An Acceptance-Based Behavioral Therapy for Individuals With Generalized Anxiety Disorder

Negative reactivity to emotions, beliefs that worries are dangerous and uncontrollable, and intolerance of uncertainty are greater in GAD than in lower-symptom individuals.

“For example, individuals with symptoms of GAD report greater negative reactivity toward their emotions (Lee, Orsillo, Roemer, & Allen, 2010; Mennin, Heimberg, Turk, & Fresco, 2005), view their worrisome thoughts as more dangerous and uncontrollable (Wells & Carter, 1999), and report intolerance of thoughts and feelings related to uncertainty (Dugas, Gagnon, Ladouceur, & Freeston, 1998) compared to individuals with lower levels of GAD symptomatology.”

• cites Lee, Orsillo, Roemer, & Allen, 2010 sourceSupported
• cites Mennin, Heimberg, Turk, & Fresco, 2005 sourceNot checked — no full text of the source
• cites Wells & Carter, 1999 sourceNot checked — no full text of the source

In the wait-list controlled trial, clients with GAD improved on GAD severity, worry, and depression, and 75% were treatment responders versus 8% on the wait list.

“Likewise, in the wait list controlled trial, clients, again all diagnosed with GAD at pre-treatment, showed significant improvement on GAD severity, worry, and depression. At post-treatment 75% of clients receiving ABBT were considered treatment responders, compared to 8% of those on the wait list.”

• cites Roemer, Orsillo, & Salters-Pendneault, 2008Not matched

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

In the open trial, clients with GAD reported significant pre-to-post and three-month follow-up changes in GAD severity, worry, and anxiety symptoms.

“In the open trial, the clients, all who were diagnosed with GAD, reported significant changes in their GAD severity, worry, and anxiety symptoms from pre to post treatment and at a three month follow-up assessment.”

• cites Roemer & Orsillo, 2007 sourceNot checked — no full text of the source

ABBT was developed to target the problematic reactivity to internal experience, experiential avoidance, and behavioral constriction seen in generalized anxiety disorder.

“In response to clinical observations and research findings that individuals with Generalized Anxiety Disorder are reactive to their internal experiences, avoid and suppress painful emotions, thoughts, and sensations, and limit their involvement in meaningful activities, an Acceptance Based Behavioral Therapy (ABBT) was developed to specifically target these responses.”

Two studies to date found significant symptom improvement with ABBT in an open trial and a wait-list controlled trial.

“To date, two studies have examined the efficacy of ABBT. In these studies, ABBT led to significant improvement in symptoms in both an open trial (Roemer & Orsillo, 2007) and in a wait list controlled trial (Roemer, Orsillo, & Salters-Pendneault, 2008).”

• cites Roemer & Orsillo, 2007 sourceNot checked — no full text of the source
• cites Roemer, Orsillo, & Salters-Pendneault, 2008Not matched

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

ABBT encourages clients to develop a more accepting, compassionate, and open relationship to their internal experiences through therapist modeling, psychoeducation, and mindfulness exercises.

“Specifically, ABBT encourages clients to develop a more accepting, compassionate, and open relationship to their internal experiences through therapist modeling, psychoeducation, and mindfulness exercises.”

People with GAD often have judgmental, over-identified relationships with their internal experiences.

“Individuals with GAD often have problematic relationships with their internal experiences characterized by judgmental reactions to these internal experiences along with an over-identification or fusion (Hayes et al., 1999) with these experiences.”

• cites Hayes et al., 1999Not matched

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

ABBT focuses on helping clients enact behavior that is personally meaningful rather than behavior motivated by avoidance of anxiety.

“Likewise, therapy focuses on identifying and enacting behaviors that are congruent with what is personally meaningful to the client rather than engaging in actions that are motivated by avoidance of anxiety.”

An ABBT session may begin with a mindfulness exercise focused on following the breath and reviewing between-session activities.

“This session begins with a mindfulness exercise focused on following his breath and then reviewing his between session activities.”

ABBT combines acceptance and mindfulness strategies with more traditional behavior therapy techniques.

“ABBT incorporates acceptance and mindfulness strategies with more traditional behavior therapy techniques.”

Session 4 uses mindfulness of emotion to show that attempts to control internal experience can contribute to distress.

“The focus of this session would be on exploring the possibility that experiential avoidance, or attempts to control one’s internal experience may be part of the problem.”

Mindfulness and acceptance are presented and practiced as an alternate response to internal experiences.

“As such, mindfulness and acceptance are presented and practiced as an alternate response to internal experiences.”

Sessions 8 to 13 focus on applying mindfulness and valued activity engagement in daily life.

“The focus of these sessions is on applying mindfulness and engagement in valued activities in William’s daily life.”

Future directions include comparing ABBT to other therapies and identifying which principles are most central.

“Thus, there are many questions about the treatment that have not yet been addressed. For example, more work is needed to compare ABBT to other therapy approaches and one such trial is currently underway.”

ABBT was developed by Roemer and Orsillo as an acceptance-based behavioral therapy for GAD.

“Accordingly, Roemer and Orsillo (2007; see Roemer & Orsillo, 2009 for a more detailed description of the treatment approach) developed an acceptance-based behavioral therapy (ABBT) for GAD.”

• cites Roemer and Orsillo (2007 sourceNot checked — no full text of the source
• cites Roemer & Orsillo, 2009Not matched

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

ABBT uses mindfulness and acceptance as an alternative to the rigid, avoidant responses characteristic of GAD.

“Specifically, ABBT uses mindfulness and acceptance approaches as an alternate response to the rigid, avoidant responses characteristic of GAD.”

Session 5 uses metaphors and mindfulness exercises to increase willingness and acceptance of emotional experiences.

“Building on session 4’s focus on navigating the paradox by increasing willingness, the focus here is on specific strategies on increasing willingness.”

William is described as having a difficult relationship with internal experiences, a pattern of experiential avoidance, and behavioral constriction.

“Consistent with an acceptance based behavioral approach, William, the composite client presented in Robichaud (this issue), expresses having 1) a difficult relationship with his internal experiences, 2) a pattern of experiential avoidance, and 3) behavioral constriction.”

• cites Robichaud (this issue)Not matched

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

The authors believe key ABBT elements are a less rigid, more decentered response to internal experience, allowing internal responses without rigidly trying to change or control them, and engaging in meaningful activities rather than avoiding anxiety-provoking situations.

“At this stage, we believe that the key elements of ABBT include having a less rigid, more decentered response to one’s internal experiences, allowing internal responses to happen without out rigidly trying to change or control them, and engaging in meaningful activities rather than rigidly avoiding anxiety-provoking situations, however, this still needs to be empirically evaluated.”

The treatment is intended to modify relationships with internal experience, reduce rigid avoidance, increase flexible responding, and increase action in important life areas.

“Specifically, treatment should modify one’s relationship with internal experience, decrease rigid, habitual avoidance, increase flexible responding to internal and external cues, and increase action in areas that are of importance to the individual so that the focus is more on engagement than on avoidance.”

ABBT focuses on valued action, meaning choices to act in value-consistent ways rather than in ways motivated by avoidance of anxiety.

“The focus is on making choices to act in value-consistent ways rather than in ways that are motivated by avoidance of anxiety.”

• cites Wilson & Murrell, 2004Not checked — no full text of the source

Sessions 6 and 7 prepare William to commit to a values-consistent life and to carry out commitments when difficult thoughts or feelings arise.

“In these two sessions, his therapist will help him prepare to start taking actions by first discussing the process of committing to a values-consistent life.”

The last sessions focus on relapse prevention and maintaining gains.

“In addition to applying the various therapy skills, these last sessions also focus on relapse prevention and maintaining gains.”