Experimental Manipulation of Processing Style: Impact on Interpretive Bias, Problem Solving, and Worry in Individuals with Generalized Anxiety Disorder

Cognitive Processes ◽

Experimental Manipulation ◽

Training Condition ◽

Generalized Anxiety ◽

Processing Style ◽

The present study investigated whether individuals with generalized anxiety disorder (GAD) could be trained to adopt an abstract or concrete processing style and the impact of processing style training on GAD symptoms and cognitive processes, including an interpretation bias, negative problem solving orientation, poor problem solving, and worry. Participants (N=47) were trained to adopt an abstract or concrete processing style, and outcome measures were completed at posttraining and 1 week follow-up. At posttraining, processing style training was effective in inducing an abstract or concrete processing style. In addition, at posttraining, the concrete training condition reported reduced concern with ambiguous scenarios and produced problem solutions that were rated as more effective compared with the abstract training condition. At follow-up, there was no difference between training conditions on processing style and associated GAD symptoms and cognitive processes. Study limitations and future directions are discussed.

The Impact Of Exposure On Generalized Anxiety Disorder-Related Symptoms And Cognitive Processes: The Role Of Stimulus Variation

10.32920/ryerson.14660361.v1 ◽

2021 ◽

Author(s):

Katie Fracalanza

Keyword(s):

Anxiety Disorder ◽

Cognitive Processes ◽

Clinical Implications ◽

Generalized Anxiety ◽

Emotional Activation ◽

Stimulus Variation ◽

Theories indicate that individuals with generalized anxiety disorder (GAD) avoid imagining threatening scenarios that have not occurred. Cognitive exposure to these images is a component of treatment; however, few studies have examined its efficacy. The current study assessed the impact of cognitive exposure and varying exposure content on GAD symptoms and cognitive processes. Forty-eight individuals with GAD were assigned to three sessions of : (1) variable exposure (VE), (2) consistent exposure (CE), or (3) neutral control writing (NC). Emotional activation was assessed during each session. Outcome measures were administered at pretest and 1-week follow-up. The CE condition showed improvements in GAD symptoms and cognitive processes, the VE condition showed less belief that their worse worry would occur, and the NC condition showed reduced GAD symptoms and interpretation bias. Emotional activation decreased across session in the CE condition; however, this did not predict outcomes. The theoretical and clinical implications are discussed.

The Impact Of Exposure On Generalized Anxiety Disorder-Related Symptoms And Cognitive Processes: The Role Of Stimulus Variation

10.32920/ryerson.14660361 ◽

2021 ◽

Author(s):

Katie Fracalanza

Keyword(s):

Anxiety Disorder ◽

Cognitive Processes ◽

Clinical Implications ◽

Generalized Anxiety ◽

Emotional Activation ◽

Stimulus Variation ◽

Theories indicate that individuals with generalized anxiety disorder (GAD) avoid imagining threatening scenarios that have not occurred. Cognitive exposure to these images is a component of treatment; however, few studies have examined its efficacy. The current study assessed the impact of cognitive exposure and varying exposure content on GAD symptoms and cognitive processes. Forty-eight individuals with GAD were assigned to three sessions of : (1) variable exposure (VE), (2) consistent exposure (CE), or (3) neutral control writing (NC). Emotional activation was assessed during each session. Outcome measures were administered at pretest and 1-week follow-up. The CE condition showed improvements in GAD symptoms and cognitive processes, the VE condition showed less belief that their worse worry would occur, and the NC condition showed reduced GAD symptoms and interpretation bias. Emotional activation decreased across session in the CE condition; however, this did not predict outcomes. The theoretical and clinical implications are discussed.

Cognitive functions in young adults with generalized anxiety disorder

European Psychiatry ◽

10.1016/j.eurpsy.2018.10.008 ◽

2018 ◽

Vol 56 (1) ◽

pp. 1-7 ◽

Cited By ~ 9

Author(s):

Kiara Leonard ◽

Amitai Abramovitch

Keyword(s):

Anxiety Disorder ◽

Cognitive Load ◽

Cognitive Functions ◽

Theoretical Models ◽

Generalized Anxiety ◽

Neuropsychological Battery ◽

Compensatory Mechanisms ◽

Neuropsychological Profile ◽

AbstractBackground:Anxiety and worry are central symptoms of Generalized Anxiety Disorder (GAD) that have been theorized to negatively impact cognitive functions. However, most of the research has focused on threat-related or emotionally-charged stimuli, and a surprisingly small number of investigations examined ‘cold’ cognitive functions using classic neuropsychological tests. Such investigations are particularly important given that some theoretical models suggest compensatory mechanisms associated with anxiety that in certain circumstances may result in intact performance. The aim of the present study is to assess the neuropsychological profile associated with GAD, using a comprehensive neuropsychological battery.Methods:A sample of 23 college students meeting criteria for DSM-5 GAD and 20 control participants completed a psychometrically valid comprehensive computerized neuropsychological battery and clinical questionnaires.Results:The GAD sample presented with significantly elevated symptomatic rates of anxiety, worry, depression and stress. However, no significant differences were found on any neuropsychological outcome measures or domain indexes. Effect sizes were small, some of which favored the GAD sample.Conclusion:Despite substantial psychopathological burden, GAD exhibited intact cognitive functioning. These results support the Cognitive Control Theory of Anxiety, suggesting that elevated primary anxiety may not impact ‘cold’ cognitive functions in the absence of threat or substantial cognitive load. Given that this is one of the only studies employing a comprehensive neuropsychological battery in GAD, more research is needed in this population to replicate these results and to examine the impact of anxiety on cognitive functions at varying degrees of cognitive load in this population.

Does cognitive-behavioural therapy influence the long-term outcome of generalized anxiety disorder? An 8–14 year follow-up of two clinical trials

Psychological Medicine ◽

10.1017/s0033291702007079 ◽

2003 ◽

Vol 33 (3) ◽

pp. 499-509 ◽

Cited By ~ 52

Author(s):

R. C. DURHAM ◽

J. A. CHAMBERS ◽

R. R. MACDONALD ◽

K. G. POWER ◽

K. MAJOR

Keyword(s):

Anxiety Disorder ◽

Secondary Care ◽

Generalized Anxiety ◽

Behaviour Therapy ◽

Term Outcome ◽

Long Term Outcome ◽

Cognitive Behaviour

Background. Generalized anxiety disorder is a common condition of excessive worry and tension which tends to run a chronic course associated with significant psychiatric and medical problems. Cognitive behaviour therapy (CBT) has been shown to be of clinical value in about 50% of cases with treatment gains maintained over follow-up periods ranging from 6 to 12 months. The potential value of CBT over the longer term has not been subject to rigorous investigation.Method. Results are reported of 8–14 year follow-up of two randomized controlled trials of cognitive-behaviour therapy for generalized anxiety disorder employing structured interview with an assessor blind to initial treatment condition. Comparison groups included medication and placebo in one study based in primary care, and analytical psychotherapy in the other based in secondary care. Follow-up samples (30% and 55% of trial entrants) were broadly representative of the original cohorts.Results. Overall, 50% of participants were markedly improved of whom 30–40% were recovered (i.e. free of symptoms). Outcome was significantly worse for the study based in secondary care in which the clinical presentation of participants was more complex and severe. For a minority (30–40%), mainly from the secondary care study, outcome was poor. Treatment with CBT was associated with significantly lower overall severity of symptomatology and less interim treatment, in comparison with non-CBT conditions, but there was no evidence that CBT influenced diagnostic status, probability of recovery or patient perceptions of overall improvement.Conclusions. Both CBT and the complexity and severity of presenting problems appear to influence the long-term outcome of GAD.

Short-Term Efficacy Of A Worry Postponement Intervention for Generalized Anxiety Disorder

10.32920/ryerson.14653938.v1 ◽

2021 ◽

Author(s):

Kathleen Tallon

Keyword(s):

Anxiety Disorder ◽

Cognitive Processes ◽

Stimulus Control ◽

Behavioural Therapy ◽

Mechanisms Of Change ◽

Generalized Anxiety ◽

Common Component ◽

Metacognitive Beliefs ◽

Before And After

Cognitive-Behavioural Therapy (CBT) is an evidence-based treatment for Generalized Anxiety Disorder (GAD). Worry postponement (WP), in which a client is asked to postpone worry until a 30-minute “worry time,” is a common component of CBT for GAD; however, the efficacy of WP has never been tested in people with GAD. Further, the mechanisms of change of WP are not known; nor are its effects on cognitive processes and symptoms related to GAD. A better understanding of the efficacy and mechanisms of change of WP could help to optimize CBT for GAD. The goals of the present study were to examine, in a sample of people with GAD, the effects of WP on worry and GAD symptoms, and cognitive processes and symptoms related to GAD. The study also examined the effects of WP on two proposed mediators: stimulus control and metacognitive beliefs. Sixty-seven adults were randomized to one of three conditions: 2- week worry postponement intervention (WP), 2-week worry monitoring intervention (MON), or an assessment only control. Participants completed outcome measures before and after the 2- week intervention period and at a 2-week follow-up. In the WP and MON conditions, participants completed daily worry monitoring using a phone-based application. All participants showed a significant decrease in past-week worry over the course of the study, with no significant differences between the conditions. There were no significant changes in GAD symptoms across conditions. There was no evidence that WP had superior effects to control groups on cognitive processes or symptoms related to GAD. There was no evidence that stimulus control or metacognitive beliefs mediated the reduction in past week worry in WP. This is the first known study to examine the effects of WP in people with GAD. Whereas worry did decrease on some indices over the course of the study, there were no significant differences between WP and two control conditions. Further this study found no evidence that WP has specific effects on two processes that are thought to be mechanisms of action. The findings of this study demonstrate the need to establish the efficacy of the treatment components used in CBT.

Effectiveness of Cognitive-Behavioral Therapy (CBT) on Quality of Life (QOL) and Worry in Patients with Generalized Anxiety Disorder (GAD)

International Journal of Indian Psychology ◽

10.25215/0202.021 ◽

2015 ◽

Vol 2 (2) ◽

Author(s):

Sheida Jabalameli ◽

Hamid Taher Neshat Doost ◽

Mohammad Bagher Kajbaf ◽

Hossein Molavi

Keyword(s):

Quality Of Life ◽

Anxiety Disorder ◽

Behavioral Therapy ◽

Control Group ◽

Generalized Anxiety ◽

The Mean ◽

Experimental Group

Generalized Anxiety Disorder (GAD) is one of the most common anxiety disorders. It has been reported that psychological treatments like Cognitive-Behavioral Therapy (CBT) is effective for patients with GAD. The purpose of the present research was to investigate the effectiveness of CBT on Quality of Life (QOL) and worry in patients with GAD. A sample of 30 patients with GAD who had been referred to psychiatry offices in Isfahan, Iran were selected and assigned into an experimental group (n=15) and a control group (n=15) randomly. The experimental group received CBT in 8 weekly sessions. All participants completed the World Health Organization Quality Of Life-Brief (WHOQOL-BREF) questionnaire and the Penn State Worry Questionnaire (PSWQ) at pretest, posttest and follow up. The results of MANCOVA showed that the mean scores of QOL in the experimental group was significantly higher than the control group at the posttest and follow up (P<0.05) and the mean scores of worry in the experimental group was significantly lower than the control group at the posttest and follow up (P<0.05) It is concluded that CBT can be applied for the patients with GAD as a useful psychological treatment. In general, CBT can improve QOL and decrease worry in patients with GAD.

Women With Generalized Anxiety Disorder Show Increased Repetitive Negative Thinking During the Luteal Phase of the Menstrual Cycle

Clinical Psychological Science ◽

10.1177/2167702620929635 ◽

2020 ◽

Vol 8 (6) ◽

pp. 1037-1045

Author(s):

Sophie H. Li ◽

Thomas F. Denson ◽

Bronwyn M. Graham

Keyword(s):

Anxiety Disorder ◽

Menstrual Cycle ◽

Negative Affect ◽

Cognitive Processes ◽

Luteal Phase ◽

Anxiety Symptoms ◽

Generalized Anxiety ◽

Repetitive Negative Thinking ◽

Negative Thinking

Repetitive negative thinking (RNT) is a transdiagnostic feature of psychiatric disorders. Women report greater RNT than do men, yet the association between uniquely female characteristics, such as fluctuating sex hormones during the menstrual cycle, and RNT has not been established. Here we examined changes in RNT and anxiety symptoms across the menstrual cycle in women with ( n = 40) and without ( n = 41) generalized anxiety disorder (GAD). Women with GAD reported an increase in RNT and negative affect from the follicular phase to the luteal phase; unexpectedly, this was not associated with changes in anxiety symptoms, estradiol, or progesterone. Nonanxious women reported no changes in RNT or anxiety symptoms over the menstrual cycle, but higher within-participants progesterone was associated with reduced RNT and negative affect. These results indicate that uniquely female biological processes may influence core cognitive processes that underlie anxiety disorders, but further investigations to determine the implications for symptom severity are required.

Insomnia and Quality of Life in Generalized Anxiety Disorder: Impact on Clinical Presentation and Response to Pregabalin and Venlafaxine-XR

European Psychiatry ◽

10.1016/s0924-9338(09)70767-9 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1 ◽

Cited By ~ 1

Author(s):

M.A. Mychaskiw ◽

J.M. Alvir ◽

B.K. Herman ◽

S. Pallanti ◽

A. Joshi

Keyword(s):

Quality Of Life ◽

Anxiety Disorder ◽

Sleep Problems ◽

Generalized Anxiety ◽

Medical Outcomes ◽

Double Blind ◽

Disturbance Factor ◽

Aims:To assess the impact of insomnia on quality of life (QoL) and functioning in patients with generalized anxiety disorder (GAD), and evaluate the efficacy of pregabalin and venlafaxine-XR in improving sleep and QoL.Methods:A double-blind trial in adults who met DSM-IV criteria for GAD, with a HAM-A total score ≥20,randomized to 8-weeks of flexible-dose treatment with pregabalin (300-600 mg/d, N=121), venlafaxine-XR (75-225 mg/d, N=125), or placebo (N=128).Results:At baseline, 64% of all subjects had insomnia (according to the Medical Outcomes Study Sleep scale [MOS]-Sleep Problems Index [SPI] criteria).While HAM-A total scores (minus the insomnia item) were similar for patients with and without baseline insomnia (25.7 vs. 25.0) those with reported significantly more impairment on the Quality of Life, Enjoyment, and Satisfaction Questionnaire (Q-LES-Q; 45.4 vs. 53.6; p< 0.0001) and Sheehan Disability Scale (SDS; 17.5 vs.14.3; p< 0.0001) than those without. At endpoint, there was a significantly greater mean improvement in MOS-sleep disturbance factor and MOS-SPI with pregabalin (-29.0 and -21.1, respectively) than venlafaxine-XR (-14.7 and -11.0) or placebo (-15.2 and -12.5; all p< 0.05). In more pregabalin (64%) than venlafaxine-XR (51%) or placebo (52%) subjects, abnormal baseline sleep had normalized by endpoint. Endpoint change in MOS-SPI significantly correlated with improvement in both Q-LES-Q and SDS-total scores (Spearman r-values, -0.48 and 0.46, respectively; both p< 0.0001; all subjects).Conclusion:Significantly greater impairment in QoL and functioning was observed in patients with high (vs. low) levels of insomnia. Pregabalin produced significantly greater improvement in insomnia than venlafaxine-XR or placebo.

ONE YEAR FOLLOW-UP OF COGNITIVE THERAPY, ANALYTIC PSYCHOTHERAPY AND ANXIETY MANAGEMENT TRAINING FOR GENERALIZED ANXIETY DISORDER: SYMPTOM CHANGE, MEDICATION USAGE AND ATTITUDES TO TREATMENT

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465899271056 ◽

1999 ◽

Vol 27 (1) ◽

pp. 19-35 ◽

Cited By ~ 16

Author(s):

Robert C. Durham ◽

Peter L. Fisher ◽

Linda R. Trevling ◽

Cathryn M. Hau ◽

Karen Richard ◽

...

Keyword(s):

Anxiety Disorder ◽

Cognitive Therapy ◽

Management Training ◽

Generalized Anxiety ◽

Medication Usage ◽

Anxiety Management ◽

Clinically Significant ◽

One Year

A one year follow-up is reported of a randomized clinical trial with generalized anxiety disorder (GAD) in which the main comparison was between analytic psychotherapy (AP) and cognitive therapy (CT), each delivered at weekly or fortnightly intervals over a six month period. CT was found to be significantly more effective than AP. However, GAD is a chronic and relapsing condition and follow-up data are needed to assess the durability of improvement and the possibility that the benefits of analytic psychotherapy may be more apparent over the longer term. Data were collected in three areas: (1) symptomatology and overall improvement; (2) medication usage and contact with GPs; and (3) attitudes to therapy. CT was clearly superior to AP on the main outcome measures and only a minority of AP patients made significant improvements. CT but not AP was associated with significant reductions in medication usage, and patients receiving CT were generally more positive about treatment received. Differences between treatments were less evident in the less intensive treatment condition where overall results were relatively poor. The most positive outcomes were achieved in the more intensive CT condition in which approximately two-thirds of patients achieved clinically significant improvements.