Disorders - Generalized Anxiety Disorder
Strawn, J.
R., Mills, J. A., Schroeder, H., Mossman, S. A., Varney, S. T., Ramsey, L. B., Poweleit, E. A., Desta, Z., Cecil, K., DelBello, M. P.
BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat pediatric anxiety disorders,
including generalized anxiety disorder (GAD); however, their efficacy and tolerability are difficult to predict. This study evaluated the efficacy
and tolerability of escitalopram in adolescents with GAD (DSM-IV-TR) and the impact of variants in HTR2A and serotonin transporter (SLC6A4) genes and
cytochrome P450 2C19 (CYP2C19) phenotypes on response as well as CYP2C19 phenotype on escitalopram pharmacokinetics from February 2015 through
November 2018. METHOD(S): Patients were treated with escitalopram (forced titration to 15 mg/d, then flexible titration to 20 mg/d) (n = 26, mean +/-
SD age: 14.8 +/- 1.7 years) or placebo (n = 25, mean +/- SD age: 14.9 +/- 1.6 years) for 8 weeks. Outcomes were the change in scores on the Pediatric
Anxiety Rating Scale (PARS) and Clinical Global Impressions (CGI) scales as well as vital signs and adverse events. Plasma escitalopram and
desmethylcitalopram area under the curve during 24 hours (AUC0-24) and maximum concentration (Cmax) were determined and compared across CYP2C19
phenotypes. RESULT(S): Escitalopram was superior to placebo for mean +/- SD baseline-to-endpoint change in PARS (-8.65 +/- 1.3 vs -3.52 +/- 1.1, P =
.005) and CGI scores, and increasing CYP2C19 metabolism was associated with decreases in escitalopram Cmax (P = .07) and AUC0-24 (P < .05). Vital
signs, corrected QT interval, and adverse events were similar in patients who received escitalopram and placebo. CONCLUSION(S): Escitalopram reduces
anxiety symptoms, and pharmacogenetics variables influence the trajectory and magnitude of improvement. Variation in CYP2C19 metabolism accounts for
significant differences in escitalopram pharmacokinetics, raising the possibility that CYP2C19 phenotype should be considered when prescribing
escitalopram. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02818751. © Copyright 2020 Physicians Postgraduate Press, Inc.
The
Journal of clinical psychiatry, 81(5) :
- Year: 2020
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Antidepressants
(any)
Ovanessian, M. M., Koerner, N., Antony, M. M., Dugas, M. J.
This experiment
tested a novel written exposure intervention for generalized anxiety disorder (GAD) that consisted of guided rescripting of participants' worst
fear. After describing their worst fear, adults with GAD (N = 79) were randomly assigned to one of three writing interventions, each consisting of
three sessions on consecutive days: (1) standard written exposure (WE), (2) written exposure with rescripting (RWE), and (3) neutral control writing
(NC). Measures of symptoms and worry-associated processes were administered at pre- and post-intervention, and at 1-week and 1-month follow-ups.
Worry declined significantly in all three conditions. Participants in WE reported significant reductions in fear of anxiety, whereas those in RWE
reported significant reductions in fear of anger. Participants in RWE and NC reported a significant decrease in fear of positive emotion. Following
RWE, participants perceived their feared scenario as less costly and perceived themselves as better able to cope with it, whereas participants in the
WE and NC did not show these changes. Cognitive avoidance, intolerance of uncertainty, and negative problem orientation did not change. Findings
suggest overall, RWE was not superior to WE, and that more research is needed to assess their therapeutic potential. Strengths and limitations are
discussed for the benefit of future research on exposure for GAD. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Journal of Experimental Psychopathology Vol 10(2), 2019, ArtID
2043808719841529, 10(2) :
- Year: 2019
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any), Narrative exposure therapy (NET), Creative expression: music, dance, drama, art
Teng, M.H., Hou, Y.M., Chang,
S.H. Cheng, H.J.
Background: Mogg and Bradley (2016) proposed that attentional bias (to threat stimuli) among patients with generalized anxiety
disorder (GAD) may be associated with the top-down attention control process. Additionally, some scholars (e.g., Enock & McNally, 2013) have designed
mobile applications to enable patients to engage in home-delivered attentional bias modification (HD-ABM); however, many problems related to these
training systems have not yet been addressed. Method: A total of 82 participants (61 women, mean age = 21.47 y) who received GAD diagnoses were
randomly assigned to an HD-ABM (n = 30), placebo training (n = 30), or waiting list (n = 22) group. Both the HDABM and placebo groups were trained
with the attention training application (through Android phones three times a day for four weeks). Results: (1) All measures of participants' self-
reported symptoms (except for trait anxiety) were significantly lower in Week 4 and in the follow-up. (2) Attentional network test (ANT) results
demonstrated that all participants' alerting scores significantly increased by Week 4. (3) Participants in the HD-ABM and placebo groups
demonstrated significant increases in their self-reported attention control scores, decreases in their attention bias index (ABI) scores, and
progress in their executive control abilities. Limitations: Self-report scales may have been insufficient for measuring effectiveness in the present
study. Conclusions: This study helps to elucidate the mechanism underlying changes in attention processes after HDABM training implemented through a
mobile application in GAD. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Journal of Affective Disorders, 246 : 444-
451
- Year: 2019
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Attention/cognitive bias
modification, Technology, interventions delivered using technology (e.g. online, SMS)
Perrin, S., Bevan, D., Payne,
S., Bolton, D.
Cognitive behavioral therapy (CBT) designed to target generalized anxiety disorder (GAD) in youth was examined in a pilot
feasibility trial. Participants (aged 10-18 years) were randomized to either 10 weeks of individual CBT (n = 20) or supported wait-list (n = 20).
Diagnostic status (primary outcome) was assessed blindly at post-treatment for both groups, and at a 3-month follow-up for treated participants. Two
participants failed to complete CBT and retained their GAD during the trial. Intention-to-treat analyses revealed large between-group differences in
favor of CBT at post-treatment for remission from GAD (80% vs 0%) and comorbid disorders (83% vs 0%), and for all secondary outcomes (child and
parent-reported). All gains were maintained at 3-month follow-up in the CBT group. Consistent with the treatment model, significant pre- to post-
treatment reductions in several cognitive processes were found for CBT but not wait-listed participants, with these gains maintained at follow-up.
Further investigations are warranted. Trial registry: ISRCTN.com Identifier ISRCTN50951795. Copyright © 2019, The Author(s).
Cognitive Therapy and Research., 43 : pages1051 - 1064
- Year: 2019
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Stefan, S., Cristea, I. A., Szentagotai
Tatar, A., David, D.
OBJECTIVE: Cognitive-behavior
therapy (CBT) is considered the \"golden standard\" psychotherapy for generalized anxiety disorder (GAD) but, at this point, we have little
information about differences among various CBT approaches. METHOD(S): We conducted a randomized controlled trial to compare three CBT protocols for
GAD: (a) Cognitive Therapy/Borkovec's treatment package; (b) Rational Emotive Behavior Therapy, and (c) Acceptance and Commitment
Therapy/Acceptance-based behavioral therapy. A number of 75 patients diagnosed with GAD, aged between 20 and 51 (m = 27.13; standard deviation =
7.50), 60 women and 11 men, were randomized to the three treatment arms. RESULT(S): All treatments were associated with large pre-post intervention
reductions in GAD symptoms and dysfunctional automatic thoughts, with no significant differences between groups. Correlation analyses showed similar
associations between changes in symptoms and changes in dysfunctional automatic thoughts. CONCLUSION(S): All three approaches appear to be similarly
effective. Implications for the theoretical models underlying each of the three cognitive-behavior therapy approaches are discussed. Copyright © 2019
Wiley Periodicals, Inc.
Journal of Clinical Psychology, 75(7) : 1188-
1202
- Year: 2019
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions, Acceptance & commitment therapy
(ACT)
Silk, Jennifer S., Price, Rebecca B., Rosen, Dana, Ryan, Neal D., Forbes, Erika E., Siegle, Greg J., Dahl, Ronald E., McMakin, Dana L., Kendall, Philip C., Ladouceur, Cecile D.
Objective:
Children who are fearful and anxious are at heightened risk for developing depression in adolescence. Treating anxiety disorders in pre-/early
adolescence may be one mechanism through which depressive symptoms later in adolescence can be prevented. We hypothesized that anxious youth who
responded positively to cognitive-behavioral therapy (CBT) for anxiety would show reduced onset of depressive symptoms 2 years later compared to
treatment nonresponders, and that this effect would be specific to youth treated with CBT compared to an active supportive comparison treatment.
Method: Participants were 80 adolescents ages 11 to 17 years who had previously completed a randomized trial comparing predictors of treatment
response to CBT and child-centered therapy (CCT). Youth met DSM-IV criteria for generalized, separation, and/or social anxiety disorder at the time
of treatment. The present study was a prospective naturalistic 2-year follow-up examining trajectories toward depression, in which participants were
reassessed for depressive symptoms 2 years after anxiety treatment. Treatment response was defined as a 35% reduction in independent evaluator-rated
anxiety severity on the Pediatric Anxiety Rating Scale after treatment. Results: As hypothesized, lower levels of depressive symptoms were observed
in anxious youth who responded to CBT for anxiety (beta = -0.807, p = .004) but not CCT (beta = 0.254, p = .505). Sensitivity analyses showed that
the effects were driven by girls. Conclusion: Findings suggest that CBT for anxiety is a promising approach to preventing adolescent depressive
symptomatology, especially among girls. The results highlight the need for better early screening for anxiety and better dissemination of CBT
programs targeting anxiety in youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Journal of the American Academy of Child &
Adolescent Psychiatry, 58(3) : 359-367
- Year: 2019
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Supportive
therapy, Other Psychological Interventions
Stefan, S., Cristea, I.
A., Szentagotai Tatar, A., David, D.
OBJECTIVE: Cognitive-behavior
therapy (CBT) is considered the \"golden standard\" psychotherapy for generalized anxiety disorder (GAD) but, at this point, we have little
information about differences among various CBT approaches. METHOD(S): We conducted a randomized controlled trial to compare three CBT protocols for
GAD: (a) Cognitive Therapy/Borkovec's treatment package; (b) Rational Emotive Behavior Therapy, and (c) Acceptance and Commitment
Therapy/Acceptance-based behavioral therapy. A number of 75 patients diagnosed with GAD, aged between 20 and 51 (m = 27.13; standard deviation =
7.50), 60 women and 11 men, were randomized to the three treatment arms. RESULT(S): All treatments were associated with large pre-post intervention
reductions in GAD symptoms and dysfunctional automatic thoughts, with no significant differences between groups. Correlation analyses showed similar
associations between changes in symptoms and changes in dysfunctional automatic thoughts. CONCLUSION(S): All three approaches appear to be similarly
effective. Implications for the theoretical models underlying each of the three cognitive-behavior therapy approaches are discussed. Copyright © 2019
Wiley Periodicals, Inc.
Journal of Clinical Psychology, 75(7) : 1188-
1202
- Year: 2019
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions, Acceptance & commitment therapy
(ACT)
Silk,
Jennifer S., Price, Rebecca B., Rosen, Dana, Ryan, Neal D., Forbes, Erika E., Siegle, Greg J., Dahl, Ronald E., McMakin, Dana L., Kendall, Philip C., Ladouceur, Cecile D.
Objective:
Children who are fearful and anxious are at heightened risk for developing depression in adolescence. Treating anxiety disorders in pre-/early
adolescence may be one mechanism through which depressive symptoms later in adolescence can be prevented. We hypothesized that anxious youth who
responded positively to cognitive-behavioral therapy (CBT) for anxiety would show reduced onset of depressive symptoms 2 years later compared to
treatment nonresponders, and that this effect would be specific to youth treated with CBT compared to an active supportive comparison treatment.
Method: Participants were 80 adolescents ages 11 to 17 years who had previously completed a randomized trial comparing predictors of treatment
response to CBT and child-centered therapy (CCT). Youth met DSM-IV criteria for generalized, separation, and/or social anxiety disorder at the time
of treatment. The present study was a prospective naturalistic 2-year follow-up examining trajectories toward depression, in which participants were
reassessed for depressive symptoms 2 years after anxiety treatment. Treatment response was defined as a 35% reduction in independent evaluator-rated
anxiety severity on the Pediatric Anxiety Rating Scale after treatment. Results: As hypothesized, lower levels of depressive symptoms were observed
in anxious youth who responded to CBT for anxiety (beta = -0.807, p = .004) but not CCT (beta = 0.254, p = .505). Sensitivity analyses showed that
the effects were driven by girls. Conclusion: Findings suggest that CBT for anxiety is a promising approach to preventing adolescent depressive
symptomatology, especially among girls. The results highlight the need for better early screening for anxiety and better dissemination of CBT
programs targeting anxiety in youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Journal of the American Academy of Child &
Adolescent Psychiatry, 58(3) : 359-367
- Year: 2019
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Supportive
therapy, Other Psychological Interventions
Teng, M.H., Hou, Y.M., Chang, S.H. Cheng, H.J.
Background: Mogg and Bradley (2016) proposed that attentional bias (to threat stimuli) among patients with generalized anxiety
disorder (GAD) may be associated with the top-down attention control process. Additionally, some scholars (e.g., Enock & McNally, 2013) have designed
mobile applications to enable patients to engage in home-delivered attentional bias modification (HD-ABM); however, many problems related to these
training systems have not yet been addressed. Method: A total of 82 participants (61 women, mean age = 21.47 y) who received GAD diagnoses were
randomly assigned to an HD-ABM (n = 30), placebo training (n = 30), or waiting list (n = 22) group. Both the HDABM and placebo groups were trained
with the attention training application (through Android phones three times a day for four weeks). Results: (1) All measures of participants' self-
reported symptoms (except for trait anxiety) were significantly lower in Week 4 and in the follow-up. (2) Attentional network test (ANT) results
demonstrated that all participants' alerting scores significantly increased by Week 4. (3) Participants in the HD-ABM and placebo groups
demonstrated significant increases in their self-reported attention control scores, decreases in their attention bias index (ABI) scores, and
progress in their executive control abilities. Limitations: Self-report scales may have been insufficient for measuring effectiveness in the present
study. Conclusions: This study helps to elucidate the mechanism underlying changes in attention processes after HDABM training implemented through a
mobile application in GAD. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Journal of Affective Disorders, 246 : 444-
451
- Year: 2019
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Attention/cognitive bias
modification, Technology, interventions delivered using technology (e.g. online, SMS)
Perrin, S., Bevan, D., Payne, S., Bolton, D.
Cognitive behavioral therapy (CBT) designed to target generalized anxiety disorder (GAD) in youth was examined in a pilot
feasibility trial. Participants (aged 10-18 years) were randomized to either 10 weeks of individual CBT (n = 20) or supported wait-list (n = 20).
Diagnostic status (primary outcome) was assessed blindly at post-treatment for both groups, and at a 3-month follow-up for treated participants. Two
participants failed to complete CBT and retained their GAD during the trial. Intention-to-treat analyses revealed large between-group differences in
favor of CBT at post-treatment for remission from GAD (80% vs 0%) and comorbid disorders (83% vs 0%), and for all secondary outcomes (child and
parent-reported). All gains were maintained at 3-month follow-up in the CBT group. Consistent with the treatment model, significant pre- to post-
treatment reductions in several cognitive processes were found for CBT but not wait-listed participants, with these gains maintained at follow-up.
Further investigations are warranted. Trial registry: ISRCTN.com Identifier ISRCTN50951795. Copyright © 2019, The Author(s).
Cognitive Therapy and Research., 43 : pages1051 - 1064
- Year: 2019
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Skodzik, T., Adelt, M. H., Nossek, V. A., Kuck, S. T., Ehring, T.
Worry is a verbal and
abstract thought activity with only little mental imagery involved. It has been shown that this processing bias leads to hampered emotional
processing of worry topics so that worry is maintained in the long run. However, there is some evidence that mental imagery during worrying has the
opposite effect: It leads to stronger emotional reactions than verbal thoughts and thereby fosters emotional processing of worry topics. In the
present study, we examined whether training mental imagery reduces pathological worry. We compared the effect of a novel training in mental imagery
(TMI; n = 37) on various worry-related outcomes to a control training in verbal thinking (TVT; n = 38) and a waiting-list control group (n = 36) in a
sample of pathologically high worriers. Both trainings showed significant within-group decline regarding e.g. pathological worry activity, worry-
related impairment and anxiety assessed both one and five weeks after the training. Cohen's d on different outcome measures ranged from.39 to 1.17.
However, unexpectedly, there were no significant differences between groups on any worry- or affect-related outcome measures. In, sum our training in
general mental imagery skills turned out to be a promising intervention for the reduction of pathological worry. However, we found a training in
verbal thinking to also have unexpected beneficial effects. The theoretical and clinical implications of these findings and methodological
limitations of our study are discussed. Copyright © 2018 Elsevier Ltd
Behaviour Research and
Therapy, 109 : 56-67
- Year: 2018
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Villabo, M.A., Narayanan,
M., Compton, S.N., Kendall, P.C., Neumer, S.P.
Objective: To compare the effectiveness of individual cognitive-behavioral therapy (ICBT) and group CBT (GCBT)
for referred children with anxiety disorders within community mental health clinics. Method: Children (N = 165; ages 7-13 years) referred to 5
clinics in Norway because of primary separation anxiety disorder (SAD), social anxiety disorder (SOC), or generalized anxiety disorder (GAD) based on
Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) criteria participated in a randomized clinical trial. Participants were
randomized to ICBT, GCBT, or wait list (WL). WL participants were randomized to 1 of the 2 active treatment conditions following the wait period.
Primary outcome was loss of principal anxiety disorder over 12 weeks and 2-year follow-up. Results: Both ICBT and GCBT were superior to WL on all
outcomes. In the intent-to-treat analysis, 52% in ICBT, 65% in GCBT, and 14% in WL were treatment responders. Planned pairwise comparisons found no
significant differences between ICBT and GCBT. GCBT was superior to ICBT for children diagnosed with SOC. Improvement continued during 2-year
follow-up with no significant between-groups differences. Conclusions: Among anxiety disordered children, both individual and group CBT can be
effectively delivered in community clinics. Response rates were similar to those reported in efficacy trials. Although GCBT was more effective than
ICBT for children with SOC following treatment, both treatments were comparable at 2-year follow-up. Dropout rates were lower in GCBT than in ICBT,
suggesting that GCBT may be better tolerated. Response rates continued to improve over the follow-up period, with low rates of relapse. (PsycINFO
Database Record (c) 2018 APA, all rights reserved) Impact Statement What is the public health significance of this article?-Findings indicate that
both individual and group cognitive-behavioral therapy can be effectively delivered by community mental health practitioners with only a minimal
amount of formal training. Outcomes were similar to those reported in more controlled settings. (PsycINFO Database Record (c) 2018 APA, all rights
reserved)
Journal of Consulting and Clinical Psychology, 86(9) : 751-
764
- Year: 2018
- 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