Disorders - Generalized Anxiety Disorder
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
Drake, K. L., Ginsburg, G. S.
It is
now widely accepted that anxiety disorders run in families, and current etiological models have proposed both genetic and environmental pathways to
anxiety development. In this paper, the familial role in the development, treatment, and prevention of anxiety disorders in children is reviewed. We
focus on three anxiety disorders in youth, namely, generalized, separation, and social anxiety as they often co-occur both at the symptom and
disorder level and respond to similar treatments. We begin by presenting an overview of a broad range of family factors associated with anxiety
disorders. Findings from these studies have informed intervention and prevention strategies that are discussed next. Throughout the paper we shed
light on the challenges that plague this research and look toward the future by proposing directions for much needed study and discussing factors
that may improve clinical practice and outcomes for affected youth and their families. (copyright) 2012 Springer Science+Business Media, LLC.
Clinical Child &
Family Psychology Review, 15(2) : 144-162
- Year: 2012
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder)
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any)
Galla, B. M., Wood, J. J., Chiu, A. W., Langer, D. A., Jacobs, J., Ifekwunigwe,
M., Larkins, C.
The current study sought to evaluate the relative long-term efficacy of a
modularized cognitive behavioral therapy (CBT) program for children with anxiety disorders. Twenty four children (5-12 years old) randomly assigned
to modular CBT or a 3-month waitlist participated in a 1-year follow-up assessment. Independent evaluators blind to treatment condition conducted
structured diagnostic interviews, and caregivers and children completed symptom checklists at pre- and post-, and 1 year follow-up assessments.
Analyses revealed that 71.4% of children who received CBT demonstrated a positive treatment response 1 year following treatment, and 83.3% were free
of any anxiety diagnosis at 1 year follow-up. Analyses further revealed robust effects of intervention on diagnostic outcomes, caregiver- and child-
report measures of anxiety at 1 year follow-up. Results provide evidence of an ongoing advantage on anxiety-specific outcomes for this modularized
school-based CBT program 1 year post-treatment.
Child Psychiatry &
Human Development, 43(2) : 219-226
- Year: 2012
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Sayyah, M., Siahpoosh, A., Khalili, H., Malayeri, A., Samaee, H.
The aim of this study was to assess the efficacy and tolerability of the aqueous extract of
Echium amoenum in combination with SSRIs in patients with General Anxiety Disorder (GAD). The study was an 8-week double-blind randomized clinical
trial. Thirty-seven adult outpatients who met the DSM-IV-TR criteria for GAD based on the structured clinical interview participated in the trial. In
this study, patients were randomly assigned to receive the aqueous extract (500 mg) plus fluoxetine or fluoxetine (20 mg/day) plus placebo. The
results showed significant difference between the two groups in the treatment of GAD. Moreover, there was not any significant difference between the
two groups in terms of observed side effects. E. amoenum is effective on anxiety disorder, especially in higher dosage, without any serious side
effects. (copyright) 2012 by School of Pharmacy.
Iranian Journal of Pharmaceutical Research, 11(2) : 697-701
- Year: 2012
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Complementary & Alternative
Interventions (CAM), Homeopathic, plant-based medicines