Do emotion regulation, attentional control, and attachment style predict response to cognitive behavioral therapy for anxiety disorders? – an investigation in clinical settings

Nielsen, Sara Kerstine Kaya; Hageman, Ida; Petersen, Anders; Daniel, Sarah Ingrid Franksdatter; Lau, Marianne Engelbrecht; Winding, Clas; Wolitzky-Taylor, Kate; Steele, Howard; Vangkilde, Signe

doi:10.1080/10503307.2018.1425933

Cited by 13 publications

(18 citation statements)

References 41 publications

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“…Not only does PT cause side effects, but also between 20 and 50% of patients have either a contra-indication or don’t respond to PT (Lydiard et al, 1996; Davidson et al, 2004; Blanco et al, 2010; Hyman, 2010). Combination of PT with CBT is recommended (Bandelow et al, 2012) but around 50% of individuals with ADs do not benefit from CBT (Nielsen et al, 2018), or prefer not to take medication,or prefer non-verbal therapy (Uttley et al, 2015). These groups of individuals may benefit from AT.…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness of Art Therapy for Anxiety in Adult Women: A Randomized Controlled Trial

et al. 2019

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Objectives: Art therapy (AT) as a treatment option for anxiety is regularly employed in clinical practice, but scientific evidence for its effectiveness is lacking, since this intervention has hardly been studied. The aim was to study the effectiveness of AT on anxiety in adult women. The specific type of AT studied was anthroposophic AT. Methods: A RCT comparing AT versus a waiting list (WL) condition on anxiety symptom severity, quality of life, and emotion regulation. Factors influencing treatment outcome were additionally explored. Participants were women, aged 18-65 years, diagnosed with generalized anxiety disorder, social anxiety disorder or panic disorder, with moderate to severe anxiety symptoms. The trial was registered in the Dutch Trial Registration (NTR28143). Results: Fifty-nine women were included, of which 47 completed the trial. Both perprotocol and intention-to treat analyses demonstrated effectiveness of AT compared to WL, showing a reduction in anxiety, an increase in subjective quality of life (both with large effects) and an improvement in accessibility of emotion regulation strategies (medium effect). Treatment effects remained after 3 months follow-up. Improved acceptance of emotions and improved goal-oriented action are aspects of emotion regulation that are associated with the decrease in anxiety level. Conclusion: AT is effective in reducing anxiety symptoms, improving quality of life and aspects of emotion regulation. Future RCTs should use active controls (treatment as usual) and study cost-effectiveness.

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Section: Introductionmentioning

confidence: 99%

The Effectiveness of Art Therapy for Anxiety in Adult Women: A Randomized Controlled Trial

et al. 2019

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“…Pharmacological treatment causes side effects and a significant percentage of patients (between 20–50% [12–15] is unresponsive or has a contra-indication. Combination with CBT is recommended [16] but around 50% of patients with anxiety disorders do not benefit from CBT [17].…”

Section: Introductionmentioning

confidence: 99%

The effectiveness of art therapy for anxiety in adults: A systematic review of randomised and non-randomised controlled trials

et al. 2018

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BackgroundAnxiety disorders are one of the most diagnosed mental health disorders. Common treatment consists of cognitive behavioral therapy and pharmacotherapy. In clinical practice, also art therapy is additionally provided to patients with anxiety (disorders), among others because treatment as usual is not sufficiently effective for a large group of patients. There is no clarity on the effectiveness of art therapy (AT) on the reduction of anxiety symptoms in adults and there is no overview of the intervention characteristics and working mechanisms.MethodsA systematic review of (non-)randomised controlled trials on AT for anxiety in adults to evaluate the effects on anxiety symptom severity and to explore intervention characteristics, benefitting populations and working mechanisms. Thirteen databases and two journals were searched for the period 1997 –October 2017. The study was registered at PROSPERO (CRD42017080733) and performed according to the Cochrane recommendations. PRISMA Guidelines were used for reporting.ResultsOnly three publications out of 776 hits from the search fulfilled the inclusion criteria: three RCTs with 162 patients in total. All studies have a high risk of bias. Study populations were: students with PTSD symptoms, students with exam anxiety and prisoners with prelease anxiety. Visual art techniques varied: trauma-related mandala design, collage making, free painting, clay work, still life drawing and house-tree-person drawing. There is some evidence of effectiveness of AT for pre-exam anxiety in undergraduate students. AT is possibly effective in reducing pre-release anxiety in prisoners. The AT characteristics varied and narrative synthesis led to hypothesized working mechanisms of AT: induce relaxation; gain access to unconscious traumatic memories, thereby creating possibilities to investigate cognitions; and improve emotion regulation.ConclusionsEffectiveness of AT on anxiety has hardly been studied, so no strong conclusions can be drawn. This emphasizes the need for high quality trials studying the effectiveness of AT on anxiety.

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“…This finding was corroborated by Niles et al (30) for patients treated for social anxiety disorder. However, Nielsen et al (31) found no evidence that emotion regulation at baseline predicted the rate of change among patients receiving group-delivered CBT for anxiety.…”

Section: Introductionmentioning

confidence: 99%

“…However, Nielsen et al. ( 31 ) found no evidence that emotion regulation at baseline predicted the rate of change among patients receiving group-delivered CBT for anxiety.…”

Section: Introductionmentioning

confidence: 99%

Emotion Regulation as a Time-Invariant and Time-Varying Covariate Predicts Outcome in an Internet-Based Psychodynamic Treatment Targeting Adolescent Depression

et al. 2020

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Objective: Although psychodynamic psychotherapy is efficacious in the treatment of depression, research on mechanisms of change is still scarce. The aim of this study was to investigate if and how emotion regulation affects outcome both as a time-invariant and a lagged time-varying predictor. Method: The sample consisted of 67 adolescents diagnosed with major depressive disorder, attending affect-focused psychodynamic internet-based treatment (IPDT). Linear mixed models were used to analyze emotion regulation as a baseline predictor and to assess the effect of within-person changes in emotion regulation on depression. Results: Analyses suggested that emotion regulation at baseline was a significant predictor of outcome, where participants with relatively larger emotion regulation deficits gained more from IPDT. Further, the results showed a significant effect of improved emotion regulation on subsequent depressive symptomatology. When not controlling for time, increased emotion regulation explained 41.23% of the variance in subsequent symptoms of depression. When detrending the results were still significant, but the amount of explained variance was reduced to 8.7%. Conclusion: The findings suggest that patients with relatively larger deficits in emotion regulation gain more from IPDT. Decreased emotion regulation deficits seem to act as a mechanism of change in IPDT as it drives subsequent changes in depression.

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Do emotion regulation, attentional control, and attachment style predict response to cognitive behavioral therapy for anxiety disorders? – an investigation in clinical settings

Abstract: In routine clinical settings, high attachment anxiety may predict poorer outcomes for group-based CBT.

Cited by 13 publications

References 41 publications

The Effectiveness of Art Therapy for Anxiety in Adult Women: A Randomized Controlled Trial

The Effectiveness of Art Therapy for Anxiety in Adult Women: A Randomized Controlled Trial

The effectiveness of art therapy for anxiety in adults: A systematic review of randomised and non-randomised controlled trials

Emotion Regulation as a Time-Invariant and Time-Varying Covariate Predicts Outcome in an Internet-Based Psychodynamic Treatment Targeting Adolescent Depression

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