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Cited by 13Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Well-being and Life SatisfactionPsychotherapy Techniques and Applications

Trajectories of change in well-being during cognitive behavioral therapies for anxiety disorders: Quantifying the impact and covariation with improvements in anxiety

Open access
Gallagher, Matthew W., Phillips, Colleen A., D'Souza, Johann, Richardson, Angela, Long, Laura J., Boswell, James F., Farchione, Todd J., Barlow, David H.·2020·Psychotherapy
DOI 10.1037/pst0000283PMC PMC7416465
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Abstract

Cognitive behavioral therapy (CBT) has been found to be very effective in reducing many forms of mental illness, but much less is known about whether CBT also promotes mental health or well-being. The goals of the present study were to (a) quantify the magnitude and timing of changes in overall well-being and specific facets of well-being during different CBTs for anxiety disorders, (b) determine whether these effects vary across transdiagnostic and disorder-specific CBT, and (c) examine how changes in well-being during treatment relate to changes in anxiety. A total of 223 adults (55.6% female, Mage = 31.1 years) were randomized to 1 of 5 CBT protocols for anxiety disorders at an outpatient clinic. Analyses included standardized mean gain effect sizes (ESsg) and latent growth curve modeling. Moderate-to-large increases in overall well-being and the 3 components of subjective, psychological, and social well-being were observed, mainly during the second half of CBT, and these increases were maintained at a 6-month follow-up. The magnitude of effects was comparable for transdiagnostic and disorder-specific CBT protocols and greater than in the waitlist condition. Parallel process latent growth curve models indicated that trajectories of change in well-being across treatment were strongly correlated with trajectories of change in clinician-rated and self-reported anxiety. Together, these findings suggest that different CBT protocols for anxiety consistently produce robust and lasting changes in well-being, and these changes are strongly linked to changes in anxiety during treatment. © 2020 American Psychological Association.

Integrity signals

Registry

Crossref · 10.1037/pst0000283

Cites

56 of 56 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

17 of 57 cited sources checked · 12 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    CBT for anxiety typically produces moderate quality-of-life gains.

    “meta-analytic reviews indicating that CBT for anxiety disorders generally leads to moderate improvements in quality of life (Hofmann, Wu, & Boettcher, 2014).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Hofmann, Wu, & Boettcher, 2014 source
  • Premisecitation

    Rising well-being over time predicts reductions in mental illness over ten years.

    “Increases in well-being across time prospectively predict declines in mental illness across a ten year timespan (Keyes, Dhingra, & Simoes, 2010)”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Keyes, Dhingra, & Simoes, 2010 source
  • Premisecitation

    Without intervention, well-being tends to remain stable.

    “although well-being levels are generally stable in the absence of interventions, there is increasing evidence that the different domains of well-being are malleable and can be effectively increased as a result of interventions (Diener & Ryan, 2009; Diener, Suh, Lucas & Smith, 1999; Ryff, 2014).”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites Diener & Ryan, 2009 source
    • cites Diener, Suh, Lucas & Smith, 1999 source
    • cites Ryff, 2014 source

      In Clinical and Intervention Studies (page unavailable), Ryff reports significant improvement with well-being therapy but no significant change in a clinical-management comparison group. That supports stability in this particular comparison, not the broader claim that well-being generally remains stable in the absence of interventions; clinical management is not necessarily no intervention. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
  • Premisecitation

    Past findings provide promising evidence that CBT promotes general increases in life satisfaction.

    “These findings provide promising evidence that CBT promotes general increases in life satisfaction”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites Gallagher et al., 2009 source

      The Discussion (Limitations and Future Directions; page unavailable) discusses the possibility of increasing well-being through intentional activity but says further research is needed to establish sustainable gains. The Methods (Measures; page unavailable) describes measuring life satisfaction. Neither passage addresses whether CBT increases life satisfaction; searches for CBT and treatment-related change found no such finding. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
    • cites Keyes, 2005 source

      The Discussion (p. 9) suggests that existing talk therapies may help promote flourishing and notes the role of cognitive-behavioral processes in depression treatment. It does not report that CBT produces increases in life satisfaction; the proposed benefit is broader and explicitly tentative. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites Keyes et al., 2002 source
  • Findingown data

    The gains persisted at the six-month follow-up.

    “and these increases were maintained at a 6-month follow-up.”
    Quote in the paperSubstantial claim
  • May combine two claims. 33
  • Classified as probably not a substantial claim. 38
  • The quote only partly states this claim. 1

  • May combine two claims.

    Premisecitation

    Interventions can effectively raise the various domains of well-being, which are malleable.

    “although well-being levels are generally stable in the absence of interventions, there is increasing evidence that the different domains of well-being are malleable and can be effectively increased as a result of interventions (Diener & Ryan, 2009; Diener, Suh, Lucas & Smith, 1999; Ryff, 2014).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Diener & Ryan, 2009 source
    • cites Diener, Suh, Lucas & Smith, 1999 source
    • cites Ryff, 2014 source

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

    Premisecitation

    Meta-analytic reviews show positive psychological interventions can have robust effects on increasing well-being and decrease associated depressive symptoms.

    “Meta-analytic reviews of positive psychological interventions designed to cultivate well-being have demonstrated that these interventions can not only have robust effects on increasing well-being, they can also decrease associated depressive symptoms (Sin & Lyubmirksy, 2009).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Sin & Lyubmirksy, 2009 source

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

    Premisecitation

    Symptoms of depression, generalized anxiety, and panic attacks are negatively correlated with subjective, psychological, and social well-being at small-to-moderate magnitudes.

    “Similarly, in a study examining the link between well-being and mental illness in a nationally representative sample of American adults, symptoms of depression, generalized anxiety, and panic attacks were all negatively correlated with subjective, psychological, and social well-being, but only at small-to-moderate magnitudes (Keyes, 2005).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Keyes, 2005 source

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

    Premisecitation

    Individuals with various anxiety disorders have large deficits in quality of life compared to controls.

    “Individuals with various anxiety disorders have been shown to have large deficits in quality of life compared to controls (Barrera & Norton, 2009)”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Barrera & Norton, 2009 source

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

    Premisecitation

    Interventions designed to promote subjective well-being lead to lasting increases in positive emotions and also promote other positive outcomes such as life satisfaction, purpose in life, and improved social functioning.

    “For example, interventions designed to promote subjective well-being not only lead to lasting increase in positive emotions, but also promote other positive outcomes such as life satisfaction, purpose in life, and improved social functioning (Cohn, Fredrickson, Brown, Mikels, & Conway, 2009; Fredrickson, 2001; Fredrickson, Cohn, Coffey, Pek, & Finkel, 2008).”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites Cohn, Fredrickson, Brown, Mikels, & Conway, 2009

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

    • cites Fredrickson, 2001 source
    • cites Fredrickson, Cohn, Coffey, Pek, & Finkel, 2008 source

      The Results (Testing the Build Hypothesis; page unavailable) link increased positive emotions during the loving-kindness meditation study to greater purpose in life, social support, positive relations, and life satisfaction. However, the Discussion (Limitations and Future Directions; page unavailable) says positive emotions decreased after the workshop and that the duration of gains needs further study. This paper therefore does not establish the claimed lasting increase in positive emotions. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

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

    Premisecitation

    The complete state model has been replicated in American and international samples and across the lifespan.

    “This model has been replicated in both American and international samples and across the lifespan (Keyes, 2002; Westerhof & Keyes, 2010).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Keyes, 2002 source
    • cites Westerhof & Keyes, 2010 source

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

    Premisecitation

    Cognitive behavioral therapy is broadly effective at reducing many types of mental illness.

    “Cognitive Behavioral Therapies (CBT) have been shown in recent decades to be broadly effective in reducing many forms of mental illness (Hofmann, Asnanni, Vonk, Sawyer, & Fang, 2012).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Hofmann, Asnanni, Vonk, Sawyer, & Fang, 2012 source

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

    Premisecitation

    Poorer well-being is linked to higher mortality risk over ten years.

    “lower levels of well-being are associated with an increased probability of mortality across a ten year timespan (Keyes & Simoes, 2010).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Keyes & Simoes, 2010 source

      The Results report an association between lower mental health and mental illness in 2005, not mortality. The Methods mention deaths only as a reason for loss to follow-up; no passage found links well-being to mortality over the ten-year period (searched: mortality, death, ten years). (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    The domains of subjective, psychological, and social well-being together represent positive mental health.

    “increasing evidence suggests that the domains of subjective well-being, psychological well-being, and social well-being together represent positive mental health (Gallagher, Lopez, & Preacher, 2009; Keyes, 2005; Keyes & Annas, 2009; Keyes, Shmotkin, & Ryff, 2002).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Gallagher, Lopez, & Preacher, 2009 source
    • cites Keyes, 2005

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

    • cites Keyes & Annas, 2009 source

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

    Premisecitation

    Decades of research show that CBT has robust effects on many mental illnesses, including anxiety disorders.

    “Decades of research have clearly demonstrated that CBT has robust effects on many different forms of mental illness, including anxiety disorders (Hofmann et al., 2012)”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Hofmann et al., 2012 source

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    Mental health is more than just the absence of mental illness.

    “Given the increasing evidence that mental health is more than just the absence of mental illness (Keyes, 2005, 2007)”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Keyes, 2005 source
    • cites Keyes, 2007 source

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

    Study design and conductcitation

    HAMA assessments were conducted by independent evaluators blind to treatment condition, with random selection for interrater reliability.

    “Independent evaluators who were blind to treatment condition conducted the HAMA assessments following the Structured Interview Guide for the Hamilton Anxiety Scale (Shear, Vander Bilt, & Rucci, 2001) and assessments were randomly selected throughout the trial to be rated by an additional independent evaluator to ensure interrater reliability (Barlow et al., 2017).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Shear, Vander Bilt, & Rucci, 2001 source
    • cites Barlow et al., 2017 source

  • May combine two claims.

    Findingown data

    Well-being change is not linear over time; it occurs mainly in the second half of treatment.

    “The research design of the present study allowed us to establish that change in well-being does not occur linearly across time, but occurs primarily during the second half of treatment.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The missing data mechanism is missing at random for the multiple imputation procedure.

  • May combine two claims.

    Findingown data

    Well-being changes during CBT occur for overall well-being and the three facets, and these changes are maintained at follow-up.

    “This study builds upon previous research by establishing that changes in well-being during CBT occur for overall well-being as well as the three facets of subjective, social, and psychological well-being, and that changes are maintained at follow-up.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The missing data mechanism is missing at random for the multiple imputation procedure.

  • May combine two claims.

    Findingown data

    Correlations between well-being and clinician-rated anxiety were consistently significant and moderate-to-large, with the strongest association for psychological well-being.

    “The magnitude for the correlation between well-being and clinician rated anxiety were consistently statistically significant and moderate to large in effect size magnitude with the largest association observed for psychological well-being and anxiety.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The missing data mechanism is missing at random for the multiple imputation procedure.

  • May combine two claims.

    Findingown data

    Well-being gains declined slightly by six-month follow-up but were mostly maintained in each active treatment condition.

    “The magnitude of increases in overall well-being and the three facets of well-being decreased slightly by the six month follow-up, but were largely maintained in each active treatment condition”
    • Also stated in: § Discussion · hedged
      “At the 6-month follow-up, the effects of CBT on well-being decreased slightly, but were largely maintained, indicating that gains in well-being were generally stable.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The missing data mechanism is missing at random for the multiple imputation procedure.

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    Correlations between well-being and self-reported anxiety were consistently significant and moderate-to-large, with the strongest association for subjective well-being.

    “The magnitude for the correlation between well-being and clinician rated anxiety were consistently statistically significant and moderate to large in effect size magnitude with the largest association observed for subjective well-being and anxiety.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The missing data mechanism is missing at random for the multiple imputation procedure.

  • May combine two claims.

    Findingown data

    Both disorder specific and transdiagnostic CBT produced significantly greater increases in overall well-being and each facet than waitlist control.

    “Both disorder specific CBT and transdiagnostic CBT resulted in statistically significantly greater increases in overall well-being and each facet of well-being compared to the waitlist control condition.”
    • Also stated in: § Discussion · plain
      “The active treatment conditions were associated with significantly greater increases in all three components of well-being compared to the waitlist control.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The missing data mechanism is missing at random for the multiple imputation procedure.

  • May combine two claims.

    Findingown data

    Comparing disorder specific CBT to transdiagnostic CBT, effects were consistently small and favored disorder specific CBT slightly for overall well-being and three facets, but were not statistically significant.

    “the effects of treatment condition were consistently small and indicated that disorder specific CBT resulted in slightly greater increases in overall well-being and the three facets, but that these between treatment effects were not statistically significant.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The missing data mechanism is missing at random for the multiple imputation procedure.

  • May combine two claims.

    Findingown data

    Comparing CBT to waitlist, partially standardized effects showed generally moderate-to-large treatment effects on well-being trajectories and three facets, with the weakest effect for social well-being.

    “the partially standardized effects of treatment on the slope parameters indicated generally moderate to large effects of treatment on trajectories of change in well-being and three facets, with the weakest effect being observed for social well-being.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The missing data mechanism is missing at random for the multiple imputation procedure.

  • May combine two claims.

    Findingown data

    Well-being gains were slightly larger in disorder specific CBT than in transdiagnostic CBT, but the difference was not statistically significant.

    “The changes in well-being were slightly higher in the disorder specific CBT conditions than the transdiagnostic CBT condition, but not statistically significantly different based on the confidence intervals of the effect sizes.”
    • Also stated in: § Discussion · plain
      “Effect sizes reflecting changes in well-being were slightly larger for SDP compared to transdiagnostic CBT; however, these effect sizes were not statistically significantly different as evidenced by non-overlapping confidence intervals.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The missing data mechanism is missing at random for the multiple imputation procedure.

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

    Premisecitation

    The complete state model of mental health integrates the three domains and suggests complete mental health is beyond mere absence of illness.

    “The complete state model of mental health integrates these three domains of well-being and suggests that complete mental health constitutes an emotional and functional state beyond the mere absence of illness.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Keyes, 2005 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    Well-being encompasses more than the mere absence of mental illness.

    “Increasing evidence demonstrates that mental health or well-being is more than just the absence of mental illness (e.g., Keyes, 2007)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Keyes, 2007 source

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

    Premisenone given

    There is limited research addressing whether different forms of CBT promote well-being similarly, whether CBT impacts different domains equally, and whether changes in well-being relate to symptom recovery.

    “In summary, although studies of CBT have increasingly examined well-being as an outcome, there is limited research addressing whether different forms of CBT promote well-being to a similar degree, whether CBT impacts different domains of well-being equally, and whether changes in well-being relate to changes in symptom recovery.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Well-being therapy (WBT) is effective in preventing relapse of major depressive disorder and treating GAD.

    “Multiple studies have demonstrated that WBT is effective in the prevention of relapse of major depressive disorder and the treatment of GAD (Fava et al., 2004, 2005; Ruini & Fava, 2009).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Fava et al., 2004, 2005

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

    • cites Ruini & Fava, 2009 source

  • May combine two claims.

    Premisecitation

    Quality-of-life measures often capture only lack of impairment, assuming that means well-being.

    “many outcomes labeled as quality of life actually reflect the absence of functional impairment and the assumption that the absence of impairment reflects well-being (Gallagher & Long, in press).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Gallagher & Long, in press

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

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Understanding the extent to which CBT promotes well-being has important implications for a more complete understanding of psychosocial functioning.

    “Understanding the extent to which CBT interventions promote well-being in addition to reducing mental illness therefore has important implications for having a more complete understanding of psychosocial functioning beyond simply identifying the reduction of mental illness.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Quality of life deficits are consistent across anxiety disorders.

    “meta-analytic reviews have found that lower levels of quality of life are consistent across the anxiety disorders (Olatunji, Cisler, & Tolin, 2007).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Olatunji, Cisler, & Tolin, 2007 source

  • May combine two claims.

    Premisecitation

    Current evidence is promising that CBT may promote well-being, but measures of well-being are not standard outcomes in clinical trials, so much less is known about whether CBT promotes mental health to the same extent it reduces mental illness.

    “Current evidence is, therefore, promising that CBT may promote well-being, but measures of well-being are not a standard outcome in clinical trials so much less is known about whether CBT promotes mental health to the same extent that CBT reduces mental illness.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    A small study of patients receiving CBT for emotional disorders demonstrated a significant increase in psychological well-being, particularly in purpose in life and self-acceptance.

    “a small study of patients receiving CBT for emotional disorders such as depression, anxiety disorders, and OCD demonstrated a significant increase in psychological well-being, particularly in purpose in life and self-acceptance (Fava, Rafanelli, Cazzaro, Conti, & Grandi, 1998).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Fava, Rafanelli, Cazzaro, Conti, & Grandi, 1998 source

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

    Premisecitation

    Symptoms of social anxiety are negatively associated with global ratings of well-being and daily experience of well-being.

    “For example, symptoms of social anxiety are negatively associated with both global ratings of well-being and the daily experience of well-being (Kashdan, Julian, Merritt, & Uswatte, 2006).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kashdan, Julian, Merritt, & Uswatte, 2006 source

  • Classified as probably not a substantial claim.

    Premisecitation

    Subjective and psychological well-being are empirically and conceptually distinct.

    “While subjective and psychological well-being are related constructs, they are empirically and conceptually distinct (Keyes et al., 2002).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Keyes et al., 2002 source

  • May combine two claims.

    Interpretationcitation

    Anxiety disorders can have lasting effects on decreasing well-being, and simply reducing anxiety is not always enough to promote well-being.

    “which suggests that anxiety disorders can have lasting effects on decreasing well-being and that simply reducing levels of anxiety is not always enough to also promote well-being”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Well-being is an important outcome in psychotherapy, and promoting well-being may reinforce or facilitate other positive outcomes or reductions in mental illness.

    “Well-being therefore represents an important outcome in the context of psychotherapy, but the promotion of well-being may also reinforce or facilitate the promotion of other positive outcomes or reductions in mental illness.”
    Quote in the paperSubstantial claim

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

    Premisereasoning

    Mental illness and well-being are related but distinct components of mental health.

    “Thus, while mental illness and well-being are related, they represent distinct components of mental health.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    High levels of subjective well-being predict improved health and longevity.

    “the presence of high levels of subjective well-being have been found to predict improved health and longevity acrossa range of research paradigms (Diener & Chan, 2011).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Diener & Chan, 2011

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

  • May combine two claims.

    Study design and conductreasoning

    The study compared CBT response to a waitlist control and also compared single disorder treatments with transdiagnostic treatment.

    “Further, the current study examined response to CBT compared to a waitlist control, but also examined differences in response to therapy between single disorder treatments and transdiagnostic treatment of anxiety.”
    Quote in the paperSubstantial claim

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

    Interpretationreasoning

    It appears more likely that anxiety changes may influence later well-being changes.

    “it appears more likely that changes in anxiety may influence subsequent changes in well-being, but this needs to be explored further.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The missing data mechanism is missing at random for the multiple imputation procedure.

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

    Study design and conductown data

    Data were not collected at every treatment session.

    “Although assessments were conducted at multiple timepoints during the treatment, data was not collected at every session.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    In this clinical trial, there was little evidence of variance in outcomes between therapists.

    “In this clinical trial there was little evidence of variance in outcomes between therapists (Boswell et al., 2019)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Boswell et al., 2019

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

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

    Premisecitation

    Existing research on the phase model is somewhat mixed.

    “Extant research on the phase model is somewhat mixed (Sembill, Vocks, Kosfelder, & Schottke, 2017).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Sembill, Vocks, Kosfelder, & Schottke, 2017

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

  • May combine two claims.

    Study design and conductown data

    Follow-up data exist for active treatment conditions but not for the waitlist condition, so no conclusions can be drawn about maintenance of effect for the waitlist group.

    “Further, there is follow-up data for the active treatment conditions, but no follow-up for the waitlist condition; therefore, we are unable to draw any conclusions about the maintenance of the effect for the waitlist group.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Internal consistencies of the OASIS were consistently high across each assessment wave (alphas .83-.88).

    “Internal consistencies of the OASIS were consistently high across each wave of assessment (alphas ranged from .83 to .88).”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    The MHC-SF is a brief, reliable, and valid method for assessing different domains of positive mental health.

    “There is increasing evidence that the MHC-SF provides a brief, but reliable and valid method of assessing different domains of positive mental health (Magyar & Keyes, 2019).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Magyar & Keyes, 2019 source

  • May combine two claims.

    Premisecitation

    The OASIS assesses anxiety symptoms and impairment across diagnostic boundaries, is sensitive to intraindividual anxiety changes during treatment, and has demonstrated validity for each of the four disorders in this study.

    “The OASIS assesses anxiety symptoms/impairment across diagnostic boundaries and is sensitive to intraindividual changes in anxiety during treatment (e.g., Barlow et al., 2017) and there is demonstrated validity with each of the four disorders examined in this study.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Norman, Cissell, Means-Christensen, & Stein, 2006 source
    • cites Barlow et al., 2017 source

  • May combine two claims.

    Interpretationown data

    CBT produces meaningful increases in overall well-being and its three facets.

    “Together, these results suggest that CBT produces meaningful increases in overall well-being and the three facets”
    • Also stated in: § Discussion · boosted
      “The findings of the present research provide evidence that CBT has a clear effect on well-being for both specific and transdiagnostic protocols.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The missing data mechanism is missing at random for the multiple imputation procedure.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Some anxiety reductions may be a necessary precursor for well-being increases during CBT.

    “It is possible that some reductions in anxiety are a necessary precursor to promoting increases in well-being during CBT.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The missing data mechanism is missing at random for the multiple imputation procedure.

  • May combine two claims.

    Interpretationown data

    CBT reduces mental illness symptoms and increases positive mental health across both transdiagnostic and disorder specific treatments.

    “Overall, the present findings suggest that not only does CBT reduce symptoms of mental illness, it increases positive aspects of mental health across both transdiagnostic and disorder specific treatments.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The missing data mechanism is missing at random for the multiple imputation procedure.

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

    Study design and conductcitation

    Participants were randomized based on principal diagnosis using block randomization to transdiagnostic CBT, disorder-specific CBT, or waitlist with a 2:2:1 allocation ratio.

    “Participants were randomized based on their principal diagnosis using block randomization to transdiagnostic CBT (Unified Protocol; UP; Barlow et al., 2017), disorder-specific CBT, or a waitlist condition using a 2:2:1 allocation ratio.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Barlow et al., 2017 source

  • May combine two claims.

    Interpretationown data

    The strength of associations between change trajectories suggests a strong link between anxiety and well-being changes during CBT, but not so strong that the outcomes are redundant.

    “The magnitude of the associations between trajectories of change suggest a strong link between changes in anxiety and changes in well-being during CBT, but not so strong of a relationship as to indicate that the outcomes are redundant.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The missing data mechanism is missing at random for the multiple imputation procedure.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Inconsistencies in how well-being is operationalized and measured, such as using general distress indicators as proxies for subjective well-being, are potentially problematic.

    “This is likely, in part, due to inconsistencies in operationalization and measurement of well-being where indicators of general distress are taken as proxies for subjective well-being rather than measuring well-being directly, which is potentially problematic.”
    Quote in the paperSubstantial claim

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

    Study design and conductnone given

    The sample was fairly homogenous in race, ethnicity, and education.

    “First, the sample was fairly homogenous in terms of race, ethnicity, and education.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    Boston University's IRB approved the study.

    “The study received IRB approval from Boston University.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    These three well-being domains can enrich understanding of mental and physical health.

    “Given the findings that subjective, psychological, and social well-being can contribute to a more complete understanding of mental and physical health (Keyes, 2007)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Keyes, 2007 source

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

    Study design and conductown data

    Model fit for the LGC models was generally good by CFI and TLI, but poor for some models by RMSEA.

    “The model fit for these four models was generally good per the CFI and TLI model fit statistics, but poor for some models per RMSEA.”
    • Also stated in: § How does CBT impact trajectories of well-being? · plain
      “The model fit for these eight models was generally good per the CFI and TLI model fit statistics, but poor for some models per RMSEA.”
    Quote in the paperNot a substantial claim

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

    Study design and conductcitation

    Model fit in LGC analyses was evaluated using CFI, TLI, and RMSEA with standard criteria.

    “Model fit in the LGC analyses was evaluated using standard model fit indices: the comparative fit index (CFI; Bentler, 1990), the Tucker–Lewis index (TLI; Tucker & Lewis, 1973), and the root-mean-square error of approximation (RMSEA; Steiger, 1990). Acceptable model fit was evaluated using standard model fit criteria: CFI and TLI values close to .95 or above and RMSEA values close to 0.08 or below”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Bentler, 1990 source
    • cites Tucker & Lewis, 1973 source
    • cites Steiger, 1990 source

  • May combine two claims.

    Premisecitation

    The HAMA is a global measure of anxiety symptom severity and interference across diagnostic conditions, widely used in CBT trials, with demonstrated validity for each of the four disorders in this study.

    “The HAMA is a global measure of anxiety symptom severity and interference across diagnostic conditions and has been extensively used in clinical trials examining the impact of CBT on anxiety disorder symptoms and there is demonstrated validity with each of the four disorders examined in this study.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Hamilton, 1959 source

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

    Premisecitation

    The phase model of psychotherapy outcome stipulates that clinical improvements in subjective well-being potentiate symptom improvement, and reductions in symptom-related distress then potentiate life-functioning improvement.

    “the initially hypothesized “phase model” of psychotherapy outcome, which stipulates that clinical improvements in subjective well-being potentiate symptom improvement, and reductions in symptom-related distress then potentiate life-functioning improvement (Howard, Lueger, Maling, & Martinovich, 1993).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Howard, Lueger, Maling, & Martinovich, 1993 source

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Missing data in all analyses were handled by multiple imputation with 1000 imputed datasets.

    “Missing data in all analysis was handled by using multiple imputation techniques in which 1000 imputed datasets were first created using Mplus, analyses were conducted using each of the imputed datasets, and then the pooled results across all of the imputed datasets were interpreted.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The missing data mechanism is missing at random for the multiple imputation procedure.

  • Classified as probably not a substantial claim.

    Premisenone given

    We know little about how well-being changes track anxiety changes during CBT.

    “our understanding of the extent to which changes in well-being relate to changes in anxiety outcomes during CBT is limited.”
    Quote in the paperSubstantial claim
60 of 60

  • The paper relies on this without support.

    The disorder-specific CBT protocols selected for the study each represent gold-standard treatment protocols for their respective disorders with clear evidence of efficacy.

    “These disorder specific protocols were selected as they each represent gold-standard treatment protocols for the respective disorders with clear evidence of efficacy.”

  • The paper relies on this without support.

    The missing data mechanism is missing at random for the multiple imputation procedure.

    “Missing data in all analysis was handled by using multiple imputation techniques”
2 of 2

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.

  • Non-overlapping intervals are cited as evidence of no difference

    Minor

    The discussion says the treatment effect sizes were not statistically significantly different, but cites non-overlapping confidence intervals as evidence. For the same estimates, non-overlapping confidence intervals would instead support a difference.

  • Different facets are named as the strongest clinician-rated anxiety correlate

    Minor

    One results paragraph identifies psychological well-being as having the largest association with clinician-rated anxiety; the next identifies subjective well-being for the same stated measure. The second paragraph discusses self-reported anxiety, suggesting that its reference to clinician-rated anxiety may be an error.

2 of 2

Cites

Flagged first, then by citations

1 of the 57 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Gallagher, M. W., Phillips, C. A., D'Souza, J., Richardson, A., Long, L. J., Boswell, J. F., Farchione, T. J., & Barlow, D. H.
Affiliations
  • University of Houston (US)
  • University at Albany, State University of New York (US)
  • Boston University (US)
ORCID
Venue
Psychotherapy
Publisher
American Psychological Association (APA)
Published
2020-09
Volume
57
Issue
3
Pages
379-390
ISSN
  • 0033-3204 (ISSN-L)
  • 1939-1536
DOI
10.1037/pst0000283
PMC
PMC7416465
OpenAlex
W3004832974
Semantic Scholar
6ccfb72dc017e0dd1e2ca3777949b7fff63fd4a4
Cited by
13
References
57
Citations by year
2026: 1 · 2025: 1 · 2024: 6 · 2023: 2 · 2022: 2 · 2020: 1
FWCI
1.21
Type
journal article
Language
en
Open access
Licence
Locations
  • Psychotherapy (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (R01MH090053)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Social Psychology › Psychological Well-being and Life Satisfaction
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
cognitive behavioral therapy, anxiety disorders, well-being, subjective well-being, psychological well-being, social well-being, treatment trajectories, anxiety reduction, parallel processes
MeSH terms
Adolescent, Adult, Aged, Anxiety Disorders, Female, Humans, Male, Middle Aged, Waiting Lists, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult, Self Report

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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