Anxiety (General)
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)
Craske MG, Stein MB, Sullivan G, Sherbourne C, Bystritsky A, Rose RD, Lang AJ, Welch S, Campbell-Sills L, Golinelli D, Roy-Byrne P. (2011). Disorder-specific impact of coordinated anxiety learning and management treatment for anxiety disorders in primary care. Arch Gen Psychiatry, 68(4):378-88.
Correspondence Address:
Not Available
Abstract: CONTEXT: Anxiety disorders commonly present in primary care, where evidence-based mental health treatments often are unavailable or suboptimally delivered. OBJECTIVE: To compare evidence-based treatment for anxiety disorders with usual care (UC) in primary care for principal and comorbid generalized anxiety disorder (GAD), panic disorder (PD), social anxiety disorder (SAD), and posttraumatic stress disorder (PTSD). DESIGN: A randomized controlled trial comparing the Coordinated Anxiety Learning and Management (CALM) intervention with UC at baseline and at 6-, 12-, and
18-month follow-up assessments. SETTING: Seventeen
MAIN OUTCOME MEASURES: Generalized Anxiety Disorder Severity Scale, Panic Disorder Severity-Self-report Scale, Social Phobia Inventory, and PTSD
Checklist-Civilian Version scores. RESULTS: CALM was superior to UC for principal GAD at 6-month (-1.61; 95%
confidence interval [CI], -2.42 to -0.79), 12-month (-2.34; -3.22 to -1.45), and 18-month (-2.37; -3.24 to -1.50), PD at 6-month (-2.00; -3.55 to -0.44) and
12-month (-2.71; -4.29 to -1.14), and SAD at 6-month (-7.05; -12.11 to -2.00) outcomes. CALM was superior to UC for comorbid SAD at 6-month (-4.26; 95% CI, -7.96 to -0.56), 12-month (-8.12, -11.84 to -4.40), and 18- month (-6.23, -9.90 to -2.55) outcomes. Effect sizes favored CALM but were not statistically significant for other comorbid disorders. CONCLUSIONS: CALM (cognitive behavior therapy and pharmacotherapy medication recommendations) is more effective than is UC for principal anxiety disorders and, to a lesser extent, comorbid anxiety disorders that present in primary care. PMID: 21464362
Dugas, M. J., Brillon, P., Savard, P. et al. (2010). A randomized clinical trial of cognitive-behavioral therapy and applied relaxation for adults with generalized anxiety disorder. Behavioral Therapy , 41(1), 46-58.
Correspondence Address:
Dugas, Michel J.: Department of Psychology, Concordia University, 7141 Sherbrooke Street West, Montreal, PQ, Canada, H4B 1R6, Michel.Dugas@concordia.ca.
Abstract
This randomized clinical trial compared cognitive-behavioral therapy (CBT), applied relaxation (AR), and wait-list control (WL) in a sample of 65 adults with a primary diagnosis of generalized anxiety disorder (GAD). The CBT condition was based on the intolerance of uncertainty model of GAD, whereas the AR condition was based on general theories of anxiety. Both manualized treatments were administered over 12 weekly 1-hour sessions. Standardized clinician ratings and self-report questionnaires were used to assess GAD and related symptoms at pretest, posttest, and at 6-, 12-, and 24-month follow-ups. At posttest, CBT was clearly superior to WL, AR was marginally superior to WL, and CBT was marginally superior to AR. Over follow-up, CBT and AR were equivalent, but only CBT led to continued improvement. Thus, direct comparisons of CBT and AR indicated that the treatments were comparable; however, comparisons of each treatment with another point of reference (either waiting list or no change over follow-up) provided greater support for the efficacy of CBT than AR. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
Feldman G, Greeson J., Senville. “Differential effects of mindful breathing, progressive muscle relaxation, and loving-kindness meditation on decentering and negative reactions to repetitive thoughts.” J. Behaviour Research and Therapy,2010, 48 (10):1002-1011.
Correspondence Address:
Not Available
Abstract
Decentering has been proposed as a potential mechanism of mindfulness-based interventions but has received limited empirical examination to date in experimental studies comparing mindfulness meditation to active comparison conditions. In the present study, we compared the immediate effects of mindful breathing (MB) to two alternative stress-management techniques: progressive muscle relaxation (PMR) and loving-kindness meditation (LKM) to test whether decentering is unique to mindfulness meditation or common across approaches. Novice meditators (190 female undergraduates) were randomly assigned to complete one of three 15-min stress-management exercises (MB, PMR, or LKM) presented by audio recording. Immediately after the exercise, participants completed measures of decentering, frequency of repetitive thoughts during the exercise, and degree of negative reaction to thoughts. As predicted, participants in the MB condition reported greater decentering relative to the other two conditions. The association between frequency of repetitive thought and negative reactions to thoughts was relatively weaker in the MB condition than in the PMR and LKM conditions, in which these two variables were strongly and positively correlated. Consistent with the construct of decentering, the relative independence between these two variables in the MB condition suggests that mindful breathing may help to reduce reactivity to repetitive thoughts. Taken together, results help to provide further evidence of decentering as a potential mechanism that distinguishes mindfulness practice from other credible stress-management approaches.
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)
Hirshfeld-Becker, D. R., Masek, B., Henin, A., et al. (2010). Cognitive behavioral therapy for 4- to 7-year-old children with anxiety disorders: A randomized clinical trial. Journal of Consulting and Clinical Psychology , 27(5), 498-510.
Correspondence Address:
Hirshfeld-Becker, Dina R.: Massachusetts General Hospital, 185 Alewife Brook Parkway, Suite 2000, Cambridge, MA, US, 02138, dhirshfeld@partners.org.
Abstract
Objective: To examine the efficacy of a developmentally appropriate parent–child cognitive behavioral therapy (CBT) protocol for anxiety disorders in children ages 4–7 years. Method: Design: Randomized wait-list controlled trial. Conduct: Sixty-four children (53% female, mean age 5.4 years, 80% European American) with anxiety disorders were randomized to a parent–child CBT intervention (n = 34) or a 6-month wait-list condition (n = 30). Children were assessed by interviewers blind to treatment assignment, using structured diagnostic interviews with parents, laboratory assessments of behavioral inhibition, and parent questionnaires. Analysis: Chi-square analyses of outcome rates and linear and ordinal regression of repeated measures, examining time by intervention interactions. Results: The response rate (much or very much improved on the Clinical Global Impression Scale for Anxiety) among 57 completers was 69% versus 32% (CBT vs. controls), p < .01; intent-to-treat: 59% vs. 30%, p = .016. Treated children showed a significantly greater decrease in anxiety disorders (effect size [ES] = .55) and increase in parent-rated coping (ES = .69) than controls, as well as significantly better CGI improvement on social phobia/avoidant disorder (ES = .95), separation anxiety disorder (ES = .82), and specific phobia (ES = .78), but not on generalized anxiety disorder. Results on the Child Behavior Checklist Internalizing scale were not significant and were limited by low return rates. Treatment response was unrelated to age or parental anxiety but was negatively predicted by behavioral inhibition. Gains were maintained at 1-year follow-up. Conclusions: Results suggest that developmentally modified parent–child CBT may show promise in 4- to 7-year-old children. (PsycINFO Database Record (c) 2010 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)
Olatunji, Bunmi O., Josh M. Cisler, and Brett J. Deacon. “Efficacy of Cognitive Behavioral Therapy for Anxiety Disorders: A Review of Meta-Analytic Findings.” Psychiatric Clinics of North America, Vol. 33, Issue 3 (September 2010): 557-577.
Correspondence Address:
Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN 37203, USA. olubunmi.o.olatunji@vanderbilt.edu
Abstract
“Numerous clinical trials have supported the efficacy of cognitive behavioral therapy (CBT) for the treatment of anxiety disorders. Accordingly, CBT has been formally recognized as an empirically supported treatment for anxiety-related conditions. This article reviews the evidence supporting the efficacy of CBT for anxiety disorders. Specifically, contemporary meta-analytic studies on the treatment of anxiety disorders are reviewed and the efficacy of CBT is examined. Although the specific components of CBT differ depending on the study design and the anxiety disorder treated, meta-analyses suggest that CBT procedures (particularly exposure-based approaches) are highly efficacious. CBT generally outperforms wait-list and placebo controls. Thus, CBT provides incremental efficacy above and beyond nonspecific factors. For some anxiety disorders, CBT also tends to outperform other psychosocial treatment modalities. The implications of available meta-analytic findings in further delineating the efficacy and dissemination of CBT for anxiety disorders are discussed.”
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)
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).