Breadcrumb

 
 

A Randomized Clinical Trial of Cognitive-Behavioral Therapy and Applied Relaxation for Adults With Generalized Anxiety Disorder

Title:

A Randomized Clinical Trial of Cognitive-Behavioral Therapy and Applied Relaxation for Adults With Generalized Anxiety Disorder

Dugas, Michel J. and Brillon, Pascale and Savard, Pierre and Turcotte, Julie and Gaudet, Adrienne and Ladouceur, Robert and Leblanc, Renée and Gervais, Nicole J. (2010) A Randomized Clinical Trial of Cognitive-Behavioral Therapy and Applied Relaxation for Adults With Generalized Anxiety Disorder. Behavior Therapy, 41 (1). pp. 46-58. ISSN 00057894

[img]
Preview
PDF
201Kb

Official URL: http://dx.doi.org/10.1016/j.beth.2008.12.004

Abstract

This randomized clinical trial compared cognitive-behavioral therapy (CBT), applied relaxation (AR) and wait-list control (WL) in a sample of 65 adults with a primary diagnosis of generalized anxiety disorder (GAD). The CBT condition was based on the intolerance of uncertainty model of GAD, whereas the AR condition was based on general theories of anxiety. Both manualized treatments were administered over 12 weekly one-hour sessions. Standardized clinician ratings and self-report questionnaires were used to assess GAD and related symptoms at pretest, posttest, and at 6-, 12- and 24-month follow-ups. At posttest, CBT was clearly superior to WL, AR was marginally superior to WL, and CBT was marginally superior to AR. Over follow-up, CBT and AR were equivalent, but only CBT led to continued improvement. Thus, direct comparisons of CBT and AR indicated that the treatments were comparable; however, comparisons of each treatment with another point of reference (either waiting list or no change over follow-up) provided greater support for the efficacy of CBT than AR.

Divisions:Concordia University > Faculty of Arts and Science > Psychology
Item Type:Article
Refereed:Yes
Authors:Dugas, Michel J. and Brillon, Pascale and Savard, Pierre and Turcotte, Julie and Gaudet, Adrienne and Ladouceur, Robert and Leblanc, Renée and Gervais, Nicole J.
Journal or Publication:Behavior Therapy
Date:2010
Keywords:Generalized anxiety disorder; cognitive-behavioral therapy; applied relaxation; randomized clinical trial; intolerance of uncertainty
ID Code:7759
Deposited By:LUIGINA VILENO
Deposited On:01 Aug 2011 14:09
Last Modified:01 Aug 2011 14:10
References:
American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington DC: Author.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington DC: Author.
Arntz, A. (2003). Cognitive therapy versus applied relaxation as treatment of generalized anxiety disorder. Behaviour Research and Therapy, 41, 633-646.
Barlow, D. H., Rapee, R. M., & Brown, T. A. (1992). Behavioral treatment of generalized anxiety disorder. Behavior Therapy, 23, 551-570.
Beck, A. T., & Clark, D. A. (1997). An information processing model of anxiety: Automatic and strategic processes. Behaviour Research and Therapy, 35, 49-58.
Beck, A. T., Steer, R. A., & Brown, T. A. (1996). Beck Depression Inventory Manual (2nd ed.). Manual San Antonio, TX: Psychological Corporation.
Bernstein, D. A., & Borkovec, T. D. (1973). Progressive relaxation training. Champaign, IL: Research Press.
Bieling, P. J., Antony, M. M., & Swinson, R. P. (1998). The State-Trait Anxiety Inventory, Trait version: Structure and content re-examined. Behaviour Research and Therapy, 36, 777-788.
Borkovec, T. D., & Costello, E. (1993). Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 61, 611-619.
Borkovec, T. D., & Nau, S. D. (1972). Credibility of analogue therapy rationales. Journal of Behavioral Therapy and Experimental Psychiatry, 3, 257-260.
Borkovec, T. D., Newman, M. G., Pincus, A. L., & Lytle, R. (2002). A component analysis of cognitive-behavioral therapy for generalized anxiety disorder and the role of interpersonal problems. Journal of Consulting and Clinical Psychology, 70, 288-298.
Brown, T. A., Antony, M. M., & Barlow, D. H. (1992). Psychometric properties of the Penn State Worry Questionnaire in a clinical disorder sample. Behaviour Research and Therapy, 30, 33-37.
Brown, T. A., Di Nardo, P. A., Lehman, C. L., & Campbell, L. A. (2001). Reliability of DSM-IV anxiety and mood disorders: Implications for the classification of emotional disorders. Journal of Abnormal Psychology, 110, 49-58.
Buhr, K., & Dugas, M. J. (in press). The role of fear of anxiety and intolerance of uncertainty in worry: An experimental manipulation. Behaviour Research and Therapy.
Chambless, D. L., Baker, M. J., Baucom, D. H., Beutler, L. E., Calhoun, K. S., Crits-Christoph, P., et al. (1998). Update on empirically validated therapies II. The Clinical Psychologist, 51, 3-15.
Chambless, D. L., & Ollendick, T. H. (2001). Empirically supported psychological interventions: Controversies and evidence. Annual Review of Psychology, 52, 685-716.
Covin, R., Ouimet, A. J., Seeds, P. M., & Dozois, D. J. A. (2008). A meta-analysis of CBT for pathological worry among clients with GAD. Journal of Anxiety Disorders, 22, 108-116.
Cox, B. J., Cohen, E., Direnfeld, D. M., & Swinson, R. P. (1996). Reply to Steer and Beck: Panic disorder, generalized anxiety disorder, and quantitative versus qualitative differences in anxiety assessment. Behaviour Research and Therapy, 34, 959-961.
D’Zurilla, T. J. (1986). Problem solving therapy: A social competence approach to clinical intervention. New York: Springer.
Di Nardo, P. A., Brown, T. A., & Barlow, D. H. (1994). Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV). San Antonio, TX: Psychological Corporation.
Di Nardo, P. A., & Barlow, D. H. (1988). Anxiety Disorder Interview Schedule-Revised (ADIS-R). Albany: Center for Stress and Anxiety Disorders, University at Albany, State University of New York.
Dugas, M. J., Freeston, M. H., Provencher, M. D., Lachance, S., Ladouceur, R., & Gosselin, P. (2001). Le Questionnaire sur l’Inquiétude et l’Anxiété. Validation dans des échantillons non cliniques et cliniques (The Worry and Anxiety Questionnaire: Validation in non-clinical and clinical samples). Journal de Thérapie Comportementale et Cognitive, 11, 31-36.
Dugas, M. J., & Koerner, N. (2005). Cognitive-behavioral treatment for generalized anxiety disorder: Current status and future directions. Journal of Cognitive Psychotherapy: An International Quarterly, 19, 61-81
Dugas, M. J., & Ladouceur, R. (2000). Treatment of GAD: Targeting intolerance of uncertainty in two types of worry. Behavior Modification, 24, 635-657.
Dugas, M. J., Ladouceur, R., Léger, E., Freeston, M. H., Langlois, F., Provencher, M., et al. (2003). Group cognitive-behavioral therapy for generalized anxiety disorder: Treatment outcome and long-term follow-up. Journal of Consulting and Clinical Psychology, 71, 821-825.
Dugas, M. J., & Robichaud, M. (2007). Cognitive-behavioral treatment for generalized anxiety disorder: From science to practice. New York: Routledge.
Fisher, (2006). The efficacy of psychological treatments for generalized anxiety disorder. In G. C. L. Davey & A. Wells (Eds.), Worry and its psychological disorders: Theory, assessment and treatment (pp. 359-377). New York: John Wiley and Sons.
Freeston, M. H., Ladouceur, R., Gagnon, F., Thibodeau, N., Rhéaume, J., Letarte, H., et al. (1997). Cognitive-behavioral treatment of obsessive thoughts: A controlled study. Journal of Consulting and Clinical Psychology, 65, 405-413.
Gosselin, P., Ladouceur, R., Morin, C. M., Dugas, M. J., & Baillargeron, L. (2006). Benzodiazepine discontinuation among adults with GAD: A randomized trial of cognitive-behavioral therapy. Journal of Consulting and Clinical Psychology, 74, 908-919.
Gould, R. A., Safren, S. A., O’Neill, W. D., & Otto, M. W. (2004). Cognitive-behavioural treatments: A meta-analytic review. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 248-264). New York: Guilford Press.
Guy, W. (Ed.) (1976). ECDEU assessment manual for psychopharmacology, revised (pp. 218-222). Rockville, MD: U. S. Department of Mental Health and Human Services, Public Health Service, Alcohol, Drug Abuse and Mental Health Administration, NIMH Psychopharmacology Research Branch.
Keedwell, P., & Snaith, R. P. (1996). What do anxiety scales measure? Acta Psychiatrica Scandinavia, 93, 177-180.
Keijsers, G. P., Hoogduin, K. A., & Schaap, C. P. (1991). Motivation for psychotherapy: The development of a prognostic instrument. Gedragstherapie, 24, 195-208.
Koerner, N., & Dugas, M. J. (2006). A cognitive model of generalized anxiety disorder: The role of intolerance of uncertainty. In G. C. L. Davey & A. Wells (Eds.), Worry and its psychological disorders: Theory, assessment and treatment (pp. 201-216). New York: John Wiley and Sons.
Ladouceur, R., Dugas, M. J., Freeston, M. H., Léger, E., Gagnon, F., & Thibodeau, N. (2000). Efficacy of a new cognitive-behavioral treatment for generalized anxiety disorder: Evaluation in a controlled clinical trial. Journal of Consulting and Clinical Psychology 68, 957-964.
Leucht, S., & Engel, R. R. (2006). The relative sensitivity of the Clinical Global Impression Scale and the Brief Psychiatric Rating Scale in antipsychotic drug trials. Neuropsychopharmacology, 31, 406-412.
Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487-495.
Molina, S., & Borkovec, T. D. (1994). The Penn State Worry Questionnaire: Psychometric properties and associated characteristics. In G. C. L. Davey & F. Tallis (Eds.), Worrying: Perspectives on theory, assessment and treatment (pp. 265-283). New York: John Wiley & Sons.
Öst, L. G. (1987). Applied relaxation: Description of a coping technique and review of controlled studies. Behaviour Research and Therapy, 25, 397-409.
Öst, L. G., & Breitholz, E. (2000). Applied relaxation vs. cognitive therapy in the treatment of generalized anxiety disorder. Behaviour Research and Therapy, 38, 770-790.
Raudenbush, S., Bryk, A., & Congdon R. (2005) HLM 6: Hierarchial linear and nonlinear modeling. SSI Scientific Software.
Roemer, L., & Orsillo, S. M. (2007). An open trial of an acceptance-based behavior therapy for generalized anxiety disorder. Behavior Therapy, 38, 72-85.
Sheehan, D. V., Lecrubier, Y., Janvas, J., Knapp, E., Weiller, E., Sheehan, M., et al. (1994). Mini International Neuropsychiatric Interview Version 4.4 (MINI). Tampa/Paris: University of South Florida/Inserm U302- Hôpital de la Salpêtrière.
Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., et al. (1997). The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, Suppl 20, 22-33.
Spielberger, C. D. (1977). Manual for the State-Trait Anxiety Inventory Y Form. Palo Alto, CA: Consulting Psychologists Press.
Steer, R. A., & Clark, D. A. (1997). Psychometric characteristics of the Beck Depression Inventory-II with college students. Measurement and Evaluation in Counselling and Development, 30, 128-136.
Suinn, R. M., & Richardson, F. (1971). Anxiety management training: A nonspecific behavior therapy program for anxiety control. Behavior Therapy, 2, 498-510.
Turner, S. M., Beidel, D. C., Spaulding, S., & Brown, J. (1995). The practice of behavior therapy: A national survey of cost and methods. The Behavior Therapist, 18, 1-4.
Watson, D., & Clark, L. A. (1984). Negative affectivity: The disposition to experience aversive emotional states. Psychological Bulletin, 96, 465-490.
Wells, A. (2006). Metacognitive therapy for worry and generalized anxiety disorder. In G. C. L. Davey & A. Wells (Eds.), Worry and its psychological disorders: Theory, assessment and treatment (pp. 259-272). New York: John Wiley and Sons.
Williams, K. E., & Chambless D. L. (1990). The relationship between therapist characteristics and outcome of in vivo exposure treatment for agoraphobia. Behavior Therapy, 21, 111-116.
Zaider, T. I., Heimberg, R. G., Fresco, D. M., Schneier, F. R., & Liebowitz, M. R. (2003). Evaluation of the Clinical Global Impression Scale among individuals with social anxiety disorder. Psychological Medicine, 33, 611-622.
All items in Spectrum are protected by copyright, with all rights reserved. The use of items is governed by Spectrum's terms of access.

Repository Staff Only: item control page

Document Downloads

More statistics for this item...

Concordia University - Footer