The GAD-7 is commonly used as a measure of general anxiety symptoms across various settings and populations. However, there has been disagreement regarding the factor structure of the GAD-7, and there is a need for larger studies investigating the psychometric properties of the measure. Patients undergoing treatment ( N = 1201), both inpatient and outpatient patients, completed the GAD-7 at pre- and post-treatment. Measures of depression, well-being, and other anxiety measures were also completed, making it possible to investigate convergent and divergent validity. Internal consistency and convergent validity were excellent for the total sample, and there was acceptable variation related to treatment groups. We conducted an exploratory factor analysis (EFA) on a random sample (50%) of the patients at intake and then conducted a confirmatory factor analysis (CFA) to confirm the factor structure in the other part of the sample at intake. The EFA indicated a clear one-factor solution, but the one-factor solution with CFA provided a poor fit to the data. Correlating the residuals among items assessing somatic symptoms led to a good fit in a respecified CFA solution. The GAD-7 has excellent internal consistency, and the one-factor structure in a heterogeneous clinical population was supported.

No abstract

This trial reports the first evidence that within-person change in shame and guilt predicts change in PTSD symptoms from session to session during treatment.

The present study examined both the intraindividual relationship between alliance components (task, goal, and bond) and subsequent posttraumatic stress disorder (PTSD) symptoms over the course of therapy and the interindividual relationships between the initial level of the alliance components and overall PTSD outcome. PTSD patients (n = 65) were randomized to either standard prolonged exposure, which includes imaginal exposure (IE) to the traumatic memory, or modified prolonged exposure, where imagery rescripting (IR) of the memory replaced IE as the imagery component of prolonged exposure in a 10-week residential program. They were assessed repeatedly (weekly) on alliance and PTSD symptom measures. The centering method of detrending (Curran & Bauer, 2011) was used to separate the variance related to the intraindividual process of change during treatment (within-person component) from the variance related to initial individual differences (between-person component). The hypothesis of a negative within-person effect of the alliance components agreement about the tasks of therapy and bond on subsequent PTSD symptoms was supported for the component task agreement. As expected, this effect was stronger in IE than in IR. Moreover, there was a negative relationship between interindividual differences in initial Task and Bond scale scores and slope of PTSD symptoms over the course of therapy. By contrast, within-person variations in PTSD symptoms did not predict subsequent alliance components. The present results suggest the importance of agreement about therapy tasks during the process of IE or IR within prolonged exposure for PTSD patients, particularly in IE.