Cited by 175Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and ApplicationsPsychological Treatments and Assessments

A randomized controlled trial of cognitive-behavioral therapy for generalized anxiety disorder with integrated techniques from emotion-focused and interpersonal therapies

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Newman, Michelle G., Castonguay, Louis G., Borkovec, Thomas D., Fisher, Aaron J., Boswell, James F., Szkodny, Lauren E., Nordberg, Samuel S.·2011·Journal of Consulting and Clinical Psychology

Abstract

OBJECTIVE: Recent models suggest that generalized anxiety disorder (GAD) symptoms may be maintained by emotional processing avoidance and interpersonal problems. METHOD: This is the first randomized controlled trial to test directly whether cognitive-behavioral therapy (CBT) could be augmented with the addition of a module targeting interpersonal problems and emotional processing. Eighty-three primarily White participants (mean age = 37) with a principle diagnosis of GAD were recruited from the community. Participants were assigned randomly to CBT plus supportive listening (n = 40) or to CBT plus interpersonal and emotional processing therapy (n = 43) within a study using an additive design. Doctoral-level psychologists with full-time private practices treated participants in an outpatient clinic. Using blind assessors, participants were assessed at pretreatment, posttreatment, 6-month, 1-year, and 2-year follow-up with a composite of self-report and assessor-rated GAD symptom measures (the Penn State Worry Questionnaire; T. J. Meyer, M. L. Miller, R. L. Metzger, & T. D. Borkovec, 1990; Hamilton Anxiety Rating Scale; M. Hamilton, 1959; assessor severity rating; State-Trait Anxiety Inventory-Trait Version; C. D. Spielberger, R. L. Gorsuch, R. Lushene, P. R. Vagg, & G. A. Jacobs, 1983) as well as with indices of clinically significant change. RESULTS: Mixed models analysis of all randomized participants showed very large within-treatment effect sizes for both treatments (CI = [-.40, -.28], d = 1.86) with no significant differences at post (CI = [-.09, .07], d = .07) or 2-year follow-up (CI = [-.01, .01]), d = .12). There was also no statistical difference between compared treatments on clinically significant change based on chi-square analysis. CONCLUSIONS: Interpersonal and emotional processing techniques may not augment CBT for all GAD participants. Trial Registry name: Clinical Trials.gov, Identifier: NCT00951652.

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Crossref · 10.1037/a0022489

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  • 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 Newman et al., 2011

    The Abstract (Method) identifies this as a randomized GAD trial, and Measures (Procedure) says the PSWQ was administered at pretreatment. The retrieved passages do not give its pretreatment score, so they cannot establish that the citing paper’s GAD subsample scored considerably lower. (LLM, conf=0.72)

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  • Most studies find that fewer than 65% of clients meet criteria for high end-state functioning at post-treatment.

    “However, GAD remains one of the least successfully treated of the anxiety disorders (Waters & Craske, 2005), with most studies finding that fewer than 65% of clients meet criteria for high end-state functioning at post-treatment (e.g., Ladouceur et al., 2000; Newman et al., 2011) and few studies examining the impact of treatment on quality of life.”

    From A randomized clinical trial comparing an acceptance-based behavior therapy to applied relaxation for generalized anxiety disorder (2013) · cites this paper as Newman et al., 2011

    The Results section (Effect of Treatment on GAD Symptom Severity; page unavailable) reports high end-state functioning in 52.9% of one treatment group at two-year follow-up, consistent with the claim’s general point that fewer than 65% can reach that outcome. But the other group reached 68.8%, and these figures are for follow-up, not post-treatment. This single trial does not establish what most studies find at post-treatment. (LLM, conf=0.76)

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  • ABBT's end-state functioning resembled Ladouceur et al. (2000) and exceeded every condition in Newman et al. (2011) and Borkovec et al. (2002) by more than 5 percentage points at post-treatment and 6-month follow-up.

    “the current study found that end state functioning for ABBT was similar to Ladouceur et al. (2000) and more than 5 percentage points higher than any condition in Newman et al. (2011) and Borkovec et al. (2002) at post-treatment and 6-month follow-up.”

    From A randomized clinical trial comparing an acceptance-based behavior therapy to applied relaxation for generalized anxiety disorder (2013) · cites this paper as Newman et al. (2011)

    The Results (Statistical Analyses; page unavailable) define end-state functioning, and the Results (Effect of Treatment on GAD Symptom Severity; page unavailable) report it for both Newman trial conditions at two-year follow-up. The passages retrieved do not give end-state percentages at post-treatment or six months, so they cannot establish that ABBT exceeded every Newman condition by more than five percentage points at those times. (LLM, conf=0.76)

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  • At follow-up, CBT plus interpersonal and emotional processing therapy was associated with more participants no longer diagnosable with generalized anxiety disorder (75% vs 63.6%) and higher responder status on interpersonal problems (83.9% vs 66.7%), but these differences were not statistically significant.

    “At follow-up, CBT+I/EP was associated with more participants no longer diagnosable with GAD (75% vs. 63.6%) and higher responder status on interpersonal problems (83.9% vs. 66.7%), although these differences were not statistically significant.”

    From Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts (2022) · cites this paper as [51]

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  • In a randomized controlled trial of CBT plus interpersonal and emotional processing therapy versus CBT plus supportive listening, the groups did not differ on treatment expectancy, credibility, or attrition.

    “The groups did not differ on treatment expectancy, credibility, or attrition.”

    From Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts (2022) · cites this paper as [51]

    The Results > Process Measures section reports no significant difference between CBT + I/EP and CBT + supportive listening in treatment expectancy or credibility. Results > Statistical Analyses reports 13 dropouts and a nonsignificant condition-by-dropout interaction for symptom change, but does not establish that attrition rates did not differ between groups. (LLM, conf=0.82)

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Cites

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Research works printed but not linked: 2

  1. Brown TA Di Nardo PA Barlow DH 1994 Anxiety Disorders Interview Schedule for DSM-IV New York Oxford University Press
  2. First MB Gibbon M Spitzer RL Williams JBW Benjamin LS 1997 Structured Clinical Interview for DSM-IV Axis II Personality Disorders Washington American Psychiatric Press

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Authors
Newman, M. G., Castonguay, L. G., Borkovec, T. D., Fisher, A. J., Boswell, J. F., Szkodny, L. E., & Nordberg, S. S.
Affiliations
Pennsylvania State University (US)
Venue
Journal of Consulting and Clinical Psychology
Published
2011-04
Volume
79
Issue
2
Pages
171-181
ISSN
  • 0022-006X (ISSN-L)
  • 1939-2117
OpenAlex
W1992605652
Cited by
174
References
32
Citations by year
2026: 3 · 2025: 6 · 2024: 6 · 2023: 7 · 2022: 10 · 2021: 15 · 2020: 11 · 2019: 5 · 2018: 9 · 2017: 15 · 2016: 12 · 2015: 16 · 2014: 19 · 2013: 21 · 2012: 10
FWCI
23.09
Type
journal article
Language
en
Open access
Locations
  • Journal of Consulting and Clinical Psychology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • ScholarSphere (Penn State Libraries) (submittedVersion, cc-by)
Funders
National Institute of Mental Health (RO1 MH58593-02)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
Keywords
generalized anxiety disorder, cognitive behavioral therapy, emotion-focused therapy, interpersonal psychotherapy, augmentation therapy, interpersonal problems, outpatient psychotherapy
MeSH terms
Adaptation, Psychological, Adolescent, Adult, Aged, Anxiety Disorders, Emotions, Humans, Middle Aged, Patient Compliance, Severity of Illness Index, Cognitive Behavioral Therapy, Treatment Outcome, Patient Selection, Self Report

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