A randomized clinical trial comparing an acceptance-based behavior therapy to applied relaxation for generalized anxiety disorder

Journal of Consulting and Clinical Psychology

Volumn 81, Issue 5, 2013, Pages 761-773

  Hayes Skelton, Sarah A ^a   Roemer, Lizabeth ^a   Orsillo, Susan M ^b  

^a UNIVERSITY OF MASSACHUSETTS BOSTON   (United States)

^b SUFFOLK UNIVERSITY   (United States)

Author keywords

anxiety; Asian American; depression; disparities; immigrant paradox

Indexed keywords

ACCEPTANCE BASED BEHAVIOR THERAPY; ADULT; ANXIETY; APPLIED RELAXATION; ARTICLE; BECK DEPRESSION INVENTORY; BEHAVIOR THERAPY; COMORBIDITY; CONTROLLED STUDY; DEPRESSION ANXIETY STRESS SCALE; DSM-IV; FEMALE; FOLLOW UP; GENERALIZED ANXIETY DISORDER; HAMILTON ANXIETY SCALE; HUMAN; MAJOR CLINICAL STUDY; MALE; PREMEDICATION; QUALITY OF LIFE; RANDOMIZED CONTROLLED TRIAL; RELAXATION TRAINING; STATE TRAIT ANXIETY INVENTORY; STRUCTURED INTERVIEW; TREATMENT DURATION; TREATMENT OUTCOME;

ACCEPTANCE AND COMMITMENT THERAPY; ADULT; ANXIETY DISORDERS; FEMALE; FOLLOW-UP STUDIES; HUMANS; MALE; MIDDLE AGED; PSYCHIATRIC STATUS RATING SCALES; RELAXATION THERAPY; TREATMENT OUTCOME; YOUNG ADULT;

EID: 84884553307     PISSN: 0022006X     EISSN: 19392117     Source Type: Journal    
DOI: 10.1037/a0032871     Document Type: Article

References (69)

1. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author
2. Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychological Assessment, 10, 176-181. doi:10.1037/1040-3590.10.2.176
3. Arch, J. J., Eifert, G. H., Davies, C., Vilardaga, J. C. P., Rose, R. D., & Craske, M. G. (2012). Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders. Journal of Consulting and Clinical Psychology, 80, 750-765. doi:10.1037/a0028310
4. Arntz, A. (2003). Cognitive therapy versus applied relaxation as treatment of generalized anxiety disorder. Behaviour Research and Therapy, 41, 633-646
5. Bar-Haim, Y., Lamy, D., Pergamin, L., Bakermans-Kranenburg, M., & van IJzendoorn, M. H. (2007). Threat-related attentional bias in anxious and nonanxious individuals: A meta-analytic study. Psychological Bulletin, 133, 1-24. doi:10.1037/0033-2909.133.1.1
6. Barnard, P. J., & Teasdale, J. D. (1991). Interacting cognitive subsystems: A systemic approach to cognitive-affective interaction and change. Cognition & Emotion, 5, 1-39. doi:10.1080/02699939108411021
7. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck Depression Inventory manual (2nd ed.). San Antonio, TX: Psychological Corporation.
8. Behar, E., DiMarco, I. D., Hekler, E. B., Mohlman, J., & Staples, A. M. (2009). Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of Anxiety Disorders, 23, 1011-1023. doi:10.1016/j.janxdis.2009.07.006
9. Bernstein, D. A., Borkovec, T. D., & Hazlett-Stevens, H. (2000). New directions in progressive relaxation training: A guidebook for helping professionals. Westport, CT: Praeger
10. Blevins, D., Roca, J., & Spencer, T. (2011). Life Guard: Evaluation of an ACT-based workshop to facilitate reintegration of OIF/OEF veterans. Professional Psychology: Research and Practice, 42, 32-39. doi: 10.1037/a0022321
11. Borkovec, T. D., Alcaine, O. M., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder. In D. S. Mennin, R. G. Heimberg, & C. L. Turk (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 77-108). New York, NY: Guilford Press
12. 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. doi:10.1037/0022-006X.61.4.611
13. Borkovec, T. D., & Nau, S. D. (1972). Credibility of analogue therapy rationales. Journal of Behavior Therapy and Experimental Psychiatry, 3, 257-260. doi:10.1016/0005-7916(72)90045-6
14. 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. doi:10.1037/0022-006X.70 .2.288
15. Borkovec, T. D., & Ruscio, A. M. (2001). Psychotherapy for generalized anxiety disorder. Journal of Clinical Psychiatry, 62, 37-42
16. Brown, T. A., Chorpita, B. F., Korotitsch, W., & Barlow, D. H. (1997). Psychometric properties of the Depression Anxiety Stress Scales (DASS) in clinical samples. Behaviour Research and Therapy, 35, 79-89. doi:10.1016/S0005-7967(96)00068-X
17. 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. doi:10.1037/0021-843X.110.1.49
18. Bruce, S. E., Machan, J. T., Dyck, I., & Keller, M. B. (2001). Infrequency of "pure" GAD: Impact of psychiatric comorbidity on clinical course. Depression and Anxiety, 14, 219-225. doi:10.1002/da.1070
19. Chambless, D. L., & Ollendick, T. H. (2001). Empirically supported psychological interventions: Controversies and evidence. Annual Review of Psychology, 52, 685-716. doi:10.1146/annurev.psych.52.1.685
20. Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Erlbaum.
21. 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. doi:10.1016/j.janxdis.2007 .01.002
22. Craigie, M. A., Rees, C. S., Marsh, A., & Nathan, P. (2008). Mindfulnessbased cognitive therapy for generalized anxiety disorder: A preliminary evaluation. Behavioural and Cognitive Psychotherapy, 36, 553-568. doi:10.1017/S135246580800458X
23. Di Nardo, P. A., Brown, T. A., & Barlow, D. H. (1994). Anxiety Disorders Interview Schedule for DSM-IV. Albany, NY: Graywind
24. Dugas, M. J., Brillon, P., Savard, P., Turcotte, J., Gaudet, A., Ladouceur, R.,Gervais, N. J. (2010). A randomized clinical trial of cognitivebehavioral therapy and applied relaxation for adults with generalized anxiety disorder. Behavior Therapy, 41, 46-58. doi:10.1016/j.beth.2008 .12.004
25. Dunlap, W. P., Cortina, W. P., Vaslow, J. B., & Burke, M. J. (1996). Meta-analysis of experiments with matched groups or repeated measures designs. Psychological Methods, 1, 170-177. doi:10.1037/1082-989X.1 .2.170
26. Evans, S., Ferrando, S., Findler, M., Stowell, C., Smart, C., & Haglin, D. (2008). Mindfulness-based cognitive therapy for generalized anxiety disorder. Journal of Anxiety Disorders, 22, 716-721. doi:10.1016/j .janxdis.2007.07.005
27. Frisch, M. B., Cornwell, J., Villanueva, M., & Retzlaff, P. J. (1992). Clinical validation of the Quality of Life Inventory: A measure of life satisfaction of use in treatment planning and outcome assessment. Psychological Assessment, 4, 92-101. doi:10.1037/1040-3590.4.1.92
28. Fuchs, C., Lee, J. K., Roemer, L., & Orsillo, S. M. (2013). Using mindfulness-and acceptance-based treatments with clients from nondominant cultural and/or marginalized backgrounds: Clinical considerations, meta-analysis findings, and introduction to the special series: Clinical considerations in using acceptance-and mindfulness-based treatments with diverse populations. Cognitive and Behavioral Practice, 20, 1-12
29. Fuchs, C., West, L. M., Graham, J. R., Hayes-Skelton, S. A., Orsillo, S. M., & Roemer, L. (2012, April). Exploring the acceptability of mindfulnessbased treatment among individuals from non-dominant cultural backgrounds. In J. R. Graham (Chair), Examining mindfulness and anxiety across diverse methods and contexts. Symposium conducted at the meeting of the Anxiety Disorders Association of America, Arlington, VA
30. Hamilton, M. (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology, 32, 50-55. doi:10.1111/j.2044-8341 .1959.tb00467.x
31. Hayes, S. A., Orsillo, S. M., & Roemer, L. (2010). Changes in proposed mechanisms of action during an acceptance-based behavioral therapy for generalized anxiety disorder. Behaviour Research and Therapy, 48, 238-245. doi:10.1016/j.brat.2009.11.006
32. Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York, NY: Guilford Press
33. Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64, 1152-1168. doi:10.1037/0022-006X.64.6 .1152
34. Hayes-Skelton, S. A., Roemer, L., & Orsillo, S. M. (2011, November). Decentering as a common mechanism across two therapies for generalized anxiety disorder. In D. A. Moscovitch & J. D. Huppert (Chairs), Early changes in emotion regulation processes during CBT for emotional disorders: Psychological markers of treatment success. Symposium conducted at the meeting of the Association of Behavioral and Cognitive Therapy, Toronto, Ontario, Canada
35. Hayes-Skelton, S. A., Usmani, A., Lee, J., Roemer, L., & Orsillo, S. M. (2012). A fresh look at potential mechanisms of change in applied relaxation: A case series. Cognitive and Behavioral Practice, 19, 451-462. doi:10.1016/j.cbpra.2011.12.005
36. Hedeker, D., & Gibbons, R. D. (1997). Application of random-effects pattern-mixture models for missing data in longitudinal studies. Psychological Methods, 2, 64-78. doi:10.1037/1082-989X.2.1.64
37. Hedeker, D., & Gibbons, R. D. (2006). Longitudinal data analysis. New York, NY: Wiley.
38. Hoffman, D. L., Dukes, E. M., & Wittchen, H. (2008). Human and economic burden of generalized anxiety disorder. Depression and Anxiety, 25, 72-90. doi:10.1002/da.20257
39. Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A metaanalytic review. Journal of Consulting and Clinical Psychology, 78, 169-183. doi:10.1037/a0018555
40. Hoyer, J., Beesdo, K., Gloster, A. T., Runge, J., Hofler, M., & Becker, E. S. (2009). Worry exposure versus applied relaxation in the treatment of generalized anxiety disorder. Psychotherapy and Psychosomatics, 78, 106-115
41. Ladouceur, R., Dugas, M. J., Freeston, M. H., Léger, E., Gagnon, F., & Thibodeau, N. (2000). Efficacy of a cognitive-behavioral treatment for generalized anxiety disorder: Evaluation in a controlled clinical trial. Journal of Consulting and Clinical Psychology, 68, 957-964. doi: 10.1037/0022-006X.68.6.957
42. Lee, J. K., Orsillo, S. M., Roemer, L., & Allen, L. B. (2010). Distress and avoidance in generalized anxiety disorder: Exploring the relationships with intolerance of uncertainty and worry. Cognitive Behaviour Therapy, 39, 126-136. doi:10.1080/16506070902966918
43. Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford Press
44. Llera, S. J., & Newman, M. G. (2010). Effects of worry on physiological and subjective reactivity to emotional stimuli in generalized anxiety disorder and nonanxious control participants. Emotion, 10, 640-650. doi:10.1037/a0019351
45. Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales. Sydney: Psychology Foundation of Australia
46. Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2005). Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behaviour Research and Therapy, 43, 1281-1310. doi:10.1016/j.brat. 2004.08.008
47. 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. doi:10.1016/0005-7967(90)90135-6
48. Michelson, S. E., Lee, J. K., Orsillo, S. M., & Roemer, L. (2011). The role of values-consistent behavior in generalized anxiety disorder. Depression and Anxiety, 28, 358-366. doi:10.1002/da.20793
49. National Collaborating Centre for Mental Health and the National Collaborating Centre for Primary Care. (2011). Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults: NICE clinical guideline 113. London, England: National Institute for Health and Clinical Excellence
50. Newman, M. G., Castonguay, L. G., Borkovec, T. D., Fisher, A. J., Boswell, J. F., Szkodny, L. E., & Nordberg, S. S. (2011). A randomized controlled trial of cognitive-behavioral therapy for generalized anxiety disorder with integrated techniques from emotion-focused and interper-sonal therapies. Journal of Consulting and Clinical Psychology, 79, 171-181. doi:10.1037/a0022489
51. Orsillo, S. M., & Roemer, L. (2011). The mindful way through anxiety: Break free from chronic worry and reclaim your life. New York, NY: Guilford Press
52. Öst, L.-G. (2007). Applied relaxation: Manual for a behavioral coping technique. Unpublished manuscript
53. Öst, L.-G., & Breitholtz, E. (2000). Applied relaxation vs cognitive therapy in the treatment of generalized anxiety disorder. Behaviour Research and Therapy, 38, 777-790
54. Roemer, L., & Orsillo, S. M. (2002). Expanding our conceptualization of and treatment for generalized anxiety disorder: Integrating mindfulness/acceptance-based approaches with existing cognitive-behavioral models. Clinical Psychology: Science and Practice, 9, 54-68. doi:10.1093/clipsy.9.1.54
55. Roemer, L., & Orsillo, S. M. (2007). An open trial of an acceptance-based behavior therapy for generalized anxiety disorder. Behavior Therapy, 38, 72-85. doi:10.1016/j.beth.2006.04.004
56. Roemer, L., & Orsillo, S. M. (2009). Mindfulness-and acceptance-based behavioral therapies in practice. New York, NY: Guilford Press
57. Roemer, L., & Orsillo, S. M. (in press). An acceptance-based behavioral therapy for generalized anxiety disorder. In D. H. Barlow (Ed.), Clinical handbook for psychological disorders: A step-by-step treatment manual (5th ed.). New York, NY: Guilford Press
58. Roemer, L., Orsillo, S. M., & Salters-Pedneault, K. (2008). Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: Evaluation in a randomized controlled trial. Journal of Consulting and Clinical Psychology, 76, 1083-1089. doi:10.1037/a0012720;10.1037/a0012720.supp
59. Rucker Sobczak, L., & West, L. M. (2013). Clinical considerations in using mindfulness-and acceptance-based approaches with diverse populations: Addressing challenges in service delivery in diverse community settings. Cognitive and Behavioral Practice, 20, 13-22. doi:10.1016/j .cbpra.2011.08.005
60. Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulnessbased cognitive therapy for depression: A new approach to preventing relapse. New York, NY: Guilford Press
61. Shear, M. K., Vander Bilt, J., Rucci, P., Endicott, J., Lydiard, B., Otto, M.W.,Frank, D. M. (2001). Reliability and validity of a structured interview guide for the Hamilton Anxiety Rating Scale (SIGH-A). Depression and Anxiety, 13, 166-178. doi:10.1002/da.1033
62. Siev, J., & Chambless, D. L. (2007). Specificity of treatment effects: Cognitive therapy and relaxation for generalized anxiety and panic disorders. Journal of Consulting and Clinical Psychology, 75, 513-522. doi:10.1037/0022-006X.75.4.513
63. Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the State-Trait Anxiety Inventory (Form Y Self-Evaluation Questionnaire). Palo Alto, CA: Consulting Psychologists Press
64. Tracey, T. J., & Kokotovic, A. M. (1989). Factor structure of the Working Alliance Inventory. Psychological Assessment, 1, 207-210. doi:10.1037/1040-3590.1.3.207
65. Treanor, M., Erisman, S. M., Salters-Pedneault, K., Roemer, L., & Orsillo, S. M. (2011). Acceptance-based behavioral therapy for GAD: Effects on outcomes from three theoretical models. Depression and Anxiety, 28, 127-136. doi:10.1002/da.20766
66. Waters, A. M., & Craske, M. G. (2005). Generalized anxiety disorder. In M. M. Antony, D. R. Ledley, & R. G. Heimberg (Eds.), Improving outcomes and preventing relapse in cognitive-behavorial therapy (pp. 77-127). New York, NY: Guilford Press
67. Wells, A., & Carter, K. (1999). Preliminary tests of a cognitive model of generalized anxiety disorder. Behaviour Research and Therapy, 37, 585-594. doi:10.1016/S0005-7967(98)00156-9
68. Wells, A., Welford, M., King, P., Papageorgiou, C., Wisely, J., & Mendel, E. (2010). A pilot randomized trial of metacognitive therapy vs. applied relaxation in the treatment of adults with generalized anxiety disorder. Behaviour Research and Therapy, 48, 429-434. doi:10.1016/j.brat.2009 .11.013
69. Wetherell, J. L., Liu, L., Patterson, T. L., Afari, N., Ayers, C. R., Thorp, S. R.,Petkus, A. J. (2011). Acceptance and commitment therapy for generalized anxiety disorder in older adults: A preliminary report. Behavior Therapy, 42, 127-134. doi:10.1016/j.beth.2010.07.002