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Cited by 149Treatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Research Topics

AN OPEN TRIAL OF EMOTION REGULATION THERAPY FOR GENERALIZED ANXIETY DISORDER AND COOCCURRING DEPRESSION.

Open access
Mennin, Douglas S., Fresco, David M., Ritter, Michael, Heimberg, Richard G.·2015·Depression and Anxiety
DOI 10.1002/da.22377PMC PMC4515189
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Abstract

Background: Although CBT is efficacious for a wide variety of psychiatric conditions, relatively fewer GAD patients achieve high endstate functioning as compared to patients receiving CBTs for other disorders. Moreover, GAD trials that utilized patient samples without prominent depression have tended to report that effect sizes for depressive outcomes were small or diminished to pretreatment levels in the follow-up period. Emotion regulation therapy (ERT) integrates principles from traditional and contemporary cognitive behavioral treatments with basic and translational findings from affect science to offer a blueprint for improving intervention by focusing on motivational, regulatory, and contextual learning mechanisms.Method: The purpose of this investigation was to provide initial support for the efficacy of ERT in an open trial of patients with GAD and cooccurring depressive symptoms. Twenty-one patients received a 20-session version of ERT delivered in weekly individual sessions. Standardized clinician ratings and self-report measures were assessed at pre-, mid-, and posttreatment as well as at three- and nine-month follow-ups. Intent-to-treat analyzes were utilized.Results: GAD patients, half with comorbid major depression, evidenced statistically, and clinically meaningful improvements in symptom severity, impairment, quality of life, and in model-related outcomes including emotional/motivational intensity, mindful attending/acceptance, decentering, and cognitive reappraisal. Patients maintained gains across the three and nine month follow-up periods.Conclusions: These findings, although preliminary, provide additional evidence for the role of emotion dysregulation in the onset, maintenance, and now treatment of conditions such as GAD and cooccurring depressive symptoms.

Integrity signals

Registry

Crossref · 10.1002/da.22377

Cites

94 of 94 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

26 of 52 cited sources checked · 8 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    GAD trials that used patient samples without prominent depression have tended to report that effect sizes for depressive outcomes were small or diminished to pre-treatment levels in follow-up.

    “many of these trials utilized samples of GAD patients without prominent MDD or depression68–70 and, in some instances, found that effect sizes for depression outcomes were small or diminished to pre-treatment levels in the follow-up period8.”
    Quote in the paperSubstantial claim2 of 4 sources checked
    • cites [68] Borkovec, 2002, A component analysis of cognitive behavioral therapy for generalized anxiety disorder and the role of interpersonal problems, J Consult Clin Psychol source
    • cites [69] Ladouceur, 2002, Efficacy of a new cognitive-behavioral treatment for generalized anxiety disorder: evaluation in a controlled clinical trial, J Consult Clin Psychol source
    • cites [70] Dugas, 2010, A randomized clinical trial of cognitive-behavioral therapy and applied relaxation for adults with generalized anxiety disorder, Behav Ther source
    • cites [8] Newman, 2010, Diagnostic comorbidity in adults with generalized anxiety disorder: impact of comorbidity on psychotherapy outcome and impact of psychotherapy on comorbid diagnoses, Behav Ther source
  • Interpretationcitation

    These findings provide additional evidence for the role of emotion dysregulation in the onset, maintenance, and treatment of GAD with and without MDD.

    “These findings, although preliminary, provide additional evidence for the role of emotion dysregulation (see52, 53) in the onset, maintenance, and now treatment of conditions such as GAD with and without MDD.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [52] Fresco, 2013, Emotion regulation therapy for generalized anxiety disorder, Cogn Behav Practice source

      The paper describes emotion-regulation deficits in GAD with and without MDD and presents Emotion Regulation Therapy as a treatment targeting those deficits (Abstract; page unavailable). It also describes maladaptive responses that can perpetuate difficulties, but the passages do not establish a role for emotion dysregulation in the onset of GAD. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [53] Mennin, 2014

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

    • Rests on an assumption: Improvements observed in the open trial are attributable to ERT rather than to passage of time, regression to the mean, expectancy effects, or other nonspecific factors.
  • Findingown data

    GAD CSR improved from pre- to mid-treatment with an effect size of 1.42.

    “Findings demonstrated improvements from pre- to mid-treatment (g = 1.42) on GAD CSR”
    Quote in the paperNot a substantial claim
  • Findingown data

    In the open trial, GAD patients receiving ERT showed improvements in impairment.

    “GAD patients, half with comorbid major depression, evidenced statistically and clinically meaningful improvements in symptom severity, impairment, quality of life, and in model-related outcomes including emotional/motivational intensity, mindful attending/acceptance, decentering, and cognitive reappraisal.”
    Quote in the paperSubstantial claim
  • Findingown data

    In the open trial, GAD patients receiving ERT showed improvements in quality of life.

    “GAD patients, half with comorbid major depression, evidenced statistically and clinically meaningful improvements in symptom severity, impairment, quality of life, and in model-related outcomes including emotional/motivational intensity, mindful attending/acceptance, decentering, and cognitive reappraisal.”
    Quote in the paperSubstantial claim
  • May combine two claims. 35
  • Classified as probably not a substantial claim. 12

  • May combine two claims.

    Premisecitation

    GAD and conceptually related conditions lag behind in treatment efficacy compared to other anxiety and mood disorders, make otherwise efficacious interventions for MDD refractory, and are associated with difficulties maintaining durability of comorbid MDD gains over the long term.

    “GAD, and conceptually related conditions (e.g., MDD with anxious apprehensive features) lag behind in treatment efficacy compared to other anxiety and mood disorders6, makes otherwise efficacious interventions for MDD refractory7, and are associated with notable difficulties in maintaining durability of comorbid MDD gains over the long term8.”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [6] Waters, 2005

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

    • cites [7] Farabaugh, 2010, Anxious depression and early changes in the HAMD-17 anxiety-somatization factor items and antidepressant treatment outcome, Int Clin Psychopharmacol source

      Split into 2 atoms — 0 confirmed, 0 partially supported, 1 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [8] Newman, 2010, Diagnostic comorbidity in adults with generalized anxiety disorder: impact of comorbidity on psychotherapy outcome and impact of psychotherapy on comorbid diagnoses, Behav Ther source

      Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    GAD, especially when comorbid with MDD, is characterized by subjective emotional intensity/distress, greater temperamental negative affect, and activation of motivational systems that prize safety over reward.

    “GAD, especially when comorbid with MDD, can be seen as characterized by subjective emotional intensity/distress20, reflecting greater temperamental negative affect25–26 and activation of motivational systems that prize obtaining safety (from perceived threat) over seeking reward27–29 [motivational mechanisms].”
    Quote in the paperSubstantial claim2 of 6 sources checked
    • cites [20] Mennin, 2007, Delineating components of emotion and its dysregulation in anxiety and mood psychopathology, Behav Ther source
    • cites [25] Krueger, 2006, Reinterpreting comorbidity: a model-based approach to understanding and classifying psychopathology, Ann Rev Clin Psychol source
    • cites [26] Watson, 2005, Rethinking the mood and anxiety disorders: a quantitative hierarchical model for DSM-V, J Abnormal Psychol source
    • cites [27] Campbell-Sills, 2004, Psychometric evaluation of the behavioral inhibition/behavioral activation scales in a large sample of outpatients with anxiety and mood disorders, Psychol Assess source
    • cites [28] Klenk, 2011, Regulatory focus and anxiety: a self-regulatory model of GAD-depression comorbidity, Pers Individ Dif source
    • cites [29] Woody, 1994, Generalized anxiety disorder (GAD) as an unsuccessful search for safety, Clin Psychol Rev source

  • Classified as probably not a substantial claim.

    Premisecitation

    Investigators have emphasized maladaptive cognitive, emotional, and interpersonal processes in increasing worry.

    “investigators have built on Borkovec’s perspective by emphasizing the role of maladaptive cognitive (i.e., intolerance of uncertainty18; meta-worry19), emotional (i.e., non-acceptance17; dysregulation16, 20), and interpersonal21, 22 processes in increasing worry.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [18] Deschenes, 2010, Experimental manipulation of beliefs about uncertainty: effects on interpretive processing and access to threat schemata, J Exp Psychol source
    • cites [19] Wells, 2009, Maladaptive thought control strategies in generalized anxiety disorder, depressive disorder, and nonpatient groups and relationships with trait anxiety, Int J Cogn Ther source
    • cites [17] Roemer, 2005, Fear and avoidance of internal experiences in GAD: preliminary tests of a conceptual model, Cogn Ther Res source

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

    Premisecitation

    Worry serves an avoidance function and becomes reinforced by increasing predictability of negative emotional experience, often at the cost of experiencing positive and rewarding states.

    “worry serves an avoidance function or, as more recently explicated, that worry becomes reinforced by increasing predictability of negative emotional experience, often at the cost of experiencing positive and rewarding states (i.e., diminishing emotional contrasts10).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Borkovec9

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

    • cites [10] Newman, 2011, A novel theory of experiential avoidance in generalized anxiety disorder: a review and synthesis of research supporting a contrast avoidance model of worry, Clin Psychol Rev source

  • May combine two claims.

    Premisecitation

    Individuals with GAD may respond poorly to motivational conflict, demonstrating deficits in attentional and cognitive elaborative regulation strategies.

    “these individuals may respond poorly to this motivational conflict, demonstrating deficits in different systems of regulation30 encompassing attentional (e.g., attentional flexibility in processing both interoceptive and exteroceptive emotional stimuli31–33, 11) and more cognitive elaborative strategies (e.g., meta-cognitive awareness, cognitive reappraisal34, 35).”
    Quote in the paperSubstantial claim3 of 7 sources checked
    • cites [30] Gross, 2013, Emotion regulation: taking stock and moving forward, Emotion source
    • cites [31] Botvinick, 2001, Conflict monitoring and cognitive control, Psychol. Rev source
    • cites [32] Clasen, 2013, Attentional biases and the persistence of sad mood in major depressive disorder, J. Abnormal Psychol source

      The Results (Attentional Bias; page unavailable) link attentional bias for emotional stimuli to impaired mood recovery, supporting the attentional-regulation part of the citation. The study concerns people with and without major depressive disorder, not GAD, and does not establish deficits in attentional flexibility across interoceptive and exteroceptive stimuli. The cognitive-elaborative examples in the citing sentence carry other citations, not this one. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [33] Mogg, 2005, Attentional bias in generalized anxiety disorder versus depressive disorder, Cogn Ther Res source
    • cites [11] Etkin, 2010, Failure of anterior cingulate activation and connectivity with the amygdala during implicit regulation of emotional processing in generalized anxiety disorder, Am J Psychiatry source

      The Discussion reports that patients with GAD could not adapt to emotional conflict and had a deficit in implicit emotional regulation. It does not establish deficits across different regulatory systems, including the attentional flexibility or cognitive elaborative strategies named in the citing sentence; those examples carry separate citations. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [34] Aldao, 2012, Paradoxical cardiovascular effects of implementing adaptive emotion regulation strategies in generalized anxiety disorder, Behav Res Ther source
    • cites [35] Andreescu, 2011, Altered cerebral blood flow patterns associated with pathologic worry in the elderly, Depress Anxiety source

      The Conclusion reports impaired top-down regulation of worry in elderly people with GAD and discusses automatic and instructed emotion regulation. It does not test responses to motivational conflict, and its finding is limited to elderly participants rather than people with GAD generally. The attentional and cognitive-elaborative examples carry other citations in the citing sentence. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    Core intervention principles that address both lesser and greater elaborative processes may be the conceptual framework underlying successful CBT interventions.

    “core intervention principles that address both lesser and greater elaborative processes (i.e., simultaneously increasing attentional flexibility, improving meta-cognitive processing, and promoting the engagement of both threat and reward contexts) may be the conceptual framework that underlies successful CBT interventions77.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [77] Mennin, 2013, United we stand: emphasizing commonalities across cognitive-behavioral therapies, Behav Ther source

  • May combine two claims.

    Premisecitation

    Non-CBT treatments such as mindfulness-based interventions or bias modification programs have shown some promise in reducing GAD severity but often did not enroll GAD patients with prominent depression, restore high endstate functioning, or significantly resolve depression when present.

    “non-CBT treatments such as mindfulness-based interventions consisting solely of meditative practice71–73 or bias modification programs74, 75, which may be seen as requiring less effort to deliver, have shown some promise in reducing GAD severity but often did not enroll GAD patients with prominent levels of depression72), restore patients to high endstate functioning75, 76, or significantly resolv”
    Quote in the paperSubstantial claim4 of 5 sources checked
    • cites [71] Hoge, 2013, Randomized controlled trial of mindfulness meditation for generalized anxiety disorder, J Clin Psychiatry source

      Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [72] Evans, 2008, Mindfulness-based cognitive therapy for generalized anxiety disorder, J Anxiety Disord source
    • cites [73] Goyal, 2014, Meditation programs for psychological stress and well-being, JAMA Intern Med source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [74] Amir, 2009, Attention modification program in individuals with generalized anxiety disorder, J Abnormal Psychol source

      Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [75] Amir, 2012, Combining computerized home-based treatments for generalized anxiety disorder: an attention modification program and cognitive behavioral therapy, Behav Ther source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Recent CBT interventions have integrated both less and more elaborate training components by synthesizing mindfulness and attention training with traditional CBT techniques, resulting in high endstate functioning achieved and maintained through follow-up while also sampling patients with prominent depression features at baseline.

    “recent CBT interventions have integrated both less and more elaborate training components by synthesizing mindfulness and attention training with traditional CBT techniques78–80, resulting in high endstate functioning which is achieved and maintained through follow-up periods, while also sampling patients evidencing prominent depression features at baseline78–80.”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [78] Ellard, 2010, Unified protocol for the transdiagnostic treatment of emotional disorders: protocol development and initial outcome data, Cogn Behav Pract source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [79] Roemer, 2008, Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: evaluation in a randomized controlled trial, J Consult Clin Psychol source

      Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [80] Wells, 2010, A pilot randomized trial of metacognitive therapy vs. applied relaxation in the treatment of adults with generalized anxiety disorder, Behav Res Ther source

  • May combine two claims.

    Premisecitation

    Worry results in increased threat conditionability, greater stimulus generalization, and diminished ability to discriminate stimuli and learning contingencies, and GAD is associated with restrictions in valued actions and goals.

    “worry results in increased threat conditionability, greater stimulus generalization, and diminished ability to discriminate stimuli and learning contingencies37–39 and GAD is associated with restrictions in valued actions and goals40.”
    Quote in the paperSubstantial claim3 of 4 sources checked
    • cites [37] Otto, 2007, Prediction of “fear” acquisition in healthy control participants in a de novo fear-conditioning paradigm, Behav Modif source

      The Results (page unavailable) link higher worry scores to greater fear conditioning in healthy adults, particularly when considered alongside lower avoidance. They do not show greater stimulus generalization or diminished discrimination; worry positively predicted differential conditioning, which measures different responses to threat and safety cues. The separate claim about GAD and valued actions is attached to citation 40, not this source. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [38] Lissek, 2012, Toward an account of clinical anxiety predicated on basic, neurally mapped mechanisms of pavlovian fear-learning: the case for conditioned overgeneralization, Depress Anxiety source

      Section IV, “GAD, SAD, and generalization” (page unavailable), reports greater conditioned-fear generalization in people with GAD; Section III discusses fear responding to safety cues in clinical anxiety. The paper does not establish that worry causes increased threat conditionability or diminished discrimination of learning contingencies. The valued-actions clause has a separate citation (40), so it is not attributed to this source. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [39] Salters-Pedneault, 2008, An experimental investigation of the effect of worry on responses to a discrimination learning task, Behav Ther source
    • cites [40] Michelson, 2011, The role of values-consistent behavior in generalized anxiety disorder, Depress Anxiety source

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

    Premisecitation

    A functional perspective of worry has been supported in studies using neurobiological, psychophysiological, behavioral, and self-report measurement.

    “A functional perspective of worry has been supported in studies utilizing neurobiological11, psychophysiological12–14, behavioral15, and self-report16–17 measurement.”
    Quote in the paperNot a substantial claim2 of 5 sources checked
    • cites [11] Etkin, 2010, Failure of anterior cingulate activation and connectivity with the amygdala during implicit regulation of emotional processing in generalized anxiety disorder, Am J Psychiatry source

      Citation 11 is attached to the neurobiological-measurement part of the sentence. The Introduction and Discussion report neural findings in generalized anxiety disorder that are consistent with a regulatory role for worry, but the Discussion explicitly presents worry’s compensatory function as speculation; the study did not directly test that function. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [12] Llera, 2010, Effects of worry on physiological and subjective reactivity to emotional stimuli in generalized anxiety disorder and nonanxious control participants, Emotion source
    • cites [13] Oathes, 2011, Chronic worry and the temporal dynamics of emotional processing, Emotion source
    • cites [14] Weinberg, 2012, Increased error-related brain activity distinguishes generalized anxiety disorder with and without comorbid major depressive disorder, J Abnormal Psychol source

      The Results (Error-Related Brain Activity; page unavailable) report a larger error-related neural response in participants with GAD without comorbid depression, and the introductory passage reports an association between worry and error-related brain activity. This supports the neurobiological-measurement portion of the citation, but the paper does not establish what function worry serves. Citation 11 is not being asked to support the other measurement types. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
    • cites [15] Cooper, 2013, Behavioral indicators of emotion avoidance and subsequent worry in generalized anxiety disorder and depression, J Exp Psychopathol source

  • May combine two claims.

    Premisecitation

    Rumination is associated with decreases in the likelihood of new reward-based learning, weakens instrumental action, and reduces engagement of potentially rewarding social networks.

    “rumination is associated with decreases in the likelihood of new reward-based learning, weakens instrumental action, and engagement of potentially rewarding social networks41–43 [contextual learning consequences].”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [41] Bar, 2009, A cognitive neuroscience hypothesis of mood and depression, Trend Cogn Sci source

      The paper’s ‘Relevant aspects of associative processing’ section describes rumination as narrow associative thinking and says associations are important for learning and action. Its ‘Concluding remarks’ link broad associations with learning and a positive-mood reward. These passages offer a basis for the learning and action portions of the claim, but do not establish reduced reward-based learning or weakened instrumental action specifically; they do not address engagement with rewarding social networks. The available passages have no page numbers. (LLM, conf=0.73)

      Experimental — accuracy not yet measured
    • cites [42] Joormann, 2010, Interference resolution in major depression, Cogn Affective Behav Neurosci source

      The Study 2 Discussion links rumination to difficulty removing irrelevant negative material from short-term memory. Searches for reward-based learning, instrumental action, and rewarding social engagement found no passage in our copy addressing those claimed consequences. (LLM, conf=0.73)

      Experimental — accuracy not yet measured
    • cites [43] Ferster, 1973, A functional analysis of depression, Am Psychol source

  • May combine two claims.

    Findingown data

    Diagnostic indices for all anxiety and mood disorders significantly improved from pre-treatment to post-treatment and follow-up periods, with effect sizes from 0.52 to 3.90.

    “Diagnostic indices for all anxiety and mood disorders significantly improved from pre-treatment to post-treatment and the follow-up periods (g’s 0.52 to 3.90).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Self-reported anxiety outcomes improved by mid-treatment with effect sizes from 0.71 to 0.98 and further by post-treatment with effect sizes from 0.85 to 1.67.

    “Findings reveal improvements by mid-treatment (g’s 0.71 to 0.98) with additional gains by post-treatment (g’s 0.85 to 1.67).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Gains in depression outcomes were maintained at 3-month and 9-month follow-ups relative to pre-treatment, with effect sizes from 0.65 to 1.17 and 0.93 to 1.35 respectively.

    “Relative to pre-treatment, gains in depression outcomes were maintained at three-month follow-up (g’s = 0.65 to 1.17) and nine-month follow-up (g’s = 0.93 to 1.35).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Both the Sheehan Disability Scale and the Quality of Life Inventory showed sizable gains by post-treatment, with effect sizes from -0.90 to 0.94.

    “but sizable gains by post-treatment for both measures (g’s= −0.90 to 0.94).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Gains in disability and quality of life were maintained at 3-month and 9-month follow-ups relative to pre-treatment, with effect sizes from -0.77 to 0.79 and -1.05 to 1.11 respectively.

    “Relative to pre-treatment, gains in disability and quality of life are maintained at three-month follow-up (g’s = −.77 to .79) and nine-month follow-up (g’s = −1.05 to 1.11).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    66.7% of patients achieved high endstate functioning post-treatment, increasing to 75.0% at 3 months and 85.0% at 9 months.

    “Findings indicated that 66.7% of patients achieved high endstate functioning following treatment and that the percent increased at three months (75.0%) and nine months (85.0%).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    45.5% of comorbid MDD patients achieved high endstate functioning post-treatment, increasing to 70% at 3 months and 80.0% at 9 months.

    “45.5% of patients with comorbid MDD achieved high endstate functioning following treatment, and the percentage increased at three months (70%) and nine months (80.0%).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The Sheehan Disability Scale improved by mid-treatment with an effect size of 0.45.

    “findings reveal improvement by mid-treatment for the SDS (g = 0.45)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    At post-treatment, all ERT model-related measures showed sizable improvements, with effect sizes from -0.61 to -1.32.

    “However, at post-treatment, all measures show sizable improvements (g’s = −0.61 to −1.32).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The Quality of Life Inventory did not improve by mid-treatment, with an effect size of -0.30.

    “but not the QOLI (g = −0.30)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    ERT model-related outcomes showed no improvements by mid-treatment, with effect sizes from -0.23 to -0.75.

    “Findings reveal no improvements by mid-treatment for candidate mechanism measures (g’s = −0.23 to −0.75).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Using a stringent MDD index requiring at least 30% improvement on at least 3 of 4 measures, 54.5% of comorbid MDD patients evidenced clinical improvement, increasing to 90.0% at 3 months but diminishing to 60.0% at 9 months.

    “a majority of patients with comorbid MDD (54.5%) evidenced clinical improvement with the rate increasing at three months (90.0%) but diminishing somewhat at nine months (60.0%).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Using a stringent GAD index requiring at least 30% improvement on at least 4 of 6 measures, 81% of patients evidenced strong gains post-treatment, maintained at 3 months (90%) and 9 months (90%).

    “a considerable majority of patients receiving open-label ERT also evidenced strong gains following treatment (81%) with the gains maintained at three months (90%) and nine months (90%).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Gains in self-reported anxiety outcomes were maintained at 3-month and 9-month follow-ups relative to pre-treatment, with effect sizes from 0.94 to 1.59 and 1.04 to 1.77 respectively.

    “Relative to pre-treatment, gains in anxiety outcomes were maintained at three-month follow-up (g’s 0.94 to 1.59) and nine-month follow-up (g’s 1.04 to 1.77).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Open-label ERT was associated with clinician-assessed improvement rates of 81.0% for CSR < 4 and 95.2% for CGI-I < 3, with gains maintained or increased at 3 and 9 months post-treatment ranging from 85% to 95%.

    “Open-label ERT was associated with impressive rates of clinician-assessed improvement (CSR < 4, 81.0% or CGI-I < 3, 95.2%) with gains maintained or increased at three months and nine months post-treatment (Range = 85% to 95%).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    At 3-month follow-up, gains in all model-related outcomes except AIM Negative Intensity were maintained relative to pre-treatment, with effect sizes from 0.25 to -1.30.

    “Relative to pre-treatment, gains in all but one model-related outcome (i.e., AIM Negative Intensity) were maintained at three-month follow-up (g’s = 0.25 to −1.30).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Self-reported depression outcomes showed some improvement by mid-treatment with effect sizes from 0.35 to 0.82 and sizable gains by post-treatment with effect sizes from 0.76 to 1.25.

    “Findings reveal some improvement by mid-treatment for depression outcomes (g’s = 0.35 to 0.82) with sizable gains by post-treatment for all measures (g’s = 0.76 to 1.25).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    ERT therapists delivered treatment components with high frequency (80% to 100%) and skillfulness (73% to 100%), and there were few lapses into non-treatment components per session (0.1 to 1.6).

    “ERT therapists evidenced high frequency (80% to 100%) and skillfulness (73% to 100%) of treatment component delivery. Further, there were relatively few lapses into non-treatment components per session (0.1 to 1.6).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Findings support the preliminary efficacy of ERT for GAD and co-occurring depressive symptoms and suggest that affect science may provide a useful framework for integrating efficacious approaches to anxiety and depression.

    “Despite these caveats, findings from this trial do support the preliminary efficacy of ERT for GAD and co-occurring depressive symptoms and suggest that affect science may provide a useful framework for integrating efficacious approaches to anxiety and depression.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Improvements observed in the open trial are attributable to ERT rather than to passage of time, regression to the mean, expectancy effects, or other nonspecific factors.
    • Rests on an assumption: The sample of 21 treatment-seeking patients is representative of the broader population of GAD patients with co-occurring depressive symptoms.

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

    Premisenone given

    Traditional CBTs largely use more cognitively elaborative, verbally mediated techniques focused on distorted beliefs, whereas mindfulness-based and bias modification programs target less elaborative attentional deficits without relying heavily on verbal exchange.

    “traditional CBTs largely utilize more cognitively elaborative, verbally mediated, techniques that are focused on cognitively elaborate deficits such as distorted beliefs. In contrast, mindfulness-based meditative interventions and bias modification programs focally target less elaborative, attentional, deficits without relying heavily on verbal, linguistically mediated, exchange.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    ERT provided notably high response rates and endstate functioning levels, used a sample with prominent baseline depression, and produced large reductions in MDD symptoms and severity that were maintained into follow-up.

    “ERT provided notably high response rates and endstate functioning levels, utilized a sample with prominent baseline depression, and produced large reductions in MDD symptoms and severity that were maintained into the follow-up period.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Improvements observed in the open trial are attributable to ERT rather than to passage of time, regression to the mean, expectancy effects, or other nonspecific factors.

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

    Premisecitation

    GAD is a chronic and debilitating condition associated with impairment equivalent to MDD, poorer life quality than MDD when only non-comorbid cases are compared, and independent associations with negative functional outcomes when both disorders are comorbid.

    “generalized anxiety disorder (GAD) is a actually a chronic and debilitating condition that is associated with diminished impairment equivalent to major depressive disorder (MDD3), poorer life quality than MDD when only non-comorbid cases are compared between the two disorders4, and independent associations with negative functional outcomes when both disorders are comorbid5.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [3] Wittchen, 2002, Generalized anxiety disorder: prevalence, burden, and cost to society, Depress Anxiety source
    • cites [4] Wittchen, 2000, Disabilities and quality of life in pure and comorbid generalized anxiety disorder and major depression in a national survey, Int Clin Psychopharmacol source
    • cites [5] Stein, 2004, Well-being and life satisfaction in generalized anxiety disorder: comparison to major depressive disorder in a community sample, J Affective Disord source

  • May combine two claims.

    Study design and conductown data

    Inter-rater agreement for treatment adherence ratings was high for frequency (90%) and skillfulness (88%).

    “High agreement was established for both frequency (90%) and skillfulness (88%) ratings.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    CBT is efficacious for a wide variety of psychiatric conditions, but relatively fewer GAD patients achieve high endstate functioning compared to patients receiving CBTs for other disorders.

    “Although CBT is efficacious for a wide variety of psychiatric conditions, relatively fewer GAD patients achieve high endstate functioning as compared to patients receiving CBTs for other disorders.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6] Waters, 2005

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

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    A Bonferroni correction was used for each family of analysis to address multiple comparisons and Type I errors.

    “Given multiple comparisons and to address the possibility of Type I errors, we utilized a Bonferroni correction for each family of analysis”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    Independent assessors blind to particular details about the patient completed clinician measures at all time points.

    “Intake interviewers (pre-treatment) as well as independent assessors (all time points) who were blind to particular details about the patient (beyond receiving ERT) completed the clinician measures.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    Institutional Review Boards approved the study procedures at both sites, and all patients offered informed consent.

    “Institutional Review Boards approved procedures for the study at both sites and all patients offered informed consent.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    An intent-to-treat analysis plan using data from all 21 patients was used.

    “Findings are based upon an intent-to-treat (ITT) analysis plan using data from all 21 patients.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    Because missing data were minimal in the follow-up period, a last observation carried forward approach was used.

    “Given that missing data were minimal in the follow-up period, a last observation carried forward approach was employed”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    There were no demographic differences across sites and no baseline clinical or demographic differences associated with treatment response.

    “There were no demographic differences across the two sites, and no baseline clinical and demographic differences associated with treatment response (analyses available upon request).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Diagnostic agreement in diagnosis and CSR within 1 point was required for study inclusion.

    “Diagnostic agreement (in diagnosis and CSR within 1 point; ADIS CSR was used at both sites) was necessary for study inclusion.”
    Quote in the paperSubstantial claim
42 of 42

  • The paper relies on this without support.

    Improvements observed in the open trial are attributable to ERT rather than to passage of time, regression to the mean, expectancy effects, or other nonspecific factors.

    “Although open trial designs have several weaknesses (e.g., lack of a control comparison, ability to address expectancy effects)”
    “a well-powered, randomized control design is necessary to corroborate the significance of these findings for the efficacy of ERT.”

  • The paper relies on this without support.

    The sample of 21 treatment-seeking patients is representative of the broader population of GAD patients with co-occurring depressive symptoms.

    “Participants were 21 treatment-seeking individuals at two PhD training clinic sites in the Northeastern United States”
    “utilized a sample with prominent baseline depression”

  • The paper relies on this without support.

    The 20-session version of ERT is an adequate dose for testing ERT's efficacy.

    “Twenty-one patients received a 20-session version of ERT delivered in weekly individual sessions.”
    “It is unclear if this length is necessary and cost-effective.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Emotion Regulation Therapy has shown efficacy in open and randomized trials for generalized anxiety disorder with and without co-occurring depression.

    “Emotion Regulation Therapy (ERT) has demonstrated efficacy in both open and randomized trials for generalized anxiety disorder (GAD) with and without co-occurring depression.”

    From Changes in Decentering and Reappraisal Temporally Precede Symptom Reduction During Emotion Regulation Therapy for Generalized Anxiety Disorder With and Without Co-Occurring Depression. (2019) · cites this paper as Mennin et al., 2015

    The Abstract (Method) and Results report improvements in an open trial of ERT for patients with GAD and co-occurring depressive symptoms. The Discussion says a randomized controlled design is still needed to corroborate efficacy; this paper does not support the claim that efficacy has been demonstrated in randomized trials. (LLM, conf=0.91)

    Experimental — accuracy not yet measured

  • ERT also improved decentering, cognitive reappraisal, and trait mindfulness and reduced negative emotionality and emotion regulation deficits, with follow-up gains (Hedge's g = 0.52-3.90).

    “ERT also resulted in model-related gains, including greater decentering, cognitive reappraisal, and trait mindfulness, as well as reduced negative emotionality and overall emotion regulation deficits (Mennin et al., 2015) with gains maintained throughout follow-up (Hedge’s g = 0.52–3.90).”

    From A Pilot Study of Emotion Regulation Therapy for Generalized Anxiety and Depression: Findings From a Diverse Sample of Young Adults. (2018) · cites this paper as Mennin et al., 2015

    The Results section on ERT model-related outcomes reports improvements after treatment and at nine-month follow-up, but notes that negative emotional intensity was an exception at three months. Its reported effect-size ranges also differ from 0.52–3.90: the Results section on diagnostic outcomes assigns that range to anxiety and mood disorder indices, not the model-related measures. Page numbers are unavailable in our copy. (LLM, conf=0.91)

    Experimental — accuracy not yet measured

  • ERT patients show high end-state functioning in anxiety and depression outcomes, with rates between 71% and 85% for GAD and 57% to 80% at 9-month follow-up.

    “Further, ERT patients evidence high end-state functioning in anxiety and depression outcomes (e.g., between 71 and 85% for GAD and 57–80% high end-state functioning at 9-month follow-up; Mennin et al., 2015, under review).”

    From A Pilot Study of Emotion Regulation Therapy for Generalized Anxiety and Depression: Findings From a Diverse Sample of Young Adults. (2018) · cites this paper as Mennin et al., 2015, under review

    The Results section, “Clinical Significance Analyses for GAD and MDD Outcomes” (page unavailable), reports high end-state functioning at nine months for 85% of GAD patients and 80% of patients with comorbid MDD. Those figures support the upper ends of the cited ranges, but our copy does not establish the stated 71% and 57% lower bounds. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Improvements in decentering consistently predict acute and enduring treatment effects for patients suffering from MDD, GAD and GAD (with and without MDD) as well as the prevention of MDD relapse following prophylactic treatment with mindfulness based cognitive therapy.

    “Improvements in decentering consistently predict acute and enduring treatment effects for patients suffering from MDD (Fresco et al., 2007b), GAD (Hoge et al., 2015) and GAD (with and without MDD; Mennin et al., 2015, under review; Renna et al., under review) as well as the prevention of MDD relapse following prophylactic treatment with mindfulness based cognitive therapy (Bieling et al., 2012).”

    From Distinct functional connectivities predict clinical response with emotion regulation therapy (2017) · cites this paper as Mennin et al., 2015, under review

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • ERT is based on an affect science framework intended to target negative emotionality and self-referencing in GAD and co-occurring depression.

    “ERT draws from an affect science framework specifically designed to address the negative emotionality and self-referencing associated with generalized anxiety and co-occurring depression (Mennin, Fresco, Ritter, & Heimberg, 2015).”

    From A Pilot Study of Emotion Regulation Therapy for Generalized Anxiety and Depression: Findings From a Diverse Sample of Young Adults. (2018) · cites this paper as Mennin, Fresco, Ritter, & Heimberg, 2015

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Some model-related effects fall below the stated medium threshold

    Minor

    The paper defines a medium effect as 0.50, but reports model-related effect sizes as small as 0.23 at mid-treatment. Thus, these effects do not exceed the medium-effect convention across time points.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. DiNardo, 1994, Anxiety Disorders Interview Schedule for DSM-IV
  2. First, 2002, Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition with Psychotic Screen

Cited by

Sorted by citations

Related

Authors
Mennin, D. S., Fresco, D. M., Ritter, M., & Heimberg, R. G.
Affiliations
  • City University of New York (US)
  • Kent State University (US)
  • G.V. (Sonny) Montgomery VA Medical Center (US)
  • Temple University (US)
Corresponding author
Mennin, Douglas S.
ORCID
Venue
Depression and Anxiety
Publisher
Wiley
Published
2015-05-06
Volume
32
Issue
8
Pages
614-623
ISSN
1091-4269 (ISSN-L)
DOI
10.1002/da.22377
PMC
PMC4515189
OpenAlex
W1818718306
Cited by
149
References
94
Citations by year
2026: 4 · 2025: 8 · 2024: 11 · 2023: 11 · 2022: 12 · 2021: 14 · 2020: 16 · 2019: 10 · 2018: 18 · 2017: 24 · 2016: 13 · 2015: 5 · 2014: 1
FWCI
16.65
Type
journal article
Language
en
Open access
Licence
doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 118 d)
Locations
  • Depression and Anxiety (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (submittedVersion)
  • PubMed Central (submittedVersion)
Funders
National Institute of Mental Health (MH070682)
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
Keywords
emotion regulation therapy, generalized anxiety disorder, comorbid depression, emotional dysregulation, cognitive behavioral therapy, acceptance, decentering, cognitive reappraisal
MeSH terms
Adult, Anxiety Disorders, Major Depressive Disorder, Depressive Disorder, Major, Emotions, Female

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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