determine whether ICBT can obtain similar benefits as CBT for GAD patients during coronavirus disease 2019 (COVID-19) due to the quarantine policy and the requirement of social distance. METHODS This meta-analysis was registered with the International Prospective Register of Systematic Reviews (PROSPERO) according to the guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement (registration number CRD42021241938). Therefore, a meta-analysis of randomized controlled trials (RCTs) examining CBT or ICBT was conducted in this study to treat GAD patients diagnosed with DMS-IV. The researchers searched PubMed, MEDLINE, Embase, PsycINFO, and the Cochrane Database of Systematic Reviews for relevant studies published from 2000 to July 5, 2022. Evidence from RCTs was synthesized by Review Manager 5.4 as mean difference (MD) for change in scores of scales through a random-effects meta-analysis. RESULTS A total of 26 trials representing 1,687 participants were pooled. The results demonstrated that ICBT and CBT were very close in the effect size of treating GAD (MD = -2.35 vs. MD = -2.79). Moreover, they still exhibited a similar response (MD = -3.45 vs. MD = -2.91) after studies with active control were removed. CONCLUSION Regarding the treatment of GAD, ICBT can achieve a similar therapeutic effect as CBT and could be CBT's candidate substitute, especially in the COVID-19 pandemic era, since the internet plays a crucial role in handling social space constraints. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=241938, identifier CRD42021241938.
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Affiliation(s)
- Wenle Zhang
- Department of Psychological Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,Department of Clinical Psychology, Capital Medical University, Beijing, China
| | - Yun Du
- Department of Psychological Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,Department of Clinical Psychology, Capital Medical University, Beijing, China
| | - Xiangyun Yang
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Encong Wang
- Department of Psychological Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jiexin Fang
- Department of Psychological Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ziqi Liu
- School of Foreign Languages, Shanghai University, Shanghai, China
| | - Shanqian Wu
- Beijing Anding Hospital, Capital Medical University, Beijing, China.,Department of Psychiatry, Capital Medical University, Beijing, China
| | - Qinqin Liu
- Department of Clinical Psychology, Capital Medical University, Beijing, China.,Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yongdong Hu
- Department of Psychological Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Assessment of intolerance of uncertainty: Validation of a modified anagram task. J Behav Ther Exp Psychiatry 2021; 73:101671. [PMID: 34182343 DOI: 10.1016/j.jbtep.2021.101671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 05/20/2021] [Accepted: 06/21/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Intolerance of uncertainty (IU) is an individual difference factor that reflects difficulty tolerating emotional distress in the context of uncertainty and is a robust transdiagnostic risk factor for emotional disorders. A limitation of prior research on IU is the heavy reliance on self-report measures to assess this construct. The aim of the present study was to examine the validity of a brief, computerized anagram task modified to assess IU (the PACT Anagram Task; PAT). METHODS Participants were 221 unselected undergraduate students (71% female; Mage = 19; 89% Caucasian) who completed the PAT and a series of self-report measures of convergent, discriminant, and incremental validity, and measures of anxiety and depression symptoms online for course credit. RESULTS Greater PAT-Distress was positively correlated measures of convergent validity and demonstrated incremental validity in relation to self-reported IU above and beyond attentional control. None of the PAT indicators were associated with compassion or empathic concern, evidencing discriminant validity. PAT-Distress and PAT-Answers were each associated with greater worry above and beyond self-reported IU. LIMITATIONS Study limitations include the cross-sectional design and lack of diversity in terms of sample demographics. Furthermore, we did not examine convergence between this task and other behavioral measures of IU. CONCLUSION Subjective distress following completion of the PAT may serve as one indicator of IU. Further research is needed in order to replicate these results and validate the use of the PAT in clinical samples.
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24
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Cognitive Behavior Therapy Targeting Intolerance of Uncertainty Versus Selective Serotonin Reuptake Inhibitor for Generalized Anxiety Disorder: A Randomized Clinical Trial. BEHAVIOUR CHANGE 2021. [DOI: 10.1017/bec.2021.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AbstractGiven the high prevalence and adverse outcomes associated with generalized anxiety disorder (GAD), development and expansion of effective treatment modalities are important. The present study compared the effectiveness of cognitive behavior therapy targeting intolerance of uncertainty (CBT-IU) and selective serotonin reuptake inhibitors (SSRIs) for treating GAD. A total of 30 Iranian patients with GAD (Mage = 25.16 ± 6.73) were randomised to receive either CBT-IU (n = 15) or SSRI (n = 15). Measures included the Structured Clinical Interview for DSM-5 (SCID-5), Penn State Worry Questionnaire (PSWQ), Why Worry-II (WW-II), Intolerance of Uncertainty Scale (IUS), and Negative Problem Orientation Questionnaire (NPOQ). Repeated measures analysis of variance tested differential treatment outcomes. The results of intention-to-treat (ITT) analysis indicated that although both CBT-IU and SSRI were effective treatments for GAD, CBT-IU produced significantly better results than SSRI at post-treatment. This clinical trial provides preliminary cross-cultural support for the treatment of GAD using CBT-IU, with findings suggesting that this non-medication intervention reduces GAD symptoms.
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25
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Task sharing in psychotherapy as a viable global mental health approach in resource-poor countries and also in high-resource settings. GLOBAL HEALTH JOURNAL 2021. [DOI: 10.1016/j.glohj.2021.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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26
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The Level of Gambling Prediction Using Depression and Anxiety in the Romanian Population. J Gambl Stud 2021; 38:653-662. [PMID: 34216323 DOI: 10.1007/s10899-021-10051-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2021] [Indexed: 10/20/2022]
Abstract
The gambling addiction problem, one which is present worldwide and at all social levels, is one of the most pervasive problems in contemporary society. According to the research literature, gambling addiction is determined by other psychiatric disorders. In the present study, we investigate the degree to which gambling can be predicted by depression and anxiety in a Romanian sample. The study has been conducted on a sample of 920 persons in the general population. Results show that depression predicts gambling in proportion of 26.3 percent, while anxiety predicts 31.5 percent of gambling variance. In the discussion portion of the study, we provide a psyhological interpretation of the results.
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27
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Sadeh N, Bredemeier K. Engaging in Risky and Impulsive Behaviors to Alleviate Distress Mediates Associations Between Intolerance of Uncertainty and Externalizing Psychopathology. J Pers Disord 2021; 35:393-408. [PMID: 31682196 PMCID: PMC8314479 DOI: 10.1521/pedi_2019_33_456] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite increasing recognition that intolerance of uncertainty is a transdiagnostic dimension of psychopathology, very little research has investigated its relevance for externalizing psychopathology and related risky/impulsive behavior. Ninety-five unselected adults (ages 19-55, 53% men) recruited from the community completed a measure of intolerance of uncertainty, externalizing traits and problems, and risky/impulsive behavior. Higher levels of intolerance of uncertainty were associated with greater endorsement of externalizing symptoms (e.g., aggression, alcohol/marijuana use, problematic impulsivity) and last-month risky and impulsive behaviors. Relations between intolerance of uncertainty and externalizing symptoms/risky behaviors were mediated by a motivation to engage in these behaviors to avoid distress, but not by the motivation to experience pleasurable emotions. Findings suggest that difficulty tolerating uncertainty may confer risk for the externalizing spectrum of psychopathology by increasing the likelihood that an individual will engage in risky behaviors to alleviate distressing or unpleasant emotions.
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Affiliation(s)
- Naomi Sadeh
- University of Delaware, Department of Psychological & Brain Sciences, 105 The Green, Newark, DE 19716, USA
| | - Keith Bredemeier
- Center for the Treatment and Study of Anxiety, University of Pennsylvania, Department of Psychiatry, 3535 Market Street, Philadelphia, PA 19104, USA
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Marcotte-Beaumier G, Bouchard S, Gosselin P, Langlois F, Belleville G, Marchand A, Dugas MJ. The Role of Intolerance of Uncertainty and Working Alliance in the Outcome of Cognitive Behavioral Therapy for Generalized Anxiety Disorder Delivered by Videoconference: Mediation Analysis. JMIR Ment Health 2021; 8:e24541. [PMID: 33720024 PMCID: PMC8077936 DOI: 10.2196/24541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/23/2020] [Accepted: 01/03/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Previous meta-analyses have shown a significant relationship between working alliance and treatment outcome in general. Some studies have examined the relationship between working alliance and treatment outcome during telepsychotherapy, but to the best of our knowledge, no study has examined the mediating role of individual components of the working alliance. OBJECTIVE As part of a clinical trial of cognitive behavioral therapy (CBT) for generalized anxiety disorder (GAD) delivered by videoconference (VC), the aim of this study is to examine the mediating role of intolerance of uncertainty on the relationship between the components of the working alliance and treatment outcome. METHODS A sample of 46 adults with primary GAD received 15 sessions of CBT for GAD delivered over VC. Participants completed the measure of working alliance immediately after the fifth therapy session. The degree of change in intolerance of uncertainty (a key psychological process) was assessed from pre- to posttreatment. Treatment outcome was assessed via changes in GAD symptoms from pretreatment to the 6-month follow-up. RESULTS The results revealed that the therapeutic bond did not predict treatment outcome (r=-0.23; P=.12). However, agreement on therapeutic goals and tasks did predict treatment outcome (r=-0.42; P=.004 and r=-0.37; P=.01, respectively). In addition, the relationship between consensus on therapeutic tasks and treatment outcome was completely mediated by changes in intolerance of uncertainty (unstandardized β=-0.03; r2=0.12), whereas consensus relative to treatment goals had a direct impact on treatment outcome. CONCLUSIONS These results provide a better understanding of the differential role of the components of the working alliance in telepsychotherapy as a facilitative factor for changes in key cognitive processes, leading to therapeutic change. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN): 12662027; http://www.isrctn.com/ISRCTN12662027.
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Affiliation(s)
- Gabrielle Marcotte-Beaumier
- Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Gatineau, QC, Canada
- Département de psychologie, Université du Québec à Montréal, Montréal, QC, Canada
| | - Stéphane Bouchard
- Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Gatineau, QC, Canada
- Centre de recherche du Centre Intégré de Santé et de Services Sociaux de l'Outaouais, Gatineau, QC, Canada
| | - Patrick Gosselin
- Département de psychologie, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Frédéric Langlois
- Département de psychologie, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | | | - André Marchand
- Département de psychologie, Université du Québec à Montréal, Montréal, QC, Canada
| | - Michel J Dugas
- Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Gatineau, QC, Canada
- Centre de recherche du Centre Intégré de Santé et de Services Sociaux de l'Outaouais, Gatineau, QC, Canada
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Hiser J, Schneider B, Koenigs M. Uncertainty Potentiates Neural and Cardiac Responses to Visual Stimuli in Anxiety Disorders. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:725-734. [PMID: 33592312 DOI: 10.1016/j.bpsc.2021.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Intolerance of uncertainty and worry about future events are cardinal features of anxiety. However, the neurobiological and physiological mechanisms underlying these characteristics of anxiety remain to be fully elucidated. METHODS Individuals with diagnosed anxiety disorders (n = 29, 22 female) and age-matched comparison subjects (n = 28, 17 female) completed a task in which pictures (aversive or neutral content) were preceded by cues indicating certainty or uncertainty about the emotional valence of the subsequent pictures. We assessed functional magnetic resonance imaging and heart rate activity with respect to the 1) cue period, 2) emotional valence of the pictures, and 3) modulatory effect of uncertainty on responses to subsequent pictures. RESULTS Individuals with anxiety disorders and comparison subjects exhibited similar functional magnetic resonance imaging and cardiac activity during the cue period and for the aversive versus neutral picture contrast. However, individuals with anxiety disorders exhibited greater modulatory effects of uncertainty on their responses to subsequent pictures. Specifically, they displayed greater functional magnetic resonance imaging activity in a number of cortical regions (visual cortex, anterior cingulate cortex, superior temporal gyrus, and anterior insula), as well as significantly reduced cardiac deceleration to pictures preceded by the uncertainty cue. CONCLUSIONS These findings suggest that heightened neural and autonomic reactivity to stimuli during conditions of uncertainty may be a key psychobiological mechanism of anxiety.
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Affiliation(s)
- Jaryd Hiser
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin.
| | - Brett Schneider
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin
| | - Michael Koenigs
- Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin
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30
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What works in the Socratic debate? An analysis of verbal behaviour interaction during cognitive restructuring. Behav Cogn Psychother 2020; 49:513-525. [PMID: 33292882 DOI: 10.1017/s1352465820000880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cognitive restructuring is one of the most complex application procedures in psychotherapy. It is widely used by psychologists from different orientations. However, the guidelines on how to apply it do not usually have empirical evidence and there is a lack of knowledge about the mechanisms of change that explain it. AIMS The analysis of verbalizations that therapists emit during the Socratic method could help to better understand the functioning and strategies of effective debates. METHOD In this study, specific verbal interaction sequences were analysed using observational methodology. The sample consisted of 113 Socratic questioning fragments belonging to 18 clinical cases, treated by behavioural therapists. RESULTS Among other findings, it was found that using questioning together with certain previous verbalizations directed the client's response more effectively and those successful debates were characterized by using the aversive component in a frequent and contingent way. CONCLUSION This study shows the most effective way to establish such an interaction in the Socratic method (following a style closer to Ellis's argumentative debate), which entails relevant practical applications in therapy.
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31
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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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32
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Leiler A, Wasteson E, Holmberg J, Bjärtå A. A Pilot Study of a Psychoeducational Group Intervention Delivered at Asylum Accommodation Centers-A Mixed Methods Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8953. [PMID: 33271975 PMCID: PMC7730684 DOI: 10.3390/ijerph17238953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/27/2020] [Accepted: 11/28/2020] [Indexed: 12/11/2022]
Abstract
Asylum seekers suffer high levels of distress but have restricted access to mental health care. This paper constitutes an evaluation of a psycho-educational group intervention, called AMIN, which was provided at two asylum accommodation centers in Sweden. A mixed-methods approach was used. To assess potential effectiveness, acceptability, and feasibility, quantitative outcome measures were combined with qualitative information from interviews with both intervention participants and staff providing the intervention. Potential effectiveness in reducing symptoms of distress and insomnia and in increasing physical quality of life was found, even though the intervention participants suffered from more severe distress than expected. In general, the intervention seemed to be acceptable to both participants and staff, with concrete strategies seeming more meaningful than abstract psychological techniques. Finally, regardless of the asylum process itself being a complicating factor, the intervention seemed feasible to deliver to individuals with different backgrounds and conditions. Taken together, these results indicate that some sessions may need further elaboration, but also that the transition to a randomized control trial is reasonable.
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Affiliation(s)
- Anna Leiler
- Institution of Psychology and Social Work, Mid Sweden University, 831 25 Östersund, Sweden; (E.W.); (J.H.); (A.B.)
| | - Elisabet Wasteson
- Institution of Psychology and Social Work, Mid Sweden University, 831 25 Östersund, Sweden; (E.W.); (J.H.); (A.B.)
| | - Joanna Holmberg
- Institution of Psychology and Social Work, Mid Sweden University, 831 25 Östersund, Sweden; (E.W.); (J.H.); (A.B.)
- Region Örebro County, 703 54 Örebro, Sweden
| | - Anna Bjärtå
- Institution of Psychology and Social Work, Mid Sweden University, 831 25 Östersund, Sweden; (E.W.); (J.H.); (A.B.)
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33
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Meagher R, Chessor D, Fogliati VJ. Treatment of Pathological Worry in Children With Acceptance‐Based Behavioural Therapy and a Multisensory Learning Aide: A Pilot Study. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Richard Meagher
- Department of Psychological Sciences, Swinburne University of Technology,
| | - Danuta Chessor
- School of Social Sciences and Psychology, University of Western Sydney,
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34
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Groves D, Clark LH, Clark GI. The relationship between worry and intolerance of uncertainty subtypes. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- David Groves
- School of Behavioural, Cognitive & Social Sciences, University of New England, Armidale, New South Wales, Australia,
| | - Laura H. Clark
- School of Behavioural, Cognitive & Social Sciences, University of New England, Armidale, New South Wales, Australia,
| | - Gavin I. Clark
- School of Behavioural, Cognitive & Social Sciences, University of New England, Armidale, New South Wales, Australia,
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Tull MT, Barbano AC, Scamaldo KM, Richmond JR, Edmonds KA, Rose JP, Gratz KL. The prospective influence of COVID-19 affective risk assessments and intolerance of uncertainty on later dimensions of health anxiety. J Anxiety Disord 2020; 75:102290. [PMID: 32823216 PMCID: PMC7422821 DOI: 10.1016/j.janxdis.2020.102290] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/20/2020] [Accepted: 08/08/2020] [Indexed: 12/17/2022]
Abstract
The COVID-19 pandemic is likely to increase risk for the development of health anxiety. Given that elevated health anxiety can contribute to maladaptive health behaviors, there is a need to identify individual difference factors that may increase health anxiety risk. This study examined the unique and interactive relations of COVID-19 affective risk assessments (worry about risk for contracting/dying from COVID-19) and intolerance of uncertainty to later health anxiety dimensions. A U.S. community sample of 364 participants completed online self-report measures at a baseline assessment (Time 1) and one month later (Time 2). Time 1 intolerance of uncertainty was uniquely associated with the Time 2 health anxiety dimension of body vigilance. Time 1 affective risk assessments and intolerance of uncertainty were uniquely associated with later perceived likelihood that an illness would be acquired and anticipated negative consequences of an illness. The latter finding was qualified by a significant interaction, such that affective risk assessments were positively associated with anticipated negative consequences of having an illness only among participants with mean and low levels of intolerance of uncertainty. Results speak to the relevance of different risk factors for health anxiety during the COVID-19 pandemic and highlight targets for reducing health anxiety risk.
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Affiliation(s)
- Matthew T. Tull
- Corresponding author at: Department of Psychology, Mail Stop 948, University of Toledo, 2801 West Bancroft Street, Toledo, OH, 43606, USA
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Kendall PC, Norris LA, Rabner JC, Crane ME, Rifkin LS. Intolerance of Uncertainty and Parental Accommodation: Promising Targets for Personalized Intervention for Youth Anxiety. Curr Psychiatry Rep 2020; 22:49. [PMID: 32666277 PMCID: PMC8098646 DOI: 10.1007/s11920-020-01170-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW After reviewing predictors of differential outcomes of cognitive behavioral therapy (CBT) for pediatric anxiety, we identify and discuss recent evidence for the role of (a) intolerance of uncertainty (IU) and (b) parental accommodation as meaningful targets for personalized intervention. RECENT FINDINGS Few studies to date have identified promising, theory-driven predictors of differential CBT outcomes. Recent findings suggest that increased IU and high levels of parental accommodation are associated with a poorer response to CBT. Several adaptations of CBT and new interventions targeting either IU or parental accommodation have been developed and found to be efficacious in preliminary studies. IU and parental accommodation are promising constructs for personalizing intervention, both in the identification of who will respond to treatment and in the development of targeted intervention. We recommend that future work test if individuals high in IU and/or parental accommodation will respond more optimally to treatments that specifically target these constructs. The results of this future work may help to move the field closer to personalized intervention.
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Affiliation(s)
- Philip C Kendall
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19122, USA.
| | - Lesley A Norris
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19122, USA
| | - Jonathan C Rabner
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19122, USA
| | - Margaret E Crane
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19122, USA
| | - Lara S Rifkin
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19122, USA
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What are the recovery and attrition outcomes for group CBT and individual CBT for generalised anxiety disorder in an IAPT service? An exploratory study. COGNITIVE BEHAVIOUR THERAPIST 2020. [DOI: 10.1017/s1754470x20000045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Group cognitive behavioural therapy (gCBT) is commonly used in Increasing Access to Psychological Therapies (IAPT) services. However, there is limited knowledge of the efficacy of gCBT as a delivery format for generalised anxiety disorder (GAD). To address gaps in literature, this study aims to explore the efficacy and attrition of individual and group CBT interventions, respectively, at Step 3 for GAD using data from a routine IAPT service over a 24-month period. Data were retrospectively derived from a routine serviceʼs IAPTus database, separating those eligible for comparison into group (n = 44) and individual (n = 55) CBT for GAD. Outcomes were differences in pre–post self-reported anxiety (GAD-7) and depression (PHQ-9) scores, clinical recovery and attrition for gCBT and individual CBT. Both gCBT and individual CBT yielded significant reductions in self-reported anxiety and depression scores over time. Results indicate that 53% of patients attending individual CBT achieved clinical recovery, with similar but less competitive rates of 41% in gCBT. Attrition rates were similar between gCBT (29.5%) and individual CBT (27.3%), respectively. Preliminary results suggest that both individual and gCBT are effective interventions for GAD patients in IAPT, offering symptom alleviation and comparable recovery and attrition rates post-intervention. This observational design offers credibility and insight into a pragmatic evaluative and explorative comparison. gCBT may offer an acceptable and potentially economical alternative.
Key learning aims
(1)
To explore whether gCBT and individual CBT yield significant symptom reduction in self-reported anxiety and depression in GAD patients from a routine IAPT service.
(2)
To explore gCBT and individual CBT clinical recovery rates in non-optimum routine conditions.
(3)
To explore whether gCBT for GAD produces unacceptable attrition rates and if this differs from attrition rates in individual CBT for GAD in a routine IAPT service.
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Abstract
AbstractGeneralized anxiety disorder (GAD) is a common (lifetime prevalence: 5.1%), recurrent condition, which often heralds other psychiatric disorders, notably depression. As by definition it is a disorder progressing over months, treatment should be designed on a long term basis. And yet, few studies have been conducted beyond the classical 6–8 weeks characterizing the acute treatment phase. This is especially true of anxiolytics, but also of antidepressants, with the exception of paroxetine and venlafaxine, which are the only drugs approved in this indication in Western countries. The efficacy of psychotherapy, notably relaxation and cognitive-behavioral therapy, is established in the treatment of GAD, but its preferred indications and possible combination with antidepressants are still to be specified. Long term, not to say very long term studies of GAD, as well as depression, will still be required in the future to improve its management and specify therapeutic modalities (combination treatment, optimal duration, continuous or intermittent therapy, choice of psychotherapeutic techniques or agents, …). Early and adequately prolonged treatment should not only result in more numerous remission periods, but also in decreased frequency of co-morbidities whether depressive, addictive, or of another nature, and should also reduce the social impact of GAD.
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Affiliation(s)
- Frédéric Rouillon
- Psychiatry Department, Hospital Albert Chenevier, 40, rue de Mesly, 94010 Creteil, France
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The efficacy of group cognitive-behavioural therapy plus duloxetine for generalised anxiety disorder versus duloxetine alone. Acta Neuropsychiatr 2019; 31:316-324. [PMID: 31405402 DOI: 10.1017/neu.2019.32] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To explore whether and how group cognitive-behavioural therapy (GCBT) plus medication differs from medication alone for the treatment of generalised anxiety disorder (GAD). METHODS Hundred and seventy patients were randomly assigned to the GCBT plus duloxetine (n=89) or duloxetine group (n=81). The primary outcomes were Hamilton Anxiety Scale (HAMA) response and remission rates. The explorative secondary measures included score reductions from baseline in the HAMA total, psychic, and somatic anxiety subscales (HAMA-PA, HAMA-SA), the Hamilton Depression Scale, the Severity Subscale of Clinical Global Impression Scale, Global Assessment of Functioning, and the 12-item Short-Form Health Survey. Assessments were conducted at baseline, 4-week, 8-week, and 3-month follow-up. RESULTS At 4 weeks, HAMA response (GCBT group 57.0% vs. control group 24.4%, p=0.000, Cohen's d=0.90) and remission rates (GCBT group 21.5% vs. control group 6.2%, p=0.004; d=0.51), and most secondary outcomes (all p<0.05, d=0.36-0.77) showed that the combined therapy was superior. At 8 weeks, all the primary and secondary significant differences found at 4 weeks were maintained with smaller effect sizes (p<0.05, d=0.32-0.48). At 3-month follow-up, the combined therapy was only significantly superior in the HAMA total (p<0.045, d=0.43) and HAMA-PA score reductions (p<0.001, d=0.77). Logistic regression showed superiority of the combined therapy for HAMA response rates [odds ratio (OR)=2.12, 95% confidence interval (CI) 1.02-4.42, p=0.04] and remission rates (OR=2.80, 95% CI 1.27-6.16, p=0.01). CONCLUSIONS Compared with duloxetine alone, GCBT plus duloxetine showed significant treatment response for GAD over a shorter period of time, particularly for psychic anxiety symptoms, which may suggest that GCBT was effective in changing cognitive style.
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But what will the results be?: Learning to tolerate uncertainty is associated with treatment-produced gains. J Anxiety Disord 2019; 68:102146. [PMID: 31669785 DOI: 10.1016/j.janxdis.2019.102146] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 08/20/2019] [Accepted: 09/18/2019] [Indexed: 12/25/2022]
Abstract
The current study examined the association between changes in intolerance of uncertainty (IU) and treatment outcomes for anxious youth. Participants were youth ages 7 to 17 who received cognitive behavioral therapy for anxiety (N = 73). Youth and their primary caregivers completed a diagnostic interview and self- and parent-report measures at pre- and post-treatment, including the Intolerance of Uncertainty Scale for Children (IUS-C/P; Przeworski, 2006), the Coping Questionnaire (CQ-C/P; Kendall, 1994) and the Multidimensional Anxiety Scale for Children (MASC-C/P; March et al., 1997). Hierarchical regression analyses evaluated the role of change in IU (the IUS-C/P) in predicting changes in functional impairment, coping efficacy, and anxiety severity post-treatment, controlling for demographic variables (age and gender), and baseline levels of IU, anxiety severity, functional impairment, and coping efficacy. Results demonstrated that treatment was associated with improvements across child-, parent- and clinician-report, and decreased IU from pre- to post-treatment was associated with (a) decreased functional impairment, (b) increased coping efficacy and (c) decreased anxiety severity. The findings indicate that a greater reduction in IU over treatment is associated with better outcomes in children and adolescents with anxiety across informants, suggesting the possibility that an increased focus on IU during treatment for youth anxiety may improve treatment outcomes. Future research should assess the causality of this relationship.
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Pharmacological and psychological interventions for generalized anxiety disorder in adults: A network meta-analysis. J Psychiatr Res 2019; 118:73-83. [PMID: 31494377 DOI: 10.1016/j.jpsychires.2019.08.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 02/06/2023]
Abstract
Generalized anxiety disorder (GAD) is a significant and common mental illness with a lifetime prevalence of 3.7%. Regardless of the complexity of treatment decisions for GAD, few studies have conducted systematic comparisons of the efficacies of varying interventions. Thus, this study performed a valid network meta-analysis (NMA) of randomized controlled trials (RCTs) to synthesize direct and indirect evidence for alternative interventions for GAD. We searched four major bibliographic databases, the Cochrane Central Register of Controlled Trials, Embase, PsycINFO, and PubMed, for published RCTs of adult patients with a diagnosis of GAD and allowed for all comorbidities. A total of 91 articles (14,812 participants) were identified in the final NMA. The results showed that all pharmacological treatments except for serotonin modulators and second-generation antipsychotics had greater effects than placebo: norepinephrine-dopamine reuptake inhibitors (standardized mean difference (SMD) -1.84, 95% credible interval -3.05 to -0.62), noradrenergic and specific serotonergic antidepressants (-0.91, -1.62 to -0.20), melatonergic receptor agonists (-0.68, -1.15 to -0.21), selective serotonin reuptake inhibitors (SSRIs; -0.67, -0.90 to -0.43), azapirones (-0.58, -1.00 to -0.17), anticonvulsants (-0.56, -0.85 to -0.28), serotonin-norepinephrine reuptake inhibitors (SNRIs; -0.54, -0.79 to -0.30), and benzodiazepines (BZDs; -0.40, -0.65 to -0.15). Most psychological and self-help interventions exerted greater effects than the waitlist group. However, no psychological interventions had greater effects compared with the psychological placebo. Overall, most pharmacological interventions had larger effect sizes than psychological interventions, and most psychological interventions showed larger effect sizes than self-help interventions.
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Geronimi EMC, Richards A, Gramszlo C, Woodruff-Borden J. A Preliminary Investigation of Cognitive Features Associated With Worry Among African American Youth. JOURNAL OF BLACK PSYCHOLOGY 2019. [DOI: 10.1177/0095798419870076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although knowledge of the cognitive factors that place children at risk for worry has grown, little is known about these processes within African American youth. The present study investigated cognitive factors associated with worry in a sample of 47 African American children, ages 8 to 13. Participants completed self-report measures of worry, intolerance of uncertainty, positive and negative beliefs about worry, and negative problem orientation. Results supported the hypothesis that cognitive factors demonstrated significant positive associations with worry. Based on a model predicting worry from all cognitive factors, negative beliefs about worry emerged as the only individual predictor. This is the first study to examine cognitive factors associated with worry in an African American sample of children and provides initial support for the applicability of these cognitive factors in future examinations of worry within this population. Future research should continue to explore cognitive as well as other factors that predispose African America children to worry.
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Non-social smartphone use mediates the relationship between intolerance of uncertainty and problematic smartphone use: Evidence from a repeated-measures study. COMPUTERS IN HUMAN BEHAVIOR 2019. [DOI: 10.1016/j.chb.2019.02.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Rodgers J, Goodwin J, Parr JR, Grahame V, Wright C, Padget J, Garland D, Osborne M, Labus M, Kernohan A, Freeston M. Coping with Uncertainty in Everyday Situations (CUES©) to address intolerance of uncertainty in autistic children: study protocol for an intervention feasibility trial. Trials 2019; 20:385. [PMID: 31248435 PMCID: PMC6598241 DOI: 10.1186/s13063-019-3479-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/29/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Anxiety is a common diagnosis in children with autism spectrum disorder (ASD). One key mechanism underlying anxiety is intolerance of uncertainty, which is a tendency to react negatively on an emotional, cognitive, and behavioural level to uncertain situations and events. We developed the first intervention programme specifically targeting intolerance of uncertainty in children with ASD: Coping with Uncertainty in Everyday Situations (CUES). CUES is a parent group intervention providing parents of children with ASD with strategies to increase tolerance to uncertainty for their children in everyday situations. The principal aims of the current study are: 1) evaluate the acceptability and feasibility of delivering CUES to parents who have a child with ASD and anxiety; and 2) inform the design of a fully powered trial. METHOD This is a feasibility and acceptability single-blind pilot randomised controlled trial comparing CUES (intervention) to a brief psychoeducation, emotional literacy, and relaxation programme (enhanced services as usual). Participants will be assessed at baseline and followed-up immediately post-treatment, and at 12 and 26 weeks post-treatment. Parents who have a child with ASD and anxiety (aged 6-16 years) will be invited to take part in the study and written parental informed consent and child assent will be obtained. Participants will be recruited from the National Health Service mental health teams in the UK. Sixty participants will be randomised to either intervention or enhanced services as usual in a 1:1 ratio. DISCUSSION The present study will provide evidence on the acceptability of the CUES intervention to parents and children, and the feasibility of recruitment and delivery to inform the design and sample size for a full-scale randomised controlled trial. Qualitative data will be obtained to understand how feasible CUES is for families, and the experiences of participants regarding their experiences of the intervention. TRIAL REGISTRATION ISRCTN, ISRCTN10139240 . Registered on 14 May 2018.
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Affiliation(s)
- Jacqui Rodgers
- Institute of Neuroscience, Sir James Spence Institute, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle, NE1 4LP UK
| | - Jane Goodwin
- Institute of Neuroscience, Sir James Spence Institute, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle, NE1 4LP UK
| | - Jeremy R. Parr
- Institute of Neuroscience, Sir James Spence Institute, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle, NE1 4LP UK
- Complex Neurodevelopmental Disorders Service, Northumberland Tyne and Wear NHS Foundation Trust, Walkergate Park Hospital, Walkergate Park, NE6 4QD UK
| | - Victoria Grahame
- Complex Neurodevelopmental Disorders Service, Northumberland Tyne and Wear NHS Foundation Trust, Walkergate Park Hospital, Walkergate Park, NE6 4QD UK
| | - Catharine Wright
- Child and Adolescent Mental Health Service, Northumbria Healthcare NHS Foundation Trust, Albion Rd Resource Centre, North Shields, NE29 0HG UK
| | - John Padget
- Complex Neurodevelopmental Disorders Service, Northumberland Tyne and Wear NHS Foundation Trust, Walkergate Park Hospital, Walkergate Park, NE6 4QD UK
| | - Deborah Garland
- Sir James Spence Institute, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle, NE1 4LP UK
| | - Malcolm Osborne
- South Tyneside’s Kids And Young Adults Klub - Special needs support group (KAYAKS), South Shields, NE33 4UG UK
| | - Marie Labus
- Research and Enterprise Services, Faculty of Medical Sciences, Newcastle University, The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Ashleigh Kernohan
- Institute of Health & Society Newcastle University Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Mark Freeston
- School of Psychology, Newcastle University, 4th Floor Ridley Building, Newcastle upon Tyne, NE1 7RU UK
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45
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Hebert EA, Dugas MJ. Behavioral Experiments for Intolerance of Uncertainty: Challenging the Unknown in the Treatment of Generalized Anxiety Disorder. COGNITIVE AND BEHAVIORAL PRACTICE 2019. [DOI: 10.1016/j.cbpra.2018.07.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Taylor L, Waite P, Halldorsson B, Percy R, Violato M, Creswell C. Protocol for a randomised controlled feasibility study examining the efficacy of brief cognitive therapy for the Treatment of Anxiety Disorders in Adolescents (TAD-A). Trials 2019; 20:240. [PMID: 31023352 PMCID: PMC6485105 DOI: 10.1186/s13063-019-3295-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 03/18/2019] [Indexed: 11/10/2022] Open
Abstract
Background Anxiety disorders affect a quarter of the population during their lifetime, and typically emerge in childhood or adolescence. Anxiety disorders disrupt young people’s social, emotional and academic development and in the absence of treatment, often follow a chronic course. Although effective treatments, such as Cognitive Behaviour Therapy (CBT), exist, only a small proportion of adolescents with anxiety disorders who need treatment receive them. Barriers to treatment provision include the fact that CBT typically requires 14–16 sessions by a highly qualified therapist and services are stretched – resulting in lengthy waiting lists and limited access to treatment. This highlights the importance of developing new ways of providing effective treatments for adolescent anxiety disorders. This study aims to assess the feasibility of a future, large-scale trial. This will give a clear indication of the likely success of running a randomised controlled trial to compare a new, brief cognitive therapy treatment to an existing CBT group therapy for adolescents with anxiety disorders. Methods/design The study will examine whether a definitive trial can be conducted on the basis of a feasibility RCT using a number of well-defined criteria. The feasibility RCT is a single-centre, randomised control trial. Forty-eight Young people (age 11–17.5 years) attending a university research clinic, who meet the diagnostic criteria for a DSM-5 anxiety disorder, will be randomly allocated to receive either (1) Adolescent Cognitive Therapy for Anxiety (ACTA), which involves six 60–90-min sessions and a booster session or (2) group CBT, which involves eight 2-h sessions and a booster session. As part of the feasibility indicators, patient outcomes, expectations and experiences, as well as health economic factors, will be assessed before, at the end of treatment and at a 3-month follow-up. Discussion The successful delivery of a future, definitive trial has the potential to bring direct benefits to young people and their families, adolescent mental health service providers, as well as benefits to adult mental health services and society more broadly by disrupting the negative trajectory commonly associated with adolescent anxiety disorders. Trial registration ISRCTN, ID: ISRCTN86123204. Retrospectively registered on 23 November 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3295-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lucy Taylor
- School of Psychology and Clinical Language Sciences, University of Reading, Harry Pitt Building, Earley Gate, Reading, RG6 6AL, UK
| | - Polly Waite
- School of Psychology and Clinical Language Sciences, University of Reading, Harry Pitt Building, Earley Gate, Reading, RG6 6AL, UK.
| | - Brynjar Halldorsson
- Departments of Experimental Psychology and Psychiatry, Anna, Watts Building, Oxford, OX2 6GG, UK
| | - Ray Percy
- School of Psychology and Clinical Language Sciences, University of Reading, Harry Pitt Building, Earley Gate, Reading, RG6 6AL, UK
| | - Mara Violato
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Cathy Creswell
- Departments of Experimental Psychology and Psychiatry, Anna, Watts Building, Oxford, OX2 6GG, UK
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GAD-Specific Cognitive Behavioral Treatment for Children and Adolescents: A Pilot Randomized Controlled Trial. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10020-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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48
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Stefan S, Cristea IA, Szentagotai Tatar A, David D. Cognitive‐behavioral therapy (CBT) for generalized anxiety disorder: Contrasting various CBT approaches in a randomized clinical trial. J Clin Psychol 2019; 75:1188-1202. [DOI: 10.1002/jclp.22779] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/11/2019] [Accepted: 03/19/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Simona Stefan
- Department of Clinical Psychology and PsychotherapyBabeş‐Bolyai University Cluj‐Napoca Romania
| | - Ioana A. Cristea
- Department of Clinical Psychology and PsychotherapyBabeş‐Bolyai University Cluj‐Napoca Romania
| | | | - Daniel David
- Department of Clinical Psychology and Psychotherapy/International Institute for the Advanced Study of Psychotherapy and Applied Mental HealthBabeş‐Bolyai University, No 37 Republicii Street Cluj‐Napoca Romania
- Department of Oncological SciencesIcahn School of Medicine at Mount SinaiNew York New York
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The role of intolerance of uncertainty in current and remitted internalizing and externalizing psychopathology. J Anxiety Disord 2019; 62:68-76. [PMID: 30639836 DOI: 10.1016/j.janxdis.2019.01.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 12/18/2018] [Accepted: 01/02/2019] [Indexed: 12/12/2022]
Abstract
Intolerance of uncertainty (IU) is a putative key, transdiagnostic factor in internalizing psychopathologies. However, it is unclear if elevated levels of IU, as measured by the Intolerance of Uncertainty Scale, short form (IUS-12) and its subscales (prospective and inhibitory IU), persist into remission of internalizing psychopathologies (or particular types of internalizing psychopathologies; e.g., fear vs. distress-misery disorders). It is also unknown if IU is specifically characteristic of internalizing (vs. externalizing) psychopathology and whether this relationship is independent of neuroticism/negative affectivity (N/NA). A large community sample (n = 517) completed a diagnostic interview and self-report measures of IU and N/NA. Results indicated that, independent of N/NA, IU was elevated in current fear and distress/misery disorders, but not externalizing disorders. Individuals with remitted fear disorders also displayed significantly elevated levels of IU in comparison to healthy controls after adjusting for levels of N/NA. In terms of subscales, elevated levels of inhibitory IU, and not prospective IU, demonstrated more reliable relationships with internalizing psychopathologies. In summary, IU was more consistently related to fear disorders, demonstrated incremental validity over and above the effects of N/NA, and may be a key, transdiagnostic mechanism in fear disorders.
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50
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Carl E, Witcraft SM, Kauffman BY, Gillespie EM, Becker ES, Cuijpers P, Van Ameringen M, Smits JAJ, Powers MB. Psychological and pharmacological treatments for generalized anxiety disorder (GAD): a meta-analysis of randomized controlled trials. Cogn Behav Ther 2019; 49:1-21. [PMID: 30760112 DOI: 10.1080/16506073.2018.1560358] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The purpose of this meta-analysis was to provide updated pooled effect sizes of evidence-based psychotherapies and medications for generalized anxiety disorder (GAD) and to investigate potential moderators of outcomes. Seventy-nine randomized controlled trials (RCT) including 11,002 participants with a diagnosis of GAD were included in a meta-analysis that tested the efficacy of psychotherapies or medications for GAD. Psychotherapy showed a medium to large effect size (g = 0.76) and medication showed a small effect size (g = 0.38) on GAD outcomes. Psychotherapy also showed a medium effect on depression outcomes (g = 0.64) as did medications (g = 0.59). Younger age was associated with a larger effect size for psychotherapy (p < 0.05). There was evidence of publication bias in psychotherapy studies. This analysis found a medium to large effect for empirically supported psychotherapy interventions on GAD outcomes and a small effect for medications on GAD outcomes. Both groups showed a medium effect on depression outcomes. Because medication studies had more placebo control conditions than inactive conditions compared to psychotherapy studies, effect sizes between the domains should not be compared directly. Patient age should be further investigated as a potential moderator in psychotherapy outcomes in GAD.
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Affiliation(s)
- Emily Carl
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Sara M Witcraft
- Department of Psychology, University of Mississippi, Oxford, MS, USA
| | | | - Eilis M Gillespie
- School of Psychology, National University of Ireland Galway & Ireland's Health Services, Galway, Ireland
| | - Eni S Becker
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Michael Van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Jasper A J Smits
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Mark B Powers
- Department of Psychology, University of Texas at Austin, Austin, TX, USA.,Division of Trauma, Critical Care, and Acute Care Surgery, Baylor University Medical Center, Dallas, TX, USA
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