Interpersonal Problems Predict Differential Response to Cognitive Versus Behavioral Treatment in a Randomized Controlled Trial
Open accessAbstract
Objective We examined dimensional interpersonal problems as moderators of cognitive behavioral therapy (CBT) versus its components (cognitive therapy [CT] and behavioral therapy [BT]). We predicted that people with generalized anxiety disorder (GAD) whose interpersonal problems reflected more dominance and intrusiveness would respond best to a relaxation-based BT compared to CT or CBT, based on studies showing that people with personality features associated with a need for autonomy respond best to treatments that are more experiential, concrete, and self-directed compared to therapies involving abstract analysis of one's problems (e.g., containing CT).Method This was a secondary analysis of Borkovec, Newman, Pincus, and Lytle (2002). Forty-seven participants with principal diagnoses of GAD were assigned randomly to combined CBT (n = 16), CT (n = 15), or BT (n = 16).Results As predicted, compared to participants with less intrusiveness, those with dimensionally more intrusiveness responded with greater GAD symptom reduction to BT than to CBT at posttreatment and greater change to BT than to CT or CBT across all follow-up points. Similarly, those with more dominance responded better to BT compared to CT and CBT at all follow-up points. Additionally, being overly nurturant at baseline was associated with GAD symptoms at baseline, post, and all follow-up time-points regardless of therapy condition.Conclusions Generally anxious individuals with domineering and intrusive problems associated with higher need for control may respond better to experiential behavioral interventions than to cognitive interventions, which may be perceived as a direct challenge of their perceptions.
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Domineering and intrusive interpersonal problems associated with the need for control lead to more benefit from self-control desensitization than from CBT or cognitive therapy alone.
“domineering and intrusive interpersonal problems associated with the need for control led to more benefit from SCD than CBT or CT alone [36].”
From Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts (2022) · cites this paper as [36]
The Results (Primary Analyses; page not provided) report that higher domineering and intrusive problems predicted significantly better response to behavioral therapy (BT) than to CBT. Comparisons with cognitive therapy (CT) were marginal at follow-up, not statistically significant; the pre–post intrusive comparison with CT was also nonsignificant. The Methods (Therapy Conditions; page not provided) identify self-control desensitization as one component of BT, not a treatment tested on its own. (LLM, conf=0.88)
Experimental — accuracy not yet measuredModeration effects of treatment response by interpersonal style or personality are notoriously small and hard to replicate.
“Studies of moderation of treatment response by interpersonal style or personality (e.g., [36]) provide one basis for this tailoring, although moderation effects are notoriously small and hard to replicate, warranting much larger samples (or combining many samples) in future research.”
From Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts (2022) · cites this paper as [36]
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Friedman, S. J. (1990) · Journal of Anxiety Disorders · doi:10.1016/0887-6185(90)90030-d · Cited by 9 · cited 1× · see citing works
“…slighted compared to those with no diagnosis (Gasperini, Battaglia, Diaferia, & Bellodi, 1990), are disproportionately likely to be separated or divorced (Afifi, Cox, & Enns, 2006; Grant et al., 2005), and endorse higher relational conflict than couples with an agoraphobic member (Friedman, 1990).”
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Adult attachment style and anxiety – The mediating role of emotion regulation
Nielsen, S. K. K., Lønfeldt, N. N., Wolitzky-Taylor, K. B., Hageman, I., Vangkilde, S., & Daniel, S. I. F. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.04.047 · Cited by 100 · see citing works
Shin, K. E., & Newman, M. G. (2019) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2019.04.005 · Cited by 75 · see citing works
“Generalized anxiety disorder (GAD), social anxiety disorder (SAD), and major depressive disorder (MDD) exhibit high comorbidity both concurrently and sequentially (e.g., Jacobson & Newman, 2017; Kessler et al., 2008).”
Self-citationWendt, L. P., Wright, A. G. C., Pilkonis, P. A., Nolte, T., Fonagy, P., Montague, P. R., Benecke, C., Krieger, T., & Zimmermann, J. (2019) · Journal of Abnormal Psychology · doi:10.1037/abn0000460 · Cited by 67 · see citing works
Hayden, M. C., Müllauer, P. K., Gaugeler, R., Senft, B., & Andreas, S. (2018) · Journal of Clinical Psychology · doi:10.1002/jclp.22673 · Cited by 47 · see citing works
Mentalization as Mediator between Adult Attachment and Interpersonal Distress
Hayden, M. C., Müllauer, P. K., Gaugeler, R., Senft, B., & Andreas, S. (2019) · Psychopathology · doi:10.1159/000496499 · Cited by 39 · see citing works
Social anxiety disorder and avoidant personality disorder from an interpersonal perspective
Frandsen, F. W., Simonsen, S., Poulsen, S., Sørensen, P. S., & Lau, M. E. (2019) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12214 · Cited by 34 · see citing works
Newman, M. G., Basterfield, C., Erickson, T. M., Caulley, E., Przeworski, A., & Llera, S. J. (2022) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2022.2125800 · Cited by 27 · see citing works
“moderated response to relaxation versus interventions including cognitive therapy [36], therefore addressing them might improve GAD outcomes.”
InfluentialSelf-citationInterpersonal agency as predictor of the within-patient alliance effects on depression severity.
Penedo, J. M. G., Babl, A., Krieger, T., Heinonen, E., Flückiger, C., & Holtforth, M. G. (2019) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000475 · Cited by 25 · see citing works
Cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD)
Newman, M. G., Zainal, N. H., & Hoyer, J. (2020) · Generalized Anxiety Disorder and Worrying · doi:10.1002/9781119189909.ch10 · Cited by 25 · see citing works
Self-citationBrugnera, A., Coco, G. L., Salerno, L., Sutton, R. S., Gullo, S., Compare, A., & Tasca, G. A. (2018) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2018.06.008 · Cited by 25 · see citing works
Interpersonal dysfunction and treatment outcome in GAD: A systematic review
Malivoire, B. L., Mutschler, C., & Monson, C. M. (2020) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2020.102310 · Cited by 22 · see citing works
Probst, T., Schramm, E., Heidenreich, T., Klein, J. P., & Michalak, J. (2020) · Journal of Clinical Psychology · doi:10.1002/jclp.22931 · Cited by 18 · see citing works
Nordahl, H., Hjemdal, O., & Adrian Wells, A. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.694565 · Cited by 18 · see citing works
Athar, M. E. (2023) · Current Psychology · doi:10.1007/s12144-023-05322-5 · Cited by 14 · see citing works
“Studies have found that interventions emphasizing intellectual insight were more effective in reducing symptoms for internalizers, while more concrete, experiential, and action-oriented therapies were more effective for externalizers (for a review see Newman et al., 2017).”
Worry and Generalized Anxiety Disorder: A Review
Newman, M. G., Cho, S., & Kim, H. (2016) · Elsevier eBooks · doi:10.1016/b978-0-12-809324-5.05108-7 · Cited by 31 · see citing works
Self-citationConstantino, M. J., Castonguay, L. G., Coyne, A. E., Boswell, J. F., & Newman, M. G. (2022) · Psychotherapy Research · doi:10.1080/10503307.2022.2086836 · Cited by 13 · see citing works
“…current iterations of CBT and inspire the development and testing of enhanced versions, including those that may need to be personalized to patients who possess certain personal or clinical characteristics (e.g., Newman et al., 2011; Newman et al., 2015; Newman et al., 2017; Westra et al., 2016).”
BackgroundSelf-citationPenedo, J. M. G., Rubel, J. A., Meglio, M., Bornhauser, L. P., Krieger, T., Babl, A., Muiños, R., Roussos, A., Delgadillo, J., Flückiger, C., et al. (2023) · Psychotherapy · doi:10.1037/pst0000507 · Cited by 13 · see citing works
Newman, M. G., Shin, K. E., & Lanza, S. T. (2019) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000385 · Cited by 12 · see citing works
“Both Newman et al. (2017) and Newman and Fisher (2013) compared CBT with cognitive therapy and self-control desensitization.”
Self-citationInterpersonal Subtypes Within Social Anxiety: The Identification of Distinct Social Features
Cooper, D., & Anderson, T. (2017) · Journal of Personality Assessment · doi:10.1080/00223891.2017.1373116 · Cited by 12 · see citing works
McCloskey, K. D., Cox, D. W., Ogrodniczuk, J. S., Laverdière, O., Joyce, A. S., & Kealy, D. (2020) · Journal of Clinical Psychology · doi:10.1002/jclp.23033 · Cited by 11 · see citing works
Interpersonal styles, peer relationships, and outcomes in residential substance use treatment
Harrison, A. J., Timko, C., & Blonigen, D. M. (2017) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2017.07.010 · Cited by 11 · see citing works
Jacobson, N. C., & Roche, M. J. (2018) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2018.10.002 · Cited by 11 · see citing works
Self-citationPenedo, J. M. G., Meglio, M., Flückiger, C., Wienicke, F. J., Breunese, J., Menchetti, M., Rucci, P., Johansson, R., Town, J. M., Abbass, A. A., et al. (2025) · Clinical Psychology Review · doi:10.1016/j.cpr.2025.102570 · Cited by 10 · see citing works
“Differential treatment effects moderated by base-line interpersonal problem dimensions have been also observed in patients with generalized anxiety disorders (G ´ omez Penedo et al., 2017; Newman et al., 2017) and eating disorders (G ´ omez Penedo et al., 2019).”
The Contrast Avoidance Model: Conclusion and synthesis of new research in the special issue
Przeworski, A., & Newman, M. G. (2024) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2024.102830 · Cited by 9 · see citing works
Self-citationShin, K. E., LaFreniere, L. S., & Newman, M. G. (2018) · Cambridge University Press eBooks · doi:10.1017/9781108140416.019 · Cited by 9 · see citing works
Self-citationSocial criticism moderates the relationship between anxiety and depression 10 years later
Lord, K. A., Jacobson, N. C., Suvak, M. K., & Newman, M. G. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.05.030 · Cited by 8 · see citing works
“However, a meta-analysis did find that the strength of the sequential relationships between anxiety and depressive symptoms degraded as time between assessments increased (Jacobson and Newman, 2017).”
BackgroundSelf-citationStrand, E. R., Hjemdal, O., Anyan, F., Nordahl, H., & Nordahl, H. M. (2023) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2841 · Cited by 8 · see citing works
Javaherirenani, R., Ahadianfard, P., & Ashouri, A. (2021) · Iranian Journal of Psychiatry and Behavioral Sciences · doi:10.5812/ijpbs.114376 · Cited by 5 · see citing works
Penedo, J. M. G., Fernández‐Álvarez, J., Maristany, M., & Hoffmann, A. F. (2022) · Revista Evaluar · doi:10.35670/1667-4545.v22.n2.38688 · Cited by 5 · see citing works
Interpersonal problems amongst mental health carers: a qualitative study
Quinlan, E., Deane, F. P., & Crowe, T. P. (2018) · Social Work in Mental Health · doi:10.1080/15332985.2018.1445062 · Cited by 5 · see citing works
Pediatric Generalized Anxiety Disorder
Cho, S., Przeworski, A., & Newman, M. G. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-813004-9.00012-8 · Cited by 6 · see citing works
Self-citationInterpersonal Models of Personality Pathology
Roche, M. J., & Ansell, E. B. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108333931.032 · Cited by 4 · see citing works
The effect of cognitive behavioral therapy on the release of interpersonal stress.
Shu, K. (2021) · Work · doi:10.3233/wor-213504 · Cited by 3 · see citing works
Personalización en Psicoterapia: Estado Actual y Desafíos para su Implementación en Latinoamérica
Manubens, R. T., Buongiorno, E., & Penedo, J. M. G. (2024) · Revista de Psicoterapia · doi:10.5944/rdp.v35i127.39808 · Cited by 2 · see citing works
Types and severity of interpersonal problems in Australian mental health carers
Quinlan, E., Deane, F. P., & Crowe, T. P. (2020) · Counselling Psychology Quarterly · doi:10.1080/09515070.2020.1722611 · Cited by 2 · see citing works
“As interpersonal problems in this domain respond most favourably to concrete, action-orientated counselling approaches such as behavioural therapy (Newman et al., 2017) with an emphasis on experiential participation and self-direction (Beutler et al., 1993), counsellors supporting long-term carers…”
BackgroundInfluentialWITHDRAWNPreprint
Montague, P. R., Benecke, C., Wendt, L. P., Pilkonis, P. A., Zimmermann, J., Krieger, T., Fonagy, P., Wright, A. G. C., & Nolte, T. (2019) · doi:10.31234/osf.io/kcdev · Cited by 2 · see citing works
Baik, S. Y., & Newman, M. G. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-91497-0.00264-2 · Cited by 2 · see citing works
Self-citationHierarchical taxonomy of psychopathology and personalized mental health treatment selection
Argyriou, E., Prestigiacomo, C. J., Samuel, D. B., Stewart, J. C., Wu, W., & Cyders, M. A. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1597879 · Cited by 1 · see citing works
Schwob, J. T., & Newman, M. G. (2026) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2026.103160 · Cited by 1 · see citing works
Self-citationAreas, M., Flückiger, C., & Penedo, J. M. G. (2026) · Research in Psychotherapy Psychopathology Process and Outcome · doi:10.4081/ripppo.2026.894
“Furthermore, baseline interpersonal distress and indices have been positioned as a meaningful moderator of differential treatment effects when treating anxiety disorders ( e.g. , Gómez Penedo et al. , 2019; Newman et al. , 2017).”
- Authors
- Newman, M. G., Jacobson, N. C., Erickson, T. M., & Fisher, A. J.
- Affiliations
- Pennsylvania State University (US)
- Seattle Pacific University (US)
- University of California, Berkeley (US)
- Corresponding author
- Newman, Michelle G.
- Venue
- Behavior Therapy
- Publisher
- Elsevier BV
- Published
- 2017-01
- Volume
- 48
- Issue
- 1
- Pages
- 56-68
- ISSN
- 0005-7894 (ISSN-L)
- PMC
- PMC5240795
- OpenAlex
- W2418256735
- Cited by
- 41
- References
- 74
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 2 · 2023: 4 · 2022: 3 · 2021: 3 · 2020: 7 · 2019: 9 · 2018: 5 · 2017: 4
- FWCI
- 8.52
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Behavior Therapy (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- ScholarSphere (Penn State Libraries) (submittedVersion, cc-by)
- SSRN Electronic Journal (submittedVersion)
- Funders
- National Institute of Mental Health (R01MH039172)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- generalized anxiety disorder, interpersonal problems, treatment moderators, cognitive behavioral therapy, cognitive therapy, behavior therapy, relaxation training, dominance, intrusiveness, need for autonomy, treatment response, experiential therapy
- MeSH terms
- Adult, Anxiety Disorders, Female, Humans, Male, Middle Aged, Relaxation, Relaxation Therapy, Cognitive Behavioral Therapy, Treatment Outcome, Stress Disorders, Traumatic, Acute
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