Acceptance-based behavioral therapy for GAD: effects on outcomes from three theoretical models.

Probably not a substantial claim: may not pass S3 (load-bearing).

Intolerance of uncertainty and negative problem orientation significantly differentiated moderate and severe GAD from mild GAD.

“intolerance of uncertainty and negative problem orientation (another construct in their model) significantly differentiated individuals with moderate and severe GAD from those in the mild range (Dugas et al., 2007).”

• cites Dugas et al., 2007 sourceSupported

May combine two claims.

In the ITT sample, significant condition-by-time interactions were found for ACS total and subscale scores (anger, positive emotion, depression, anxiety) and for DERS total.

“Significant condition by time interactions emerged for both the total and subscale scores (anger, positive emotion, depression and anxiety) on the ACS and total scores on the DERS.”

May combine two claims.

Several dependent variables were significantly correlated with one another, suggesting possible shared or overlapping variance.

“As the correlations in Table 2 indicate, several of the dependent variables were significantly related to one another, suggesting possible shared or overlapping variance.”

May combine two claims.

In the full treatment sample, growth curve analyses showed a non-significant effect of Time, indicating that initial treatment gains were maintained through the 3- and 9-month follow-ups.

“Growth curve analyses revealed a non-significant effect of Time, meaning that the initial gains reported by clients during their post-assessment were maintained several months following the end of treatment.”

May combine two claims.

Most measures continued to improve nonsignificantly with small to medium effect sizes (ds .22-.42), while DERS and ACS-anxiety scores remained stable.

“In fact, most measures continued to improve, nonsignificantly, with small to medium effect sizes (ds between .22 and .42), except DERS and ACS-anxiety scores, which remained stable.”

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).

No adverse events were reported during the study.

“No adverse events were reported throughout the duration of the study.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Several emotional difficulties are uniquely related to GAD beyond the contributions of comorbid diagnoses.

“Mennin and colleagues (2007) found that several of these emotional difficulties are uniquely related to GAD, above and beyond the contributions of other comorbid diagnoses.”

• cites Mennin et al., 2007 sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

Perceptions of uncontrollability help maintain anxiety through activation of fear networks and development of anxious cognitive schemas.

“these perceptions are thought to help maintain anxiety through activation of certain fear networks, as well as through the development of anxious cognitive schemas (see Barlow, 2002 for a book length review of these and associated topics).”

• cites Barlow, 2002Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Mennin and colleagues conceptualize GAD primarily as a disorder of maladaptive emotion regulation.

“conceptualize generalized anxiety disorder as primarily a disorder of maladaptive emotion regulation.”

• cites Mennin, Heimberg, Turk, & Fresco, 2005 sourceNot checked — no full text of the source
• cites Mennin, Holaway, Fresco, Moore, & Heimberg, 2007 sourceNot checked — no full text of the source

May combine two claims.

The earlier trial provides preliminary evidence that ABBT is efficacious and affects the mechanisms of change in its model.

“This provides preliminary evidence of the efficacy of this intervention and its impact on mechanisms of change identified in the model on which it is based.”

Classified as probably not a substantial claim. May combine two claims.

Participants were randomly assigned to either ABBT or a waitlist control, with 15 in the ABBT group and 16 in the waitlist group.

“Clients were randomly assigned to immediate (n = 15) or delayed (n = 16) treatment.”

• Also stated in: § Participants · plain

  “Thirty-one participants consented to participate in this trial and were randomly assigned to either treatment (ABBT, n = 15) or a wait list control (n = 16).”

Probably not a substantial claim: may not pass S3 (load-bearing).

In this sample, the Difficulties in Emotion Regulation Scale had internal consistency of .95.

“The internal consistency in this sample was .95.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In Mennin's model, people may use worry as a coping strategy because of heightened emotional intensity, negative reactions to emotions, and difficulty understanding emotional experiences.

“individuals may employ worry as a coping strategy due to heightened emotional intensity, negative reactions to emotions, and difficulty understanding their emotional experiences (Mennin et al., 2005).”

• cites Mennin et al., 2005 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Two treatment participants withdrew during therapy, and four waitlist participants withdrew before the post-waitlist assessment.

“Two treatment participants withdrew during the course of therapy (one due to time constraints, after session 10, and one due to an interest in a more exploratory therapy, after session five), while four waiting list clients withdrew prior to the post-waiting list assessment (to pursue treatment).”

May combine two claims.

Worry is a form of cognitive avoidance that may interfere with successful emotional processing.

“research and theory suggest that worry is a form of cognitive avoidance that may interfere with successful emotional processing (Borkovec et al., 2004)”

• cites Borkovec et al., 2004Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Other researchers have found similar emotion regulation difficulties among people with GAD or chronic worry.

“Other researchers have found similar evidence of difficulties in a variety of emotion regulation domains among individuals with GAD or chronic worry (e.g., Salters-Pedneault, Roemer, Tull, Rucker, & Mennin, 2006; Roemer et al., 2009).”

• cites Salters-Pedneault, Roemer, Tull, Rucker, & Mennin, 2006 sourceNot checked — no full text of the source
• cites Roemer et al., 2009 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The English version of the Intolerance of Uncertainty Scale has demonstrated excellent internal consistency and good test-retest reliability.

“The English version of the IUS has demonstrated excellent internal consistency (Cronbach's α = .94) and good test-retest reliability (r = .74).”

• cites Buhr & Dugas, 2002 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Worry is negatively reinforced by the reduction in autonomic arousal it produces.

“Borkovec and colleagues have posited that worry is negatively reinforced through the reduction in autonomic arousal that it engenders (Borkovec et al., 2004; Borkovec & Hu, 1990).”

• cites Borkovec et al., 2004Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Borkovec & Hu, 1990 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

People with intense emotions and difficulty regulating them may find worry especially negatively reinforcing.

“Given this, individuals with intense emotions and difficulty regulating them may find worry particularly negatively reinforcing.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Intolerance of uncertainty is an important cognitive component of GAD.

“Dugas, Gagnon, Ladouceur, and Freeston (1998) propose that intolerance of uncertainty, defined as negative reactions to uncertain or ambiguous circumstances, is an important cognitive component of GAD.”

• cites Dugas et al., 1998 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

The sample size, though small, was sufficient to detect large effect sizes.

“Although small, this sample size enabled detection of large effect sizes.”

Classified as probably not a substantial claim.

Perceptions of uncontrollability are an important predisposing factor for pathological anxiety.

“Barlow (cf. 2002) has argued that perceptions of uncontrollability are an important predisposing factor for the development of pathological anxiety.”

• cites Barlow, 2002Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim.

Inclusion criteria were broad in order to maximize clinical applicability and external validity.

“In order to maximize the clinical applicability and external validity of any findings, inclusion criteria were broad and included the following:”

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).

In this sample, the Intolerance of Uncertainty Scale had internal consistency of .95.

“Internal consistency in this sample was .95.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The Affective Control Scale has demonstrated good internal consistency, discriminant and convergent validity, and acceptable two-week test-retest reliability.

“ACS total and subscale scores have demonstrated good internal consistency (total = 0.94, anger = .072, positive affect = 0.84, depression = 0.91, and anxiety = 0.89), discriminant and convergent validity, as well as acceptable 2-week test-retest reliability, r = 0.78 (Berg, Shapiro, Chambless, & Ahrens, 1998; Williams et al., 1997).”

• cites Berg, Shapiro, Chambless, & Ahrens, 1998 sourceNot checked — no full text of the source
• cites Williams et al., 1997 sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

The ABBT model holds that people with GAD narrow attention toward threat and the future, react negatively to and try to avoid internal experiences, and avoid or limit engagement in important life areas.

“This model emphasizes an individual's tendency to narrow her/his focus toward threatening or future oriented information, to respond negatively to and attempt to avoid her/his internal experiences (such as anxious thoughts and emotions), and to avoid or restrict her/his engagement in important areas of her/his life.”

• cites Roemer & Orsillo, 2005 sourceNot checked — no full text of the source
• cites Roemer & Orsillo, 2009 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The Difficulties in Emotion Regulation Scale has demonstrated good internal consistency and test-retest reliability in an undergraduate sample and is significantly associated with GAD symptomology.

“The DERS has demonstrated good internal consistency and test-retest reliability in an undergraduate sample, and has been significantly associated with GAD symptomology (Salters-Pedneault et al., 2006).”

• cites Salters-Pedneault et al., 2006 sourceNot checked — no full text of the source

May combine two claims.

Clinical and non-clinical samples with GAD symptoms report greater affective intensity, more distress about emotional reactions, and less ability to accurately identify emotions than controls.

“evidence seems to suggest that both clinical and non-clinical samples of individuals with GAD symptoms report greater affective intensity and distress about emotional reactions, as well as a decreased ability to accurately identify emotions, when compared to controls (Mennin et al., 2005).”

• cites Mennin et al., 2005 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Intolerance of uncertainty distinguishes GAD patients from non-clinical controls.

“Intolerance of uncertainty has been found to distinguish GAD patients from non-clinical controls (Dugas et al., 1998)”

• cites Dugas et al., 1998 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Nine participants were taking psychotropic medication but had been on a stable dose for at least three months and agreed not to change their dosage during treatment.

“Nine of the participants (five of whom were in the ABBT condition) reported taking psychotropic medication (anxiolytics, antidepressants or both) but had remained on a stable dose for at least three months and agreed to not alter their dosage during treatment.”

May combine two claims.

There were no significant baseline differences between conditions in gender, racial self-identification, or age.

“Chi-square analyses and independent t-tests revealed no significant differences between conditions in gender, racial self-identification, or age.”

Probably not a substantial claim: may not pass S3 (load-bearing).

A cognitive-behavioral treatment based on the intolerance-of-uncertainty model has shown promising results.

“A cognitive-behavioral treatment based on this model has been developed and has shown promising results (Dugas & Koerner, 2005).”

• cites Dugas & Koerner, 2005 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In this sample, the Affective Control Scale had internal consistency of .94 for the total score, .84 for anger, .87 for positive affect, .87 for depression, and .87 for anxiety.

“Internal consistency in this sample was .94 (total score), .84 (anger), .87 (positive affect), .87 (depression), and .87 (anxiety).”

Probably not a substantial claim: may not pass S3 (load-bearing).

The Intolerance of Uncertainty Scale has significant positive correlations with measures of psychopathology, including worry.

“Moreover, the IUS demonstrated significant positive correlations with measures of psychopathology, including worry (Buhr & Dugas, 2002).”

• cites Buhr & Dugas, 2002 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The study was conducted in compliance with the relevant institutional review boards.

“The study was conducted in compliance with the University of Massachusetts at Boston, Boston University, Suffolk University, and Boston VA Healthcare System Institutional Review Boards.”

May combine two claims.

Chronic rigid attempts to control and avoid internal experiences increase distress and impair quality of life.

“This in turn leads to chronic, rigid attempts to control and avoid internal experiences, which further increases distress and impairs quality of life (Hayes, Wilson, Gifford, Follette, & Strosahl, 1996)”

• cites Hayes, Wilson, Gifford, Follette, & Strosahl, 1996 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Intolerance of uncertainty distinguishes GAD patients from patients with other anxiety disorders.

“and GAD patients from patients with other anxiety disorders (Ladouceur et al., 1999).”

• cites Ladouceur et al., 1999 sourceNot checked — no full text of the source

May combine two claims.

The sample size and minimal racial diversity limit generalizability of the findings.

“In addition, the sample size and minimal racial diversity of the sample limits the ability to generalize from the current findings.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

Current measures of control may not capture these subtleties or the change in control expectancies that likely result from ABBT.

“Current measures of control may not be sensitive to these subtleties or the change in expectancies about control that likely occur as a function of ABBT.”

• AssumptionRests on an assumption: Clients typically enter therapy wanting to change their internal experiences to change their lives, and they view their inability to control anxiety and other emotions as a personal weakness.
• AssumptionRests on an assumption: Emotions and other reactions naturally arise as people engage in life, and people lack total control over others and their environments.

Probably not a substantial claim: may not pass S3 (load-bearing).

Factor analysis supports a three-factor structure for the ACQ-R (stress control, emotion control, threat control) plus a higher-order perceived control factor, in both clinical and non-clinical samples.

“Factor analysis indicates the presence of three factors, representative of the domains mentioned above, as well as a higher order factor of perceived control in both clinical and non-clinical samples.”

• cites Brown et al., 2004 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In the present sample, the ACQ-R showed internal consistency of .85 for the total score, .67 for emotion control, .85 for threat control, and .76 for stress control.

“Internal consistency in this sample was .85 (total score), .67 (emotion control), .85 (threat control), and .76 (stress control).”

May combine two claims.

Because suppression, avoidance, and control attempts increase negative thoughts and emotional discomfort, relinquishing control and reducing this struggle is likely associated with increased efficacy.

“Inasmuch as attempts at suppression, avoidance and control increase negative thoughts and emotional discomfort (Eifert & Heffner, 2003), relinquishing control, and therefore reducing this struggle, is likely associated with an increased sense of efficacy.”

• cites Eifert & Heffner, 2003 sourceNot checked — no full text of the source

• AssumptionRests on an assumption: Emotions and other reactions naturally arise as people engage in life, and people lack total control over others and their environments.

Probably not a substantial claim: may not pass S3 (load-bearing).

Mindfulness and acceptance-based approaches may increase a person's sense of agency or mastery regarding their anxiety.

“Like many traditional forms of CBT, mindfulness and acceptance-based approaches may increase one's sense of agency or mastery in regard to their anxiety (Arch & Craske, 2008).”

• cites Arch & Craske, 2008 sourceNot checked — no full text of the source

• AssumptionRests on an assumption: Emotions and other reactions naturally arise as people engage in life, and people lack total control over others and their environments.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The principal investigator assigned condition by coin flip, and later clients matched to an enrolled client on gender, racial minority status, and GAD severity were assigned to the opposite condition to balance these variables.

“The PI (L. Roemer) assigned condition using a coin flip; subsequent clients who matched an enrolled client in gender, racial minority status, and GAD severity (moderate versus severe) were automatically assigned to the opposite condition in order to ensure balance in these variables across conditions in this small sample.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

ABBTs may change clients' expectations about whether and how they can gain control over certain situations, which may affect their reports on perceived control measures.

“Relatedly, ABBTs may alter clients’ expectations about the possibility and necessity of gaining control over certain situations (such as internal reactions to an event, the behavior of other people, or the future), which may affect their reports on measures of perceived control.”

• AssumptionRests on an assumption: Clients typically enter therapy wanting to change their internal experiences to change their lives, and they view their inability to control anxiety and other emotions as a personal weakness.

Classified as probably not a substantial claim. May combine two claims.

Thirty-one consenting participants were randomly assigned to treatment or wait-list using a randomized block procedure.

“The 31 participants who consented to take part in the study were randomly assigned to either a treatment or wait-list condition in a randomized block fashion.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The ACQ-R has acceptable scale reliabilities for stress control (r = .71), emotion control (r = .73), threat control (r = .73), and the higher-order perceived control factor (r = .85).

“Scale reliabilities were acceptable for stress control (r = .71), emotion control (r = .73), threat control (r = .73), and the higher order factor of perceived control (r = .85).”

• cites Brown et al., 2004 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Four participants dropped out during the waiting-list period.

“As mentioned previously, four participants dropped out of the study during the waiting list period.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Mindfulness may increase a sense of influence over experience without creating beliefs about the ability or need to control internal experience.

“Thus, mindfulness may increase a sense of influence or ability to influence experience, without engendering beliefs about the ability (or need) to control internal experience.”

• AssumptionRests on an assumption: Emotions and other reactions naturally arise as people engage in life, and people lack total control over others and their environments.

May combine two claims.

ABBT appears to affect several components addressed in current models of GAD, and these changes appear stable over time.

“In short, it appears that this ABBT affects several of the components addressed in current models of GAD, while growth curve analyses indicate that these changes appear to be stable over time.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Some ACQ-R items may assess influence rather than rigid control.

“For example, in the ACQ-R (Brown et al., 2004) items such as “I am unconcerned if I become anxious in a situation, because I am confident in my ability to cope with my symptoms” may be assessing influence rather than rigid control.”

• cites Brown et al., 2004 sourceNot checked — no full text of the source

• AssumptionRests on an assumption: Clients typically enter therapy wanting to change their internal experiences to change their lives, and they view their inability to control anxiety and other emotions as a personal weakness.

May combine two claims.

Because assessments occurred only at pre- and post-treatment, the course of change cannot be determined, which is necessary to identify mechanisms of action.

“Further, assessments were only conducted pre- and post-treatment, so we cannot determine the course of change, which is necessary for determining mechanisms of action.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Shared mechanisms of action may underlie many traditional cognitive-behavioral and acceptance-based behavioral treatments.

“In short, there may be shared mechanisms of action underlying many traditional cognitive-behavioral and acceptance-based behavioral treatments (Arch & Craske, 2008).”

• cites Arch & Craske, 2008 sourceNot checked — no full text of the source

• AssumptionRests on an assumption: The theoretical models of GAD discussed in the paper have broad empirical support for their distinct conceptualizations.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The ACQ-R is a 15-item instrument that assesses perceived control over anxiety-related events.

“The Anxiety Control Questionnaire-Revised (ACQ-R; Brown et al., 2004) is a 15-item measure of one's perceived control over anxiety related events.”

• cites Brown et al., 2004 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable).

The construct of control may be more multifaceted than how it is conceptualized in many current measures.

“The construct of control may be much more multifaceted than its conceptualization in many current measures.”

• AssumptionRests on an assumption: Clients typically enter therapy wanting to change their internal experiences to change their lives, and they view their inability to control anxiety and other emotions as a personal weakness.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The measures used may not fully represent the various models, and other important contributing or maintaining factors may have gone unassessed.

“In addition, the measures used in the current may not represent a complete assessment of the various models, and there may be other important contributing and maintaining factors in these models that may have gone unassessed.”