Category: Treatment - CBT
Meta-analytic reviews suggest that responsivity to cognitive-behavioral therapy (CBT) differs by anxiety diagnoses and symptom profiles. For example, individuals with generalized anxiety disorder show significantly larger treatment gains than those with social anxiety disorder (Norton & Price, 2007), and individuals with higher baseline levels of behavioral avoidance show reduced improvement during CBT for panic disorder and agoraphobia (Porter & Chambless, 2015). These findings raise questions about how differing levels of worry and avoidance may interactively influence treatment responsivity across diagnostic groups. To address this question, we examined clinical outcome in a sample of 51 adults (64.3% female) undergoing outpatient CBT at a specialty anxiety clinic. Treatment was open CBT and outcomes were examined for a maximum of 16 weeks. We examined three clinical outcomes of interest: severity of depressed and anxious mood (both assessed by the corresponding subscales of the Depression, Anxiety, and Stress Scales; Lovibond & Lovibond, 1995) and a global measure of emotional distress and interference (assessed by the Weekly Adjustment Scale; Peterson, 2015). In separate mixed-effect regression models for each outcome measure, we evaluated whether baseline levels of worry (assessed via the Penn State Worry Questionnaire; Meyer et al., 1990) and avoidance of social situations (via the “avoidance” subscale of the Inventory of Social Interactions; Amir, Freshman, & Foa, unpublished scale) predicted symptom change over time, controlling for pre-treatment severity of the outcome variable and for number of observations. We found that the interaction of higher worry combined with lower avoidance marked individuals who were more responsive to treatment, as evident by findings for both the depression (b=.46, t=2.10, p=.036 for the 3-way Worry x Avoidance x Time interaction) and the global adjustment measure (b=.67, t=3.46, p=.002for the 3-way interaction). Interactive levels of worry and avoidance did not predict change in the anxiety outcome measure (p>.10). Accordingly, we found that profiles of worry and avoidance were most important for predicting symptom domains outside of an anxiety scale, perhaps reflecting general mood responsivity rather than core anxiety patterns. We interpret these findings in the context of research suggesting that higher levels of subclinical worry may increase mental rehearsal of newly learned associations (e.g., Joos et al., 2013; Otto et al., 2007), and that avoidance mediates the relationship between anxiety and later depression symptoms (Jacobson and Newman, 2014).
Eugenia Gorlin– Postdoctoral Fellow, Boston University, Brookline, Massachusetts
Alexandra Gold– Graduate student, Boston University
Shanshan Hu– Boston University
Elijah Patten– Research Assistant, Boston University
Hannah Boettcher– Doctoral Student, Boston University, Boston, Massachusetts
Lisa Smith– Director, Center for Anxiety and Related Disorders, Boston University, Boston, Massachusetts
Michael Otto– Professor, Boston University, Boston
Eugenia I. Gorlin is currently a Post-Doctoral Fellow in the Department of Psychological and Brain Sciences at Boston University. Her core interests target the motivational and neurocognitive factors that interactively contribute to emotional disorders and/or impair treatment outcome. Clinically, she applies evidence-based treatment principles to patients with affective and substance use disorders, with the greatest specialization in the treatment of anxiety disorders. She has 11 publications spanning these areas of interests. She is an frequent presenter at national conferences, including ABCT, and has received awards for her research and teaching.
Director, Center for Anxiety and Related Disorders
Michael W. Otto, PhD, is Professor in the Department of Psychological and Brain Sciences at Boston University. He has had a major career focus on developing and validating new psychosocial treatments for anxiety, mood, psychotic, and substance use disorders, with a particular focus on treatment refractory populations. This includes a translational research agenda investigating brain-behavior relationships in therapeutic learning. His focus on hard-to-treat conditions and principles underlying behavior-change failures led him to an additional focus on health behavior promotion, including investigations of addictive behaviors, medication adherence, sleep, and exercise. Across these health behaviors, he has been concerned with cognitive, attention, and affective factors that derail adaptive behaviors, and the factors that can rescue these processes. He also investigates exercise as an intervention for affective and addictive disorders, as well as for cognitive enhancement. He has over 400 publications spanning his research interests, and was identified as a “top producer” in the clinical empirical literature, and an ISI Highly Cited Researcher. He is a Past President of the Association of Behavioral and Cognitive Therapies, and is currently President of Division 12 of the American Psychological Association.