Changes in Decentering and Reappraisal Temporally Precede Symptom Reduction During Emotion Regulation Therapy for Generalized Anxiety Disorder With and Without Co-Occurring Depression.

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

When generalized anxiety disorder and major depressive disorder co-occur, subjective distress and functional impairment may be greater and treatment response may be worse.

“When co-occurring, the subjective distress and functional impairment may be even larger, and the treatment response worse (Farabaugh et al., 2012; Newman, Przeworski, Fisher, & Borkovec, 2010; Olatunji, Cisler, & Deacon, 2010).”

• cites Farabaugh et al., 2012 sourcePartly supported

  The Introduction defines anxious depression broadly as MDD with either a co-occurring anxiety disorder or high anxiety symptoms, and the Discussion reports poorer treatment response in that group than in patients with depression alone. The paper does not establish that result specifically for co-occurring generalized anxiety disorder and MDD, nor does it report greater subjective distress or functional impairment for that pairing. Page numbers are unavailable in our copy. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites Newman et al., 2010 sourceDisputed

  The Abstract links GAD comorbidity generally to greater severity and disability, but the paper's psychotherapy findings contradict the claim of worse treatment response. The Discussion reports that participants with comorbid MDD showed greater improvement in GAD symptoms and reached comparable posttreatment symptom levels to those without comorbidity. (LLM, conf=0.88)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured
• cites Olatunji et al., 2010 sourceNot checked — no full text of the source

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

In Hoge and colleagues' study, changes in mindfulness and decentering mediated the effect of mindfulness-based stress reduction on anxiety symptoms but not worry; when both mediators were included, only decentering remained significant.

“Analyses revealed that changes in both mindfulness and decentering significantly mediated the effect of MBSR on anxiety symptoms but not worry. When both mediators were included in the model, only increases in decentering remained statistically significant.”

• cites Hoge et al., 2015 sourcePartly supported

  The Results (Mediation Analyses, Anxiety Symptoms; page unavailable) support the claim that mindfulness and decentering each mediated anxiety reduction when tested separately, but only decentering remained significant when tested together. The Results (Mediation Analyses, Worry; page unavailable) contradict the phrase “but not worry”: change in mindfulness significantly mediated reductions in worry. (LLM, conf=0.92)

  Experimental — accuracy not yet measured

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

Cognitive behavioral therapies have successfully treated generalized anxiety disorder, with moderate-to-large acute effects that are largely maintained at follow-up.

“CBTs have successfully treated GAD, demonstrating moderate to large effects during the acute phase of GAD treatment that are largely maintained throughout follow-up (Cuijpers et al., 2014; Hayes-Skelton, Roemer, & Orsillo, 2013; Mennin, Fresco, O’Toole, & Heimberg, 2018; Wells et al., 2010).”

• cites Cuijpers et al., 2014 sourceNot checked — no full text of the source
• cites Hayes-Skelton et al., 2013Not matched

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

• cites Mennin et al., 2018 sourceSupported

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

In a previous correlation-based mediation analysis, both cognitive reappraisal and decentering were associated with better anxiety outcomes, with the largest effects for decentering.

“In a previous correlation-based mediation analysis, both cognitive reappraisal and decentering were shown to be associated with better anxiety outcomes, with the largest effects detected for the latter (Mennin et al., 2018).”

• cites Mennin et al., 2018 sourcePartly supported

  The Discussion (page unavailable) says that both decentering and reappraisal statistically mediated effects on worry and anxiety. The Method describes a product-of-coefficients mediation analysis, rather than a correlation-based one, and the available Results passage does not establish that decentering had the largest effects. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

In Hayes-Skelton and colleagues' study, decentering was a common mediator across acceptance-based behavior therapy and applied relaxation; decentering increased in both conditions and predicted better symptom outcomes.

“Decentering was found to be a common mediator across both treatment conditions. Decentering significantly increased across both treatment conditions, and this increase predicted better symptom outcomes.”

• cites Hayes-Skelton et al., 2015 sourcePartly supported

  The Results report a significant increase in decentering, an association with reduced worry symptoms, and no significant difference in its rate of change between acceptance-based behavioral therapy and applied relaxation. The Discussion also reports that changes in decentering preceded changes in anxiety symptoms across treatments. However, the authors describe these findings as support for a potential common mechanism, not as establishing decentering as a common mediator. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

A core feature of distress disorders is maladaptive self-referential processing, including worry and rumination.

“A core feature of distress disorders is the engagement of maladaptive self-referential processes, including the metacognitive processes of worry and rumination (Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008; Wells, 2005).”

• cites Nolen-Hoeksema et al., 2008 sourcePartly supported

  In “Rumination and Worry” (page unavailable), the paper describes worry and rumination as self-focused, repetitive thoughts associated with and exacerbating depression and anxiety. It also calls worry a defining feature of generalized anxiety disorder. These passages support the connection, but do not establish maladaptive self-referential processing as a core feature of distress disorders generally or classify both processes as metacognitive. (LLM, conf=0.82)

  Experimental — accuracy not yet measured
• cites Wells, 2005 sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Hoge and colleagues' analyses did not address the timeline of change because mediators and outcomes were measured only before and after treatment.

“These analyses do not speak to the timeline of change, as mediators and outcomes were only evaluated pre- and posttreatment.”

• cites Hoge et al., 2015 sourceSupported

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

Decentering has been linked to lower anxiety and depression symptoms.

“Decentering has been associated with a range of positive mental health outcomes, including lower levels of anxiety and depression symptoms (for an overview see Bernstein et al., 2015).”

• cites Bernstein et al., 2015 sourceSupported

Classified as probably not a substantial claim.

Some prior studies have found that metacognitive abilities mediate outcomes in other cognitive behavioral therapies for generalized anxiety disorder.

“A few studies thus far have demonstrated a mediating role for these metacognitive abilities in other cognitive behavioral therapies (CBTs) for GAD.”

• cites Hoge et al., 2015 sourcePartly supported

  The Discussion reports that decentering and mindfulness mediated symptom improvements in this paper’s MBSR study of patients with GAD. It also describes improvements with other cognitive-behavioral treatments for GAD, but does not report that metacognitive abilities mediated outcomes in those treatments. The Introduction discusses earlier CBT findings in depression, not GAD. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites Arch et al., 2012 sourceNot checked — no full text of the source
• cites Hayes-Skelton et al., 2015 sourcePartly supported

  The Discussion reports that, in this study of GAD, changes in decentering preceded changes in anxiety symptoms across acceptance-based behavioral therapy and applied relaxation. But the paper does not establish that a few prior studies demonstrated mediation in CBTs specifically for GAD: its discussion of a prior ACT-versus-CBT mediation finding concerns anxiety disorders more broadly, and it says decentering had not been systematically examined as a treatment mechanism for GAD. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

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

Therapist skillfulness and ERT intervention consistency were very high, above 90%, in the coded sessions.

“Overall skillfulness of therapists and ERT intervention consistency was very high (>90%; for more details see Renna et al., 2018).”

• cites Renna et al., 2018 sourceSupported

May combine two claims.

A recent randomized controlled trial established indirect effects of both decentering and reappraisal, explaining the superior effect of ERT compared with an attention control group.

“in which we were able to establish indirect effects of both decentering and reappraisal, explaining the superior effect obtained for individuals receiving ERT compared with an attention control group (Mennin et al., 2018).”

• cites Mennin et al., 2018 sourceSupported

May combine two claims.

The design had no competing mediators and no control group, preventing firm causal conclusions.

“Our design - with no competing mediators and no control group - prevents us from drawing firm causal conclusions (e.g., Kazdin, 2007).”

• cites Kazdin, 2007 sourceSupported

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

Session-by-session changes in decentering predicted pre- to posttreatment symptom improvement for social anxiety disorder during group CBT in an open trial.

“session-by-session changes in decentering was recently found to predict pre- to posttreatment symptom improvement for individuals with social anxiety disorder during group CBT in an open trial.”

• cites Hayes-Skelton & Lee, 2018 sourceSupported

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

In a cross-sectional SEM study, the relationship between cognitive reappraisal and social anxiety was fully accounted for by decentering.

“Results revealed that the relationship between cognitive reappraisal and social anxiety was fully accounted for by decentering.”

• cites Hayes-Skelton & Graham, 2013 sourceSupported

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

In an initial fMRI study, gains in decentering through ERT were predicted by pretreatment intrinsic functional connectivity clusters in anterior and posterior default network.

“In an initial fMRI study, Fresco and colleagues (2017) demonstrated that gains in decentering through the course of ERT was predicted by pretreatment intrinsic functional connectivity clusters in the anterior and posterior of the default network (Fresco et al., 2017), a network demonstrated to be central to self-referential processing.”

• cites Fresco et al., 2017 sourceSupported

May combine two claims.

All variables changed in the expected direction from pre- to posttreatment, with large effect sizes (Cohen's d > .8).

“All variables moved in the expected direction from pre- to posttreatment, corresponding to large effect sizes (Cohen’s d > .8, calculated as the mean difference between pre- and posttreatment, standardized by the SD difference score).”

May combine two claims.

Changes in trait anxiousness did not significantly temporally precede changes in decentering, though the association was trending (z = −1.76, p = .078, r = .32).

“The reverse direction, where changes in worry (z = −1.48, p = .138, r = .27) and trait anxiousness (z = −1.76, p = .078, r = .32) temporally preceded changes in decentering were not significant, although the latter was trending.”

Classified as probably not a substantial claim.

A central aim of Emotion Regulation Therapy is to teach adaptive emotion regulation, including decentering and cognitive reappraisal.

“An important goal in ERT is to teach clients adaptive emotion regulation, including healthier metacognitive abilities such as decentering and cognitive reappraisal.”

• Also stated in: § Abstract · hedged

  “ERT is hypothesized to work, in part, by improving emotion regulation skills, including the metacognitive skills of decentering and cognitive reappraisal.”

• cites Mennin & Fresco, 2014Not matched

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

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

Clinical improvement is fostered through cognitive change, and many cognitive behavioral therapies for generalized anxiety disorder target worry by building healthier metacognitive skills.

“Accordingly, clinical improvement is fostered via cognitive change, and many forms of CBTs for GAD have targeted worry through the building of healthier metacognitive skills (e.g., Clark & Beck, 2010; Mennin & Fresco, 2014; Roemer & Orsillo, 2009; Wells, 2009).”

• cites Clark & Beck, 2010Not matched

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

• cites Mennin & Fresco, 2014Not matched

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

• cites Roemer & Orsillo, 2009Not matched

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

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

In Arch and colleagues' study, the outcome was measured only before and after treatment, so when the outcome changed relative to mediator change remains unknown.

“Although the mediator was evaluated multiple times during treatment, the outcome was only completed at pre- and posttreatment. It thus remains to be known, when during treatment the outcome changed, and if this indeed took place following a change in the mediator.”

• cites Arch et al., 2012 sourceNot checked — no full text of the source

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

Excessive worry is a defining diagnostic feature of generalized anxiety disorder.

“Specifically concerning GAD, excessive worry is a defining diagnostic feature (American Psychiatric Association, 2013)”

• cites American Psychiatric Association, 2013Not 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). May combine two claims.

Generalized anxiety disorder often co-occurs with major depressive disorder, and the two are thought to share heightened emotionality and overreliance on cognitive and behavioral avoidance.

“GAD often co-occurs with major depressive disorder (MDD) and the two disorders are believed to share a heightened emotionality, as well as an overreliance on cognitive and behavioral avoidance (Mennin & Fresco, 2013).”

• cites Mennin & Fresco, 2013Not matched

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

Classified as probably not a substantial claim.

A shared assumption among cognitive behavioral therapy treatment models is that psychopathology is partly characterized by maladaptive cognitive processes that contribute to emotional dysfunction.

“Although variation exists between cognitive behavioral therapies (CBTs), a shared assumption among the underlying treatment models is that psychopathology is, in part, characterized by maladaptive cognitive processes which contribute to emotional dysfunction (Mennin, Ellard, Fresco, & Gross, 2013).”

• cites Mennin et al., 2013Not matched

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

Probably not a substantial claim: may not pass S4 (based).

Time-lagged segment analyses in which the mediator at one session predicts the outcome at the next session, with no temporal overlap between segments, allow causal interpretations.

“One way of doing this is to measure both the proposed mediators and outcomes every session and perform so-called time-lagged segment analyses, where the mediator at sessionx, controlled for sessionX-1, predicts outcome at sessionX+1, controlled for sessionX, thus ensuring no overlap in time between the segments and allowing for causal interpretations.”

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

Identifying factors responsible for change in treatment can point to ways to improve therapeutic strategies so they target change-potent components more directly.

“Indeed, factors responsible for change during these treatments are important to identify as they can point to pathways of improving therapeutic strategies so they more directly target change-potent components (Kazdin, 2014).”

• cites Kazdin, 2014 sourceNot checked — no full text of the source

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

Cognitive reappraisal has been linked to positive affective, cognitive, and social outcomes.

“Across a number of studies, this ability has been associated with a range of positive outcomes, including affective (e.g., decreasing negative affect), cognitive (e.g., memory performance), and social outcomes (e.g., closer relationships with friends; for an overview see Gross, 2014).”

• cites Gross, 2014Not 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).

Diagnostic reliability between the SCID interviewer and an independent assessor for generalized anxiety disorder was high, with kappa values from .71 to 1.00.

“Diagnostic reliability between the SCID interviewer and independent assessor for GAD was high with kappa ratings ranging from .71 to 1.00, demonstrating good to excellent reliability.”

May combine two claims.

Taken together, metacognitive skills including decentering and related constructs appear to change with various cognitive behavioral therapies and likely play a mediational role in treating generalized anxiety disorder.

“Taken together, metacognitive skills including decentering and related constructs, appear to change as a function of a number of different CBTs and likely play a mediational role in the treatment of GAD.”

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

In Arch and colleagues' study, session-by-session change in cognitive defusion mediated worry outcomes in both cognitive behavioral therapy and acceptance and commitment therapy, with a stronger finding in cognitive behavioral therapy.

“In a group of individuals with mixed anxiety disorders (19% had a diagnosis of GAD) following CBT and Acceptance and Commitment Therapy (ACT), session-by-session change in cognitive defusion was shown to mediate worry outcomes in both treatments. This finding was more prominent in patients receiving CBT as compared to ACT.”

• cites Arch et al., 2012 sourceNot checked — no full text of the source

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

Although metacognitive skills are considered important for change in generalized anxiety disorder treatments, why these treatments work remains poorly understood.

“Although metacognitive skills are considered crucial in producing change in these treatments for GAD (e.g., Clark & Beck, 2010; Roemer & Orsillo, 2009; Mennin & Fresco, 2014; Wells, 2009), much is yet to be understood in terms of why these treatments work.”

• cites Clark & Beck, 2010Not matched

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

• cites Roemer & Orsillo, 2009Not matched

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

• cites Mennin & Fresco, 2014Not 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). May combine two claims.

Decentering and reappraisal are metacognitive skills routinely practiced in cognitive behavioral therapy packages and are considered to represent healthier metacognition.

“In particular, decentering and reappraisal are two metacognitive skills, routinely practiced in CBT packages, considered to represent healthier metacognition.”

May combine two claims.

Only a small number of studies have conducted mediational investigations, and even fewer have considered the timeline of change when studying improved metacognitive abilities as facilitators of change in cognitive behavioral therapies for generalized anxiety disorder.

“However, only a sparse number of studies have conducted mediational investigations and even fewer have taken the timeline of change into account in the investigation of improved metacognitive abilities as facilitative of change in CBTs for GAD.”

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

Emotion regulation occurs dynamically throughout different points in the emotion generative process.

“Indeed, emotion regulation is believed to occur dynamically throughout different points in the emotion generative process (e.g., Gross, 2015; Rottenberg & Gross, 2007).”

• cites Gross, 2015 sourceNot checked — no full text of the source
• cites Rottenberg & Gross, 2007 sourceNot checked — no full text of the source

May combine two claims.

The small number of participants prevented testing a multiple mediation model, so the unique variance of each mediator could not be established.

“Given the small number of participants in the present study, a multiple mediation model was not feasible, and the explanation of unique variance could thus not be established.”

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

The ERT model suggests that metacognitive regulation always involves attention regulation, but attention regulation can occur without metacognitive regulation.

“Indeed, the ERT model suggests that metacognitive regulation always involve attention regulation but that attention regulation can occur without metacognitive regulation (Mennin & Fresco, 2014).”

• cites Mennin & Fresco, 2014Not matched

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

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

Other treatment components could be necessary for or enhance the causal relationship between metacognitive abilities and anxiety outcome.

“This means that other treatment components could be necessary for or enhancing this causal relationship between metacognitive abilities and anxiety outcome to exist.”

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

In GAD, individuals shown an anxiety-inducing video and instructed to disengage from a subsequent slide presentation of disgusting images reported more worrying than those not instructed to disengage and healthy controls.

“Cooper and colleagues (2013) found that individuals with GAD who were shown an anxiety-inducing video and instructed to disengage from a subsequent slide presentation of disgusting images reported more worrying than both those with GAD who were not instructed to disengage and healthy controls.”

• cites Cooper and colleagues (2013)Not 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). May combine two claims.

The present findings rely on self-report data, which can be subject to reporting bias and reflect only one modality of assessment.

“Finally, the present findings rely on self-report data. This manner of assessment has obvious clinical utility and allows for an analysis like the one used in the current study, but can be subject to reporting bias and only reflects one modality of assessment.”

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

The Experiences Questionnaire decentering subscale had acceptable internal consistency at pretreatment, with a Cronbach's alpha of .68.

“The internal consistency of the EQ at pretreatment was acceptable (α = .68).”

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

In an experimental setting, engaging attention with the emotional meaning of threat words led to more subsequent worry.

“Hirsch and colleagues (2011) found that when individuals engaged their attention with the emotional meaning of threat words, they worried more subsequently.”

• cites Hirsch and colleagues (2011)Not 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).

If an emotional response is intensifying, its regulation may require increased cognitive elaboration or verbal mediation.

“In other words, if an emotional response is intensifying, its regulation may require increased cognitive elaboration or verbal mediation (Gross, 2015; Mennin & Fresco, 2014).”

• cites Gross, 2015 sourceNot checked — no full text of the source
• cites Mennin & Fresco, 2014Not 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). May combine two claims.

Reappraisal is consistently related to anxiety symptom improvement in CBTs, but few studies meet criteria to conclusively demonstrate that it causes improvement.

“Smits and colleagues (2012) conclude that reappraisal (i.e., threat reappraisal) is consistently related to anxiety symptom improvement in CBTs, but that a very limited number of studies meet most of the criteria necessary to conclusively demonstrate that it causes symptom improvement.”

• cites Smits and colleagues (2012)Not 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).

Interaction effects were not explored in the present study.

“although the present findings point to a main effect of the metacognitive treatment components, interaction effects were not explored.”

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

Decentering and cognitive reappraisal are elaborative metacognitive emotion regulation skills, verbally mediated, with reappraisal requiring the most cognitive elaboration.

“Specifically, decentering and cognitive reappraisal are considered elaborative metacognitive emotion regulation skills, meaning that they are verbally mediated, with reappraisal requiring the most cognitive elaboration (Mennin & Fresco, 2014).”

• cites Mennin & Fresco, 2014Not matched

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

May combine two claims.

The reappraisal-trait anxiousness relationship may be driven by MDD, but the small MDD sample precludes firm conclusions.

“Although this finding suggests that the relationship for reappraisal and outcome may be driven by presence of MDD, the relatively small number of patients with MDD in the sample precludes any firm conclusions.”

May combine two claims.

The largest effect was for worry, which may indicate that decentering primarily targets self-referential aspects of the GAD diagnosis.

“The largest effect was obtained for worry, which may indicate that decentering primarily targets self-referential aspects of the GAD diagnosis.”

May combine two claims.

Changes in both decentering and cognitive reappraisal temporally preceded reductions in anxiety symptoms during ERT.

“We demonstrated that changes in both decentering and cognitive reappraisal indeed preceded reductions in anxiety symptoms.”

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

The present study adds to the literature on metacognitive components as drivers of change in CBTs for GAD.

“In conclusion, the present study adds to the literature on metacognitive components as drivers of change in CBTs for GAD.”

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

The Emotion Regulation Questionnaire-Reappraisal Subscale had strong internal consistency at session 1, with a Cronbach's alpha of .86.

“The scale demonstrated strong internal consistency in the current study at session 1 (α = .86).”

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

Twenty-eight of the 31 participants completed all 16 weeks of ERT.

“Twenty-eight of 31 participants completed the full 16 weeks of ERT.”

May combine two claims.

Session-by-session improvements in decentering and cognitive reappraisal temporally preceded reductions in anxiety-related outcomes through ERT, best conceptualized as a unidirectional relation.

“Specifically, we demonstrated that session-by-session improvements in decentering and cognitive reappraisal temporally preceded reductions in anxiety-related outcomes through a course of ERT, and that this was best conceptualized as a unidirectional relation.”

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

The Penn State Worry Questionnaire had a Cronbach's alpha of .80 at session 1.

“The PSWQ consists of 15 items (e.g., “My worries overwhelmed me” and ”Many situations made me worry”) and in the current study obtained a Cronbach’s alpha at session 1 of .80.”

May combine two claims.

The time-lagged segment analyses had no temporal overlap between predictor and outcome segments, which potentially permits causal interpretations.

“Thus, there was no overlap in time between the segments, potentially allowing for causal interpretations.”

May combine two claims.

Although neuroimaging studies did not explicitly test mediation, they bolster the current findings by suggesting potential neural markers accompanying metacognitive mechanism improvements from ERT.

“Although these studies did not explicitly test mediation, they bolster the current study’s findings by suggesting potential neural markers that may accompany metacognitive mechanism improvements from ERT.”

May combine two claims.

Two reliability analyses (EQ and STAI) revealed Cronbach's alphas just below 0.70, posing a threat to internal reliability.

“Third, two reliability analyses (i.e., EQ and STAI) revealed Cronbach’s alphas just below the often recommended 0.70 (Nunnally, 1978), which may in part be due to the low number of items, but still pose a threat to the internal reliability.”

• cites Nunnally, 1978Not 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).

The State Trait Anxiety Inventory-7 had moderate internal consistency at session 1, with a Cronbach's alpha of .64.

“Internal consistency of the STAI-7 was moderate at session 1 (Cronbach’s α = .64).”

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

Adherence to the Emotion Regulation Therapy protocol was assessed by audio recording all treatment sessions and coding all 16 sessions from 40% of cases, with 25% of those cases double-coded.

“Concerning adherence to the treatment protocol (i.e., therapist skillfulness and frequency of ERT components), all treatment sessions were audio recorded, and research assistants coded all 16 sessions from 40% of all cases, with 25% of these cases coded by two coders.”

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

A clearer understanding of temporal dynamics between metacognition and anxiety symptoms can inform and improve ERT and other treatments for GAD and distress disorders.

“Having a clearer understanding of the temporal dynamics between metacognition and symptoms of anxiety can inform and improve not only ERT but also other treatments for GAD and the distress disorders, more generally.”

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

The GAD-7 had acceptable internal consistency at session 1, with a Cronbach's alpha of .72.

“Symptoms of generalized anxiety disorder was evaluated with the GAD-7 (e.g, “Feeling nervous, anxious or on edge” and “Not being able to stop or control worrying”; Spitzer, Kroenke, Williams, & Löwe, 2006) and obtained an acceptable internal constancy at session 1 (α = .72).”

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

Following ERT, patients had lower negative affect ratings and greater recruitment of lateral PFC to negative versus neutral images, with strengthened dorsolateral PFC activity associated with improvements in decentering, cognitive reappraisal, and clinical outcomes.

“Following treatment, patients had lower negative affect ratings and greater recruitment of the lateral PFC to negative versus neutral images with strengthened dorsolateral PFC activity associated with improvements in both decentering and cognitive reappraisal as well as clinical outcomes (Raab et al., under review).”

• cites Raab et al., under reviewNot 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).

Weekly measures in the present study do not capture emotion dynamics at the momentary level.

“With weekly measures, as employed in the present study, we are not capturing the emotion dynamics at this momentary level.”

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

Twelve doctoral students in clinical psychology were trained to deliver the Emotion Regulation Therapy protocol and received weekly supervision from the protocol developers.

“Twelve doctoral students in clinical psychology were trained to administer the ERT protocol and received weekly supervision by the protocol developers (DMF and DSM).”