Study of the effects of cognitive behavioral therapy versus dialectical behavior therapy on executive function and reduction of symptoms in generalized anxiety disorder

Afshari, Behrooz; Dehkordi, Fatemeh Jafarian; Farid, Ali Asghar Asgharnejad; Rezaie, Zeinab; Aramfar, Behnoosh; Balagabri, Zohreh; Mardi, Nayereh

doi:10.47626/2237-6089-2020-0156

Cited by 5 publications

(9 citation statements)

References 34 publications

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“…After removing duplicates and examining titles and abstracts we selected 125 records for full-text assessment. Eventually, we selected 66 studies for inclusion in the network analysis (eAppendixes D, E, F, and G in Supplement 1). Overall, 5597 participants were randomly assigned to the 8 different psychotherapies (behavior therapy, CBT, cognitive restructuring, psychoeducation, psychodynamic therapy, relaxation therapy, supportive psychotherapy, and third-wave CBTs) and 2 different control conditions (treatment as usual and waiting list) (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

“…The mean (SD) number of therapy sessions was 11 (5) per RCT. Twenty-seven studies (41%) used scales specifically designed to capture generalized anxiety disorder symptoms.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-three studies (35%) were at high risk of bias, 32 studies (48%) were evaluated as having “some concerns,” and 11 studies (17%) were considered at low risk of bias (Table 2, eAppendix H in Supplement 1). In the domain of “selection of the reported result,” the majority of the RCTs failed to provide information on the study protocol and the preplanned analysis plan, leading to “some concerns” judgment in 42 studies (64%); 41 studies (62%) failed to adequately report on the randomization process in the “randomization process” domain, with details on allocation concealment being almost never reported. That RCT statistical analyses were carried out mainly following a per-protocol approach (44 [67%]) had a backlash on the “deviations from the intended interventions” domain, with more than half the studies being classified as either having some concerns (22 [33%]) or at high risk (19 [29%]) .…”

Section: Resultsmentioning

confidence: 99%

“…That RCT statistical analyses were carried out mainly following a per-protocol approach (44 [67%]) had a backlash on the “deviations from the intended interventions” domain, with more than half the studies being classified as either having some concerns (22 [33%]) or at high risk (19 [29%]) . On the other hand, 60 RCTs (91%) had low risk of bias in the measurement of the outcome.…”

Section: Resultsmentioning

confidence: 99%

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Psychotherapies for Generalized Anxiety Disorder in Adults

Papola,

Miguel,

Mazzaglia

et al. 2024

JAMA Psychiatry

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ImportanceGeneralized anxiety disorder (GAD) is one of the most common mental disorders in adults. Psychotherapies are among the most recommended treatments for GAD, but which should be considered as first-line treatment needs to be clarified.ObjectiveTo use a network meta-analysis to examine the short- and long-term associations of different psychotherapies with outcomes of effectiveness and acceptability in adults with GAD.Data SourcesMEDLINE, Embase, PsycINFO, and the Cochrane Register of Controlled Trials were searched from database inception to January 1, 2023, to identify randomized clinical trials (RCTs) of psychotherapies for adults with GAD.Study SelectionRCTs comparing any type of psychotherapy against another or with a control condition for the treatment of adults (≥18 years, both sexes) with a primary diagnosis of GAD were eligible for inclusion.Data Extraction and SynthesisThis study followed Cochrane standards for extracting data and assessing data quality and used the PRISMA guideline for reporting. Risk of bias of individual studies was assessed using the second version of the Cochrane risk of bias tool, and the Confidence in Network Meta-Analysis was used to rate the certainty of evidence for meta-analytical results.Main Outcomes and MeasuresEight psychotherapies were compared against one another and with 2 control conditions. Primary outcomes were severity of GAD symptoms and acceptability of the psychotherapies. Random-effects model pairwise and network meta-analyses were conducted. For effectiveness, standardized mean differences (SMDs) were pooled, and for acceptability, relative risks with 95% CIs were calculated.ResultsData from 66 RCTs were included. Effect size estimates on data from 5597 participants (mean [SD], 70.9% [11.9%] women; mean [SD] age, 42.2 [12.5] years) suggested that third-wave cognitive behavior therapies (CBTs) (SMD, −0.78 [95% CI, −1.19 to −0.37]; certainty, moderate), CBT (SMD, −0.68 [95% CI, −1.05 to −0.32]; certainty, moderate), and relaxation therapy (SMD, −0.54 [95% CI, −1.04 to −0.05]; certainty, low) were associated with reduced GAD symptoms vs treatment as usual. Relative risks for all-cause discontinuation (indication of acceptability) signaled no differences compared with treatment as usual for all psychotherapies (eg, relative risk, 1.07 [95% CI, 0.73-1.57] for CBT vs treatment as usual). When excluding studies at high risk of bias, relaxation therapy lost its superiority over treatment as usual (SMD, −0.40; 95% CI, −1.15 to 0.34). When considering anxiety severity at 3 to 12 months after completion of the intervention, only CBT remained significantly associated with greater effectiveness than treatment as usual (SMD, −0.58; 95% CI, −0.93 to −0.23).Conclusions and RelevanceGiven the evidence in this systematic review and network meta-analysis for its associations with both acute and long-term effectiveness, CBT may represent the first-line therapy of GAD. Third-wave CBTs and relaxation therapy were associated with short-term effectiveness and may also be offered.

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Section: Resultsmentioning

confidence: 99%

“…The mean (SD) number of therapy sessions was 11 (5) per RCT. Twenty-seven studies (41%) used scales specifically designed to capture generalized anxiety disorder symptoms.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Psychotherapies for Generalized Anxiety Disorder in Adults

Papola,

Miguel,

Mazzaglia

et al. 2024

JAMA Psychiatry

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“…Results suggest that EFT is a potentially promising treatment for GAD [40]. Dialectical behaviour therapy (DBT) for GAD was more effective in improving executive function than CBT [41].…”

Section: Psychological Therapymentioning

confidence: 99%

Update on treatments for anxiety-related disorders

Lee

Stein

2022

Current Opinion in Psychiatry

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Purpose of reviewThis review examines recent evidence that informs the treatment of anxiety-related disorders.Recent findingsIn addition to selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and benzodiazepines, agomelatine has demonstrated efficacy in treating generalized anxiety disorder (GAD). Other novel products, such as ketamine, psilocybin and cannabidiol, are in the process of gathering evidence in support of the treatment of anxiety disorders. In psychological therapy, various psychological treatments for anxiety disorders, such as mindfulness-based intervention, acceptance and commitment therapy, psychodynamic therapy, emotion-focused therapy and dialectical behavioural therapy, have been tried. Still, most therapies have not proven superior to cognitive behavioural therapy (CBT). In very preliminary findings: Repetitive transcranial magnetic stimulation (rTMS) was effective in GAD; transcranial direct current stimulation (tDCS) was effective for social anxiety disorder (SAD) and GAD and augmented exposure therapy for specific fears. Internet and mobile-based interventions have comparable efficacy to face-to-face therapy.SummaryPharmacotherapy of anxiety disorders is expanding to novel products. Despite trying other psychological therapies for anxiety disorders, most therapies were comparable to but not superior to CBT. rTMS and tDCS were also used and show early promise for GAD, but further studies are needed. Most internet or mobile app based psychological therapies were based on CBT, and some can be considered as alternatives to in-person face-to-face therapy.

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Effectiveness of internet-delivered dialectical behavior therapy skills training on executive functions among college students with borderline personality traits: a non-randomized controlled trial

Vijayapriya,

Tamarana

2023

RES PSYCHOTHER-PSYCH

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Given the enormous influence of emotions on cognitive processes, individuals with borderline personality disorder (BPD) suffer from marked deficits in higher-order thinking abilities. Considering the prevalence of BPD among college students, this study aimed to investigate the changes in perceived executive functioning among college students with traits/presence of BPD undergoing internet-delivered dialectical behavior therapy skills training (DBT-ST) that included the mindfulness and emotion regulation modules. An internet-delivered version of DBT-ST was opted for, as technological advancements in the present era promote the use of online platforms for psychotherapy. This non-randomized controlled trial consisted of 36 college students with traits/presence of BPD. The intervention group attended 13 sessions of DBT-ST, and the control group attended 13 sessions of behavioral activation. Perceived executive functioning was assessed using the Behavior Rating Inventory of Executive Functions for Adults. A 2-way repeated measures analysis of variance was used to evaluate the treatment impact on the outcome variable. Results showed that the DBT-ST group had larger improvements in their abilities to initiate, plan, and organize current and future-oriented task demands and to organize their everyday environment, compared to the control group. Both, the DBT-ST group and the control group demonstrated improvements in emotional control, working memory, and their abilities to shift and task monitor. Findings suggest that the internet-delivered version of DBT-ST, consisting of the mindfulness and emotion regulation modules, can foster notable improvements in executive functions among college students with traits/presence of BPD. Improved executive functioning is one of the several multifaceted outcomes of dialectical behavior therapy.

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Study of the effects of cognitive behavioral therapy versus dialectical behavior therapy on executive function and reduction of symptoms in generalized anxiety disorder

Cited by 5 publications

References 34 publications

Psychotherapies for Generalized Anxiety Disorder in Adults

Psychotherapies for Generalized Anxiety Disorder in Adults

Update on treatments for anxiety-related disorders

Effectiveness of internet-delivered dialectical behavior therapy skills training on executive functions among college students with borderline personality traits: a non-randomized controlled trial

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