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.

scholarly journals Anticipatory Activation in the Amygdala and Anterior Cingulate in Generalized Anxiety Disorder and Prediction of Treatment Response

2009 ◽  
Vol 166 (3) ◽  
pp. 302-310 ◽  
Author(s):  
Jack B. Nitschke ◽  
Issidoros Sarinopoulos ◽  
Desmond J. Oathes ◽  
Tom Johnstone ◽  
Paul J. Whalen ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Treatment Response ◽  
Generalized Anxiety Disorder ◽  
Anterior Cingulate ◽  
Generalized Anxiety ◽  
Anticipatory Activation

scholarly journals Smartphone-Detected Ambient Speech and Self-Reported Measures of Anxiety and Depression: Exploratory Observational Study (Preprint)

2020 ◽  
Author(s):  
Daniel Di Matteo ◽  
Wendy Wang ◽  
Kathryn Fotinos ◽  
Sachinthya Lokuge ◽  
Julia Yu ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Observational Study ◽  
Generalized Anxiety Disorder ◽  
Social Anxiety Disorder ◽  
Strong Relationship ◽  
Self Report ◽  
Generalized Anxiety ◽  
Depression And Anxiety ◽  
Severity Of Depression

BACKGROUND The ability to objectively measure the severity of depression and anxiety disorders in a passive manner could have a profound impact on the way in which these disorders are diagnosed, assessed, and treated. Existing studies have demonstrated links between both depression and anxiety and the linguistic properties of words that people use to communicate. Smartphones offer the ability to passively and continuously detect spoken words to monitor and analyze the linguistic properties of speech produced by the speaker and other sources of ambient speech in their environment. The linguistic properties of automatically detected and recognized speech may be used to build objective severity measures of depression and anxiety. OBJECTIVE The aim of this study was to determine if the linguistic properties of words passively detected from environmental audio recorded using a participant’s smartphone can be used to find correlates of symptom severity of social anxiety disorder, generalized anxiety disorder, depression, and general impairment. METHODS An Android app was designed to collect periodic audiorecordings of participants’ environments and to detect English words using automatic speech recognition. Participants were recruited into a 2-week observational study. The app was installed on the participants’ personal smartphones to record and analyze audio. The participants also completed self-report severity measures of social anxiety disorder, generalized anxiety disorder, depression, and functional impairment. Words detected from audiorecordings were categorized, and correlations were measured between words counts in each category and the 4 self-report measures to determine if any categories could serve as correlates of social anxiety disorder, generalized anxiety disorder, depression, or general impairment. RESULTS The participants were 112 adults who resided in Canada from a nonclinical population; 86 participants yielded sufficient data for analysis. Correlations between word counts in 67 word categories and each of the 4 self-report measures revealed a strong relationship between the usage rates of death-related words and depressive symptoms (<i>r</i>=0.41, <i>P</i>&lt;.001). There were also interesting correlations between rates of word usage in the categories of reward-related words with depression (<i>r</i>=–0.22, <i>P</i>=.04) and generalized anxiety (<i>r</i>=–0.29, <i>P</i>=.007), and vision-related words with social anxiety (<i>r</i>=0.31, <i>P</i>=.003). CONCLUSIONS In this study, words automatically recognized from environmental audio were shown to contain a number of potential associations with severity of depression and anxiety. This work suggests that sparsely sampled audio could provide relevant insight into individuals’ mental health. CLINICALTRIAL

Stress Control: A Pilot Study of Large Group Therapy for Generalized Anxiety Disorder

1990 ◽  
Vol 18 (2) ◽  
pp. 143-146 ◽  
Author(s):  
Jim White ◽  
Mary Keenan
Keyword(s):  
Anxiety Disorder ◽  
Pilot Study ◽  
Group Therapy ◽  
Generalized Anxiety Disorder ◽  
Group Treatment ◽  
Care Service ◽  
Self Report ◽  
Generalized Anxiety ◽  
Large Group ◽  
Cost Effective Treatment

A pilot study is reported on a six session didactic large group treatment package for Generalized Anxiety Disorder (GAD) patients referred to a primary care service. Thirty patients underwent the course. By combining a didactic therapy element with workshops, the therapy package allowed a much larger number of individuals to attend the group than could be dealt with in “traditional” group therapy. Two psychologists ran the course. There were few practical difficulties involved in running the course and the range of self-report outcome measures suggest that large group didactic therapy may be a clinically and cost-effective treatment for GAD.

Cognitive-Behavioral Treatment for Generalized Anxiety Disorder: Current Status and Future Directions

2005 ◽  
Vol 19 (1) ◽  
pp. 61-81 ◽  
Author(s):  
Michel J. Dugas ◽  
Naomi Koerner
Keyword(s):  
Anxiety Disorder ◽  
Generalized Anxiety Disorder ◽  
Behavioral Treatment ◽  
Randomized Clinical Trials ◽  
Assessment Tools ◽  
Self Report ◽  
Cognitive Behavioral ◽  
Current Status ◽  
Generalized Anxiety ◽  
Future Directions

In this article, we present a cognitive-behavioral model and treatment of generalized anxiety disorder (GAD). In the first section, we review a model of GAD that includes four main components: intolerance of uncertainty, positive beliefs about worry, negative problem orientation, and cognitive avoidance. Next we present the GAD assessment tools used at our clinic, which include standardized interviews and self-report questionnaires of GAD symptoms and underlying cognitive-behavioral processes. We then provide a step-by-step description of a treatment that is based on the aforementioned model of GAD, and that has six core components: presentation of treatment rationale (learning to cope with uncertainty); worry awareness training; reevaluation of the usefulness of worrying; problem-solving training; cognitive exposure; and relapse prevention. Following the treatment description, we summarize the efficacy data from our completed randomized clinical trials, and present some preliminary findings from our ongoing trial comparing our treatment to applied relaxation and wait-list control. In the final section, we present an in-depth discussion of future directions for the study and treatment of GAD, with a focus on the approach-avoidance nature of GAD. Given the movement in the field favoring the expansion of cognitive-behavioral treatments, we also comment on the possible implications of the newest integrative therapies for our existing treatment.

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