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Towards a Unified Worry Exposure Protocol for Generalised Anxiety Disorder: A Pilot Study

Published online by Cambridge University Press:  12 August 2013

Cameron McIntosh*
Affiliation:
University of Western Sydney, Sydney, New South Wales, Australia
Rocco Crino
Affiliation:
Charles Sturt University, Bathurst, NSW, Australia
*
Address for correspondence: Cameron McIntosh, St Vincent's Hospital Gambling Treatment Program, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia. Email: [email protected]
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Abstract

Background: Worry exposure is a cognitive–behaviour therapy (CBT) technique frequently used to treat GAD, yet there are only a few studies on its effectiveness. Aim: To compare two worry exposure protocols developed for GAD to make a preliminary determination about the most effective way in which to present the feared stimuli to participants. Method: Nine university students suffering from GAD were administered four 1-hour treatment sessions. Exposure was conducted by either directly imagining (DI) or via audio-recording/playback (AR) exposure to their feared event. General worry and intolerance of uncertainty (IOU) were the primary dependent variables. Results: All participants in the DI and half of the AR condition reported subclinical GAD at post-treatment, with results being maintained at 3-month follow-up and the treatment responders also reported decreased depression, anxiety and stress. Conclusions: The DI protocol was more effective than the AR methodology in this sample, and may be an appropriate standard for worry exposure research and clinical practice.

Type
Standard Papers
Copyright
Copyright © The Author(s), published by Cambridge University Press on behalf of Australian Academic Press Pty Ltd 2013 

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References

American Psychiatric Association (APA). (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association (APA). (2000). Diagnostic and Statistical Manual of Mental Disorders: Text revision (4th ed., rev.). Washington, DC: American Psychiatric Association.Google Scholar
Barlow, D.H., Rapee, R.M., & Brown, T.A. (1992). Behavioral treatment of generalized anxiety disorder. Behaviour Therapy, 23, 551570.CrossRefGoogle Scholar
Behar, E., Alcaine, O., Zuellig, A.R., & Borkovec, T.D. (2003). Screening for generalized anxiety disorder using the Penn State Worry Questionnaire: A receiver operating characteristic analysis. Journal of Behavior Therapy and Experimental Psychiatry 34 (1), 2543.Google Scholar
Borkovec, T.D. (1994). The nature, functions, and origins of worry. In Davey, G. & Tallis, F. (Eds.), Worrying: Perspectives on theory assessment and treatment, (pp.533). Sussex, England: Wiley & Sons.Google Scholar
Borkovec, T.D., Alcaine, O.M., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder. In Heimberg, R., Turk, C., & Mennin, D. (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 77108). New York: Guilford Press.Google Scholar
Borkovec, T.D., & Costello, E. (1993). Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 61, 611619.Google Scholar
Borkovec, T.D., & Nau, S.D. (1972). Credibility of analogue therapy rationales. Journal of Behaviour Therapy and Experimental Psychiatry, 3, 257260.Google Scholar
Borkovec, T.D., Newman, M.G., Pincus, A.L., & Lytle, R. (2002). A component analysis of cognitive behavioural therapy for generalized anxiety disorder and the role of interpersonal problems. Journal of Consulting and Clinical Psychology, 70, 288298.Google Scholar
Borkovec, T.D., & Roemer, L. (1995). Perceived functions of worry among generalized anxiety disorder subjects: Distraction from more emotionally distressing topics? Journal of Behavior Therapy and Experimental Psychiatry, 26, 2530.Google Scholar
Borkovec, T.D., Shadick, R.N., & Hopkins, M.B. (1991). The nature of pathological and normal worry. In Rapee, R. & Barlow, D. (Eds.), Chronic anxiety: Generalized anxiety disorder and mixed anxiety-depression (pp. 2951). New York: Guilford Press.Google Scholar
Buhr, K., & Dugas, M.J. (2002). The intolerance of uncertainty scale: psychometric properties of the English version. Behaviour Research and Therapy, 40, 931946.Google Scholar
Covin, R., Ouimet, A.J., Seeds, P.M., & Dozois, D.J. (2008). A meta-analysis of CBT for pathological worry among clients with GAD. Journal of Anxiety Disorders, 22, 108116.CrossRefGoogle ScholarPubMed
Craske, M.G. (1999). Anxiety disorders: Psychological approaches to theory and treatment. Boulder, CO: Westview Press.Google Scholar
Craske, M.G., Barlow, D.H., & Leary, T.A. (1992). Mastery of your anxiety and worry. Albany, NY: Graywind.Google Scholar
Crawford, J.R., & Henry, J.D. (2003). The Depression Anxiety Stress Scales (DASS): Normative data and latent structure in a large non-clinical sample. British Journal of Clinical Psychology, 42, 111131.Google Scholar
Devilly, G.J., & Borkovec, T.D. (2000). Psychometric properties of the credibility/expectancy questionnaire. Journal of Behavior Therapy and Experimental Psychiatry, 31, 7386.Google Scholar
Di Nardo, E.A., Brown, T.A., & Barlow, D.H. (1994). Anxiety Disorders Interview Schedule for DSM-1V: Lifetime Version (ADIS-IV-L). San Antonio, TX: The Psychological Corporation.Google Scholar
Dugas, M.J., Ladouceur, R., Léger, E., Freeston, M.H., Langlois, F., Provencher, M., & Boisvert, J.M. (2003). Group cognitive-behavioral therapy for generalized anxiety disorder: Treatment outcome and long-term follow-up. Journal of Consulting and Clinical Psychology, 71, 821825.Google Scholar
Dugas, M.J., & Koerner, N. (2005). Cognitive behavioral treatment for generalized anxiety disorder: Current status and future directions. Journal of Cognitive Psychotherapy: An International Quarterly, 19, 6181.Google Scholar
Dugas, M.J., & Robichaud, M. (2007). Cognitive-behavioral treatment for generalized anxiety disorder: From science to practice. New York, Routledge.Google Scholar
Foa, E.B., Steketee, G., Turner, R.M., & Fischer, S.C. (1980). Effects of imaginal exposure to feared disasters in obsessivecompulsive checkers. Behaviour Research and Therapy, 18, 449–;455.Google Scholar
Foa, E.B., & Kozak, M.J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 2035.CrossRefGoogle ScholarPubMed
Freeston, M.H., Rhéaume, J., Letarte, H., Dugas, M.J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17 (6), 791802.Google Scholar
Frisch, M.B. (1994). Quality of Life Inventory: Manual and treatment guide. Minneapolis: National Computer Systems.Google Scholar
Holmes, E.A., Arntz, A., & Smucker, M.R. (2007). Imagery rescripting in cognitive behaviour therapy: Images, treatment techniques and outcomes. Journal of Behavior Therapy and Experimental Psychiatry, 38 (4), 297305.CrossRefGoogle Scholar
Hoyer, J., & Beesdo-Baum, K. (in press). Prolonged imaginal exposure based on worry scenarios. In Neudeck, P. & Wittchen, H.U., Exposure techniques in psychotherapy. New York: Springer.Google Scholar
Hoyer, J., Beesdo, K., Gloster, A.T., Runge, J., Hofler, M., & Becker, E.S. (2009). Worry exposure versus applied relaxation in the treatment of generalized anxiety disorder. Psychotherapy and Psychosomatics, 78, 106115.Google Scholar
Hoyer, J., van der Heiden, C., & Portman, M.E. (2011). Psychotherapy of generalized anxiety disorder. Psychiatric Annals, 41, 8794.Google Scholar
Hunot, V., Churchill, R., Silva de Lima, M., & Teixeira, V. (2007). Psychological therapies for generalized anxiety disorder. Cochrane Database of Systematic Reviews, (1), CD001848.Google Scholar
Huppert, J.D., & Ryan, M. (2004). Generalized anxiety disorder. In Stein, D.J. (Ed.), Clinical manual of anxiety disorders (pp. 147171). Washington, DC: American Psychiatric Press.Google Scholar
Kessler, R.C., Berglund, P.A., Dewit, D.J., Ustun, T.B., Wang, P.S., & Wittchen, H.U. (2002). Distinguishing generalized anxiety disorder from major depression: Prevalence and impairment from current pure and comorbid disorders in the US and Ontario. International Journal of Methods in Psychiatric Research, 11 (3), 99111.Google Scholar
Ladouceur, R., Dugas, M.J., Freeston, M.H., Leger, E., Gagnon, F., & Thibodeau, N. (2000). Efficacy of a new cognitive-behavioral treatment for generalized anxiety disorder: Evaluation in a controlled clinical trial. Journal of Consulting and Clinical Psychology, 68, 957964.Google Scholar
Lovibond, P.F., & Lovibond, S.H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33 (3), 335343.Google Scholar
Molina, S., & Borkovec, T.D. (1994). The Penn State Worry Questionnaire: Psychometric properties and associated characteristics. In Davey, G.C.L. & Tallis, F. (Eds.), Worrying: Perspective on theory assessment and treatment. Oxford, UK: John Wiley and Sons.Google Scholar
Meyer, T.J., Miller, M.L., Metzger, R.L., & Borkovec, T.D. (1990). Development and validation of the Penn State Worry Questionnaire, Behaviour Research and Therapy, 28, 487495.Google Scholar
Newman, M.G., Zuellig, A.R., Kachin, K.E., Constantino, M.J., & Cashman-McGrath, L. (2002). Preliminary reliability and validity of the generalized anxiety disorder questionnaire-IV: A revised self-report diagnostic measure of generalized anxiety disorder. Behavior Therapy, 33 (2), 215233.Google Scholar
Olatunji, B.O., Cisler, J.M., & Deacon, B.J. (2010). Efficacy of cognitive behavioural therapy for anxiety disorders: A review of meta-analytic findings. Psychiatric Clinics of North America, 33, 557577.Google Scholar
Parsonson, B.S., & Baer, D.M. (1992). The visual analysis of data, and current research into the stimuli controlling it. In Kratochwill, T.R. & Levin, J.R. (Eds.), Single-case research design and analysis (pp. 1540). Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
Provencher, M.D., Freeston, M.H., Dugas, M.J., & Ladoucer, R. (2000). Catastrophizing assessment of worry and threat schemata among worriers. Behavioural and Cognitive Psychotherapy, 28 (3), 211224.Google Scholar
Rubin, D.B., Spates, C.R., Johnson, D.A., & Jouppi, L. (2009). Dosed versus prolonged exposure in the treatment of fear: An experimental evaluation and review of behavioral mechanisms. Journal of Anxiety Disorders, 23, 806812.Google Scholar
Salkovskis, P.M. (1996). The cognitive approach to anxiety: Threat beliefs, safety-seeking behaviour and the special case of health: Anxiety and obsessions. In Salkovskis, P.M. (Ed.), Frontiers of cognitive therapy. New York: Guilford Press.Google Scholar
Sloan, T., & Telch, M.J. (2002). The effects of safety-seeking behavior and guided threat reappraisal on fear reduction during exposure: An experimental investigation. Behaviour Research and Therapy, 40, 235251.Google Scholar
van der Heiden, C., & ten Broeke, E. (2009). The when, why, and how of worry exposure. Cognitive and Behavioral Practice, 16 (4), 386393.Google Scholar
Wells, A., & Carter, K. (2001). Further tests of a cognitive model of generalized anxiety disorder: Metacognitions and worry in GAD, panic disorder, social phobia, depression, and nonpatients. Behavior Therapy 32 (1), 85102.Google Scholar
Westen, D., & Bradley, R. (2005). Empirically supported complexity: Rethinking evidence based practice in psychotherapy. Current Directions in Psychological Science, 14 (5), 266–71.Google Scholar
Wild, J., Hackmann, A., & Clark, D.M. (2007). When the present visits the past: Updating traumatic memories in social phobia. Journal of Behavior Therapy and Experimental Psychiatry, 38 (4), 386401.Google Scholar
Wolitzky-Taylor, K.B., & Telch, M.J. (2010). Efficacy of self-administered treatments for pathological academic worry: A randomized controlled trial. Behaviour Research and Therapy, 48 (9), 840850.Google Scholar
Wolpe, J. (1958). Psychotherapy by reciprocal inhibition. Stanford: Stanford University Press.Google Scholar