Amir, N., Beard, C., Burns, M., & Bomyea, J. (2009). Attention modification program in individuals with generalized anxiety disorder. Journal of Abnormal Psychology, 118(1), 28-33.

Correspondence Address:
Nader Amir, Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, US, 92120-4913, namir@mail.sdsu.edu.

Abstract
Research suggests that individuals with generalized anxiety disorder (GAD) show an attention bias for threat-relevant information. However, few studies have examined the causal role of attention bias in the maintenance of anxiety and whether modification of such biases may reduce pathological anxiety symptoms. In the present article, the authors tested the hypothesis that an 8-session attention modification program would (a) decrease attention bias to threat and (b) reduce symptoms of GAD. Participants completed a probe detection task by identifying letters (E or F) replacing one member of a pair of words. The authors trained attention by including a contingency between the location of the probe and the nonthreat word in one group (Attention Modification Program; AMP) and not in the other (attention control condition; ACC). Participants in the AMP showed change in attention bias and a decrease in anxiety, as indicated by both self-report and interviewer measures. These effects were not present in the ACC group. These results are consistent with the hypothesis that attention plays a causal role in the maintenance of GAD and suggest that altering attention mechanisms may effectively reduce anxiety. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

Flannery-Schroeder, E., Choudhury, M.S., & Kendall, Philip C. (2005). Group and individual cognitive-behavioral treatments for youth with anxiety disorders: 1 year follow-up. Cognitive Therapy and Research, 29, 253-259.

Correspondence Address:
Ellen Flannery-Schroeder, Department of Psychology, University of Rhode Island, 10 Chafee Road, Suite 8, Kingston, RI, US, 02881, efschroeder@uri.edu.

Abstract
This study reports the 1-year follow-up of a cognitive-behavioral treatment for anxiety disorders in children and adolescents. Thirty-seven anxiety-disordered youth (aged 8-14 years at the time of treatment) were randomly assigned to individual cognitive-behavioral treatment (ICBT), group cognitive-behavioral treatment (GCBT), or a waitlist control (WLC) condition. Previously reported posttreatment results demonstrated significant reductions in anxiety whereas children in the WLC failed to demonstrate changes in report of anxiety or in diagnostic status. At the present 1-year follow-up, 81% of ICBT and 77% of GCBT children no longer met criteria for their primary anxiety disorder. Multivariate analyses of variance demonstrated maintenance of treatment gains for both ICBT and CGBT but failed to reveal differences between the conditions. Results not only suggest the nondifferential efficacy of individual and group cognitive-behavioral treatments for anxiety-disordered children but also add to the evidence suggesting GCBT as a "probably efficacious treatment." (PsycINFO Database Record (c) 2005 APA, all rights reserved)

Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D., & Geller, P. A. (2007). A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behavior Modification, 31, 772-799.

Correspondence Address:
Evan M. Forman, Department of Psychology, Drexel University, 245 N. 15th Street, MS 515, Philadelphia, PA, US, 19102, evan.forman@drexel.edu.

Abstract
Acceptance and commitment therapy (ACT) has a small but growing database of support. One hundred and one heterogeneous outpatients reporting moderate to severe levels of anxiety or depression were randomly assigned to traditional cognitive therapy (CT) or to ACT. To maximize external validity, the authors utilized very minimal exclusion criteria. Participants receiving CT and ACT evidenced large, equivalent improvements in depression, anxiety, functioning difficulties, quality of life, life satisfaction, and clinician-rated functioning. Whereas improvements were equivalent across the two groups, the mechanisms of action appeared to differ. Changes in "observing" and "describing" one's experiences appeared to mediate outcomes for the CT group relative to the ACT group, whereas "experiential avoidance," "acting with awareness," and "acceptance" mediated outcomes for the ACT group. Overall, the results suggest that ACT is a viable and disseminable treatment, the effectiveness of which appears equivalent to that of CT, even as its mechanisms appear to be distinct. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology , 78(2), 169-183.

Correspondence Address:
Stefan G. Hofmann, Department of Psychology, Boston University, 648 Beacon Street, 6th Floor, Boston, MA, US, 02215-2002, shofmann@bu.edu .

Abstract
Objective: Although mindfulness-based therapy has become a popular treatment, little is known about its efficacy. Therefore, our objective was to conduct an effect size analysis of this popular intervention for anxiety and mood symptoms in clinical samples. Method: We conducted a literature search using PubMed, PsycINFO, the Cochrane Library, and manual searches. Our meta-analysis was based on 39 studies totaling 1,140 participants receiving mindfulness-based therapy for a range of conditions, including cancer, generalized anxiety disorder, depression, and other psychiatric or medical conditions. Results: Effect size estimates suggest that mindfulness-based therapy was moderately effective for improving anxiety (Hedges’s g = 0.63) and mood symptoms (Hedges’s g = 0.59) from pre- to posttreatment in the overall sample. In patients with anxiety and mood disorders, this intervention was associated with effect sizes (Hedges’s g) of 0.97 and 0.95 for improving anxiety and mood symptoms, respectively. These effect sizes were robust, were unrelated to publication year or number of treatment sessions, and were maintained over follow-up. Conclusions: These results suggest that mindfulness-based therapy is a promising intervention for treating anxiety and mood problems in clinical populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Kendall, P. C., Hudson, J. L., Gosch, E., Flannery-Schroeder, E., Suveg, C. (2008). Cognitive-behavioral therapy for anxiety disordered youth: A randomized clinical trial evaluating child and family modalities. Journal of Consulting and Clinical Psychology, 76(2), 282-297.

Correspondence Address:
Philip C. Kendall, Department of Psychology, Temple University, Weiss Hall, 1701 North 13th Street, Philadelphia, PA, US, 19122-6085, pkendall@temple.edu.

Abstract
This randomized clinical trial compared the relative efficacy of individual (child) cognitive-behavioral therapy (ICBT), family cognitive-behavioral therapy (FCBT), and a family-based education/support/ attention (FESA) active control for treating anxiety disordered youth ages 7-14 years (M = 10.27). Youth (N = 161; 44% female; 85% Caucasian, 9% African American, 3% Hispanic, 3% other/mixed) with a principal diagnosis of separation anxiety disorder, social phobia, or generalized anxiety disorder and their parents participated. Outcome analyses were conducted using hierarchical linear models on the intent-to-treat sample at posttreatment and 1-year follow-up using diagnostic severity, child self-reports, parent reports, and teacher reports. Chi-square analyses were also conducted on diagnostic status at post and 1-year follow-up. Children evidenced treatment gains in all conditions, although FCBT and ICBT were superior to FESA in reducing the presence and principality of the principal anxiety disorder, and ICBT outperformed FCBT and FESA on teacher reports of child anxiety. Treatment gains, when found, were maintained at 1-year follow-up. FCBT outperformed ICBT when both parents had an anxiety disorder. Implications for treatment and suggestions for research are discussed. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Main, N. A., Elliot, S. A., & Brown, J. S. L. (2005). Comparison of three different approaches used in large-scale stress workshops for the general public. Behavioural and Cognitive Psychotherapy, 33, 299-309.

Correspondence Address:
Nicole A Main, 7th Floor, Premier House, 112 Station Road, Edgware, MDX, United Kingdom, HA8 7BJ, nicole.main@beh-mht.nhs.uk.

Abstract
Given the large unmet need for services for anxiety, there is a need to develop larger-scale psychological interventions. Group interventions could help meet the need but the kind of Cognitive Behavioural Therapy (CBT) approach used merits investigation. The aim of the study was to compare the effectiveness and attendance of participants self-referring to three different CBT workshops: CBT, Cognitive Therapy (CT) only, and Behavioural (BT) only. Between 1998 and 2001 a series of day-long self-referral stress workshops were offered to members of the general public in South East London. A comparison was made of those attending the workshops immediately and those attending the workshops after a 3-month delay. Participants attending all three types of workshop reported reduced stress and anxiety compared with those in the wait-list control conditions. All three workshops were equally well attended. Results support previous findings showing the clinical effectiveness of large-scale stress workshops for the general public who suffer from high levels of anxiety. The specific kind of CBT approach did not make a marked difference either to attendance or outcome, although the CT groups invoked a greater degree of change on standardized measures than the BT or CBT groups. (PsycINFO Database Record (c) 2005 APA, all rights reserved)

Rapee, R. M., Gaston, J. E., & Abbott, M. J. (2009). Testing the Efficacy of Theoretically Derived Improvements in the Treatment of Social Phobia. Journal of Consulting and Clinical Psychology, 77(2), 317-327.

Correspondence Address:
Ronald M. Rapee, Department of Psychology, Macquarie University, Sydney, NSW, Australia, 2109, Ron.Rapee@mq.edu.au.

Abstract
Recent theoretical models of social phobia suggest that targeting several specific cognitive factors in treatment should enhance treatment efficacy over that of more traditional skills-based treatment programs. In the current study, 195 people with social phobia were randomly allocated to 1 of 3 treatments: standard cognitive restructuring plus in vivo exposure, an “enhanced” treatment that augmented the standard program with several additional treatment techniques (e.g., performance feedback, attention retraining), and a nonspecific (stress management) treatment. The enhanced treatment demonstrated significantly greater effects on diagnoses, diagnostic severity, and anxiety during a speech. The specific treatments failed to differ significantly on self-report measures of social anxiety symptoms and life interference, although they were both significantly better than the nonspecific treatment. The enhanced treatment also showed significantly greater effects than standard treatment on 2 putative process measures: cost of negative evaluation and negative views of one's skills and appearance. Changes on these process variables mediated differences between the treatments on changes in diagnostic severity. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

Stewart, R. E., & Chambless, D. L. (2009). Cognitive–behavioral therapy for adult anxiety disorders in clinical practice: A meta-analysis of effectiveness studies. Journal of Consulting and Clinical Psychology, 77(4), 595-606.

Correspondence Address:
Rebecca E. Stewart, Department of Psychology, University of Pennsylvania, Solomon Laboratories, 3720 Walnut Street, Philadelphia, PA, US, 19104, , restewar@psych.upenn.edu .

Abstract
The efficacy of cognitive–behavioral therapy (CBT) for anxiety in adults is well established. In the present study, the authors examined whether CBT tested under well-controlled conditions generalizes to less-controlled, real-world circumstances. Fifty-six effectiveness studies of CBT for adult anxiety disorders were located and synthesized. Meta-analytic effect sizes are presented for disorder-specific symptom measures as well as symptoms of generalized anxiety and depression for each disorder, and benchmarked to results from randomized controlled trials. All pretest–posttest effect sizes for disorder-specific symptom measures were large, suggesting that CBT for adult anxiety disorders is effective in clinically representative conditions. Six studies included a control group, and between-groups comparisons yielded large effect sizes for disorder-specific symptoms in favor of CBT. Benchmarking indicated that results from effectiveness studies were in the range of those obtained in selected efficacy trials. To test whether studies that are more representative of clinical settings have smaller effect sizes, the authors coded studies for 9 criteria for clinical representativeness. Results indicate an inverse relationship between clinical representativeness and outcome, but the magnitude of the relationship is quite small. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

Van Ingen, D. J., Freiheit, S. R., & Vye, C. S. (2009). From the lab to the clinic: Effectiveness of cognitive-behavioral treatments for anxiety disorders. Professional Psychology: Research and Practice, 40(1), Feb 2009, 69-74. Psychotherapy: Theory, Research, Practice, Training, 46(1), 42-51.

Correspondence Address:
Daniel J. van Ingen, Clinical Research Department - CTSIS, Chrestomathy, Inc., 7465 Eden Prairie Road, Eden Prairie, MN 55346, Phone: 612-501-5358, danccenter@yahoo.com.

Abstract
A controversy exists over whether results of randomized controlled trials of psychological treatment methods generalize to routine clinical practice. To examine the generalizability of cognitive-behavioral interventions for anxiety disorders, a meta-analysis of 11 effectiveness studies was conducted. Only studies that closely approximated real-world clinical practice were included in the present meta-analysis (e.g., studies were conducted in a non-university setting, practitioners had regular caseloads, clients were not excluded if they had comorbid conditions). Cognitive-behavioral interventions were associated with significant improvement in anxiety symptoms at the end of treatment (dw = 1.35) and again at follow-up (dw = 1.14). On the basis of these results, it seems that cognitive-behavioral interventions for anxiety disorders generalize to real-world clinical practice. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

Walkup, J. T., Albano, A. M., et al. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine, 359(26), 2753-2766.

Correspondence Address:
John T. Walkup, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, 600 N. Wolfe St., Baltimore, MD, US, 21287.

Abstract
Background: Anxiety disorders are common psychiatric conditions affecting children and adolescents. Although cognitive behavioral therapy and selective serotonin-reuptake inhibitors have shown efficacy in treating these disorders, little is known about their relative or combined efficacy. Methods: In this randomized, controlled trial, we assigned 488 children between the ages of 7 and 17 years who had a primary diagnosis of separation anxiety disorder, generalized anxiety disorder, or social phobia to receive 14 sessions of cognitive behavioral therapy, sertraline (at a dose of up to 200 mg per day), a combination of sertraline and cognitive behavioral therapy, or a placebo drug for 12 weeks in a 2:2:2:1 ratio. We administered categorical and dimensional ratings of anxiety severity and impairment at baseline and at weeks 4, 8, and 12. Results: The percentages of children who were rated as very much or much improved on the Clinician Global Impression-Improvement scale were 80.7% for combination therapy (P < 0.001), 59.7% for cognitive behavioral therapy (P < 0.001), and 54.9% for sertraline (P < 0.001); all therapies were superior to placebo (23.7%). Combination therapy was superior to both monotherapies (P < 0.001). Results on the Pediatric Anxiety Rating Scale documented a similar magnitude and pattern of response; combination therapy had a greater response than cognitive behavioral therapy, which was equivalent to sertraline, and all therapies were superior to placebo. Adverse events, including suicidal and homicidal ideation, were no more frequent in the sertraline group than in the placebo group. No child attempted suicide. There was less insomnia, fatigue, sedation, and restlessness associated with cognitive behavioral therapy than with sertraline. Conclusions: Both cognitive behavioral therapy and sertraline reduced the severity of anxiety in children with anxiety disorders; a combination of the two therapies had a superior response rate. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

Westra, H. A., Arkowitz, H., & Dozois, D. J. A. (2009). Adding a motivational interviewing pretreatment to cognitive behavioral therapy for generalized anxiety disorder: A preliminary randomized controlled trial. Journal of Anxiety Disorders , 23(8), 1106-1117.

Correspondence Address:
Henny A. Westra, York University, Department of Psychology, 127 Behavioral Sciences, 4700 Keele Street, Toronto, ON, Canada, M3J 1P3 , hwestra@yorku.ca..

Abstract
Seventy-six individuals with a principal diagnosis of generalized anxiety disorder (GAD) were randomly assigned to receive either an MI pretreatment or no pretreatment (NPT), prior to receiving CBT. Significant group differences favoring the MI-CBT group were observed on the hallmark GAD symptom of worry and on therapist-rated homework compliance, which mediated the impact of treatment group on worry reduction. Adding MI pretreatment to CBT was specifically and substantively beneficial for individuals with high worry severity at baseline. There was evidence of relapse at 6-month follow-up for high severity individuals who received MI-CBT, but significant moderator effects favoring the high severity MI-CBT group were again apparent at 12-months post-treatment. Pending replication in a more controlled test, these findings suggest that MI may be a promising adjunct to CBT for GAD for those of high severity, a group which has been less responsive to CBT in past research. (PsycINFO Database Record (c) 2009 (PsycINFO Database Record (c) 2009 APA, all rights reserved).