Manipulation de l'intolérance a l'incertitude et inquiétudes.

In the model of Generalized Anxiety Disorder (GAD) proposed by Dugas, Gagnon, Ladouceur, and Freeston (1998), Intolerance of Uncertainty (IU) plays a central role in the acquisition and maintenance of worries. The goal of the present study was to clarify the relationship between IU and worries about a personally relevant event reported by an individual. Thirty participants were assigned to both conditions of increased and decreased IU within a one-week interval. The manipulation of IU was achieved through asking participants: a) to imagine they had ingested a medication and b) repeat aloud statements reflecting increased or decreased intolerance. The results indicate that participants whose level of IU was increased showed a higher level of worry and those whose level of IU was decreased showed a lower level of worry. These results are coherent with our theoretical model of worry and GAD, which stipulates that IU plays a key role in the acquisition of excessive worry (Dugas et al., 1998) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Specificity of treatment effects: Cognitive therapy and relaxation for generalized anxiety and panic disorders": Correction.

Reports an error in "Specificity of treatment effects: Cognitive therapy and relaxation for generalized anxiety and panic disorders" by Jedidiah Siev and Dianne L. Chambless (Journal of Consulting and Clinical Psychology, 2007[Aug], Vol 75[4], 513-522). The individual measures were not listed in the domains labeled "Panic" and "Cognitive" for the ?st and Westling (1995) citation in Table 3. The corrected table is included, with the added text appearing in bold font. (The following abstract of the original article appeared in record 2007-11558-001.) The aim of this study was to address claims that among bona fide treatments no one is more efficacious than another by comparing the relative efficacy of cognitive therapy (CT) and relaxation therapy (RT) in the treatment of generalized anxiety disorder (GAD) and panic disorder without agoraphobia (PD). Two fixed-effects meta-analyses were conducted, for GAD and PD separately, to review the treatment outcome literature directly comparing CT with RT in the treatment of those disorders. For GAD, CT and RT were equivalent. For PD, CT, which included interoceptive exposure, outperformed RT on all panic-related measures, as well as on indices of clinically significant change. There is ample evidence that both CT and RT qualify as bona fide treatments for GAD and PD, for which they are efficacious and intended to be so. Therefore, the finding that CT and RT do not differ in the treatment of GAD, but do for PD, is evidence for the specificity of treatment to disorder, even for 2 treatments within a CBT class, and 2 disorders within an anxiety class. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacy of a cognitive–behavioral treatment for generalized anxiety disorder: Evaluation in a controlled clinical trial.

Recent advances in the understanding of worry have led to the development of treatments for generalized anxiety disorder (GAD). The present study tested a GAD treatment that targeted intolerance of uncertainty, erroneous beliefs about worry, poor problem orientation, and cognitive avoidance. Twenty-six primary GAD patients were randomly allocated to a treatment condition (n?=?14) or a delayed treatment control condition (n?=?12). Self-report, clinician, and significant other ratings assessed GAD and associated symptoms. The results show that the treatment led to statistically and clinically significant change at posttest and that gains were maintained at 6- and 12-month follow-ups. Furthermore, 20 of 26 participants, (77%) no longer met GAD diagnostic criteria following treatment. With regard to the treatment's underlying model, the results show that intolerance of uncertainty significantly decreased over treatment and that gains were maintained at both follow-ups. Although nonspecific factors were not significant predictors of treatment outcome, their role in the treatment of GAD requires further investigation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based psychological treatments for late-life anxiety.

This project identified evidence-based psychotherapy treatments for anxiety disorders in older adults. The authors conducted a review of the geriatric anxiety treatment outcome literature by using specific coding criteria and identified 17 studies that met criteria for evidence-based treatments (EBTs). These studies reflected samples of adults with generalized anxiety disorder (GAD) or samples with mixed anxiety disorders or symptoms. Evidence was found for efficacy for 4 types of EBTs. Relaxation training, cognitive-behavioral therapy (CBT), and, to a lesser extent, supportive therapy and cognitive therapy have support for treating subjective anxiety symptoms and disorders. CBT for late-life GAD has garnered the most consistent support, and relaxation training represents an efficacious, relatively low-cost intervention. The authors provide a review of the strengths and limitations of this research literature, including a discussion of common assessment instruments. Continued investigation of EBTs is needed in clinical geriatric anxiety samples, given the small number of available studies. Future research should examine other therapy models and investigate the effects of psychotherapy on other anxiety disorders, such as phobias and posttraumatic stress disorder in older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder.

Nondirective (ND), applied relaxation (AR), and cognitive behavioral (CBT) therapies for generalized anxiety disorder (GAD) were compared. The latter 2 conditions were generally equivalent in outcome but superior to ND at postassessment. The 3 conditions did not differ on several process measures, and ND created the greatest depth of emotional processing. Follow-up results indicated losses in gains in ND, maintained gains in the other 2 conditions, especially CBT, and highest endstate functioning for CBT. AR and CBT thus contain active ingredients in the treatment of GAD; support exists for further development of imagery exposure methods or cognitive therapy because of their likely role in promoting maintenance of change with this disorder. Expectancy for improvement was also associated with outcome, suggesting the need for further research on this construct for understanding the nature of GAD and its amelioration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An open trial of integrative therapy for generalized anxiety disorder.

Cognitive-behavioral therapy (CBT), although effective, has the lowest average effect size for generalized anxiety disorder (GAD), when compared to effect sizes of CBT for other anxiety disorders. Additional basic and applied research suggests that although interpersonal processes and emotional avoidance may be maintaining GAD symptomatology, CBT has not sufficiently addressed interpersonal issues or emotion avoidance. This study aimed to test the feasibility and preliminary efficacy of an integrative psychotherapy, combining CBT with techniques to address interpersonal problems and emotional avoidance. Eighteen participants received 14 sessions of CBT plus interpersonal emotional processing therapy and three participants (for training and feasibility purposes) received 14 sessions of CBT plus supportive listening. Results showed that the integrative therapy significantly decreased GAD symptomatology, with maintenance of gains up to 1 year following treatment. In addition, comparisons with extant literature suggested that the effect size for this new GAD treatment was higher than the average effect size of CBT for GAD. Results also showed clinically significant change in GAD symptomatology and interpersonal problems with continued gains during the 1-year follow-up. Implications of these results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Specificity of treatment effects: Cognitive therapy and relaxation for generalized anxiety and panic disorders.

[Correction Notice: An erratum for this article was reported in Vol 76(5) of Journal of Consulting and Clinical Psychology (see record 2008-13625-021). In the article, "Specificity of Treatment Effects: Cognitive Therapy and Relaxation for Generalized Anxiety and Panic Disorders," by Jedidiah Siev and Dianne L. Chambless (Journal of Consulting and Clinical Psychology, 2007, Vol. 75, No. 4, pp. 513-522), the individual measures were not listed in the domains labeled "Panic" and "Cognitive" for the ?st and Westling (1995) citation in Table 3. The corrected table is included, with the added text appearing in bold font.] The aim of this study was to address claims that among bona fide treatments no one is more efficacious than another by comparing the relative efficacy of cognitive therapy (CT) and relaxation therapy (RT) in the treatment of generalized anxiety disorder (GAD) and panic disorder without agoraphobia (PD). Two fixed-effects meta-analyses were conducted, for GAD and PD separately, to review the treatment outcome literature directly comparing CT with RT in the treatment of those disorders. For GAD, CT and RT were equivalent. For PD, CT, which included interoceptive exposure, outperformed RT on all panic-related measures, as well as on indices of clinically significant change. There is ample evidence that both CT and RT qualify as bona fide treatments for GAD and PD, for which they are efficacious and intended to be so. Therefore, the finding that CT and RT do not differ in the treatment of GAD, but do for PD, is evidence for the specificity of treatment to disorder, even for 2 treatments within a CBT class, and 2 disorders within an anxiety class. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Le trouble d'anxiété généralisée: éléments fondamentaux et interventions psychologiques.

Discusses excessive and uncontrollable worry as the main diagnostic feature of generalized anxiety disorder (GAD). A conceptual model of GAD worry is formulated, relating excessive worry to intolerance of uncertainty. Although worry is associated with anxiety and depression, it is not always negatively appraised. Paradoxically, the anxiety associated with worry leads to selective attention to threatening information and increased perception of risk. Attempts to apply problem solving skills are hampered by poor problem orientation. Treatment outcome studies for GAD have shown limited effectiveness, as worries often remain excessive and physical symptoms are not entirely eliminated. The authors recommend that treatment for GAD should include 2 components: (1) cognitive exposure to mental images associated with worry, and (2) problem solving training, where emphasis is on improving problem orientation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A component analysis of cognitive-behavioral therapy for generalized anxiety disorder and the role of interpersonal problems.

Clients with generalized anxiety disorder (GAD) received either (1) applied relaxation and self-control desensitization, (2) cognitive therapy, or (3) a combination of these methods. Treatment resulted in significant improvement in anxiety and depression that was maintained for 2 yrs. The large majority no longer met diagnostic criteria; a minority sought further treatment during follow-up. No differences in outcome were found between conditions; review of the GAD therapy literature suggested that this may have been due to strong effects generated by each component condition. Finally, interpersonal difficulties remaining at posttherapy, measured by the Inventory of Interpersonal Problems Circumplex Scales (L. E. Alden, J. S. Wiggins, & A. L. Pincus, 1990) in a subset of clients, were negatively associated with posttherapy and follow-up improvement, suggesting the possible utility of adding interpersonal treatment to cognitive-behavioral therapy to increase therapeutic effectiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group cognitive-behavioral therapy for generalized anxiety disorder: Treatment outcome and long-term follow-up.

A recently developed cognitive-behavioral treatment for generalized anxiety disorder (GAD) targets intolerance of uncertainty by the reevaluation of positive beliefs about worry, problem-solving training, and cognitive exposure. As previous studies have established the treatment's efficacy when delivered individually, the present study tests the treatment in a group format as a way to enhance its cost-benefit ratio. A total of 52 GAD patients received 14 sessions of cognitive-behavioral therapy in small groups of 4 to 6 participants. A wait-list control design was used, and standardized clinician ratings and self-report questionnaires assessed GAD symptoms, intolerance of uncertainty, anxiety, depression, and social adjustment. Results show that the treatment group, relative to the wait-list group, had greater posttest improvement on all dependent variables and that treated participants made further gains over the 2-year follow-up phase of the study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of anxiety on attentional allocation and task performance: an information processing analysis

An information processing signal detection methodology was employed to examine attentional allocation and its correlates in both normal comparison (NC) and generalized anxiety disorder (GAD) participants. In particular, the impact of neutral distractor and negative feedback cues on performance of an attention vigilance task was investigated. Individuals with GAD (N = 15) evidenced impaired performance on an attention vigilance task relative to NC participants (N = 15) when neutral distractor cues were presented. Contrary to prediction, no group differences in performance were detected under conditions in which participants were presented negative feedback cues they were told were relevant to their performance. Instead, GAD participants exhibited improvement during the experimental task such that their performance was equivalent to NC participants. Across trials, the clinically anxious group endorsed significantly higher levels of worry and negative affectivity; however, they failed to respond with concomitant physical arousal (e.g. increased muscle tension). These data are discussed within the context of Eysenck and Calvo's (1992, Cognition and Emotion, 6, 409-434) processing efficiency theory. Additionally, the results of this investigation provide support for Barlow's (1988, Anxiety and its disorders: The nature and treatment of anxiety and panic) conceptualization of anxiety as requiring the interaction of cognitive schema and physiological arousal.     

Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: Evaluation in a randomized controlled trial.

Generalized anxiety disorder (GAD) is a chronic anxiety disorder, associated with comorbidity and impairment in quality of life, for which improved psychosocial treatments are needed. GAD is also associated with reactivity to and avoidance of internal experiences. The current study examined the efficacy of an acceptance-based behavioral therapy aimed at increasing acceptance of internal experiences and encouraging action in valued domains for GAD. Clients were randomly assigned to immediate (n = 15) or delayed (n = 16) treatment. Acceptance-based behavior therapy led to statistically significant reductions in clinician-rated and self-reported GAD symptoms that were maintained at 3- and 9-month follow-up assessments; significant reductions in depressive symptoms were also observed. At posttreatment assessment 78% of treated participants no longer met criteria for GAD and 77% achieved high end-state functioning; these proportions stayed constant or increased over time. As predicted, treatment was associated with decreases in experiential avoidance and increases in mindfulness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Les variables cognitives impliquées dans l'inquiétude face à la maladie.

The essential feature of Hypochondriasis is preoccupation with fear of having a serious disease based on a misinterpretation of bodily symptoms. While it is classified as a somatoform disorder, it presents many similarities with anxiety disorders, particularly Generalized Anxiety Disorder (GAD) which is core feature is excessive worry. Since these disorders present similar symptoms, it is also possible that similar cognitive mechanisms may be involved in their development and maintenance. The goal of the present study was to verify the relationship between illness worry and cognitive mechanisms related to GAD: Intolerance of uncertainty, faulty believes about the usefulness of worry, negative problem orientation, and cognitive avoidance. Three hundred and forty six adults (N=346) participated in this correlational study by completing relevant questionnaires. Results demonstrated that most GAD mechanisms were significant predictors of illness worry. Cognitive avoidance and negative problem orientation, entered first in the model, were the strongest predictors of the variance in illness worry scores. Faulty beliefs about worry explained only a marginal part of that variance once the first two predictors have been entered. Results also suggested that cognitive avoidance was a better predictor of illness worry compared to somatosensory-amplification, a cognitive mechanism considered as central in understanding Hypochondriasis (see Barsky & Wyshak, 1990). Clinical implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

GABA synthesis in astrocytes after infection with defective herpes simplex virus vectors expressing glutamic acid decarboxylase 65 or 67

Defective herpes simplex virus (HSV) vectors containing glutamic acid decarboxylase (GAD) cDNAs, either GAD65 or GAD67, were used to examine GAD function and GABA synthesis in rat cortical astrocytes, CNS cells that do not endogenously synthesize GABA. GAD vector infection resulted in isoform-specific expression of GAD as determined by western blotting and immunohistochemistry. Astrocytes infected with a beta-galactosidase vector or uninfected expressed no GAD and contained no detectable GABA. GABA was detected in glial fibrillary acid protein-expressing cells after GAD65 vector infection. Significant amounts of GABA, as determined by HPLC, were synthesized in cultures infected with either GAD vector. The levels of GABA in GAD67 vector-infected cells were almost twofold higher than in GAD65 vector-infected cells. Vector infection did not alter levels of other intracellular amino acids. GABA was tonically released from astrocytes infected with the GAD67 vector, but no increase in release could be detected after treatment of the cells with K+, veratridine, glutamate, or bradykinin. The ability to transduce astrocytes so that they express GAD and thereby increase GABA levels provides a potential strategy for the treatment of neurologic disorders associated with hyperexcitable or diminished inhibitory activity.     

Cognitions in generalized anxiety disorder and panic disorder patients

Forty-three patients with generalized anxiety disorder (GAD) and 44 patients with panic disorder (PD) were given a standardized interview about thoughts and images during times of anxiety. The two groups differed significantly regarding the ideational content of anxiety. GAD patients experienced more thoughts focusing on themes of mental catastrophes and other catastrophes when suffering from anxiety or anxiety attacks, while PD patients mostly described the theme of physical catastrophes. Only 34% (n = 30) of the total sample reported experiencing images when feeling anxious/having panic. For PD patients (70%) onset of anxiety or panic attacks was precipitated by somatic symptoms (a physical feeling). GAD patients reported that onset of anxiety was precipitated by all three alternatives given: a physical feeling (42%), anxious thoughts (37%), or "it all came at once" (21%). The implications of these results are discussed.     

Treatment of generalized anxiety disorder in older adults.

Older adults with generalized anxiety disorder (GAD; N=75; M age=67.1 years) were randomly assigned to cognitive-behavioral therapy (CBT), a discussion group (DG) organized around worry provoking topics, or a waiting period. Participants in both active conditions improved relative to the waiting list. Although CBT participants improved on more measures than DG participants, the authors found only 1 significant difference immediately after treatment and no differences at 6-month follow-up. Effect sizes were smaller than in younger samples, but CBT showed large effects and DG showed medium-sized effects. Overall, results indicate that brief treatment of late-life GAD is beneficial, but they provide only limited support for the superiority of CBT to a credible comparison intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Unlinking Negative Cognition and Symptoms of Depression: Evidence of a Specific Treatment Effect for Cognitive Therapy.

In this study, the authors examined whether cognitive therapy alters the association between negative cognition and symptoms of depression. Participants were recruited during psychiatric hospitalization for depression. Following discharge, they were randomly assigned to 6 months of outpatient treatment. Treatment consisted of pharmacotherapy either alone or in combination with cognitive therapy and/or family therapy. Following this 6-month treatment period, negative cognition and symptoms of depression were assessed monthly for 1 year. Hierarchical linear modeling indicated that the association between negative cognition and depression during follow-up was weaker for patients randomized to cognitive therapy than for patients who did not receive cognitive therapy. Cognitive therapy appeared to unlink negative cognition and symptoms of depression to a greater extent than other forms of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attentional Biases for Negative Interpersonal Stimuli in Clinical Depression.

An information-processing paradigm was used to examine attentional biases in clinically depressed participants, participants with generalized anxiety disorder (GAD), and nonpsychiatric control participants for faces expressing sadness, anger, and happiness. Faces were presented for 1,000 ms, at which point depressed participants had directed their attention selectively to depression-relevant (i.e., sad) faces. This attentional bias was specific to the emotion of sadness; the depressed participants did not exhibit attentional biases to the angry or happy faces. This bias was also specific to depression; at 1,000 ms, participants with GAD were not attending selectively to sad, happy, or anxiety-relevant (i.e., angry) faces. Implications of these findings for both the cognitive and the interpersonal functioning of depressed individuals are discussed and directions for future research are advanced. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal Problems and the Outcome of Interpersonally Oriented Psychodynamic Treatment of GAD.

The present study tested hypotheses concerning interpersonal problems and the course of brief psychodynamic treatment of generalized anxiety disorder (GAD). The authors found that the largest changes from pre- to post-therapy were evident for the Nonassertive, Exploitable, and Intrusive subscales of the Inventory of Interpersonal Problems. Relatively small changes were seen on the Overly Nurturant subscale, which was hypothesized to be most relevant to GAD. Changes in interpersonal problems were significantly associated with improvement in symptoms and worry. Brief dynamic therapy was not found to uniquely improve interpersonal problems compared with supportive therapy, although the psychodynamic approach was statistically and clinically superior to supportive therapy on symptomatic remission rates. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

An open trial of brief supportive-expressive psychotherapy in the treatment of generalized anxiety disorder.

Conducted a treatment development study applying brief supportive-expressive psychodynamic psychotherapy (P. Crits-Christoph et al; see record 95-195001-002) to the treatment of generalized anxiety disorder (GAD). Background and rationale for the development of this therapy are presented, along with the project's methods and results. Project goals were to develop a treatment manual, train therapists, and assess the treatment's integrity and efficacy. Outcome data on 26 patients (aged 22–64 yrs) with a Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) diagnosis of GAD indicate that the treatment is promising. Patients revealed significant change in anxiety, depression, worry, and interpersonal problems. Ratings of therapist adherence and competence indicate that the treatment manual can be implemented with fidelity and can be discriminated from other treatments. Methodological issues in the planning of treatment research on GAD, particularly the problem of comorbidity, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)