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Cited by 8Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMindfulness and Compassion InterventionsPsychotherapy Techniques and Applications

Randomized pilot trial of cognitive-behavioral therapy and acceptance-based behavioral therapy in the treatment of Spanish-speaking Latino primary care patients with generalized anxiety disorder

Open access
Vera, Mildred, Obén, Adriana, Juarbe, Deborah, Hernández, Norberto, Pérez-Pedrogo, Coralee·2021·Journal of Behavioral and Cognitive Therapy
DOI 10.1016/j.jbct.2020.11.007PMC PMC9269989
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Abstract

The evidence base supporting the usefulness of traditional cognitive-behavioral therapy (CBT) and newer acceptance-based CBT treatments for generalized anxiety disorder (GAD) has grown over the past decades. GAD is prevalent among several Latino subgroups, particularly Puerto Ricans. However, there remains uncertainty regarding the appropriateness of these interventions for Spanish-speaking Latinos since they have been routinely excluded in both efficacy and effectiveness studies. As an initial step to bridge this gap, this pilot study examined the potential efficacy of two CBT interventions for GAD, traditional CBT and acceptance-based behavioral therapy (ABBT), in a sample of Spanish-speaking Latinos. Ninety primary care patients with GAD were randomly assigned to receive CBT (n = 30), ABBT (n = 30), or treatment as usual (TAU) (n = 30). Excessive worry, the core feature of GAD, was assessed with the Penn State Worry Questionnaire (PSWQ), which is considered the gold standard measure of GAD-related worry. At follow-up, PSWQ scores for participants in the CBT and ABBT groups were statistically lower than those of the TAU group and statistically comparable to each other. CBT and ABBT reduced worry level to a greater degree than usual care by follow-up. Our findings provide preliminary, yet crucial data, which support the potential of both interventions targeting GAD symptoms among Spanish-speaking Latino primary care patients. © 2020

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Registry

Crossref · 10.1016/j.jbct.2020.11.007

Cites

99 of 99 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

23 of 74 cited sources checked · 7 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Appropriate evidence-based treatments for generalized anxiety disorder in this Latino population are missing.

    “Although GAD has been found to be prevalent among several Latino subgroups, particularly Puerto Ricans, appropriate evidence-based treatments for this population are missing (Alegría et al., 2007; Alegría, Alvarez, Ishikawa, DiMarzio, & McPeck, 2016).”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites Alegría et al., 2007 source

      The introductory passage labeled Abstract in our copy describes a gap between Latinos’ need for mental health services and their availability, particularly for immigrants and people with limited English proficiency. The Methods identify generalized anxiety disorder as a condition assessed, but the paper does not establish that appropriate evidence-based GAD treatments are missing for this population. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites Alegría, Alvarez, Ishikawa, DiMarzio, & McPeck, 2016 source

      The Evidence-Based Practices section (page unavailable) says most evidence-based practices have not been tested with different racial or ethnic populations or culturally adapted for them. This supports a general concern about appropriate treatments, but the paper does not establish that evidence-based treatments for GAD are missing for Latinos specifically. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Premisecitation

    Generalized anxiety disorder is prevalent among several Latino subgroups, particularly Puerto Ricans.

    “Although GAD has been found to be prevalent among several Latino subgroups, particularly Puerto Ricans, appropriate evidence-based treatments for this population are missing (Alegría et al., 2007; Alegría, Alvarez, Ishikawa, DiMarzio, & McPeck, 2016).”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites Alegría et al., 2007 source

      The Methods list generalized anxiety disorder among the anxiety disorders assessed, and the Results report higher rates of psychiatric disorders among Puerto Ricans than among other Latino subgroups. The paper reports subgroup comparisons for anxiety disorders as a category, not for generalized anxiety disorder specifically, so it does not establish that GAD is particularly prevalent among Puerto Ricans. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites Alegría, Alvarez, Ishikawa, DiMarzio, & McPeck, 2016 source

      The Abstract discusses treatment disparities for depression and substance use disorders, not the prevalence of generalized anxiety disorder. Searches for GAD, anxiety prevalence, and Puerto Ricans found no passage in our copy addressing prevalence among Latino subgroups. (LLM, conf=0.75)

      Experimental — accuracy not yet measured
  • Premisecitation

    Previous studies support the efficacy of traditional and newer CBT approaches for generalized anxiety disorder in predominantly non-Hispanic White populations.

    “These results are in line with previous studies that support the efficacy of traditional and newer CBT approaches for GAD in predominantly non-Hispanic White populations (Borkovec et al., 2004; Butler et al., 2006; Hunot, Churchill, Teixeira, & Silva de Lima, 2007; Orsillo & Roemer, 2011; Otte, 2011; Roemer & Orsillo, 2009).”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites Borkovec et al., 2004

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

    • cites Butler et al., 2006 source

      Section 2.2 (page not available) reports preliminary evidence that cognitive therapy is effective for GAD, including superiority to wait-list or no-treatment controls. The cited review does not establish efficacy for newer CBT approaches or identify the studied populations as predominantly non-Hispanic White. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites Hunot, Churchill, Teixeira, & Silva de Lima, 2007 source

      The Authors’ conclusions and Interventions sections support the efficacy of CBT for short-term treatment of GAD and describe several CBT approaches. The review does not establish that the studied populations were predominantly non-Hispanic White; its Participants section reports age and gender but not that racial or ethnic composition. Its newer acceptance-based treatment appears among ongoing studies, not as evidence of efficacy. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Premisecitation

    Studies link ABBT to sizable reductions in anxiety and depression symptoms.

    “Research findings show that ABBT has been associated with considerable improvements in anxiety and depression symptoms (Hayes-Skelton et al., 2013; Roemer, Orsillo, & Salters-Pedneault, 2008; Treanor, Erisman, Salters-Pedneault, Roemer, & Orsillo, 2011).”
    Quote in the paperSubstantial claim3 of 3 sources checked
    • cites Hayes-Skelton et al., 2013 source
    • cites Roemer, Orsillo, & Salters-Pedneault, 2008 source
    • cites Treanor, Erisman, Salters-Pedneault, Roemer, & Orsillo, 2011 source

      The introductory passage reports that the ABBT trial found significant effects on anxious and depressive symptom reports compared with a waiting-list control. This paper presents secondary analyses of other outcomes; its Results describe medium-to-large effects for those outcomes, not the magnitude of the symptom improvements. Thus it supports the association with improvement, but not specifically the claim that symptom improvements were considerable. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • Premisecitation

    For patients facing disadvantages in income, education, or minority status, primary care plays a key role in mental health service delivery.

    “The primary care setting is especially important for mental health care delivery in patients disadvantaged by income, education and minority status (Department of Health and Human Services, 2011; McGuire & Miranda, 2008).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Department of Health and Human Services, 2011

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

    • cites McGuire & Miranda, 2008 source

      The paper’s discussion of disparities (section labeled Abstract; no page supplied) treats primary care as a setting for depression and anxiety care among racial and ethnic minorities. It also discusses an intervention developed for low-income and minority patients. It does not establish that primary care is especially important for patients disadvantaged by income or education, or compare its importance with other settings. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
  • May combine two claims. 31
  • Classified as probably not a substantial claim. 27
  • The quote only partly states this claim. 2

  • May combine two claims.

    Premisecitation

    CBT has strong clinical acceptance and empirical support for treating GAD.

    “Cognitive-behavioral therapy (CBT) enjoys high clinical approval and empirical support for the treatment of GAD (Borkovec et al., 2004; Butler, Chapman, Forman, & Beck, 2006).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Borkovec et al., 2004

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

    • cites Butler, Chapman, Forman, & Beck, 2006 source

      Section 2.2 (page not provided) describes preliminary but strong evidence that cognitive therapy is effective for GAD; Section 3 also calls it highly effective. The paper does not address whether CBT enjoys high clinical approval, so that part of the claim is unsupported. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

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

    Premisecitation

    GAD is common among Latinos, especially Puerto Ricans.

    “Generalized anxiety disorder (GAD) is prevalent among Latinos (Alegrzía et al., 2008a,b; Asnaani, Richey, Dimaite, Hinton, & Hofmann, 2010).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Alegrzía et al., 2008a,b

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

    • cites Asnaani, Richey, Dimaite, Hinton, & Hofmann, 2010 source

      The Methods and Results report GAD diagnoses among Hispanic respondents and find them more likely than Asian American respondents to receive a GAD diagnosis. The Conclusions say Puerto Ricans have higher rates of anxiety disorders than Mexican Americans, but do not establish that GAD specifically is especially common among Puerto Ricans. The printed citing sentence makes only the broader claim about Latinos. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    It is uncertain whether CBT and ABBT are appropriate for Spanish-speaking Latinos because they have usually been left out of efficacy and effectiveness research.

    “However, there remains uncertainty regarding the appropriateness of these interventions for Spanish-speaking Latinos since they have been routinely excluded in both efficacy and effectiveness studies.”
    • Also stated in: § Introduction · plain
      “there remains uncertainty regarding the appropriateness of these interventions for Spanish-speaking Latinos since they have been routinely excluded in treatment outcome studies (Lau, Chang, & Okazaki, 2010).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Lau, Chang, & Okazaki, 2010 source

      The Language Inclusion section (page not available in our copy) reports that 40% of 76 studies of culturally adapted interventions included only native English speakers, supporting concern about exclusion from treatment research. It does not establish that Spanish-speaking Latinos were routinely excluded from both efficacy and effectiveness studies of CBT and ABBT specifically, or assess the appropriateness of those two interventions for them. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    ABBT and established CBT both produced significant change across treatment and follow-up.

    “More recently, investigators examined the effectiveness of ABBT in comparison to an established CBT treatment (Hayes-Skelton et al., 2013) showing that both treatments led to significant change across treatment and follow-up.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Hayes-Skelton et al., 2013 source

      The Discussion (page not provided) reports statistically and clinically significant improvement with both ABBT and applied relaxation (AR) through short-term follow-up. The Methods identify AR—not CBT—as the trial’s comparison treatment, and the paper discusses CBT as a separate treatment in other studies. Thus the improvement finding is supported, but describing the comparison arm as established CBT is not. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    An initial crossover trial found that ABBT brought GAD symptoms into the non-clinical range by follow-up, with gains maintained for another 9 months.

    “In an initial crossover study, in which randomized participants received ABBT immediately or where placed on a waiting list to receive it later, ABBT significantly reduced GAD symptoms to non-clinical levels at follow-up, with benefits sustained over further 9 months (Roemer et al., 2008).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Roemer et al., 2008 source

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

    Premisecitation

    The validity of the Spanish version of the Patient Health Questionnaire-9 is supported by psychometric studies.

    “Psychometric studies sustain the validity of the Spanish version of the PHQ-9 (Diez-Quevedo, Rangil, Sanchez-Planell, Kroenke, & Spitzer, 2001; Baader et al., 2012).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Diez-Quevedo, Rangil, Sanchez-Planell, Kroenke, & Spitzer, 2001 source
    • cites Baader et al., 2012 source

  • Classified as probably not a substantial claim.

    Premisecitation

    Scant availability of linguistic and culturally competent services is a key barrier to mental health care access for minority populations.

    “They highlight that the scant availability of linguistic and culturally competent services is a key barrier to mental health care access for minority populations.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Alegría et al., 2016 source

  • Classified as probably not a substantial claim.

    Premisecitation

    A major factor contributing to persistent mental health care disparities is the mistaken assumption that evidence-based treatments are easily available for diverse populations.

    “Alegría et al. (2016) sustain that a major factor that has contributed to the persistence of mental health care disparities is the mistaken assumption that evidence-based treatments are easily available for diverse populations.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Alegría et al., 2016 source

  • May combine two claims.

    Findingown data

    At follow-up, PSWQ scores were statistically lower in CBT and ABBT than in TAU, and CBT and ABBT did not differ statistically from each other.

    “At follow-up, PSWQ scores for participants in the CBT and ABBT groups were statistically lower than those of the TAU group and statistically comparable to each other.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The PSWQ is the gold-standard measure of GAD-related worry.

  • May combine two claims.

    Findingown data

    Depression severity shifted to mild for the ABBT group and moderate for the CBT group, while the treatment-as-usual group remained at moderate severity.

    “Depression severity level shifted to mild for the ABBT group (6.89, 95% CI: 4.01 to 9.78) and moderate for the CBT group (9.88, 95% CI: 7.14 to 12.62), while severity level remained moderate for the TAU group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Baseline depression severity was at the moderately severe level for ABBT and CBT groups and at the moderate level for the treatment-as-usual group.

    “Baseline depression severity mean scores were at the moderately severe level for the ABBT and CBT groups and at the moderate level for the TAU group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Based on clinically significant change criteria, 57% of the ABBT group, 60% of the CBT group, and 43% of the treatment-as-usual group achieved a reliable decrease in Penn State Worry Questionnaire scores.

    “Based on criteria for clinically significant change, 57% of the ABBT group, 60% of the CBT group, and 43% of the TAU group were classified as having achieved a reliable decrease in PSWQ scores.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    A significant time-by-treatment interaction was found for Depression and Anxiety Stress Scale-21 stress scores (F = 4.30, p < .01).

    “Findings showed a significant interaction effect between time and treatment (F = 4.30, p < .01).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Mean Penn State Worry Questionnaire scores for ABBT and CBT groups improved from the high range at baseline to the moderate range at follow-up, while usual care participants remained at a high level.

    “Mean scores on the PSWQ scale for both ABBT and CBT groups show that the level of worry improved from the high range at baseline to the moderate range at follow-up, whereas mean scores for usual care participants remained at a high level (Table 2).”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Intent-to-treat analysis yielded a significant time-by-group interaction for Depression and Anxiety Stress Scale-21 anxiety scores (F = 3.29, p < .01).

    “Intent to treat analysis yielded a significant result for the time-by-group interaction (F = 3.29, p < .01) (Table 2).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    GAD contributes to higher risk of cardiovascular disease, and reducing GAD symptoms is linked to lower risk of new-onset cardiovascular disease.

    “Liu, Tian, Liu, Nigatu, and Wang (2019) examined the impact of GAD on the course of cardiovascular disease, they found that while GAD contributes to increase the risk of cardiovascular disease (CVD), a reduction of GAD symptoms is associated with reduced risk of new-onset CVD.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Liu, Tian, Liu, Nigatu, and Wang (2019) source

  • May combine two claims.

    Premisecitation

    Among anxiety disorders in primary care, GAD is the most frequent, yet it often goes unrecognized because patients present with somatic symptoms.

    “GAD is the most common anxiety disorder seen in primary care, but it is often unrecognized as many patients usually present with somatic symptoms that are often attributed to physical disorders (Kroenke, Spitzer, Williams, Monahan, & Löwe, 2007; Wittchen et al., 2002).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Kroenke, Spitzer, Williams, Monahan, & Löwe, 2007 source
    • cites Wittchen et al., 2002

      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).

    Premisecitation

    Worry serves as a cognitive avoidance mechanism that people use to prevent anticipated disasters and manage emotional reactivity from perceived threat.

    “According to Borkovec et al. (Borkovec et al., 2003; Borkovec, Alcaine, & Behar, 2004), worry functions as a type of cognitive avoidance mechanism used to identify ways of preventing anticipated disasters and to cope with the emotional reactivity generated by the perceived threat.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Borkovec et al., 2003 source
    • cites Borkovec, Alcaine, & Behar, 2004

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

  • May combine two claims.

    Premisecitation

    According to meta-analyses and systematic reviews, traditional CBT produces significant reductions in GAD symptoms and outperforms no treatment or alternative treatments.

    “Findings from meta-analyses and systematic reviews show that traditional CBT significantly reduces GAD symptoms and is more effective than no treatment or alternative treatments (Borkovec & Ruscio, 2001; Cuijpers et al., 2014; Gould, Safren, Washington, & Otto, 2004).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Borkovec & Ruscio, 2001

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

    • cites Cuijpers et al., 2014 source
    • cites Gould, Safren, Washington, & Otto, 2004

      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).

    Premisecitation

    Excessive worry is the central feature of GAD.

    “The core feature of GAD is out-of-control, excessive worry regarding ordinary daily situations (American Psychiatric Association, 2013).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites American Psychiatric Association, 2013

      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).

    Premisecitation

    ABBT targets reactions to internal experiences, not their content or how often they occur.

    “ABBT is characterized by a focus on altering how individuals react to their internal experiences (thoughts, emotions, sensations, and memories) instead of changing the content or frequency of the experiences themselves (O’connor, Munnelly, Whelan, & McHugh, 2018; Roemer, Williston, Eustis, & Orsillo, 2013).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites O’connor, Munnelly, Whelan, & McHugh, 2018 source
    • cites Roemer, Williston, Eustis, & Orsillo, 2013 source

  • Classified as probably not a substantial claim.

    Premisecitation

    In traditional CBT models, behavioral avoidance and worry are viewed as maladaptive coping strategies for problem-solving and reducing unwanted thoughts and emotions.

    “Traditional CBT models for GAD address behavioral avoidance and worry as maladaptive coping strategies used by the individual in the attempt to problem-solve and reduce undesirable thoughts and emotions (Borkovec, 1994; Borkovec et al., 2004).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Borkovec, 1994

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

    • cites Borkovec et al., 2004

      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.

    Premisecitation

    CBT outcomes resemble those of medication and are generally maintained at 6- and 12-month follow-up.

    “Furthermore, the benefits of CBT are comparable to those reported for pharmacological interventions and tend to be sustained over 6- and 12-month follow-up (Borkovec et al., 2002; Covin, Ouiment, Seeds, & Dozois, 2008; Cuijpers et al., 2014; Heuzenroeder et al., 2004; Mitte, 2005).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Borkovec et al., 2002 source
    • cites Covin, Ouiment, Seeds, & Dozois, 2008 source
    • cites Cuijpers et al., 2014 source

  • May combine two claims.

    Study design and conductown data

    Of those who started, 63.6% in ABBT and 42.3% in CBT attended at least 15 sessions.

    “Among treatment initiators, treatment was completed (15 sessions or more) by 63.6% in the ABBT group and 42.3% in the CBT group.”
    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 conductcitation

    The Spanish ABBT version kept the English manual's core elements and added culturally relevant wording.

    “While maintaining fidelity to the core elements of the English ABBT manual, the Spanish version includes language, idioms, and examples relevant to Latino culture (Bernal et al., 2009).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Bernal et al., 2009 source

  • May combine two claims.

    Study design and conductown data

    Dropout rates before initiating treatment and during treatment were high.

    “Dropout rates before initiating treatment and during treatment were high.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    In this study, the Depression and Anxiety Stress Scale-21 subscales had good internal consistency at baseline (depression alpha = 0.84, anxiety alpha = 0.83, stress alpha = 0.86).

    “In the current study, the subscales demonstrated good internal consistency at baseline with Cronbach’s alpha coefficients of 0.84 for the depression subscale, 0.83 for the anxiety subscale, and 0.86 for the stress subscale.”
    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 conductown data

    Every session was recorded, and a randomly selected subset was reviewed.

    “All sessions were recorded, and a random sample was reviewed.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Doctoral students in clinical psychology rated 71 sessions for adherence to the intended protocols.

    “A total of 71 (ABBT = 36; CBT = 35) sessions were rated for adherence to the respective protocols by doctoral students in clinical psychology.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    In this study, the Penn State Worry Questionnaire had good internal consistency at pre-treatment (alpha = .80).

    “In the current study, the PSWQ demonstrated good internal consistency at pre-treatment (α = .80).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    ABBT's central premise holds that awareness, openness, and acceptance, rather than control or avoidance of unwanted feelings, keep anxiety from intensifying.

    “The basic premise underlying the therapy is that anxious responses can be kept from intensifying by responding with awareness, openness, and acceptance rather than efforts to control or avoid unwanted feelings (Orsillo & Roemer, 2005).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Orsillo & Roemer, 2005 source

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

    Study design and conductown data

    From 130 eligible patients, 40 could not be reached again, so 90 entered randomization.

    “A total of 130 patients with significant GAD symptoms were eligible for randomization, of these 40 were lost to further contact leaving a sample of 90 patients that were randomized: 30 to treatment as usual (TAU), 30 to ABBT, and 30 to CBT.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    Adaptation of CBT stressed equivalence in concepts and culture while preserving the English manual's active ingredients.

    “Special emphasis was placed on the attainment of conceptual and cultural equivalence, while maintaining fidelity to the active core elements in the English CBT manual.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Eligible participants were enrolled by trained research staff using a sequence produced by a computer random number generator.

    “Trained research staff with background in psychology was responsible for enrolling eligible participants using a number sequence developed by a computer random number generator.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    The Patient Health Questionnaire-9 has good psychometric properties and excellent discriminatory power for identifying depression.

    “The PHQ-9 has demonstrated good psychometric properties and has been shown to have excellent discriminatory power to identify patients with depression (Williams et al., 2005).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Williams et al., 2005 source

  • May combine two claims.

    Premisecitation

    The Depression and Anxiety Stress Scale-21 has high internal consistency and concurrent validity, distinguishing well between depression, anxiety, and stress.

    “The DASS-21 demonstrates high internal consistency and concurrent validity indicating that it distinguishes well between features of depression, anxiety, and stress (Antony, Cox, Enns, Bieling, & Swinson, 1998).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Antony, Cox, Enns, Bieling, & Swinson, 1998 source

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

    Study design and conductown data

    The clinicians were trained in ABBT by Drs. Roemer and Orsillo and in CBT by Dr. Borkovec.

    “They received ABBT training from Drs. Roemer and Orsillo and CBT training from Dr. Borkovec.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    In this study, the Patient Health Questionnaire-9 had excellent internal consistency at pre-treatment (alpha = .90).

    “Internal consistency in the current study was excellent at pre-treatment (α = .90).”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    The Penn State Worry Questionnaire has demonstrated strong reliability and validity.

    “The PSWQ has shown excellent reliability and validity (Brown, Antony, & Barlow, 1992; Fresco, Heimberg, Mennin, & Turk, 2002).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Brown, Antony, & Barlow, 1992 source
    • cites Fresco, Heimberg, Mennin, & Turk, 2002 source

  • May combine two claims.

    Study design and conductown data

    ABBT participants attended an average of 12.8 sessions; CBT participants attended 9.

    “The average number of sessions attended was 12.8 for ABBT and 9 for CBT.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Assessments were conducted by assessors blind to randomization.

    “Assessments were arranged outside of treatment session and were conducted by assessors blind to randomization.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    The psychometric properties and factor structure of the Spanish version of the Depression and Anxiety Stress Scale-21 were comparable to the English version.

    “The psychometric properties and factor structure of the Spanish version of the DASS-21were comparable to those of the English version (Daza, Novy, Stanley, & Averill, 2002).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Daza, Novy, Stanley, & Averill, 2002 source

  • May combine two claims.

    Interpretationown data

    CBT and ABBT resulted in clinically significant improvements.

    “Our results demonstrate that CBT and ABBT resulted in clinically significant improvements.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    The Spanish version of the Penn State Worry Questionnaire has appropriate test-retest reliability, high internal consistency, and good convergent and discriminant validity.

    “The Spanish version of the PSWQ has demonstrated appropriate test-retest reliability, high internal consistency, and good convergent and discriminant validity (Nuevo-Benítez, Montorio-Cerrato, & Ruiz-Díaz, 2002; Rodríguez-Biglieri, 2011).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Nuevo-Benítez, Montorio-Cerrato, & Ruiz-Díaz, 2002

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

    • cites Rodríguez-Biglieri, 2011 source

  • May combine two claims.

    Study design and conductown data

    Completion rates were 90% TAU, 73.3% ABBT, and 73.3% CBT at week 20, and 96.7% TAU, 70% ABBT, and 86.7% CBT at week 28.

    “In addition to baseline the following percentages completed week-20 and week-28 assessments: week-20, 90% TAU patients, 73.3% ABBT patients, and 73.3% CBT patients, and week-28, 96.7% TAU patients, 70% ABBT patients, and 86.7% CBT patients.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Staff enrolling participants called a central office to learn the treatment assignment for each person.

    “To obtain random assignment information for each participant, enrollment staff contacted the central office to receive information corresponding to the assigned treatment condition.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Multiple studies document poor initiation and retention in mental health treatment for low-income and ethnic minority populations.

    “These findings are consistent with multiple studies that document poor initiation and retention in mental health treatment for low-income and ethnic minority populations (Arnow et al., 2007; Bados, Balaguer, & Saldaña, 2007; Blanco et al., 2007; Kozhimannil, Trinacty, Busch, Huskamp, & Adams, 2011; Santiago, Kaltman, & Miranda, 2013).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Arnow et al., 2007 source
    • cites Bados, Balaguer, & Saldaña, 2007 source
    • cites Blanco et al., 2007 source

  • May combine two claims.

    Study design and conductnone given

    Study recruiters did not systematically select patients for screening in primary care reception rooms, which may subject the data to some selection bias.

    “A second limitation was that study recruiters did not systematically select patients for screening in primary care reception rooms; this may subject the data to some selection bias.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    For many measures of mental health care, Latinos received worse quality of care than non-Hispanic Whites, with no narrowing of disparities over time.

    “For many measures of mental health care Latinos received worse quality of care than non-Hispanic Whites, showing no narrowing of disparities overtime.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Mompe et al., 2015

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

49 of 49

  • The paper relies on this without support.

    The PSWQ is the gold-standard measure of GAD-related worry.

    “which is considered the gold standard measure of GAD-related worry”

  • The paper relies on this without support.

    The components on the adherence checklist serve as proxy measures for essential therapy elements.

    “For each session an adherence checklist listed the required components which were considered as proxy measures for therapy essential elements.”

  • The paper relies on this without support.

    This is the first randomized trial to investigate both traditional and newer CBT approaches for generalized anxiety disorder in Spanish-speaking primary care patients.

    “To our knowledge, this is the first randomized trial to investigate the use of both traditional and newer CBT approaches for the treatment of GAD in Spanish-speaking primary care patients.”
    “This pilot RCT is the first to explore the potential benefits of two CBT based interventions for the treatment of Spanish-speaking Latino primary care patients with GAD.”

  • The paper relies on this without support.

    The Penn State Worry Questionnaire is the gold standard measure of generalized anxiety disorder-related worry.

    “Excessive worry, the core feature of GAD, was assessed with the PSWQ, which is considered the gold standard measure of GAD-related worry.”

  • The paper relies on this without support.

    Excessive worry is the core feature of generalized anxiety disorder.

    “Excessive worry, the core feature of GAD, was assessed with the PSWQ, which is considered the gold standard measure of GAD-related worry.”
5 of 5

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?

Cites

Flagged first, then by citations

12 of the 111 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. Alegría, 2002, Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino whites, Psychiatric Services, 53, 1547, 10.1176/appi.ps.53.12.1547 · DOI
  2. Brach, 2008, Demographics and health care access and utilization of limited-English-Proficient and English-Proficient Hispanics, Research Findings, 28
  3. Nuevo-Benítez, 2002, Application of the Penn State Worry Questionnaire (PSWQ) to elderly population, Ansiedad Estrés, 8, 157

Cited by

Sorted by citations

Related

Authors
Vera, M., Obén, A., Juarbe, D., Hernández, N., & Pérez-Pedrogo, C.
Affiliations
University of Puerto Rico, Medical Sciences Campus (PR)
Corresponding author
Vera, Mildred
ORCID
Pérez-Pedrogo, Coralee
Venue
Journal of Behavioral and Cognitive Therapy
Publisher
Elsevier BV
Published
2021-06
Volume
31
Issue
2
Pages
91-103
ISSN
2589-9791 (ISSN-L)
DOI
10.1016/j.jbct.2020.11.007
PMC
PMC9269989
OpenAlex
W3113918872
Semantic Scholar
ac7d67a886a8e5005f6c7dc70eb377a0b91c2962
Cited by
8
References
111
Citations by year
2025: 1 · 2024: 1 · 2023: 2 · 2022: 3 · 2021: 1
FWCI
1.69
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Behavioral and Cognitive Therapy (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
generalized anxiety disorder, cognitive behavioral therapy, Spanish-speaking Latinos, Puerto Ricans, primary care patients, excessive worry, Penn State Worry Questionnaire, treatment efficacy

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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.

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