A Randomized Clinical Trial of Cognitive-Behavioral Therapy and Applied Relaxation for Adults With Generalized Anxiety Disorder

Dugas, Michel J.; Brillon, Pascale; Savard, P.; Turcotte, J.; Gaudet, Adrienne; Ladouceur, Robert; Leblanc, Renée; Gervais, Nicole

doi:10.1016/j.beth.2008.12.004

Cited by 172 publications

(108 citation statements)

References 39 publications

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“…There is considerable evidence that intolerance of uncertainty (IU) is a cognitive vulnerability factor for worry (Koerner & Dugas, 2008;Ladouceur, Gosselin, & Dugas, 2000; Mediators of repetitive negative thinking 4 Sexton, Norton, Walker, & Norton, 2003;van der Heiden, Melchior, Muris, Bouwmeester, Bos, & van der Molen, 2010) and an important maintaining factor for GAD (Behar, DiMarco, Hekler, Mohlman, & Staples, 2009;Dugas, Gagnon, Ladouceur, & Freeston, 1998). Intervention trials have found that changes in IU are associated with improvements in worry and anxiety symptoms during cognitive behavioral therapy (CBT, Dugas et al, 2003;Dugas et al, 2010). …”

Section: Introductionmentioning

confidence: 99%

Intolerance of uncertainty and negative metacognitive beliefs as transdiagnostic mediators of repetitive negative thinking in a clinical sample with anxiety disorders

McEvoy

Mahoney

2013

Journal of Anxiety Disorders

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This study aimed to replicate and extend a hierarchical model of vulnerability to worry, with neuroticism and extraversion as higher-order factors and negative metacognitions and intolerance of uncertainty as second-order factors. The model also included a transdiagnostic measure of repetitive negative thinking (RNT) and depression symptoms as outcome variables to determine whether relationships would extend beyond worry, which has traditionally been studied within the context of generalized anxiety disorder (GAD). Participants (N = 99) were referrals to a specialist anxiety disorders clinic with a principal anxiety disorder who completed a battery of self-report questionnaires assessing neuroticism, extraversion, metacognitions, intolerance of uncertainty, worry, RNT, and depression symptoms.Mediational analyses using bootstrapping provided support for transdiagnostic and diagnosis-specific mediation effects. Negative metacognitions fully mediated the relationship between neuroticism and RNT for the whole sample and for subsamples with and without generalized anxiety disorder (GAD). Intolerance of uncertainty mediated the relationship between neuroticism and worry (for the whole sample and for those with GAD) and between neuroticism and RNT (for those with GAD).Implications for theory, treatment, and nosology are discussed.

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Section: Introductionmentioning

confidence: 99%

Intolerance of uncertainty and negative metacognitive beliefs as transdiagnostic mediators of repetitive negative thinking in a clinical sample with anxiety disorders

McEvoy

Mahoney

2013

Journal of Anxiety Disorders

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“…The treatment has been tested in four published randomised clinical trials, with results showing that it is more efficacious than a waiting list control, 34,35 supportive therapy 36 and applied relaxation. 37 The findings also show that 60-77% of patients attain GAD remission and that 50-55% achieve high-end state functioning following the treatment. The CBT protocol developed by Dugas and Robichaud (i.e.…”

Section: Cognitive Behavioural Therapymentioning

confidence: 60%

Pilot of a randomised controlled trial of the selective serotonin reuptake inhibitor sertraline versus cognitive behavioural therapy for anxiety symptoms in people with generalised anxiety disorder who have failed to respond to low-intensity psychological treatments as defined by the National Institute for Health and Care Excellence guidelines

Buszewicz

Cape

Serfaty

et al. 2017

Health Technol Assess

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Background Generalised anxiety disorder (GAD) is common, causing unpleasant symptoms and impaired functioning. The National Institute for Health and Care Excellence (NICE) guidelines have established good evidence for low-intensity psychological interventions, but a significant number of patients will not respond and require more intensive step 3 interventions, recommended as either high-intensity cognitive behavioural therapy (CBT) or a pharmacological treatment such as sertraline. However, there are no head-to-head comparisons evaluating which is more clinically effective and cost-effective, and current guidelines suggest that treatment choice at step 3 is based mainly on patient preference. Objectives To assess clinical effectiveness and cost-effectiveness at 12 months of treatment with the selective serotonin reuptake inhibitor (SSRI) sertraline compared with CBT for patients with persistent GAD not improved with NICE-defined low-intensity psychological interventions. Design Participant randomised trial comparing treatment with sertraline with high-intensity CBT for patients with GAD who had not responded to low-intensity psychological interventions. Setting Community-based recruitment from local Improving Access to Psychological Therapies (IAPT) services. Four pilot services located in urban, suburban and semirural settings. Participants People considered likely to have GAD and not responding to low-intensity psychological interventions identified at review by IAPT psychological well-being practitioners (PWPs). Those scoring ≥ 10 on the Generalised Anxiety Disorder-7 (GAD-7) anxiety measure were asked to consider involvement in the trial. Inclusion criteria Aged ≥ 18 years, a score of ≥ 10 on the GAD-7, a primary diagnosis of GAD diagnosed on the Mini International Neuropsychiatric Interview questionnaire and failure to respond to NICE-defined low-intensity interventions. Exclusion criteria Inability to participate because of insufficient English or cognitive impairment, current major depression, comorbid anxiety disorder(s) causing greater distress than GAD, significant dependence on alcohol or illicit drugs, comorbid psychotic disorder, received antidepressants in past 8 weeks or high-intensity psychological therapy in previous 6 months and any contraindications to treatment with sertraline. Randomisation Consenting eligible participants randomised via an independent, web-based, computerised system. Interventions (1) The SSRI sertraline prescribed in therapeutic doses by the patient’s general practitioner for 12 months and (2) 14 (± 2) CBT sessions delivered by high-intensity IAPT psychological therapists in accordance with a standardised manual designed for GAD. Main outcome measures The primary outcome was the Hospital Anxiety and Depression Scale – Anxiety component at 12 months. Secondary outcomes included measures of depression, social functioning, comorbid anxiety disorders, patient satisfaction and economic evaluation, collected by postal self-completion questionnaires. Results Only seven internal pilot participants were recruited against a target of 40 participants at 7 months. Far fewer potential participants were identified than anticipated from IAPT services, probably because PWPs rarely considered GAD the main treatment priority. Of those identified, three-quarters declined participation; the majority (30/45) were reluctant to consider the possibility of randomisation to medication. Limitations Poor recruitment was the main limiting factor, and the trial closed prematurely. Conclusions It is unclear how much of the recruitment difficulty was a result of conducting the trial within a psychological therapy service and how much was possibly a result of difficulty identifying participants with primary GAD. Future work It may be easier to answer this important question by recruiting people from primary care rather than from those already engaged in a psychological treatment service. Trial registration Current Controlled Trials ISCRTN14845583. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 45. See the NIHR Journals Library website for further project information.

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“…Plus spécifiquement, nous voulions évaluer si ce traitement psychologique est efficace dans la réduction des symptômes de dépression et d'anxiété associés à une maladie cardiaque (par exemple, perte d'intérêt pour les activités quoti diennes, difficultés de sommeil, inquiétudes envahissantes, comporte ments d'évitement). Contrairement aux protocoles de traitement des études menées précé -demment, le protocole utilisé ici tient compte de la situation particulière des patients cardiaques et il est issu de manuels de traitements empiriquement validés (Barlow, 2002 ;Dugas, 2002 ;Leahy et Holland, 2000).…”

Section: La Présente éTudeunclassified

“…Le traitement offert aux patients est issu d'un compte rendu de nos expériences cliniques avec des patients ayant une maladie cardiaque, combiné aux éléments des protocoles de traitement de la dépres -sion majeure et des troubles anxieux empiriquement validés auprès des populations en bonne santé physique (Barlow, 2001 ;Dugas, 2002 ;Leahy et Holland, 2000). Contrairement aux protocoles de traitement habituels, celui-ci met l'accent sur l'impact émotionnel de la maladie cardiaque et des contraintes imposées par celle-ci (par exemple, perte d'emploi, de mobilité, etc.…”

Section: Protocole De Traitementunclassified

L’intégration d’un traitement psychologique en réadaptation cardiaque à l’Hôpital Montfort : une diminution des risques associés aux maladies cardiaques

Greenman

Morin-Turmel

Grenier

2010

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Les buts de cette étude étaient l’intégration et la mise à l’épreuve d’un traitement psychologique au sein du Service de réadaptation cardiaque à l’Hôpital Montfort. Des patients (hommes et femmes), âgés entre 35 et 85 ans, avec une maladie cardiaque et qui se plaignaient de symptômes d’anxiété et de dépression ont participé à cette étude. Les résultats suggèrent que la thérapie cognitivo-comportementale (TCC) peut réduire de façon significative les symptômes de dépression et d’anxiété chez les patients cardiaques. Dans notre échantillon (N = 11), les patients ayant suivi au moins dix séances de traitement ont présenté une diminution importante de leurs symptômes, et personne ne répondait aux critères d’un diagnostic de dépression ou d’anxiété après l’intervention.The goals of the study were to introduce and test a psychological treatment at the Montfort Hospital’s Cardiac Rehabilitation Service. The participants were male and female patients between the ages of 35 and 85 with heart disease who reported symptoms of anxiety and depression. The results suggest that cognitive-behavioural therapy (CBT) may significantly reduce symptoms of depression and anxiety in cardiac patients. In our sample (N = 11), patients completing at least 10 treatment sessions showed a significant decrease in their symptoms, and none met the criteria for a diagnosis of depression or anxiety after the treatment

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A Randomized Clinical Trial of Cognitive-Behavioral Therapy and Applied Relaxation for Adults With Generalized Anxiety Disorder

Cited by 172 publications

References 39 publications

Intolerance of uncertainty and negative metacognitive beliefs as transdiagnostic mediators of repetitive negative thinking in a clinical sample with anxiety disorders

Intolerance of uncertainty and negative metacognitive beliefs as transdiagnostic mediators of repetitive negative thinking in a clinical sample with anxiety disorders

L’intégration d’un traitement psychologique en réadaptation cardiaque à l’Hôpital Montfort : une diminution des risques associés aux maladies cardiaques

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