Evidence-based assessment of treatment outcomes for late-life generalized anxiety disorder using the Penn State Worry Questionnaire (PSWQ) and Penn State Worry Questionnaire – Abbreviated (PSWQ-A)

2021 ◽  
pp. 1-13
Author(s):  
Carly Johnco ◽  
Viviana M. Wuthrich ◽  
Gretchen A. Brenes ◽  
Julie Loebach Wetherell ◽  
Jan Mohlman
Keyword(s):  
Older Adults ◽  
Treatment Outcome ◽  
Anxiety Disorder ◽  
Treatment Response ◽  
Generalized Anxiety Disorder ◽  
Late Life ◽  
Generalized Anxiety ◽  
Penn State Worry Questionnaire ◽  
Penn State ◽  
State Worry

ABSTRACT Objective: The Penn State Worry Questionnaire (PSWQ) is a commonly used measure of treatment outcome for late-life generalized anxiety disorder (GAD). However, there is considerable variability in the definitions used to define treatment response and remission. This study aimed to provide empirically derived guidelines for assessing treatment response and remission among older adults with GAD using the PSWQ and the abbreviated PSWQ (PSWQ-A). Design: Longitudinal assessment of GAD symptoms pre- and posttreatment. Participants: Participants were 259 older adults aged 60–86 years with a diagnosis of GAD who were assessed before and after treatment. Intervention: Participants were randomly assigned to cognitive behavioral therapy or control (waitlist, discussion group, or supportive therapy) conditions. Measurements: Signal-detection analyses using receiver operating characteristic (ROC) methods were used to determine optimal agreement between structured diagnostic interviews and scores on the PSWQ and PSWQ-A. Results: Results suggest that a score of ≤51 was optimal for defining diagnostic remission status on the PSWQ, and a score of ≤24 was optimal on the PSWQ-A. A 9% reduction or ≥4-point reduction was optimal for assessing treatment response on the PSWQ. The PSWQ-A was poor at identifying treatment response status. Conclusions: Findings suggest that most of the previously used definitions have underestimated the treatment effects for late-life GAD. However overall, the PSWQ and PSWQ-A are suboptimal for assessing treatment outcome for late-life GAD. The standardization of response and remission criteria has implications for comparison between treatment trials, and for the benchmarking of outcomes in clinical practice.

scholarly journals Efficacy of Virtual Reality Based Worry Exposure Therapy on the Anxiety Severity and Worry in Generalized Anxiety Disorder

2021 ◽  
Vol 9 (2) ◽  
pp. 21
Author(s):  
Neda Keshavarz ◽  
Touraj Hashemi Nosrat Abad ◽  
Mansour Beyrami ◽  
Majid Mahmoud alilou ◽  
Abbas Bakhshipour Roudsari
Keyword(s):  
Virtual Reality ◽  
Anxiety Disorder ◽  
Generalized Anxiety Disorder ◽  
Exposure Therapy ◽  
Reliable Change Index ◽  
Single Subject ◽  
Generalized Anxiety ◽  
Penn State Worry Questionnaire ◽  
Penn State ◽  
State Worry

Background: Generalized anxiety disorder is one of the most common anxiety disorders observed in clinical centers and the general population. This study aimed to evaluate the efficacy of virtual reality-based worry exposure therapy on the Anxiety Severity and worry in patients with symptoms of generalized anxiety disorder. Materials and Methods: This study was conducted in the framework of a single-subject experimental design using Multiple baselines with a 6-week follow-up. Three women with GAD were selected through a structured clinical interview based on the criteria of Diagnostic and Statistical Manual of Mental Disorders 5 by Convenience Sampling among those who referred to the Counseling centers in Tabriz. The protocol of this study followed the manual by Becker and Margraf which describes imaginal exposure for GAD applied in 15 sessions. The only difference was that in this research exposure to virtual reality replaced with imagination. In this study, three 360-degree films were made by the researcher used for exposure. The content made in the form of 360-degree videos and displayed to patients through virtual reality tools. The scales to assess changes in Anxiety Severity and worry include The Penn State Worry Questionnaire and The Overall Anxiety Severity and Impairment Scale. Data analyzed with visuals inspection, improvement percentage, and reliable change index strategies. Results: Results showed that virtual reality-based worry exposure therapy has significant efficiency on the reduction of Anxiety Severity and worry clinically and statistically (p<0.05). Conclusion: Virtual reality-based worry exposure therapy has appropriate efficacy in reducing GAD symptom severity.

scholarly journals Treatment Response for Late-Life Generalized Anxiety Disorder

2011 ◽  
Vol 199 (10) ◽  
pp. 811-814 ◽  
Author(s):  
Ashley S. Roseman ◽  
Jeffrey A. Cully ◽  
Mark E. Kunik ◽  
Diane M. Novy ◽  
Howard M. Rhoades ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Treatment Response ◽  
Generalized Anxiety Disorder ◽  
Late Life ◽  
Generalized Anxiety

scholarly journals Dorsal Anterior Cingulate Cortical Thickness Is Associated with Improvement in Worry Severity Following Treatment in Late-Life Generalized Anxiety Disorder

2019 ◽  
Author(s):  
Anusha Rangarajan ◽  
Helmet Talib Karim ◽  
Dana L. Tudorascu ◽  
Sarah Walker ◽  
Howard Aizensteina ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Treatment Response ◽  
Generalized Anxiety Disorder ◽  
Cortical Thickness ◽  
Pearson Correlation ◽  
Late Life ◽  
Post Treatment ◽  
Anterior Cingulate ◽  
Generalized Anxiety ◽  
Pre Treatment

We recently showed that late-life participants with generalized anxiety disorder (GAD), compared with non-anxious elderly, had lower cortical thickness in the dorsal anterior cingulate cortex (ACC) and the orbitofrontal cortex (OFC). In this follow-up study, we investigated the association between cortical thickness and clinical markers of treatment response in a subgroup from that same sample. Twelve GAD participants were randomly selected and were included in an open label twelve-week treatment with citalopram and pre-/post-treatment magnetic resonance imaging (MRI). Cortical thickness measurements were obtained with Freesurfer. Six regions were selected based on previous results: left dorsal ACC, left rostral ACC, left and right medial orbitofrontal, right pars triangularis and right pars opercularis. A two-tailed paired t-test (non-parametric Wilcoxon Signed Rank test) was used to compare pre- and post-treatment for all clinical variables. For each region of interest (ROI), the Pearson correlation coefficient was estimated between pre-treatment cortical thickness and change in Penn State Worry Questionnaire (PSWQ) from pre- to post-treatment. Our results indicate that greater left pre-treatment dorsal ACC cortical thickness was associated with improvement in worry severity post-treatment. In late-life GAD, greater treatment response is associated with greater cortical thickness in areas pivotal for emotion regulation.

Measurement Invariant but Non-Normal Treatment Responses in Guided Internet Psychotherapies for Depressive and Generalized Anxiety Disorders

Assessment ◽  
2021 ◽  
pp. 107319112110625
Author(s):  
Tom H. Rosenström ◽  
Ville Ritola ◽  
Suoma Saarni ◽  
Grigori Joffe ◽  
Jan-Henry Stenberg
Keyword(s):  
Anxiety Disorder ◽  
Treatment Response ◽  
Generalized Anxiety Disorder ◽  
Health Assessment ◽  
Psychotherapy Research ◽  
Self Report ◽  
Generalized Anxiety ◽  
Equivalence Testing ◽  
Sum Scores ◽  
Normally Distributed

Assessment of treatment response in psychotherapies can be undermined by lack of longitudinal measurement invariance (LMI) in symptom self-report inventories, by measurement error, and/or by wrong model assumptions. To understand and compare these threats to validity of outcome assessment in psychotherapy research, we studied LMI, sum scores, and Davidian Curve Item Response Theory models in a naturalistic guided internet psychotherapy treatment register of 2,218 generalized anxiety disorder (GAD) patients and 3,922 depressive disorder (DD) patients (aged ≥16 years). Symptoms were repeatedly assessed by Generalized Anxiety Disorder Assessment-7 (GAD-7) or Beck Depression Inventory. The symptom self-reports adhered to LMI under equivalence testing, suggesting sum scores are reasonable proxies for disorder status. However, the standard LMI assumption of normally distributed latent factors did not hold and inflated treatment response estimates by 0.2 to 0.3 standard deviation units compared with sum scores. Further methodological research on non-normally distributed latent constructs holds promise in advancing LMI and mental health assessment.

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