anxiety

The current meta-analysis compared the efficacy of CBT for GAD between adults of working age and older people. In addition, we conducted a qualitative content analysis of treatment protocols used in studies with older clients to explore potential factors that may enhance treatment outcomes with this particular client group. Applying the inclusion criteria resulted in the identification of 15 studies with 22 comparisons between CBT and control groups (770 patients). When examining overall effect sizes for CBT for GAD between older people and adults of working age there were no statistically significant differences in outcome. However, overall effect size of CBT for GAD was moderate for older people (g = 0.55, 95% CI 0.22–0.88) and large for adults of working age (g = 0.94, 95% CI 0.52–1.36), suggesting that there is still room for improvement in CBT with older people. The main difference in outcome between CBT for GAD between the two age groups was related to methodological quality in that no older people studies used an intention-to-treat design. The content analysis demonstrated that studies with older clients were conducted according to robust CBT protocols but did not take account of gerontological evidence to make them more age-appropriate.

Rigorous evaluations of cognitive behavioral self-help books for anxiety in pure self-help contexts are lacking. The present study evaluated the effectiveness of an Acceptance and Commitment Therapy (ACT) self-help workbook for anxiety-related concerns, with no therapist contact, in an international sample. Participants (N = 503; 94% mental health diagnosis) were randomized to an immediate workbook (n = 256) or wait-list condition (n = 247). Assessments at pretreatment, 12 weeks, 6 months, and 9 months evaluated anxiety and related symptoms, quality of life, and ACT treatment processes (e.g., psychological flexibility). Participants in the wait-list arm crossed over to the workbook following the 12-week assessment. The workbook condition yielded significant improvements on all assessments from pre- to posttreatment relative to wait-list, and these gains were maintained at follow-ups. The pattern observed in the wait-list condition was virtually identical to the active treatment arm after receiving the workbook, but not before. Attrition was notable, but supplemental analyses suggested dropout did not influence treatment effects for all but one measure. Overall, findings provide preliminary support for the effectiveness of this self-help workbook and suggest ACT-based self-help bibliotherapy might be a promising low-cost intervention for people experiencing significant anxiety-related concerns.

The present study represents one of the first comparisons of the long-term effectiveness of traditional cognitive behavior therapy (i.e., Beckian cognitive therapy; CT) and acceptance and commitment therapy (ACT). One hundred thirty-two anxious or depressed outpatients were randomly assigned to receive either CT or ACT, and were assessed at posttreatment (n = 90) and at 1.5-year (n = 91) follow-up. As previously reported, the two treatments were equivalently effective at posttreatment according to measures of depression, anxiety, overall (social/occupational/symptom-related) functioning, and quality of life. However, current results suggest that treatment gains were better maintained at follow-up in the CT condition. Clinical significance analyses revealed that, at follow-up, one-third more CT patients were in the clinically normative range in terms of depressive symptoms and more than twice as many CT patients were in the normative range in terms of functioning levels. The possible long-term advantage of CT relative to ACT in this population is discussed.

The present study investigated mechanisms of change for two group treatments for social anxiety disorder (SAD): cognitive behavioral group therapy (CBGT) and mindfulness and acceptance-based group therapy (MAGT). Participants were treatment completers (n = 37 for MAGT, n = 32 for CBGT) from a randomized clinical trial. Cognitive reappraisal was the hypothesized mechanism of change for CBGT. Mindfulness and acceptance were hypothesized mechanisms of change for MAGT. Latent difference score (LDS) analysis results demonstrate that cognitive reappraisal coupling (in which cognitive reappraisal is negatively associated with the subsequent rate of change in social anxiety) had a greater impact on social anxiety for CBGT than MAGT. The LDS bidirectional mindfulness model (mindfulness predicts subsequent change in social anxiety; social anxiety predicts subsequent change in mindfulness) was supported for both treatments. Results for acceptance were less clear. Cognitive reappraisal may be a more important mechanism of change for CBGT than MAGT, whereas mindfulness may be an important mechanism of change for both treatments.

Acceptance and Commitment Therapy (ACT) has a growing empirical base in the treatment of anxiety among adults and children with other concerns. This study reports on the main outcomes of a randomized controlled trial of ACT and traditional cognitive behavioral therapy (CBT) in children with a Diagnostic and Statistical Manual of Mental Disorders (4th ed.) anxiety disorder. Participants were 193 children from urban Sydney, Australia, who were block-randomized to a 10-week group-based program of ACT or CBT or a 10-week waitlist control (WLC). Completers included 157 children (ACT = 54, CBT = 57, WLC = 46; M = 11 years, SD = 2.76; 78% Caucasian, 58% female). Pretreatment, posttreatment, and 3 months posttreatment assessments included clinician/self/parent-reported measures of anxiety, quality of life (QOL; anxiety interference, psychosocial and physical health-related QOL), and acceptance/defusion outcomes. Completer and intention-to-treat analyses revealed that ACT and CBT were both superior to WLC across outcomes, reflecting statistically and clinically significant differences, with gains maintained at 3 months posttreatment. Both completer and intention-to-treat analyses found ACT and CBT to produce similar outcomes. There was some support for ACT having greater effect sizes for QOL outcomes but not for avoidance/fusion. Although this study does not suggest that ACT is equivalent to CBT or should be adopted in its place, it does provide evidence that ACT might be another empirically supported treatment option for anxious youth. Further research is needed to replicate these findings.
 

Recent acceptance- and mindfulness-based cognitive–behavioral interventions explicitly target the clarification and commitment to a purpose in life. Yet, scant empirical evidence exists on the value of purpose as a mechanism relevant to psychopathology or well-being. The present research explored daily (within-person) fluctuations in purposeful pursuits and well-being in a community sample of 84 adults with (n = 41) and without (n = 43) the generalized subtype of social anxiety disorder (SAD). After completing an idiographic measure of purpose in life, participants monitored their effort and progress toward this purpose, along with their well-being each day. Across 2 weeks of daily reports, we found that healthy controls reported increased self-esteem, meaning in life, positive emotions, and decreased negative emotions. People with SAD experienced substantial boosts in well-being indicators on days characterized by significant effort or progress toward their life purpose. We found no evidence for the reverse direction (with well-being boosting the amount of effort or progress that people with SAD devote to their purpose), and effects could not be attributed to comorbid mood or anxiety disorders. Results provide evidence for how commitment to a purpose in life enriches the daily existence of people with SAD. The current study supports principles that underlie what many clinicians are already doing with clients for SAD. 

Anxiety disorders present a significant concern for children, affecting up to 20% of those under 12 years old. The importance of parenting behavior in the development and maintenance of childhood anxiety disorders has been established both theoretically and empirically. We review the literature on cognitive-behavioral parenting interventions aimed at reducing child anxiety and discuss the limitations of this approach and of the research to date. We then present Acceptance and Commitment Therapy (ACT) as a treatment model that holds promise for shifting problematic parent–child interactions, and we review the relevant theoretical and empirical literature supporting this promise.

To find the full text version of this article and others (as well as download a full text .pdf.), ACBS members can visit the ScienceDirect homepage here.

Acceptance and Commitment Therapy, a popular transdiagnositic treatment approach, is based on the central tenant that human suffering develops and is exacerbated by psychological inflexibility. Cognitive fusion and experiential avoidance are two interrelated processes central to psychological inflexibility. Despite substantive theoretical rationale that these two processes impact one another’s association with emotional distress and psychopathology, the interaction between cognitive fusion and experiential avoidance in relation to psychological distress has yet to be empirically examined in the extant literature. As such, we examined this interactive effect in relation to four indices of psychological distress (anxiety, depression, stress, and posttraumatic stress) in a large sample of community adults recruited via the internet (N=955). The predicted interactive effect was found across all four symptom measures, with the significant positive association between cognitive fusion and symptom measures being strongest at higher levels of experiential avoidance. These results provide support for proposals that individuals with high cognitive fusion and high experiential avoidance may be particularly prone to experiencing psychological distress.

To find the full text version of this article and others (as well as download a full text .pdf.), ACBS members can visit the ScienceDirect homepage here.