2009 Abstracts

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Ahmed, M., Westra, H. A. (2009). Impact of a treatment rationale on expectancy and engagement in cognitive behavioral therapy for social anxiety. Cognitive Therapy and Research , 33(3), 314-322.

Correspondence Address:
Mariyam Ahmed, Department of Psychology, York University, 4700 Keele Street, Behavioral Sciences Building, Toronto, ON, Canada, M3J 1P3. ahmedmar@yorku.ca.

Abstract
Although presentation of a treatment rationale is posited to enhance expectations for change, this contention has not been directly evaluated. In this analogue study, the Cognitive Behavioral Therapy (CBT) rationale for social anxiety was presented via videotape by an experienced CBT therapist, to 77 undergraduate students with high fear of negative evaluation. Results indicated significant increases in self-efficacy for anxiety change, confidence in conducting interpersonal exposures, and perceived helpfulness of exposure, pre- to post-rationale presentation. A positive response to the treatment rationale was related to increased frequency of interpersonal exposure at one-month follow-up. Furthermore, individual differences in self-efficacy for anxiety change at baseline moderated the impact of rationale response on exposure frequency. (PsycINFO Database Record (c) 2009 (PsycINFO Database Record (c) 2009 APA, all rights reserved).

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)

Carson, Ri. C., Hollon, S. D., Shelton, R. C. (2009). Depressive realism and clinical depression. Behaviour Research and Therapy, in press.

Correspondence Address:
Steven D. Hollon. Ph.D., Department of Psychology, Vanderbilt University, 306 Wilson Hall, Nashville, Tennessee 37240 USA steven.d.hollon@vanderbilt.edu.

Abstract
Depressive realism suggests that depressed individuals make more accurate judgments of control than their nondepressed counterparts. However, most studies demonstrating this phenomenon were conducted in nonclinical samples. In this study, psychiatric patients who met criteria for major depressive disorder underestimated control in a contingent situation and were consistently more negative in their judgments than were nondepressed controls. Depressed patients were less likely than their nondepressed counterparts to overestimate control in a noncontingent situation, but largely because they perceived receiving less reinforcement. Depressed patients were no more likely to use the appropriate logical heuristic to generate their judgments of control than their nondepressed counterparts and each appeared to rely on different primitive heuristics. Depressed patients were consistently more negative than their nondepressed counterparts and when they did appear to be more “accurate” in their judgments of control (as in the noncontingent situation) it was largely because they applied the wrong heuristic to less accurate information. These findings do not support the notion of depressive realism and suggest that depressed patients distort their judgments in a characteristically negative fashion. (PsycINFO Database Record (c) 2009 (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Carter, J. C., McFarlane, T. L., Bewell, C., Olmsted, M. P., Woodside, D. B., Kaplan, A. S., Crosby, R. D. Maintenance treatment for anorexia nervosa: A comparison of cognitive behavior therapy and treatment as usual. International Journal of Eating Disorders, 42 (3), 202-207.

Correspondence Address:
Jacqueline C. Carter, Toronto General Hospital, 200 Elizabeth Street EN8-241, Toronto, ON, Canada, M5G 2C4, Jacqueline.carter@uhn.on.ca.

Abstract
Objective: The aim of this study was to compare two maintenance treatment conditions for weight-restored anorexia nervosa (AN): individual cognitive behavior therapy (CBT) and maintenance treatment as usual (MTAU). Method: This study was a nonrandomized clinical trial. The participants were 88 patients with AN who had achieved a minimum body mass index (BMI) of 19.5 and control of binge eating and purging symptoms after completing a specialized hospital-based program. Forty-six patients received 1 year of manualized individual CBT and 42 were in an assessment-only control condition (i.e., MTAU) for 1 year. This condition was intended to mirror follow-up care as usual. Participants in both the conditions were assessed at 3-month intervals during the 1-year study. The main outcome variable was time to relapse. Results: When relapse was defined as a BMI =17.5 for 3 months or the resumption of regular binge eating and/or purging behavior for 3 months, time to relapse was significantly longer in the CBT condition when compared with MTAU. At 1 year, 65% of the CBT group and 34% of the MTAU group had not relapsed. Discussion: The current findings provide preliminary evidence that CBT may be helpful in improving outcome and preventing relapse in weight-restored AN. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

Cook, J. M., Biyanova, T., & Coyne, J. C. (2009). Influential psychotherapy figures, authors, and books: An Internet survey of over 2,000 psychotherapists. Psychotherapy: Theory, Research, Practice, Training, 46(1), 42-51. International Journal of Eating Disorders, 42 (3), 202-207.

Correspondence Address:
Joan M. Cook, Yale University, Northeast Program Evaluation Center, 950 Campbell Avenue, West Haven, CT, US, 06516, Joan.Cook@yale.edu.

Abstract
In a partial replication and extension of a survey conducted 25 years ago (Smith, 1982), over 2,400 North American psychotherapists completed a Web-based survey in which they identified prominent figures in the psychotherapy field who have most influenced their practice and the best psychotherapy books they had read in the past 3 years. There is a continued prominence to leaders of the field from 25 years ago but who are now deceased, notably the top-ranked Carl Rogers. Three books on the top-10 list represent empirically supported therapies (ESTs); two are treatment manuals for an EST, and one is a self-help book derived from an EST that has itself been shown to be efficacious bibliotherapy. Differences between psychologist and nonpsychologist therapists in the choice of influential figures, authors, and books are negligible. Implications are discussed in terms of the contemporary context into which therapeutic innovations are disseminated, as well as the conditions that may be necessary for successful dissemination.(PsycINFO Database Record (c) 2009 APA, all rights reserved)

Farrell, J. M., Shaw, I. A., & Webber, M. A. (2009). A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: A randomized controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 40(2), 317-328.

Correspondence Address:
Joan M. Farrell, Indiana University, School of Medicine, Department of Psychiatry, Center for Borderline Personality Disorder Treatment & Research, Larue D. Carter Memorial Hospital, 2601 Cold Spring Road, Indianapolis, IN, US, 46222, joan.farrell@fssa.in.gov .

Abstract
This study tests the effectiveness of adding an eight-month, thirty-session schema-focused therapy (SFT) group to treatment-as-usual (TAU) individual psychotherapy for borderline personality disorder (BPD). Patients (N = 32) were randomly assigned to SFT-TAU and TAU alone. Dropout was 0% SFT, 25% TAU. Significant reductions in BPD symptoms and global severity of psychiatric symptoms, and improved global functioning with large treatment effect sizes were found in the SFT-TAU group. At the end of treatment, 94% of SFT-TAU compared to 16% of TAU no longer met BPD diagnosis criteria (p < .001). This study supports group SFT as an effective treatment for BPD that leads to recovery and improved overall functioning. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Fournier, J. C., DeRubeis, R. J., Shelton, R. C., Hollon, S. D., Amsterdam, J. D., & Gallop, R. (2009). Prediction of response to medication and cognitive therapy in the treatment of moderate to severe depression. Journal of Consulting and Clinical Psychology, 77(4), Aug 2009, 775-787. Psychotherapy: Theory, Research, Practice, Training, 46(1), 42-51.

Correspondence Address:
Jay C. Fournier, Department of Psychology, University of Pennsylvania, 3720 Walnut Street, Philadelphia, PA, US, 19104, jcf@sas.upenn.edu .

Abstract
A recent randomized controlled trial found nearly equivalent response rates for antidepressant medications and cognitive therapy in a sample of moderate to severely depressed outpatients. In this article, the authors seek to identify the variables that were associated with response across both treatments as well as variables that predicted superior response in one treatment over the other. The sample consisted of 180 depressed outpatients: 60 of whom were randomly assigned to cognitive therapy; 120 were assigned to antidepressant medications. Treatment was provided for 16 weeks. Chronic depression, older age, and lower intelligence each predicted relatively poor response across both treatments. Three prescriptive variables—marriage, unemployment, and having experienced a greater number of recent life events—were identified, and each predicted superior response to cognitive therapy relative to antidepressant medications. Thus, 6 markers of treatment outcome were identified, each of which might be expected to carry considerable clinical utility. The 3 prognostic variables identify subgroups that might benefit from alternative treatment strategies; the 3 prescriptive variables identify groups who appear to respond particularly well to cognitive therapy. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

Kennard, B. D., Silva, S. G., Tonev, S., Rohde, P., Hughes, J. L., Vitiello, B., Kratochvil, C. J., Curry, J. F., Emslie, G. J., Reinecke, M., March, J. (2009). Remission and recovery in the Treatment for Adolescents With Depression Study (TADS): Acute and long-term outcomes. Journal of the American Academy of Child & Adolescent Psychiatry, 48, (2), 186-195.

Correspondence Address:
Betsy D. Kennard, University of Texas, Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX, US, 75390-8589, Beth.kennard@utsouthwestern.edu.

Abstract
Objective: We examine remission rate probabilities, recovery rates, and residual symptoms across 36 weeks in the Treatment for Adolescents with Depression Study (TADS). Method: The TADS, a multisite clinical trial, randomized 439 adolescents with major depressive disorder to 12 weeks of treatment with fluoxetine, cognitive/behavioral therapy, their combination, or pill placebo. The pill placebo group, treated openly after week 12, was not included in the subsequent analyses. Treatment differences in remission rates and probabilities of remission over time are compared. Recovery rates in remitters at weeks 12 (acute phase remitters) and 18 (continuation phase remitters) are summarized. We also examined whether residual symptoms at the end of 12 weeks of acute treatment predicted later remission. Results: At week 36, the estimated remission rates for intention-to-treat cases were as follows: combination, 60%; fluoxetine, 55%; cognitive/behavioral therapy, 64%; and overall, 60%. Paired comparisons reveal that, at week 24, all active treatments converge on remission outcomes. The recovery rate at week 36 was 65% for acute phase remitters and 71% for continuation phase remitters, with no significant between-treatment differences in recovery rates. Residual symptoms at the end of acute treatment predicted failure to achieve remission at weeks 18 and 36. Conclusions: Most depressed adolescents in all three treatment modalities achieved remission at the end of 9 months of treatment. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Masheb, R. M., Kerns, R. D., Lozano, C., Minkin, M. J., & Richman, S. (2009). A randomized clinical trial for women with vulvodynia: Cognitive-behavioral therapy vs. supportive psychotherapy. Pain , Vol 141(1-2), 31-40.

Correspondence Address:
Robin M. Masheb, Yale University School of Medicine, P.O. Box 208098, New Haven, CT, US, 06520-8098, robin.masheb@yale.edu.

Abstract
Many treatments used for women with vulvodynia are based solely upon expert opinion. This randomized trial aimed to test the relative efficacy of cognitive-behavioral therapy (CBT) and supportive psychotherapy (SPT) in women with vulvodynia. Of the 50 participants, 42 (84%) completed 10-week treatments and 47 (94%) completed one-year follow-up assessments. Mixed effects modeling was used to make use of all available data. Participants had statistically significant decreases in pain severity (p’s < 0.001) with 42% of the overall sample achieving clinical improvement. CBT, relative to SPT, resulted in significantly greater improvement in pain severity during physician examination (p = 0.014), and greater improvement in sexual function (p = 0.034), from pre- to post-treatment. Treatment effects were well maintained at one-year follow-up in both groups. Participants in the CBT condition reported significantly greater treatment improvement, satisfaction and credibility than participants in the SPT condition (p’s < 0.05). Findings from the present study suggest that psychosocial treatments for vulvodynia are effective. CBT, a directed treatment approach that involves learning and practice of specific pain-relevant coping and self-management skills, yielded better outcomes and greater patient satisfaction than a less directive approach. (PsycINFO Database Record (c) 2009 (PsycINFO Database Record (c) 2009 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)

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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)

Vinttengl, J. R., Clark, L. A., & Jarrett, R. B. (2009). Continuation-Phase Cognitive Therapy's Effects on Remission and Recovery From Depression Journal of Consulting and Clinical Psychology, 77(2), 367-371.

Correspondence Address:
Jeffrey R. Vittengl, Department of Psychology, Truman State University, 100 East Normal Street, Kirksville, MO, US, 63501-4221, vittengl@truman.edu.

Abstract
The authors tested the effects of continuation-phase cognitive therapy (C-CT) on remission and recovery from recurrent major depressive disorder, defined as 6 weeks and 8 months, respectively, of continuously absent or minimal symptoms. Responders to acute-phase cognitive therapy were randomized to 8 months of C-CT (n = 41) or assessment control (n = 43), and they were followed 16 additional months (R. B. Jarrett et al., 2001). Relative to controls, a few more patients in C-CT remitted (88% vs. 97%), and significantly more recovered (62% vs. 84%). All patients without remission and recovery relapsed, but most patients who remitted (60%) and who recovered (75%) did not later relapse or recur. The authors discuss the importance of defining efficacious treatment as producing remission and recovery. (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)

Weisz, J. R., Southam-Gerow, M. A., Gordis, E. B., Connor-Smith, J. K., Chu, B. C., Langer, D. A., McLeod, B. D., Jensen-Doss, A., Updegraff, A., Weiss, B. (2009). Cognitive–behavioral therapy versus usual clinical care for youth depression: An initial test of transportability to community clinics and clinicians. Journal of Consulting and Clinical Psychology, 77 (3), 383-396.

Correspondence Address:
John R. Weisz, Department of Psychology, Harvard University, William James Hall, 33 Kirkland Street, Cambridge, MA, US, 02138, jweisz@jbcc.harvard.edu.

Abstract
Community clinic therapists were randomized to (a) brief training and supervision in cognitive–behavioral therapy (CBT) for youth depression or (b) usual care (UC). The therapists treated 57 youths (56% girls), ages 8–15, of whom 33% were Caucasian, 26% were African American, and 26% were Latino/Latina. Most youths were from low-income families and all had Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) depressive disorders (plus multiple comorbidities). All youths were randomized to CBT or UC and treated until normal termination. Session coding showed more use of CBT by CBT therapists and more psychodynamic and family approaches by UC therapists. At posttreatment, depression symptom measures were at subclinical levels, and 75% of youths had no remaining depressive disorder, but CBT and UC groups did not differ on these outcomes. However, compared with UC, CBT was (a) briefer (24 vs. 39 weeks), (b) superior in parent-rated therapeutic alliance, (c) less likely to require additional services (including all psychotropics combined and depression medication in particular), and (d) less costly. The findings showed advantages for CBT in parent engagement, reduced use of medication and other services, overall cost, and possibly speed of improvement—a hypothesis that warrants testing in future research. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

Werrij, M. Q., Jansen, A., Mulkens, S., Elgersma, H., Ament, A.J.H.A., Hospers, H. J. (2009). Adding cognitive therapy to dietetic treatment is associated with less relapse in obesity. Journal of Psychosomatic Research 67(4), 315-324.

Correspondence Address:
Marieke Q. Werrij, Department of Work and Social Psychology (Uns 5), Faculty of Psychology, Maastricht University, P.O. Box 616, Maastricht, Netherlands, 6200 MD, , m.werrij@psychology.unimaas.nl .

Abstract
Objective: The treatment of obesity is universally disappointing; although usually some weight loss is reported directly after treatment, eventual relapse to, or even above, former body weight is common. In this study it is tested whether the addition of cognitive therapy to a standard dietetic treatment for obesity might prevent relapse. It is argued that the addition of cognitive therapy might not only be effective in reducing weight and related concerns, depressed mood, and low self-esteem, but also has an enduring effect that lasts beyond the end of treatment. Methods: Non-eating-disordered overweight and obese participants in a community health center (N=204) were randomly assigned to a group dietetic treatment+cognitive therapy or a group dietetic treatment+physical exercise. Results: Both treatments were quite successful and led to significant decreases in BMI, specific eating psychopathology (binge eating, weight-, shape-, and eating concerns) and general psychopathology (depression, low self-esteem). In the long run, however, the cognitive dietetic treatment was significantly better than the exercise dietetic treatment; participants in the cognitive dietetic treatment maintained all their weight loss, whereas participants in the physical exercise dietetic treatment regained part (25%) of their lost weight. Conclusion: Cognitive therapy had enduring effects that lasted beyond the end of treatment. This potential prophylactic effect of cognitive therapy is promising; it might be a new strategy to combat the global epidemic of obesity. (PsycINFO Database Record (c) 2009 (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).