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Cited by 502Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMindfulness and Compassion InterventionsChild and Adolescent Psychosocial and Emotional Development

Efficacy of an Acceptance-Based Behavior Therapy for Generalized Anxiety Disorder: Evaluation in a Randomized Controlled Trial

Open access
Roemer, Lizabeth, Orsillo, Susan M., Salters-Pedneault, Kristalyn·2008·Journal of Consulting and Clinical Psychology
DOI 10.1037/a0012720PMC PMC2596727
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Abstract

Generalized anxiety disorder (GAD) is a chronic anxiety disorder, associated with comorbidity and impairment in quality of life, for which improved psychosocial treatments are needed. GAD is also associated with reactivity to and avoidance of internal experiences. The current study examined the efficacy of an acceptance-based behavioral therapy aimed at increasing acceptance of internal experiences and encouraging action in valued domains for GAD. Clients were randomly assigned to immediate (n = 15) or delayed (n = 16) treatment. Acceptance-based behavior therapy led to statistically significant reductions in clinician-rated and self-reported GAD symptoms that were maintained at 3- and 9-month follow-up assessments; significant reductions in depressive symptoms were also observed. At posttreatment assessment 78% of treated participants no longer met criteria for GAD and 77% achieved high end-state functioning; these proportions stayed constant or increased over time. As predicted, treatment was associated with decreases in experiential avoidance and increases in mindfulness. © 2008 American Psychological Association.

Integrity signals

Registry

Crossref · 10.1037/a0012720

Cites

30 of 30 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 9 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The effect of time on DASS-stress was medium, suggesting a modest increase in stress symptoms over time.

    “However, the effect size of time on DASS-stress was medium, suggesting a modest increase in these symptoms over time.11”
    Quote in the paperNot a substantial claim
  • Findingown data

    Worry scores continued to decline modestly during the follow-up period.

    “while worry scores continued to decrease modestly during follow up.”
    Quote in the paperNot a substantial claim
  • Findingown data

    At post-treatment or post-waiting-list, 76.92% of treated participants versus 16.67% of wait-list participants no longer met GAD criteria.

    “At post-treatment/waiting list, 76.92% of those treated compared with 16.67 % of those on the wait-list no longer met criteria for GAD (χ2 = 9.08, p <.01).”
    Quote in the paperSubstantial claim
  • Findingown data

    Significant condition-by-time interactions were found for clinician-rated GAD severity, PSWQ, DASS-Stress, and BDI.

    “with significant condition by time interactions for clinician rated GAD severity, PSWQ, and DASS-Stress, and the BDI.”
    Quote in the paperSubstantial claim
  • Findingown data

    In the controlled trial, condition-by-time interactions for primary and secondary outcomes had medium to large effect sizes.

    “The controlled effect sizes for condition by time interactions for primary and secondary outcomes were medium to large”
    Quote in the paperSubstantial claim
  • May combine two claims. 22
  • Classified as probably not a substantial claim. 30

  • May combine two claims.

    Findingown data

    From pre- to post-treatment, multi-level regression analyses showed significant decreases in GAD severity, PSWQ, DASS-Stress, DASS-Anxiety, BDI, number of additional diagnoses, and AAQ scores, and significant increases in MAAS and QOLI scores.

    “Multi-level regression analyses of change revealed significant decreases in GAD severity, PWSQ, DASS-Stress, DASS-Anxiety, BDI, number of additional diagnosis, and AAQ scores, and significant increases in MAAS and QOLI scores, from pre- to post-treatment (all ps <.001).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Growth curve analyses showed that treatment gains were maintained for all outcomes, with nonsignificant time coefficients.

    “Growth curve analyses (reported in Table 5) indicated that treatment gains were maintained for all outcomes (i.e., nonsignificant coefficients of time)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The treatment significantly affected both experiential avoidance and mindfulness, providing initial support for the proposed mechanisms of change in ABBT.

    “Initial support was found for the proposed mechanisms of change in ABBT as the treatment had a significant effect on both experiential avoidance and mindfulness.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    At post-treatment or post-waiting-list, 75% of treated participants and 8.3% of wait-list participants met high end-state functioning criteria.

    “and 75% of treated participants vs. 8.3 % of those in the wait-list condition met criteria for high end-state functioning, (χ2 = 10.97, p <.01).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    At post-assessment, 77% of the treated sample met criteria for both high end-state functioning and responder status, and these proportions remained stable through the 3- and 9-month follow-ups.

    “Seventy-seven percent of the treated sample met criteria for high end-state functioning and responder status at post-assessment and these proportions were stable through 3- and 9-month follow-up.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    At post-treatment or post-waiting-list, 75% of treated participants and 8.3% of wait-list participants met responder status criteria.

    “At post-treatment/waiting list, 75% of participants in the treatment condition and 8.3 % of the wait-list condition met criteria for responder status, (χ2 = 10.97, p <.01)”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    The Mindful Attention Awareness Scale had an internal consistency of α = .88 in this sample.

    “α in this sample was .88.”
    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

    The principal investigator assigned the 31 remaining clients in a randomized blocked fashion using a coin flip, with matched clients assigned to the opposite condition to balance the groups.

    “The remaining 31 clients were randomly assigned to the treatment or waiting list condition in a randomized blocked fashion by the PI. Condition assignment was done using a coin flip; subsequent clients who matched an enrolled client in gender, racial minority status, and GAD severity (moderate versus severe) were assigned to the opposite condition to ensure balance across conditions in this small”
    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

    The DASS-21 anxiety and stress subscales had internal consistencies of α = .79 and α = .87 in this sample.

    “In the current study, the anxiety and stress sub-scales were used as indicators of anxiety, αs = .79 and .87 respectively.”
    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

    During this study at CARD, reliability was k = .56 for GAD diagnoses and k = .77 for GAD clinical severity ratings.

    “During the time period of this study at CARD, reliability for GAD diagnoses were k = .56, and for CSR ratings of GAD, k=.77.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Thirty-one participants were randomly allocated to either immediate treatment (15) or a waiting-list control (16).

    “Thirty-one clients consented to participation and were randomized to treatment (n = 15) or waiting list control (n = 16).”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    Doctoral students who had extensive training and demonstrated diagnostic reliability administered all assessments.

    “All assessments were administered by doctoral students at the Center for Anxiety and Related Disorders (CARD) who had undergone extensive training and demonstrated reliability in diagnoses4.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    The 16-item Acceptance and Action Questionnaire had an internal consistency of α = .84 in this sample.

    “The α in this sample was .84.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    The Penn State Worry Questionnaire had an internal consistency of α = .795 in this sample.

    “a 16-item measure of trait levels of excessive worry (α = .795 in the current sample)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Worrying lowers autonomic reactivity and diverts worriers from more distressing topics.

    “Engaging in the worry process reduces autonomic reactivity and distracts worriers from more distressing topics (Borkovec, Alcaine, & Behar, 2004).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Borkovec, Alcaine, & Behar, 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.

    Study design and conductcitation

    In a prior CARD study, the ADIS-IV showed reliability of k = .67 for principal GAD diagnoses and k = .72 for GAD clinical severity ratings.

    “The ADIS-IV has a reliability for principal GAD diagnoses of k = .67, and for CSR ratings of GAD of k = .72, in a study conducted at CARD (Brown, DiNardo, Lehmann, & Campbell, 2001).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Brown, DiNardo, Lehmann, & Campbell, 2001 source

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

    Study design and conductown data

    Two sessions per client were randomly chosen and rated for adherence by graduate students familiar with ABBT.

    “Two sessions from each client were randomly selected and rated for adherence by graduate students with extensive exposure to ABBT.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    After treatment or waiting list, a CARD assessor who did not know the condition assessed the clients.

    “Following treatment or waiting list, clients were assessed by a CARD assessor uninformed of condition”
    Quote in the paperSubstantial claim

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

    Study design and conductnone given

    Diagnoses were confirmed through consensus meetings with a doctoral-level psychologist and by therapists during initial meetings.

    “Diagnoses were confirmed in consensus meetings with a doctoral level psychologist (Dr. T.A. Brown) and by therapists in their initial meetings.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    The abbreviated Quality of Life Inventory had an internal consistency of α = .836 in this sample.

    “an abbreviated version of the Quality of Life Inventory (QOLI; Frisch, Cornwell, Villanueva, & Retzlaff, 1992), a measure of life satisfaction with an α of .836 in the current sample”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    The Beck Depression Inventory had an internal consistency of α = .87 in this sample.

    “The Beck Depression Inventory (BDI-I-A; Beck, Rush, Shaw, & Emery, 1979), α =.87 in the current sample”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    The staff member and the potential participant remained blind to condition until informed consent was completed.

    “Both the staff member and potential participant were blind to condition until the informed consent process was complete.”
    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

    Two participants dropped out of therapy and four dropped out of the waiting-list condition.

    “Two participants withdrew from therapy and four from the waiting list.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    Most CARD assessors were not involved in the study, but three therapists also served as CARD assessors and could have been biased by loyalty to the study.

    “Most of the CARD assessors were uninvolved with the study, but three therapists were also CARD assessors (not for their own clients) and could have been biased by a loyalty to the study.”
    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

    Four participants missed the 3-month follow-up and six missed the 9-month follow-up.

    “Of these participants, four missed 3-month and six missed 9-month follow-up assessment.”
    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

    The study did not assess the reliability of post-treatment and follow-up assessments or the reliability of GAD diagnosis.

    “Also, we did not assess reliability of post and follow-up assessments and reliability of GAD diagnosis.”
    Quote in the paperNot a substantial claim

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

    Study design and conductreasoning

    Because competency ratings were absent, treatment effects might have been underestimated due to poor delivery of the intervention.

    “Further, the absence of competency ratings raises the possibility that treatment effects are underestimated due to poor competency in delivery of the intervention.”
    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

    Self-report measures were missing for one client at post-treatment, one at 3-month follow-up, and two at 9-month follow-up.

    “Also, self-report measures only are missing for one client at post, one at 3-month and two at 9-month follow-up.9”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    Adherence ratings made by graduate students could have been biased by allegiance.

    “Similarly, adherence ratings done by graduate students could have been biased by allegiance.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    The completer sample had 80% power to detect effects of d ≥ 1.17 at alpha = .05.

    “For the completer sample, power = .80 to detect effects of d ≥ 1.17 at alpha = .05.”
    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

    Sessions used an average of 10.64 allowed strategies, and two minor nonprotocol events were recorded.

    “Sessions averaged 10.64 allowed strategies; two minor nonprotocol events were recorded.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Two raters rated 25% of sessions with acceptable reliability, k = .70.

    “Twenty-five percent of sessions were rated by two raters with acceptable reliability, k = .70.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    The intention-to-treat sample had 80% power to detect effects of d ≥ 1.04 at alpha = .05.

    “In the ITT sample, power = .80 to detect effects of d ≥ 1.04 at alpha = .05.”
    Quote in the paperNot a substantial claim

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

    Interpretationown data

    Because the sample was largely White, the efficacy and acceptability of ABBT still need to be determined for clients from diverse racial and ethnic backgrounds.

    “Also, given that the sample largely self-identified as White, we need to determine the efficacy and acceptability of ABBT across clients from diverse racial and ethnic backgrounds.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Three participants started medication during the study, but the evidence for significant and durable treatment effects weakened only slightly when those participants were excluded.

    “Three participants began taking medication over the course of the study, although evidence for significant, durable effects of treatment diminished only slightly when those participants were dropped from analyses.”
    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

    Assessors were not told the treatment condition, but the study did not confirm that they were blind to condition.

    “Further, although assessors were not informed of treatment condition, we did not confirm that they were blind to condition.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    The reliability of clinician severity ratings at pre-assessment was good.

    “Although reliability of clinician severity ratings (a primary outcome measure) at pre-assessment was good”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    A diagnostically heterogeneous sample could reduce the size of between-group effects.

    “Using a diagnostically heterogeneous sample could minimize between group effects.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    A waiting-list control comparison cannot rule out possible nonspecific factors.

    “The use of a waiting list control comparison does not rule out the possible influence of nonspecific factors.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The treatment-related changes appear to be clinically significant and to last over time.

    “The changes associated with treatment appear to be clinically significant and durable.”
    Quote in the paperSubstantial claim
40 of 40

  • The paper relies on this without support.

    Clients with GAD tend to choose behaviors that reduce anxiety rather than maximize satisfaction, and they are distracted by worries during important activities.

    “In addition, clients describe making behavioral choices aimed at decreasing anxiety, rather than maximizing satisfaction, and being distracted by worries when they are engaged in important activities.”
1 of 1

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?

  • A small randomized controlled trial comparing ABBT with a waiting list control found significant effects on clinical assessor ratings of GAD, anxious and depressive symptoms, quality of life, mindfulness, and experiential avoidance.

    “A small randomized controlled trial comparing an ABBT for GAD to a waiting list control condition revealed significant effects of treatment on clinical assessor ratings of GAD, as well as reports of anxious and depressive symptoms, quality of life, mindfulness, and experiential avoidance (Roemer et al., 2008).”

    From Acceptance-based behavioral therapy for GAD: effects on outcomes from three theoretical models. (2011) · cites this paper as Roemer et al., 2008

    The Results (Controlled Trial; page not supplied) report significant effects on clinician-rated GAD severity, several self-reported anxiety measures, depressive symptoms, mindfulness, and experiential avoidance. The quality-of-life effect approached but did not reach significance; the same was true of the DASS-Anxiety measure. The claim overstates the findings by calling all listed effects significant. (LLM, conf=0.92)

    Experimental — accuracy not yet measured

  • PSWQ scores at pre-treatment in the GAD subsample were considerably lower than those in recently published randomized trials for GAD.

    “In addition, the Penn State Worry Questionnaire scores at pre-treatment in the GAD subsample were considerably lower that those in recently published randomized trials for GAD (Newman et al., 2011; Roemer et al., 2008), which may hold implications for the interpretation of findings in this subgroup.”

    From Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders (2012) · cites this paper as Roemer et al., 2008

    The Participants and Measures sections identify this as a randomized GAD trial that measured PSWQ scores. Preliminary Analyses says pre-treatment PSWQ results are in Table 2 and that scores differed between the trial’s two conditions. The passages available from our copy do not give the baseline scores, so they cannot establish that the citing paper’s GAD subsample scored considerably lower. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

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

    “recent CBT interventions have integrated both less and more elaborate training components by synthesizing mindfulness and attention training with traditional CBT techniques78–80, resulting in high endstate functioning which is achieved and maintained through follow-up periods, while also sampling patients evidencing prominent depression features at baseline78–80.”

    From AN OPEN TRIAL OF EMOTION REGULATION THERAPY FOR GENERALIZED ANXIETY DISORDER AND COOCCURRING DEPRESSION. (2015) · cites this paper as [79]

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

    Experimental — accuracy not yet measured

  • In Study 1, the original trial showed large magnitude improvements at post-treatment for worry, clinician-rated GAD severity, and quality of life.

    “The main results for study 1, which were reported by Roemer, Orsillo, and Salters-Pednault (2008), showed large magnitude improvements at post treatment and maintenance of gains across follow-up time points for worry, clinician-rated severity of GAD symptoms, and quality of life.”

    From Relationships between amount of post-intervention mindfulness practice and follow-up outcome variables in an acceptance-based behavior therapy for Generalized Anxiety Disorder: The importance of informal practice (2014) · cites this paper as Roemer, Orsillo, and Salters-Pednault (2008)

    The Results (Maintenance of Treatment Response; page unavailable) report post-treatment improvements in worry, clinician-rated GAD severity, and quality of life, with gains maintained through follow-up. But the Discussion describes the controlled effect on quality of life as medium-sized and marginally significant, not large; the claim overstates that outcome. (LLM, conf=0.89)

    Experimental — accuracy not yet measured

  • The finding that DBT skills and psychological flexibility predicted anxiety improvement is consistent with growing evidence supporting the efficacy of newer generation cognitive behavioral approaches, particularly ACT and DBT, for anxiety symptoms and disorders.

    “The latter finding is consistent with the growing body of evidence supporting the efficacy of newer generation cognitive behavioral approaches, in particular ACT and DBT, for anxiety symptoms and disorders (Arch et al., 2012; Landy, Schneider & Arch, 2015; Roemer, Orsillo & Salters-Pedneault, 2008; Swain, Hancock, Hainsworth, & Bowman, 2013).”

    From Differential role of CBT skills, DBT skills and psychological flexibility in predicting depressive versus anxiety symptom improvement (2016) · cites this paper as Roemer, Orsillo & Salters-Pedneault, 2008

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

    Experimental — accuracy not yet measured

Self-check

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

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

  • Table 2 variability is described two different ways

    Minor

    The analysis plan says Table 2 reports standard errors, but the preliminary analyses say it reports standard deviations. These are different statistics.

1 of 1

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Related

Authors
Roemer, L., Orsillo, S. M., & Salters-Pedneault, K.
Affiliations
  • University of Massachusetts Boston (US)
  • Suffolk University (US)
ORCID
Venue
Journal of Consulting and Clinical Psychology
Publisher
American Psychological Association (APA)
Published
2008-12
Volume
76
Issue
6
Pages
1083-1089
ISSN
  • 0022-006X (ISSN-L)
  • 1939-2117
DOI
10.1037/a0012720
PMC
PMC2596727
OpenAlex
W2124962851
Cited by
502
References
32
Citations by year
2026: 8 · 2025: 11 · 2024: 21 · 2023: 16 · 2022: 14 · 2021: 33 · 2020: 37 · 2019: 31 · 2018: 26 · 2017: 31 · 2016: 37 · 2015: 36 · 2014: 45 · 2013: 42 · 2012: 37
FWCI
23.21
Type
journal article
Language
en
Open access
Locations
  • Journal of Consulting and Clinical Psychology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion)
Funders
National Institute of Mental Health (MH63208)
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 › Child and Adolescent Psychosocial and Emotional Development
Keywords
generalized anxiety disorder, acceptance and commitment therapy, experiential avoidance, mindfulness, depressive symptoms, treatment efficacy, treatment delay
MeSH terms
Adult, Anxiety Disorders, Behavior Therapy

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

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