anxiety

Anxiety disorders entail avoidance of feared situations and anxious experiences, which is believed to maintain anxiety pathology. It remains unclear if predominant coping styles, like avoidance, are similar across anxiety disorders or if each disorder has its own coping profile. This has important implications for conceptualization of maintenance mechanisms and treatment planning for clients presenting with different anxiety problems, since ineffective and inflexible coping may perpetuate distress. This study examined (a) differences and similarities in coping styles among individuals meeting strict screening criteria for Generalized Anxiety Disorder, Panic Disorder, Social Anxiety and Comorbid anxieties, (b) whether greater avoidance is associated with having symptoms of and anxiety disorder and with greater psychological distress and/or anxiety comorbidity. Participants (n=457; 295 female; Mage=40.09) were a community sample in Cyprus who completed measures of coping (COPE-B), experiential avoidance (AAQ-II), and the Psychiatric Diagnostic Screening Questionnaire (PDSQ) to assess anxiety symptoms. Results showed that disorders were similar in coping, characterized mostly by avoidance and self-blame. Individuals with anxiety symptoms engaged in more avoidance than controls. Greater distress and comorbidity were associated with more avoidance (experiential avoidance, denial, behavioral disengagement) as expected. Findings highlight the role of avoidance as a paramount coping style and potential maintenance mechanism of anxiety pathology. Given that empirically validated treatments, like Cognitive Behavior Therapy (CBT) and Acceptance and Commitment Therapy (ACT), mostly teach new ways of coping with symptoms and distress, understanding how individuals with anxiety disorders typically cope and how this may perpetuate their pathology is important in improving case conceptualization and setting appropriate treatment goals.

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.

Because most behavioral treatments are time-limited, skills and practices that foster long-term maintenance of gains made during treatment are of critical importance. While some studies have found mindfulness practice to be associated with improvements in outcome variables over the course of treatment (Vettese, Toneatto, Stea, Nguyen, & Wang, 2009), very little is known about the effects of continued mindfulness practice following treatment termination. The current study examined the relationships between separate single item measurements of three types of mindfulness practices (formal, informal, and mindfulness of breath in daily life) and long term outcomes in worry, clinician-related anxiety severity, and quality of life following treatment with an acceptance-based behavior therapy (ABBT) for Generalized Anxiety Disorder (GAD) in two separate treatment studies. Results from Study 1 showed that at 9-month follow-up, amount of informal mindfulness practice was significantly related to continued beneficial outcomes for worry, clinician-rated anxiety severity, and quality of life. Similarly, in Study 2, at 6-month follow-up, amount of informal mindfulness practice was significantly related to continued beneficial outcomes for anxiety severity and worry, and at 12-month follow-up informal mindfulness practice was significantly related to continued beneficial outcomes for quality of life and worry, and mindfulness of breath was significantly related to worry and quality of life. Formal practice was not significantly related to outcomes in either study, or in the combined sample. These findings support the further study of informal mindfulness practices as important tools for continued beneficial clinical outcomes following treatment for people with a principal diagnosis of GAD. 

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.

Background

Health Anxiety of hypochondriasis is a disabling and persistent disorder with a high prevalence in primary care, and insufficient treatment opportunities and knowledge of treatment processes. Acceptance and Commitment Therapy (ACT) is a third-wave behavioral therapy, which has shown positive treatment effects in a variety of mental disorders. ACT is proposed to work through the process of 'psychological flexibility,' but no studies have yet examined possible processes of change in an act-based treatment of health anxiety.

Aim

The pilot study investigated whether changes in 'psychological flexibility' and 'mindfulness' mediated treatment outcome in health anxiety symptoms.

Methods

34 Danish patients with severe health anxiety were allocated 10 sessions of group-based ACT. The patients completed self-report questionnaires at baseline, at end of treatment, and at 6-month follow-up, measuring health anxiety symptoms (Whiteley Index), psychological flexibility (AAQ-II), and mindfulness (FFMQ)

Results

Paired t-tests showed that psychological flexibility and mindfulness increased significantly during treatment (effect sizes ranged from SRM = .55-.76, p<.05). Regression analysis and Likelihood Ratio Tests showed that in particular psychological flexibility was significantly associated with the previously reported 49% reduction in health anxiety symptoms at 6-month followup.

Conclusions

Findings from the uncontrolled study indicated that the decrease in health anxiety symptoms at 6-month follow-up was associated with the change in psychological flexibility and mindfulness during treatment. These findings support the processes of change proposed in ACT.

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.

Depression and anxiety disorders are prevalent among college students. Innovative, cost effective approaches are needed to help prevent the incidence and worsening of these problems. Initial feasibility research with a prototype web-based program based on Acceptance and Commitment Therapy called ACT on College Life (ACT-CL), which currently includes two modules targeting values and acceptance, indicated it may be a promising approach for preventing depression and anxiety among college students. The current feasibility study compared the ACT-CL prototype to an active control website providing basic education on depression and anxiety disorders in a randomized controlled trial with 228 undergraduate college students using a universal prevention design. Assessments were conducted at baseline, post intervention and 1- and 3-month follow up. Results indicated significantly lower user engagement and satisfaction ratings with the ACT-CL prototype relative to the control website and initial pilot trial. Analyses with both the intent to treat sample and program completers only generally found no differences between condition over time on outcome and process measures, although in a few instances the control condition outperformed ACT-CL. Subgroup analyses did not identify any consistent results indicating ACT-CL was more or less effective or usable in any subgroup of students. Psychological flexibility processes were predictive of outcomes at baseline and of changes in outcomes over time. A pattern of results suggested that the more users engaged in the ACT-CL program the more they improved on psychological flexibility processes. Possible explanations for low program engagement and satisfaction ratings for the ACT-CL prototype and lack of treatment effects are explored including website design features, sample characteristics, and other methodological factors. Overall, these results suggest that the existing components of a prototype version of ACT-CL do not outperform an active control website and that some website features may reduce user engagement and satisfaction.