Disorders - Generalized Anxiety Disorder
Peris, T. S., Compton, S. N., Kendall, P. C., Birmaher, B., Sherrill, J., March, J., Gosch, E., Ginsburg, G., Rynn, M., McCracken, J.T., Keeton, C. P., Sakolsky, D., Suveg, C., Aschenbrand, S., Almirall, D., Iyengar, S., Walkup, J. T., Albano, A. M., Piacentini, J.,
Objective: To evaluate changes in the trajectory of youth anxiety following the introduction of specific cognitive-behavior therapy (CBT) components: relaxation training, cognitive restructuring, and exposure tasks. Method: Four hundred eighty-eight youths ages 7-17 years (50% female; 74% < 12 years) were randomly assigned to receive either CBT, sertraline (SRT), their combination (COMB), or pill placebo (PBO) as part of their participation in the Child/Adolescent Anxiety Multimodal Study (CAMS). Youths in the CBT conditions were evaluated weekly by therapists using the Clinical Global Impression Scale-Severity (CGI-S; Guy, 1976) and the Children's Global Assessment Scale (CGAS; Shaffer et al., 1983) and every 4 weeks by blind independent evaluators (IEs) using the Pediatric Anxiety Ratings Scale (PARS; RUPP Anxiety Study Group, 2002). Youths in SRT and PBO were included as controls. Results: Longitudinal discontinuity analyses indicated that the introduction of both cognitive restructuring (e.g., changing self-talk) and exposure tasks significantly accelerated the rate of progress on measures of symptom severity and global functioning moving forward in treatment; the introduction of relaxation training had limited impact. Counter to expectations, no strategy altered the rate of progress in the specific domain of anxiety that it was intended to target (i.e., somatic symptoms, anxious self-talk, avoidance behavior). Conclusions: Findings support CBT theory and suggest that cognitive restructuring and exposure tasks each make substantial contributions to improvement in youth anxiety. Implications for future research are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (journal abstract).
Journal of Consulting & Clinical Psychology, 83(2) : 239-252
- Year: 2015
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Specific Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Antidepressants (any)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Piacentini, J., Bennett, S., Compton, S. N., Kendall, P. C., Birmaher, B., Albano, A. M., March, J., Sherrill, J., Sakolsky, D., Ginsburg, G., Rynn, M., Bergman, R. L., Gosch, E., Waslick, B., Iyengar, S., McCracken, J., Walkup, J.
Objective We report active treatment group differences on response and remission rates and changes in anxiety severity at weeks 24 and 36 for the Child/Adolescent Anxiety Multimodal Study (CAMS). Method CAMS youth (N = 488; 74% (less-than or equal to)12 years of age) with DSM-IV separation, generalized, or social anxiety disorder were randomized to 12 weeks of cognitive-behavioral therapy (CBT), sertraline (SRT), CBT+SRT (COMB), or medication management/pill placebo (PBO). Responders attended 6 monthly booster sessions in their assigned treatment arm; youth in COMB and SRT continued on their medication throughout this period. Efficacy of COMB, SRT, and CBT (n = 412) was assessed at 24 and 36 weeks postrandomization. Youth randomized to PBO (n = 76) were offered active CAMS treatment if nonresponsive at week 12 or over follow-up and were not included here. Independent evaluators blind to study condition assessed anxiety severity, functioning, and treatment response. Concomitant treatments were allowed but monitored over follow-up. Results The majority (>80%) of acute responders maintained positive response at both weeks 24 and 36. Consistent with acute outcomes, COMB maintained advantage over CBT and SRT, which did not differ, on dimensional outcomes; the 3 treatments did not differ on most categorical outcomes over follow-up. Compared to COMB and CBT, youth in SRT obtained more concomitant psychosocial treatments, whereas those in SRT and CBT obtained more concomitant combined (medication plus psychosocial) treatment. Conclusions COMB maintained advantage over CBT and SRT on some measures over follow-up, whereas the 2 monotherapies remained indistinguishable. The observed convergence of COMB and monotherapy may be related to greater use of concomitant treatment during follow-up among youth receiving the monotherapies, although other explanations are possible. Although outcomes were variable, most CAMS-treated youth experienced sustained treatment benefit. Clinical trial registration information - Child and Adolescent Anxiety Disorders (CAMS); URL: http://clinicaltrials. gov. Unique identifier: NCT00052078.
Journal of the American Academy of Child & Adolescent Psychiatry, 53(3) : 297-310
- Year: 2014
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Wergeland, G. J. H., Fjermestad, K. W., Marin, C. E., Haugland, BS-M., Bjaastad, J. F., Oeding, K., Bjelland, I., Silverman, W. K., Ost, L-G., Havik, O. E., Heiervang, E. R.
Objective: Conducted a randomized controlled trial to investigate the effectiveness of cognitive behavioral therapy (CBT), and compared the relative effectiveness of individual (ICBT) and group (GCBT) treatment approaches for anxiety disorders in children and adolescents.; Methods: Referred youth (N = 182, M age = 11.5 years, range 8-15 years, 53% girls) with separation anxiety, social phobia, or generalized anxiety disorder were randomly assigned to ICBT, GCBT or a waitlist control (WLC) in community clinics. Pre-, post-, and one year follow-up assessments included youth and parent completed diagnostic interview and symptom measures. After comparing CBT (ICBT and GCBT combined) to WLC, ICBT and GCBT were compared along diagnostic recovery rates, clinically significant improvement, and symptom measures scores using traditional hypothesis tests, as well as statistical equivalence tests.; Results: Significantly more youth lost all anxiety disorders after CBT compared to WLC. Full diagnostic recovery rate was 25.3% for ICBT and 20.5% in GCBT, which was not significantly different. There was continued lack of significant differences between ICBT and GCBT at one year follow-up. However, equivalence between GCBT and ICBT could only be demonstrated for clinical severity rating of the principal anxiety disorder and child reported anxiety symptoms post-treatment.; Conclusion: Findings support the effectiveness of CBT compared to no intervention for youth with anxiety disorders, with no significant differences between ICBT and GCBT. However, the relatively low recovery rates highlight the need for further improvement of CBT programs and their transportability from university to community settings.; Copyright © 2014 Elsevier Ltd. All rights reserved.
Behaviour Research & Therapy, 57 : 1-12
- Year: 2014
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other service delivery and improvement interventions
Christensen, H., Batterham, P., Mackinnon, A., Griffiths, K M., Hehir, K. K., Kenardy, J., Gosling, J., Bennett, K.
Background: Generalized Anxiety Disorder (GAD) is a high prevalence, chronic disorder. Web-based interventions are acceptable, engaging, and can be delivered at scale. Few randomized controlled trials evaluate the effectiveness of prevention programs for anxiety, or the factors that improve effectiveness and engagement. Objective: The intent of the study was to evaluate the effectiveness of a Web-based program in preventing GAD symptoms in young adults, and to determine the role of telephone and email reminders. Methods: A 5-arm randomized controlled trial with 558 Internet users in the community, recruited via the Australian Electoral Roll, was conducted with 6- and 12-month follow-up. Five interventions were offered over a 10-week period. Group 1 (Active website) received a combined intervention of psycho-education, Internet-delivered Cognitive Behavioral Therapy (ICBT) for anxiety, physical activity promotion, and relaxation. Group 2 (Active website with telephone) received the identical Web program plus weekly telephone reminder calls. Group 3 (Active website with email) received the identical Web program plus weekly email reminders. Group 4 (Control) received a placebo website. Group 5 (Control with telephone) received the placebo website plus telephone calls. Main outcome measures were severity of anxiety symptoms as measured by the GAD 7-item scale (GAD-7) (at post-test, 6, and 12 months). Secondary measures were GAD caseness, measured by the Mini International Neuropsychiatric Interview (MINI) at 6 months, Centre for Epidemiologic Studies-Depression scale (CES-D), Anxiety Sensitivity Index (ASI), Penn State Worry Questionnaire (PSWQ), and Days out of Role. Results: GAD-7 symptoms reduced over post-test, 6-month, and 12-month follow-up. There were no significant differences between Group 4 (Control) and Groups 1 (Active website), 2 (Active website with telephone), 3 (Active website with email), or 5 (Control with telephone) at any follow-up. A total of 16 cases of GAD were identified at 6 months, comprising 6.7% (11/165) from the Active groups (1, 2, 3) and 4.5% (5/110) from the Control groups (4, 5), a difference that was not significant. CES-D, ASI, and PSWQ scores were significantly lower for the active website with email reminders at post-test, relative to the control website condition. Conclusions: Indicated prevention of GAD was not effective in reducing anxiety levels, measured by GAD-7. There were significant secondary effects for anxiety sensitivity, worry, and depression. Challenges for indicated prevention trials are discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved). (journal abstract)
Journal of Medical Internet Research, Vo 16(9) : 176-189
- Year: 2014
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Psychoeducation, Other Psychological Interventions, Physical activity, exercise, Relaxation
, Technology, interventions delivered using technology (e.g. online, SMS)
Christensen, H., Mackinnon, A. J., Batterham, P. J., Bridianne, O. D., Guastella, A. J., Griffiths, K. M., Eagleson, C., Hehir, K. K., Kenardy, J., Bennett, K., Hickie, I.
Background: Generalised AnxietyDisorder (GAD) is a high prevalence, chronic disorder that can be treated effectively through a number of web-based programs. However, online web programs for GAD have not been compared to standard pharmacological treatment. The present study compares an Internet Intervention (ActiveWebsite) for GAD and a selective serotonin re-uptake inhibitor (SSRI) (Sertraline), with an online attention placebo condition (Control Website). Objective: To evaluate the effectiveness of a web-based intervention for GAD in comparison to standard antidepressant medication and an online attention placebo condition over a 10 week period, and with a follow-up at 6 and at 12 months. Methods: The study was part of a larger scale prevention program. 152 people aged 18-30 yearswho met the criteria for GAD on the MINI received referrals to the treatment sub-study. The primary outcome was anxiety symptoms measured by the Generalised Anxiety Disorder 7-item Scale (GAD-7), and the secondary outcome was depression measured by the Center for Epidemiologic Studies Depression Scale (CES-D). Results: Therewas very poor uptake to the trial (around 14% of those referred). However, even in this small sample, Sertraline compared to the ControlWebsitewas significant at post-test and 6 months, and the Internet Intervention was significant at post-test. Relative to the ControlWebsite condition at post-test, for the GAD-7 and CES-D respectively, the between group effect sizes were d=2.43 and d=0.68 for the ActiveWebsite condition, and 3.00 and 0.20 for the Sertraline condition. The within group effect size for the ControlWebsite from baseline to post-test was -0.04 for the GAD-7 and 0.31 for CES-D respectively. Conclusions: The findings will need to be extended and confirmed in a larger trial. However, they do suggest that both standard pharmacological treatment and online interventions for GAD are effective in sampleswith a diagnosis of GAD recruited via online methods. The low rate of engagement for face-to-face treatment by those who opt first for a web program suggests that treatment preferences are important in help-seeking.
Internet Interventions, 1(4) : 169-174
- Year: 2014
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Technology, interventions delivered using technology (e.g. online, SMS)
Ginsburg, G. S., Becker, E. M., Keeton, C. P., Sakolsky, D., Piacentini, J., Albano, A. M., Compton, S. N., Iyengar, S., Sullivan, K., Caporino, N., Peris, T., Birmaher, B., Rynn, M., March, J., Kendall, P. C.
IMPORTANCE Pediatric anxiety disorders are highly prevalent and impairing and are considered gateway disorders in that they predict adult psychiatric problems. Although they can be effectively treated in the short term, data are limited on the long-term outcomes in treated children and adolescents, particularly those treated with medication., OBJECTIVE To determine whether acute clinical improvement and treatment type (ie, cognitive behavioral therapy, medication, or their combination) predicted remission of anxiety and improvement in global functioning at a mean of 6 years after randomization and to examine predictors of outcomes at follow-up., DESIGN, SETTING, AND PARTICIPANTS This naturalistic follow-up study, as part of the Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), was conducted at 6 academic sites in the United States and included 288 youths (age range, 11-26 years; mean age, 17 years). Youths were randomized to 1 of 4 interventions (cognitive behavioral therapy, medication, combination, or pill placebo) in the Child/Adolescent Anxiety Multimodal Study (CAMS) and were evaluated a mean of 6 years after randomization. Participants in this study constituted 59.0%of the original CAMS sample. EXPOSURES Participants were assessed by independent evaluators using a semistructured diagnostic interview to determine the presence of anxiety disorders, the severity of anxiety, and global functioning. Participants and their parents completed questionnaires about mental health symptoms, family functioning, life events, and mental health service use., MAIN OUTCOMES AND MEASURES Remission, defined as the absence of all study entry anxiety disorders. RESULTS Almost half of the sample (46.5%) were in remission a mean of 6 years after randomization. Responders to acute treatment were significantly more likely to be in remission (odds ratio, 1.83; 95%CI, 1.08-3.09) and had less severe anxiety symptoms and higher functioning; the assigned treatment arm was unrelated to outcomes. Several predictors of remission and functioning were identified., CONCLUSIONS AND RELEVANCE Youths rated as responders during the acute treatment phase of CAMS were more likely to be in remission a mean of 6 years after randomization, although the effect size was small. Relapse occurred in almost half (48%) of acute responders, suggesting the need for more intensive or continued treatment for a sizable proportion of youths with anxiety disorders. (copyright) 2014 American Medical Association.
JAMA Psychiatry, 71(3) : 310-318
- Year: 2014
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Lee, J. K., Orsillo, S. M.
Background and objectives Research suggests mindfulness-based treatments may enhance efficacy of CBT for Generalized Anxiety Disorder (GAD). One hypothesized mechanism of mindfulness is cognitive flexibility; however, research findings to date are mixed as to a) whether cognitive inflexibility represents a characteristic of GAD, and b) whether mindfulness impacts cognitive flexibility. It is proposed that limitations in study methodology may partially account for these mixed findings. The present study investigated cognitive flexibility as a potential mechanism of mindfulness in a sample with elevated GAD symptoms using a modified emotional Stroop switching task while attempting to control for limitations of previous research. The purpose of the study was: 1) to explore cognitive inflexibility as a potential characteristic of GAD, and 2) to examine whether a brief mindfulness induction has measurable impact on cognitive flexibility. Methods A total of 66 participants (53 with elevated GAD symptoms, and 13 non-anxious) were randomized to a mindful-breathing, music-assisted relaxation, or thought wandering condition prior to completing an emotional Stroop and emotional Stroop switching task. Results Results suggest that GAD may be characterized by an inflexible style of responding, and exposure to mindfulness and relaxation result in partial improvements in cognitive flexibility. Limitations Limitations of this study include small sample size, brief induction period, and use of an analog sample. Conclusions The present findings suggest that mindfulness may be associated with partial improvement in cognitive flexibility. (copyright) 2013 Elsevier Ltd. All rights reserved.
Journal of Behavior Therapy & Experimental Psychiatry, 45(1) : 208-216
- Year: 2014
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Mindfulness based therapy, Creative expression: music, dance, drama, art
, Relaxation
Holmes, M. C., Donovan, C. L., Farrell, L. J., March, S.
The aim of this study was to provide a preliminary examination of a disorder-specific treatment program for children with generalised anxiety disorder (GAD) that employed strategies targeting underlying cognitive factors. Forty-two children with a primary diagnosis of GAD, aged between 7 and 12 years, were randomly assigned to either a treatment (TX) or waitlist (WLC) condition. Clinical diagnostic interviews as well as parent and child questionnaires were completed at pre- and post-assessment for both conditions, and at 3-month follow-up for the TX group. For the completer analyses at post-treatment, 52.9 % of children in the TX group (0% in the WLC group) were free of their primary GAD diagnosis. By 3-month follow-up, 100% of children in the TX group were free of their GAD diagnosis, 50% were free of all diagnoses. Overall, there is preliminary evidence that a disorder-specific treatment program for children with GAD is effective in treating this chronic and disabling disorder.
Behaviour Research & Therapy, 61 : 122-135
- Year: 2014
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
McGowan, S. K., Behar, E.
For individuals with generalized anxiety disorder, worry becomes associated with numerous aspects of life (e.g., time of day, specific stimuli, environmental cues) and is thus under poor discriminative stimulus control (SC). In addition, excessive worry is associated with anxiety, depressed mood, and sleep difficulties. This investigation sought to provide preliminary evidence for the efficacy of SC procedures in reducing anxiety-, mood-, and sleep-related symptoms. A total of 53 participants with high trait worry were randomly assigned to receive 2 weeks of either SC training (consisting of a 30-min time- and place-restricted worry period each day) or a control condition called focused worry (FW; consisting of instructions to not avoid naturally occurring worry so that worry and anxiety would not paradoxically increase). At post-training, SC was superior to FW in producing reductions on measures of worry, anxiety, negative affect, and insomnia, but not on measures of depression or positive affect. Moreover, SC was superior to FW in producing clinically significant change on measures of worry and anxiety. Results provide preliminary support for the use of SC training techniques in larger treatment packages for individuals who experience high levels of worry.;
Behavior Modification, 37(1) : 90-112
- Year: 2013
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
McIntosh, C., Crino, R.
Background: Worry exposure is a cognitive-behaviour therapy (CBT) technique frequently used to treat GAD, yet there are only a few studies on its effectiveness. Aim: To compare two worry exposure protocols developed for GAD to make a preliminary determination about the most effective way in which to present the feared stimuli to participants. Method: Nine university students suffering fromGAD were administered four 1-hour treatment sessions. Exposure was conducted by either directly imagining (DI) or via audio-recording/playback (AR) exposure to their feared event. General worry and intolerance of uncertainty (IOU) were the primary dependent variables. Results: All participants in the DI and half of theARcondition reported subclinical GAD at post-treatment, with results being maintained at 3- month follow-up and the treatment responders also reported decreased depression, anxiety and stress. Conclusions: The DI protocol was more effective than the AR methodology in this sample, and may be an appropriate standard for worry exposure research and clinical practice. (copyright) 2013 The Author(s).
Behaviour Change, 30(3) : 210-225
- Year: 2013
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention
Gosling, J., Batterham, P., Christensen, H., Griffiths, K., Mackinnon, A., Kenardy, J.
Introduction: Sleep disturbance is a common occurrence in depression and anxiety, and is often a residual symptom even after successful treatment. The current study aimed to test whether pretreatment sleep disturbance moderated program effects on social anxiety symptoms in a web-based generalized anxiety program. Methods: 374 Australian adults aged between 18 and 30 with subclinical symptoms of GAD, but not meeting diagnostic criteria for GAD, Social Phobia or Panic Disorder, were randomly assigned to either a 10-week web-based GAD program based on CBT ('ecouch') or a webbased attention-matched control condition. Participants were recruited from the compulsory Australian Electoral Roll. Pretreatment sleep disturbance was measured using an item from the CES-D capturing the number of days per week participants experienced restless sleep, and social anxiety symptoms were assessed at screener, posttest and 6-month follow-up using the Social Phobia Inventory (SPIN). Results: Social anxiety symptoms reduced significantly from pre- to posttest for participants with and without sleep disturbance. However, a significant three-way interaction between time, condition and sleep disturbance indicated that this effect was only maintained at 6-month follow-up for those participants without initial sleep disturbance who received the CBT intervention. At 6-month follow-up, these participants showed significantly lower social anxiety symptoms than participants with sleep disturbance in the active condition or participants with and without sleep disturbance in the control condition based on an Intention To Treat analysis [t (236.8) = -2.4; p = 0.016]. Discussion: Web-based CBT targeting generalized anxiety appears to have lasting effects on social anxiety symptoms but only for those without sleep disturbance. This may indicate that sleep disturbance interferes with treatment and that best results might be achieved through specifically targeting sleep-related symptoms.
Sleep & Biological Rhythms, 11 : 66
- Year: 2013
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Technology, interventions delivered using technology (e.g. online, SMS)
Goldbeck, L., Ellerkamp, T.
Background: Music therapy has been shown to be effective for children with psychopathology, providing an alternative nonverbal approach to the treatment of children with anxiety disorders. Objective: This pilot study investigates the efficacy of Multimodal Music Therapy (MMT), a combination of music therapy and cognitive-behavioral therapy, compared to treatment as usual (TAU). Methods: Thirty-six children aged 8-12 years with a primary diagnosis of an anxiety disorder were randomly assigned to 15 sessions of MMT or to TAU. Diagnostic status and dimensional outcome variables were assessed at the end of treatment and 4 months later. Results: MMT was superior compared to TAU according to the remission rates after treatment (MMT 67%; TAU 33%; x2 5 4.0; p 5 0.046) and remissions persisted until four months post-treatment. Dimensional measures showed equivalent improvement after either MMT or TAU. Conclusions: The results regarding the efficacy of MMT are promising for children with anxiety disorders. Further evaluation with larger samples and comparisons to pure CBT are recommended. (copyright) 2012 by the American Music Therapy Association.
Journal of Music Therapy, 49(4) : 395-413
- Year: 2012
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder)
, Specific Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Creative expression: music, dance, drama, art