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Cited by 443Mindfulness and Compassion InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders

Open access
Arch, Joanna J., Eifert, Georg H., Davies, Carolyn, Vilardaga, Jennifer C. Plumb, Rose, Raphael D., Craske, Michelle G.·2012·Journal of Consulting and Clinical Psychology
DOI 10.1037/a0028310PMC PMC4718567
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Abstract

Objective: Randomized comparisons of acceptance-based treatments with traditional cognitive behavioral therapy (CBT) for anxiety disorders are lacking. To address this gap, we compared acceptance and commitment therapy (ACT) to CBT for heterogeneous anxiety disorders. Method: One hundred twenty-eight individuals (52% female, mean age = 38, 33% minority) with 1 or more DSM-IV anxiety disorders began treatment following randomization to CBT or ACT; both treatments included behavioral exposure. Assessments at pre-treatment, post-treatment, and 6-and 12-month follow-up measured anxiety-specific (principal disorder Clinical Severity Ratings [CSRs], Anxiety Sensitivity Index, Penn State Worry Questionnaire, Fear Questionnaire avoidance) and non-anxiety-specific (Quality of Life Index [QOLI], Acceptance and Action Questionnaire-16 [AAQ]) outcomes. Treatment adherence, therapist competency ratings, treatment credibility, and co-occurring mood and anxiety disorders were investigated. Results: CBT and ACT improved similarly across all outcomes from pre-to post-treatment. During follow-up, ACT showed steeper linear CSR improvements than CBT (p <.05, d = 1.26), and at 12-month follow-up, ACT showed lower CSRs than CBT among completers (p <.05, d = 1.10). At 12-month follow-up, ACT reported higher AAQ than CBT (p =.08, d = 0.42; completers: p <.05, d = 0.56), whereas CBT reported higher QOLI than ACT (p <.05, d = 0.42). Attrition and comorbidity improvements were similar; ACT used more non-study psychotherapy at 6-month follow-up. Therapist adherence and competency were good; treatment credibility was higher in CBT. Conclusions: Overall improvement was similar between ACT and CBT, indicating that ACT is a highly viable treatment for anxiety disorders. © 2012 American Psychological Association.

Integrity signals

Registry

Crossref · 10.1037/a0028310

Cites

73 of 73 references verified0 citation errors · 0 not checkable

Statistics

19 tests recomputed · 0 with the reported and recomputed p on opposite sides of .05

Claims the paper makes

5 of 35 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Case studies, multiple-baseline studies, and a single randomized trial provide early evidence that ACT is effective for anxiety disorders.

    “Case studies, multiple-baseline treatment studies and a single randomized clinical trial provide nascent evidence that ACT is an effective treatment for anxiety disorders”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Twohig et al., 2010 source

      The Introduction (page not provided) describes a prior multiple-baseline study in four adults with OCD, and the Discussion (page not provided) reports that this randomized trial found greater improvement in OCD symptoms with ACT than with progressive relaxation training. The paper does not establish the claimed case-study evidence or effectiveness across anxiety disorders generally; its trial findings concern OCD. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites Dalrymple & Herbert, 2007 source
    • cites Eifert et al., 2009 source
  • Premisecitation

    CBT is effective for anxiety disorders relative to wait-list or psychological control conditions, as shown by numerous randomized trials and meta-analyses.

    “have demonstrated the effectiveness of CBT for anxiety disorders, including panic disorder, generalized anxiety disorder, social anxiety disorder, obsessive compulsive disorder, specific phobia and posttraumatic stress disorder, relative to wait-list and/or psychological control conditions.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Butler, Chapman, Forman, & Beck, 2006 source

      The Summary and conclusions reports strong effects for generalized anxiety disorder, panic disorder, social phobia, and PTSD compared with no-treatment, wait-list, or placebo controls. Section 2.5 reports substantial improvement in OCD symptoms, but not a comparison with wait-list or psychological controls; the review does not address specific phobia among the disorders listed. Thus the source does not support the full disorder-by-disorder claim. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites Hofmann & Smits, 2008

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

    • cites Norton & Price, 2007 source
  • Findingcitation

    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.”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites Newman et al., 2011 source

      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)

      Experimental — accuracy not yet measured
    • cites Roemer et al., 2008 source

      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
  • Findingnone given

    Treatment credibility was higher in CBT than in ACT.

    “Therapist adherence and competency were good; treatment credibility was higher in CBT.”
    • Also stated in: § Results · plain
      “treatment credibility was higher in CBT.”
    Quote in the paperNot a substantial claim
  • Findingown data

    At 12-month follow-up, CBT reported higher QOLI than ACT (p < .05, d = .43).

    “whereas CBT reported higher QOLI than ACT (p < .05, d = .43).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 52
  • Borderline: one of the tests for a substantial claim is unclear. 3
  • Classified as probably not a substantial claim. 40
  • Not yet classified. 1

  • May combine two claims.

    Premisecitation

    The CBT protocol used the same basic treatment elements across all anxiety disorders but tailored content to each specific disorder, an approach previously tested.

    “Our CBT protocol included the same basic treatment elements across all of the disorders (e.g., psychoeducation, cognitive restructuring, exposure – see Methods) but tailored the content of these elements to each specific disorder, an approach we have successfully tested in previous studies (e.g., Craske et al., 2011).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Craske et al., 2011 source

  • Borderline on S1 (asserted), S4 (based): unclear from the text.

    Findingnone given

    CBT and ACT improved similarly across all outcomes from pre- to post-treatment.

    “CBT and ACT improved similarly across all outcomes from pre- to post-treatment.”
    Quote in the paperNot a substantial claim

  • Borderline on S4 (based): unclear from the text.

    Findingnone given

    Anxiety-related outcomes continued to improve through the six-month follow-up within both ACT and CBT.

    “Anxiety-related outcomes continued to improve through the six-month follow-up assessment within both ACT and CBT.”
    Quote in the paperNot a substantial claim

  • Borderline on S4 (based): unclear from the text.

    Findingnone given

    Both ACT and CBT resulted in robust reductions in co-occurring mood and anxiety disorders.

    “Both ACT and CBT resulted in robust reductions in co-occurring mood and anxiety disorders.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    At pre-treatment, ACT and CBT did not differ significantly on anxiety-specific or broader outcome measures, although ASI differences approached significance.

    “At pre-treatment, ACT and CBT evidenced no significant differences on anxiety specific or broader outcome measures, although ASI differences approached significance, t(111) = 1.91, p = .058 (all other outcome ps > .2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The HLM ITT model for CSR outcomes showed significant linear, quadratic, and cubic change over time, but no significant Group × Time interactions.

    “With the intercept (0) representing Pre, the HLM ITT model for CSR outcomes showed significant effects of linear, quadratic and cubic change over Time, all ps <.001, but no significant Group × Time interactions.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Broader outcomes continued to improve through six-month follow-up and gains endured from six to twelve months.

    “Broader outcomes continue to improve through six-month follow up and gains endured from six to twelve-month follow up.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    After treatment, ACT continued to improve on CSR from Post to 12-month follow-up more than CBT, which maintained but did not improve as much.

    “However, after treatment, the groups showed significant differences in CSR linear slope (within the full model accounting for Group on higher order change terms) such that ACT continued to improve from Post to 12mFU, whereas CBT maintained but did not continue to improve as much, B = .58, SE = .28, t(126) = 2.03, p = .04, d = 1.33 (effect size of group difference from Post to 12mFU), see Figure 2a”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The groups did not differ significantly in rates of reduction of co-occurring disorders over time; both groups showed decreases following treatment.

    “Nor did the groups differ significantly in rates of reduction of co-occurring disorders over Time, with both groups showing decreases in co-occurring disorders following treatment, see Table 5.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Eighty-five of 128 participants (66%) completed the full 12 sessions, including 68% in CBT and 65% in ACT.

    “Eighty-five of 128 Ps (66%) completed the full 12 sessions of therapy, including 68% (48/71) in CBT and 65% (37/57) in ACT.”
    Quote in the paperNot a substantial claim

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

    Findingown data

    At Post, CBT resulted in borderline greater dropped medication than ACT.

    “At Post, however, CBT resulted in borderline greater dropped medication than ACT, B = 2.13, SE = 1.10, p = .05 (p = .053), Exp(B) = 8.42 (95% CI: .97 to 73.06), with 37.04% (10/27) of CBT versus 7.14% (1/14) of ACT Ps dropping medication from Pre to Post.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    On broader outcomes, both groups showed large improvements in psychological flexibility and more moderate improvements in quality of life at post-treatment.

    “On broader outcomes, both groups showed large improvements in psychological flexibility and more moderate improvements in quality of life at post-treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The HLM ITT models for AAQ and QOLI outcomes showed significant linear, quadratic, and cubic change over time, but no significant Group × Time interactions.

    “The HLM ITT models for AAQ and QOLI outcomes showed significant effects of linear, quadratic, and cubic change over Time, all ps ≤ .001, but no significant Group × Time interactions from pre- to post-treatment, or after treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    No significant pre- or post-treatment differences emerged between treatment finishers with complete versus incomplete follow-up data on primary outcomes, except that those with incomplete follow-up data had higher pre-treatment ASI scores.

    “For treatment finishers with complete vs. incomplete data, no significant differences emerged at Pre or Post, with the minor exception that Ps with incomplete FU data had higher ASI scores at Pre (p = .04, pη2 =.05) but not at Post.”
    Quote in the paperSubstantial claim

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

    Findingown data

    ACT utilized more non-study psychotherapy at 6-month follow-up than CBT.

    “although ACT utilized more non-study psychotherapy at 6-month follow-up.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Principal PD/A diagnosis predicted superior CSR outcomes at Post and 6-month follow-up, but not at 12-month follow-up.

    “In HLM analyses, principal PD/A diagnosis predicted superior CSR outcomes compared to non-PD/A principal diagnoses, at Post (B = −1.14, SE = .45, t(126) = −2.53, p = .01, d = 1.31) and 6mFU (B = −1.01, SE = .51, t(126) = −2.11, p = .04, d = 1.16), but not at 12mFU (B = −.62, p = .26).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    At 12-month follow-up, ACT reported higher AAQ than CBT (p = .08, d = .42; completers: p < .05, d = .59).

    “At 12-month follow-up, ACT reported higher AAQ than CBT (p = .08, d = .42; Completers: p < .05, d = .59)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    From six to twelve months, improvement slowed but treatment gains endured.

    “From six to twelve months, improvement slowed but treatment gains endured.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Attrition and comorbidity improvements were similar between ACT and CBT.

    “Attrition and comorbidity improvements were similar”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    At 12-month follow-up, group differences in AAQ approached significance, with ACT showing greater psychological flexibility than CBT.

    “In addition, group differences in AAQ approached significance, B = 5.10, SE = 2.86, t(117) = 1.78, p = .08, d = .42, with ACT showing greater psychological flexibility than CBT, see Figure 2c.”
    • Also stated in: § Primary Outcomes · plain
      “Consistent with hypotheses, however, ACT participants reported higher levels of psychological flexibility than CBT at 12-month follow up on a measure specifically designed to capture ACT-related improvement (Hayes et al., 2004).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Hayes et al., 2004 source

  • May combine two claims.

    Findingown data

    The HLM ITT models for ASI, PSWQ, and FQ outcomes showed significant linear, quadratic, and cubic change over time, but no significant Group × Time interactions.

    “The HLM ITT model for ASI, PSWQ, and FQ outcomes showed significant effects of linear, quadratic, and cubic change over Time, all ps <.01, but no significant Group × Time interactions from pre- to post-treatment, or after treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Therapists averaged good overall skills across both treatments with no differences between groups.

    “Despite the use of novice student therapists, therapists averaged “good” overall skills across both treatments with no differences between treatment groups.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    The sample largely reflected the racial, ethnic, and sex distribution of U.S. residents at the time of data collection, supporting broad generalizability.

    “Finally, regarding the generalizability of our findings, our sample largely reflected the racial, ethnic, and sex distribution of U.S. residents at the time of data collection (Bureau, 2012), supporting the broad generalizability of our findings.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Bureau, 2012

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

  • May combine two claims.

    Findingown data

    Some differences emerged: CBT resulted in higher quality of life whereas ACT resulted in greater psychological flexibility, and among completers lower principal anxiety disorder severity over follow-up.

    “On the other hand, some differences did emerge, in that CBT resulted in higher quality of life whereas ACT resulted in greater psychological flexibility, and, among those who completed treatment, lower principal anxiety disorder severity, over the follow-up.”
    Quote in the paperNot a substantial claim

  • Not yet classified.

    Finding

    Attrition rates were relatively high across both ACT and CBT, but no group differences emerged.

    “Attrition rates were relatively high across both ACT and CBT; however, no group differences emerged.”
    Quote in the paperNot yet classified

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

    Study design and conductown data

    Fifteen randomized participants dropped before treatment initiation.

    “Fifteen of the original 143 Ps, blinded to treatment randomization (unaware if they had been randomized to ACT or CBT), dropped prior to treatment initiation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Participants who dropped before treatment did not differ significantly from those who began treatment on sociodemographic variables or by blind assignment to ACT versus CBT.

    “Ps who dropped prior to treatment did not differ significantly from Ps who began treatment on any sociodemographic variable from Table 1 (ps ≥ .20), nor did not differ by blind assignment to ACT vs. CBT (n = 8 each, p = .66).”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    The QOLI has good test-retest reliability and internal validity.

    “The Quality of Life Inventory (QOLI; Frisch, 1994b) assesses values and life satisfaction across 16 broad life domains and has good test-retest reliability and internal validity (Frisch et al., 2005).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Frisch et al., 2005 source

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

    Study design and conductown data

    All therapists completed extensive training, including an intensive 3-day workshop with the principal treatment manual author, before treating patients.

    “All therapists completed extensive training including an intensive 3-day workshop with the principal treatment manual author (author M.G.C. for CBT, and author G.E. or Dr. Hayes for ACT) prior to treating Ps.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    ACT and CBT manuals were matched on the number of sessions devoted to exposure but differed in coping skills and the framing of exposure.

    “ACT and CBT manuals were matched on the number of sessions devoted to exposure but differed in coping skills and the framing of the intent of exposure.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    There were no differences between ACT-only and CBT-only therapists in mean number of patients treated.

    “there were no differences between ACT- and CBT-only therapists.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In a randomized effectiveness trial of 101 undiagnosed anxious and depressed patients, ACT and CBT were equally effective across symptom measures but operated through somewhat different mechanisms.

    “One randomized effectiveness trial (n=101) in undiagnosed anxious and depressed patients (Forman, Herbert, Moitra, Yeomans, & Geller, 2007) compared ACT and CBT1, concluding that the two treatments were equally effective across symptom outcome measures, but operated via somewhat different mechanisms.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Forman, Herbert, Moitra, Yeomans, & Geller, 2007 source

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

    Study design and conductnone given

    Interviewers completed 15-20 hours of training and demonstrated adequate diagnostic reliability on 3 consecutive interviews.

    “Doctoral students in clinical psychology or research assistants served as interviewers after completing 15–20 hours of training and demonstrating adequate diagnostic reliability on 3 consecutive interviews.”
    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 conductnone given

    ADIS-IV interviews were audio-recorded and 15% (n=22) were randomly selected for blind rating by a second interviewer.

    “ADIS-IV interviews were audio-recorded and 15% (n = 22) were randomly selected for blind rating by a second interviewer.6”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    In those two studies, anxiety disorders were not formally diagnosed, which limits conclusions about treating anxiety disorders.

    “In neither study, however, were anxiety disorders formally diagnosed, significantly limiting the conclusions for the treatment of anxiety disorders.”
    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

    Participants who dropped before treatment had somewhat higher CSRs than those who began treatment, but the difference was not statistically significant.

    “Ps who dropped treatment showed somewhat higher CSRs (M = 6.07, SD = .96) relative to Ps who began treatment (M = 5.63, SD = .92), but group differences were small and did not reach statistical significance p = .08. pη2 = 02.”
    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

    Current sample alpha for the PSWQ was .90 at pre-treatment and .93 at post-treatment.

    “Current sample αs = .90 (Pre) and .93 (Post).”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    The PSWQ showed elevations across all anxiety disorders relative to non-anxious controls.

    “Although particularly elevated in GAD, the PSWQ shows elevations across all anxiety disorders relative to non-anxious controls (Brown, Antony, & Barlow, 1992).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Brown, Antony, & Barlow, 1992 source

  • May combine two claims.

    Premisecitation

    A substantial proportion of people with anxiety disorders do not respond to CBT, relapse after successful treatment, seek additional treatment, or remain vulnerable to later anxiety and mood disorders.

    “However, a significant percentage of individuals with anxiety disorders do not respond to CBT (e.g., Barlow, Gorman, Shear, & Woods, 2000), relapse following successful treatment (Brown & Barlow, 1995), seek additional treatment (Brown & Barlow, 1995), or remain vulnerable to developing anxiety and mood disorders throughout the lifespan (see Craske, 2003).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Barlow, Gorman, Shear, & Woods, 2000 source
    • cites Brown & Barlow, 1995 source
    • cites Craske, 2003

  • May combine two claims.

    Premisecitation

    That acceptance-based GAD treatment was developed for GAD alone and had not been compared with another active treatment.

    “However, this promising treatment was developed for generalized anxiety disorder alone and it has not yet been compared to another active treatment.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Roemer, Orsillo and colleagues (2008)

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

  • May combine two claims.

    Study design and conductown data

    Inter-rater agreement for specific disorders was: SAD and OCD ICC=1.00, PD/A .91, GAD .85, and SP .75.

    “Inter-rater agreement for each specific disorder (met DSM-IV criteria vs. subclinical vs. none) was as follows: SAD (10 subclinical or clinical cases) and OCD (3 cases) ICC = 1.00 (100% agreement), PD/A (11 cases) ICC = .91, GAD (8 cases) ICC = .85, and SP (7 cases) ICC = .75.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In a small randomized study of 28 undiagnosed general clinic patients, ACT reduced symptoms more than CBT and affected treatment processes at a different rate.

    “A small (n=28) randomized treatment study comparing ACT and CBT for undiagnosed “general clinic patients” (Lappalainen et al., 2007) found that ACT reduced symptoms to a greater degree than CBT and effected treatment processes at a different rate.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Lappalainen et al., 2007 source

  • May combine two claims.

    Study design and conductown data

    Eleven of the 15 pre-treatment dropouts did not complete the pretreatment questionnaire, so differences on questionnaire measures could not be determined.

    “Eleven of the 15 Ps (73%) dropped prior to completing the pretreatment questionnaire assessment; therefore, we could not determine if they differed from Ps who initiated treatment on questionnaire measures.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    The ASI showed elevation across most anxiety disorders relative to nonanxious controls.

    “Although particularly elevated in panic disorder (Taylor, Koch, & McNally, 1992), the ASI shows elevation across most anxiety disorders (Rapee, Brown, Antony, & Barlow, 1992) relative to nonanxious controls (Peterson & Reiss, 1992).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Rapee, Brown, Antony, & Barlow, 1992 source
    • cites Peterson & Reiss, 1992

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

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The study did not stratify patients on any variables in order to maximize statistical power.

    “To maximize statistical power for the main group comparison hypotheses, we did not stratify patients on any variables.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    The mean number of patients treated by therapists who treated both conditions was significantly higher than by ACT-only or CBT-only therapists.

    “The mean patient number for therapists treating in both conditions was significantly higher than the mean for ACT- or CBT-only therapists, ps < .001, pη2= .77 for each comparison”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    Randomization sequences were produced by www.randomizer.org.

    “Randomization sequences were produced by www.randomizer.org CBT to ACT.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The ACT protocol used in this study was designed for all anxiety disorders, with values-guided behavioral exercises tailored to specific disorders.

    “The ACT protocol used in the current study (Eifert & Forsyth, 2005) was designed for application across all of the anxiety disorders, with the content of values-guided behavioral exercises tailored to specific anxiety disorders.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Eifert & Forsyth, 2005

      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 conductown data

    Current sample alpha for the ASI was .85 at pre-treatment and .93 at post-treatment.

    “Current sample α’s = .85 (Pre) and .93 (Post).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    All participants who began treatment (n=128) were included in the intent-to-treat sample.

    “All Ps who began treatment (n = 128) were included in the intent-to-treat (ITT) sample (n=57 ACT, n=71 CBT).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Assessors were blind to treatment condition.

    “Assessors were blind to treatment condition.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Clinical diagnoses were ascertained using the ADIS-IV.

    “Clinical diagnoses were ascertained using the Anxiety Disorders Interview Schedule-IV (ADIS-IV) (Brown, DiNardo, & Barlow, 1994).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Brown, DiNardo, & Barlow, 1994

      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).

    Study design and conductcitation

    The treatment credibility questionnaire was adapted from Borkovec and Nau (1972).

    “Ps completed a six-item treatment credibility questionnaire adapted from Borkovec and Nau (1972), see Supplementary materials.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Borkovec and Nau (1972) source

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    To check treatment integrity, a blind rater noted which of 49 therapist adherence items occurred in each 5-minute segment.

    “To check treatment integrity, the blind rater (McGrath) noted which of 49 therapist adherence items (e.g., specific therapist behaviors or therapy content) occurred in each 5-minute segment of therapy.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductcitation

    A power analysis indicated that 67 total participants were needed for 80% power to detect a between-group effect size of .70 at 12-month follow-up, and 126 were needed for an effect size of .50.

    “Power analyses, conducted in Optimal Design (see Raudenbush & Liu, 2000), indicated that to reach 80% power, a cross sectional between-group difference (e.g., at 12mFU) with an effect size of .70 required 67 total Ps, whereas a between-group effect size of .50 required 126 total Ps.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Raudenbush & Liu, 2000 source

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

    Study design and conductnone given

    The first author of the DUACRS, who had no involvement with the study and extensive training in both ACT and CBT, completed adherence ratings.

    “The first author of the DUACRS (McGrath), who had no involvement with the current study and extensive training in both ACT and CBT, completed adherence ratings.”
    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

    Current sample alpha for the AAQ was .78 at pre-treatment and .86 at post-treatment.

    “Current αs were .78 (Pre) and .86 (Post).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    For intent-to-treat analyses, all data points for participants who entered treatment were entered into the model.

    “Therefore, for the intent-to-treat (ITT) analyses, all data points for Ps who entered treatment were entered into the model.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    Less than 5% of data were modified or eliminated during outlier correction.

    “Less than 5% of the data were modified or eliminated during outlier correction.”
    Quote in the paperNot a substantial claim

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

    Study design and conductreasoning

    For non-CSR outcomes, pre-treatment CSR was covaried on the intercept to account for pre-treatment diagnostic severity.

    “For analyses of non-CSR outcomes, pre-CSR was covaried on the intercept to account for pre-treatment diagnostic severity.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Treatment sessions were audiotaped and 143 sessions from 91 participants were randomly selected for adherence and competency ratings using the DUACRS.

    “Treatment sessions were audiotaped and 143 sessions from 91 participants (50 in CBT, 41 in ACT) were randomly selected for treatment adherence and therapist competency ratings using the Drexel University ACT/CT Therapist Adherence and Competence Rating Scale (DUACRS; McGrath, Forman, & Herbert, in preparation).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

    Premisecitation

    The AAQ-16 is hypothesized to be more sensitive to clinical change than the 7- and 9-item AAQ.

    “The AAQ-16 is a 16-item version of the 7- and 9-item AAQ that is hypothesized to be more sensitive to clinical change (Hayes et al., 2004).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Hayes et al., 2004 source

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

    Study design and conductown data

    Total sample alpha for treatment credibility was .94; ACT alpha was .92 and CBT alpha was .95.

    “Total sample α = .94; ACT α = .92 and CBT α = .95.”
    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

    Current sample alpha for the QOLI was .86 at pre-treatment and .84 at post-treatment.

    “Current αs = .86 (Pre) and .84 (Post).”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    Therapist adherence and competency were good.

    “Therapist adherence and competency were good”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    HLM/HMLM incorporates participants with missing data by estimating the best fitting model from available data.

    “HLM/HMLM incorporates Ps with missing data by estimating the best fitting model from the data available for each P (Hedeker & Gibbons, 2006).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Hedeker & Gibbons, 2006

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

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Individual disorder outcomes were not analyzed further because the study was not designed or powered to examine group differences for individual anxiety disorders.

    “Individual disorder outcomes were not analyzed or discussed further, however, because we did not design or power this study to examine group differences in outcomes for individual anxiety disorders.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    Therapist allegiance was not assessed, which may have impacted treatment results given that the study was conducted within a CBT-renowned research clinic.

    “Third, we did not assess therapist allegiance, which may have impacted treatment results given that the study was conducted within a CBT-renowned research clinic.”
    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 conductnone given

    The randomization sequence was generated using a website, whereas use of an external agency would have been preferable.

    “Seventh, we used a website to generate the randomization sequence whereas use of an external agency would have been preferable.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Attrition was comparable to some large CBT trials but higher than the mean attrition reported in a meta-analysis of CBT studies for anxiety disorders.

    “Attrition was comparable to some large trials of CBT for anxiety disorders (e.g. Barlow et al., 2000) but was higher than the mean attrition (23%) reported in a meta-analysis of CBT studies for anxiety disorders (Hofmann & Smits, 2008).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Barlow et al., 2000 source
    • cites Hofmann & Smits, 2008

      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), S4 (based).

    Interpretationreasoning

    Based on the relatively inexperienced and junior nature of the therapists, allegiance is unlikely to be a significant factor.

    “Based on the relatively inexperienced and junior nature of the therapists, however, allegiance is unlikely to be a significant factor.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The sample was relatively educated, so the findings may not generalize to less educated samples.

    “On the other hand, our sample was relatively educated (the average participant had completed 3.5 years of college) and thus, our findings may not generalize to less educated samples.”
    Quote in the paperNot a substantial claim

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

    Study design and conductreasoning

    A single item rating from the Fear Questionnaire was used for behavioral avoidance due to the lack of avoidance measures relevant to all anxiety disorders.

    “Sixth, we utilized a single item rating from the Fear Questionnaire for behavioral avoidance due to the lack of avoidance measures relevant to all anxiety disorders.”
    Quote in the paperNot a substantial claim

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

    Study design and conductreasoning

    The roughly equal number of treatment sessions devoted to behavioral exposure in ACT and CBT may have obscured treatment differences.

    “Also, the roughly equal number of treatment sessions devoted to behavioral exposure in ACT and CBT may have obscured treatment differences.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Reasons for attrition were not systematically assessed, so whether ACT and CBT differed in dropout due to dissatisfaction could not be assessed.

    “Fifth, we did not systematically assess reasons for attrition, and thus could not assess whether ACT and CBT differed in the extent to which patients dropped out because they were unsatisfied with treatment.”
    Quote in the paperNot a substantial claim

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

    Interpretationnone given

    The results may differ in the hands of more experienced therapists.

    “Therapist experience raises another limitation, which is that the results may differ in the hands of more experienced therapists.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Principal diagnostic severity analyses of patients treated only by both-type therapists showed the same pattern, suggesting that therapist differences did not impact overall study findings.

    “Principal diagnostic severity analyses of patients treated only by “both-type” therapists showed the same pattern of outcomes, however, suggesting that these differences did not impact overall study findings.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    ACT and CBT resulted in significant improvements from pre- to post-treatment that were maintained or improved upon during follow-up on both anxiety-specific and broader outcomes.

    “In summary, ACT and CBT resulted in significant improvements from pre- to post-treatment that were maintained or improved upon during follow up, on both anxiety-specific and broader outcomes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The credibility difference did not appear to influence attrition rates, which did not differ by group.

    “This difference did not appear to influence attrition rates, which did not differ by group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    Relatively high attrition rates may have resulted in underestimated treatment effects or compromised ability to accurately assess treatment-related improvements in the ITT sample.

    “Second, relatively high attrition rates may have resulted in underestimated treatment effects or compromised ability to accurately assess treatment-related improvements in the ITT sample.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    No no-treatment or treatment-as-usual control group was included, which may have obscured the capacity to assess improvement due to treatment versus the passage of time.

    “Eighth, we did not include a no-treatment or treatment-as-usual control group, which may have obscured our capacity to assess improvement due to treatment versus the passage of time.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    HLM and HMLM utilized patients with incomplete data and drew upon all available data in the ITT analyses; separate completer analyses were also conducted.

    “On the other hand, we utilized a sophisticated statistical approach (HLM, HMLM) that utilized patients with incomplete data and drew upon all available data in the ITT analyses; we also conducted a separate Completers analyses.”
    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

    Supervision quality was not assessed, so the impact of the group difference in supervision modality could not be investigated.

    “We did not assess supervision quality and thus could not investigate the impact of this group difference.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    ACT and CBT were clearly distinguished from one another and therapists strongly adhered to the designated treatment.

    “An important finding to emerge from blind treatment integrity ratings was that ACT and CBT were clearly distinguished from one another and that therapists strongly adhered to the designated treatment.”
    Quote in the paperSubstantial claim
84 of 84

  • The paper relies on this without support.

    CBT shares common treatment elements across anxiety disorders with variation in content specific to each disorder.

    “Second, CBT shares common treatment elements across the anxiety disorders with variation in content specific to each disorder.”

  • The paper relies on this without support.

    Differences in the rate of improvement should translate into different outcomes at post-treatment or follow-up.

    “Differences in rate of improvement should translate into different outcomes at post-treatment or follow up.”

  • The paper relies on this without support.

    CBT is the current gold standard psychosocial treatment for anxiety disorders.

    “the current gold standard psychosocial treatment for anxiety disorders”

  • The paper relies on this without support.

    This study is the first randomized clinical trial comparing ACT and CBT for anxiety disorders.

    “To our knowledge, this study represents the first randomized clinical trial comparing ACT and CBT for anxiety disorders.”

  • The paper relies on this without support.

    Exposure is a potent change agent.

    “given the potency of exposure as a change agent”
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?

  • There were too few participants to detect whether CBT conferred significant benefit over ACT or vice versa.

    “there were too few participants to detect whether CBT conferred significant benefit over ACT or vice versa.”

    From Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood (2015) · cites this paper as Arch et al. (2012)

    The Results (Primary Outcomes; page unavailable) report statistically significant differences in both directions: ACT had lower principal anxiety-disorder severity than CBT among completers at 12-month follow-up, while CBT had higher quality-of-life ratings than ACT. Reduced sample size left a separate therapist-subgroup reanalysis underpowered, but the paper did detect significant differences in the main comparisons. (LLM, conf=0.90)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured

  • The 14 individuals with generalized anxiety disorder who received ACT demonstrated medium to large effects on outcome measures.

    “A recent study comparing ACT to CBT (with behavioral exposures in both conditions) showed comparable effects of the two treatments, with the 14 individuals with GAD who received ACT demonstrating medium to large effects on outcome measures (Arch et al., 2012).”

    From A randomized clinical trial comparing an acceptance-based behavior therapy to applied relaxation for generalized anxiety disorder (2013) · cites this paper as Arch et al., 2012

    The Discussion (Primary Outcomes; page unavailable) reports moderate to large improvements in the ACT group, but those findings concern the mixed-anxiety sample, not specifically participants with GAD. The Results (Primary Outcomes; page unavailable) says Table 4 contains disorder-specific effect sizes; the passages available from our copy do not give the GAD values or establish that 14 participants with GAD received ACT. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • The feasibility of a non-inferiority RCT comparing ACT with CBT in working-age people with mixed anxiety disorders has been demonstrated.

    “The feasibility of such an approach has been demonstrated in a non-inferiority RCT of ACT compared with CBT in working-age people with mixed anxiety disorders.88”

    From Acceptance and commitment therapy for older people with treatment-resistant generalised anxiety disorder: The FACTOID feasibility study (2021) · cites this paper as [88]

    The Abstract Method and Methods Participants sections describe a randomized ACT-versus-CBT trial in people with mixed anxiety disorders; participants’ mean age was 38. The Introduction describes its aim as comparing relative efficacy, not testing non-inferiority, and the reported similarity in outcomes does not establish a formal non-inferiority design or result. The source therefore supports the feasibility of conducting the comparison, but not the description of it as a non-inferiority RCT. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • The fact that the current results mirrored prior findings in terms of similarity in outcomes across CBT and ACT and trends for the positive predictive value of high experiential avoidance for CBT outcomes suggests some degree of replicability and consistency across samples.

    “Still, the fact that the current results mirrored our prior findings in terms of similarity in outcomes across CBT and ACT and trends for the positive predictive value of high experiential avoidance for CBT outcomes (Arch et al., 2012; Wolitzky-Taylor et al., 2012) suggests some degree of replicability and consistency across samples.”

    From Randomized controlled trial of cognitive behavioral therapy and acceptance and commitment therapy for social phobia: Outcomes and moderators (2014) · cites this paper as Arch et al., 2012

    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

  • 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 Arch et al., 2012

    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

Statistics that don’t add up

Each reported p-value recomputed from its test statistic and degrees of freedom.

  • Inconsistent p-value: t(65) = 2.12, p = .03

    Minor

    The paper reports p = .03 here; recomputing from the test statistic and its degrees of freedom gives p = .038 (two-tailed). The check cannot tell whether the statistic or the p-value is the misprint.

    Reported p = .03 · recomputed p = .038

1 of 1

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Doesn’t add upt(65) = 2.12reported p = .03 · recomputed p = .038

    “t(65) = 2.12, p = .03”

  • Consistentt(111) = 1.91reported p = .058 · recomputed p = .059

    “t(111) = 1.91, p = .058”

  • Consistentt(126) = -2.53reported p = .01 · recomputed p = .013

    “t(126) = −2.53, p = .01”

  • Consistentt(126) = -2.11reported p = .04 · recomputed p = .037

    “t(126) = −2.11, p = .04”

  • ConsistentF(1, 76) = 9.08reported p = .004 · recomputed p = .004

    “F(1, 76) = 9.08, p = .004”

  • ConsistentF(1, 62) = 6.34reported p = .01 · recomputed p = .014

    “F(1, 62) = 6.34, p = .01”

  • ConsistentF(1, 77) = 1.17reported p = .28 · recomputed p = .283

    “F(1,77) = 1.17, p = .28”

  • ConsistentF(1, 87) = 316.88reported p < .001 · recomputed p < .001

    “F(1, 87) = 316.88, p < .001”

  • ConsistentF(1, 87) = 813.58reported p < .001 · recomputed p < .001

    “F(1, 87) = 813.58, p < .001”

  • ConsistentF(1, 87) = 22.77reported p < .001 · recomputed p < .001

    “F(1, 87) = 22.77, p < .001”

  • ConsistentF(1, 87) = 1.72reported p = .19 · recomputed p = .193

    “F(1, 87) = 1.72, p = .19”

  • ConsistentF(1, 73) = 5.18reported p = .03 · recomputed p = .026

    “F (1, 73) = 5.18, p = .03”

  • Consistentχ²(1) = 0.4reported n.s. · recomputed p = .527

    “χ2(1)= .40, n.s.”

  • ConsistentF(1, 126) = 0.12reported p = .73 · recomputed p = .730

    “F(1, 126) = .12, p = .73”

  • Consistentt(126) = 2.03reported p = .04 · recomputed p = .044

    “t(126) = 2.03, p = .04”

  • Consistentt(77) = 2.05reported p = .04 · recomputed p = .044

    “t(77) = 2.05, p = .04”

  • Consistentt(117) = 1.78reported p = .08 · recomputed p = .078

    “t(117) = 1.78, p = .08”

  • Consistentt(83) = 2.04reported p = .04 · recomputed p = .045

    “t(83) = 2.04, p = .04”

  • Consistentt(66) = 2.65reported p = .01 · recomputed p = .010

    “t(66) = 2.65, p = .01”

19 of 19

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.

  • Completer AAQ t statistic does not match its coefficient and SE

    Minor

    The reported AAQ coefficient divided by its standard error is approximately 2.55, rather than the stated t value of 2.65.

    Reported 2.65 · recomputed 2.550943

  • PD/A follow-up t statistic does not match its coefficient and SE

    Minor

    Dividing the reported coefficient by its standard error gives a t magnitude of approximately 1.98, not 2.11. The difference exceeds what rounding of the printed inputs can explain.

    Reported -2.11 · recomputed -1.980392

  • Therapist categories total 38, not 39

    Minor

    The counts of CBT-only, ACT-only, and both-treatment therapists sum to 38 rather than the stated total of 39.

    Reported 39 · recomputed 38

  • Pretreatment dropout counts disagree

    Minor

    The paper says 15 participants dropped out before treatment, but the stated count of eight from each group totals 16. The randomized and treatment-started group counts imply eight ACT dropouts and seven CBT dropouts.

4 of 4

Cites

Flagged first, then by citations

5 of the 78 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Arch, J. J., Eifert, G. H., Davies, C., Vilardaga, J. C. P., Rose, R. D., & Craske, M. G.
Affiliations
  • University of Colorado Boulder (US)
  • Chapman University (US)
  • University of California, Los Angeles (US)
ORCID
Venue
Journal of Consulting and Clinical Psychology
Publisher
American Psychological Association (APA)
Published
2012
Volume
80
Issue
5
Pages
750-765
ISSN
  • 0022-006X (ISSN-L)
  • 1939-2117
DOI
10.1037/a0028310
PMC
PMC4718567
OpenAlex
W2120540917
Semantic Scholar
83b01b5f8c127a081b74ff96952a3ec9695d9e50
Cited by
443
References
78
Citations by year
2026: 24 · 2025: 20 · 2024: 21 · 2023: 33 · 2022: 20 · 2021: 30 · 2020: 38 · 2019: 35 · 2018: 28 · 2017: 37 · 2016: 31 · 2015: 47 · 2014: 42 · 2013: 26 · 2012: 10
FWCI
45.33
Type
journal article
Language
en
Open access
Locations
  • Journal of Consulting and Clinical Psychology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Chapman University Digital Commons (Chapman University) (submittedVersion)
Funders
National Institute of Mental Health (R21MH081299)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
acceptance and commitment therapy, cognitive behavioral therapy, anxiety disorders, medication adherence, treatment credibility, quality of life, anxiety sensitivity, worry, avoidance, therapist competence, attrition, comorbidities
MeSH terms
Adult, Anxiety Disorders, Female, Humans, Male, Middle Aged, Psychotherapy, Quality of Life, Surveys and Questionnaires, Severity of Illness Index, Cognitive Behavioral Therapy, Treatment Outcome

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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