Do treatment responders maintain their gains following a randomized clinical trial comparing an acceptance-based behavior therapy to applied relaxation for generalized anxiety disorder?

May combine two claims.

These gains were maintained through 24-month follow-up, based on two studies reporting this data.

“These gains were then maintained through 24-month follow-up, based on the two studies reporting this data (Barlow et al., 1992; Dugas et al., 2010).”

• cites Barlow et al., 1992 sourceNot checked — no full text of the source
• cites Dugas et al., 2010 sourceSupported

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

Support for the efficacy of ABBT comes from an open trial, a waitlist RCT, and comparative efficacy trials with supportive therapy, applied relaxation, and cognitive-behavioral therapy.

“Support for the efficacy of ABBT comes from an open trial (Roemer & Orsillo, 2007), a waitlist RCT (Roemer, Orsillo, & Salters-Pedneault, 2008), and comparative efficacy trials with supportive therapy (de Almeida Sampaio et al., 2020), applied relaxation (Hayes-Skelton, Roemer, & Orsillo, 2013), and cognitive-behavioral therapy (Vera, Obén, Juarbe, Hernández, & Pérez-Pedrogo, 2021).”

• cites Roemer & Orsillo, 2007 sourceNot checked — no full text of the source
• cites Roemer, Orsillo, & Salters-Pedneault, 2008 sourceSupported
• cites Hayes-Skelton, Roemer, & Orsillo, 2013 sourceSupported

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

AR may have yielded better outcomes than in other trials because of extended length and extensive focus on applying skills to early cues.

“As we noted in our outcome paper (Hayes-Skelton, Roemer, & Orsillo, 2013), AR may have yielded better outcomes than in other trials because of the extended length and extensive focus on applying skills to early cues.”

• cites Hayes-Skelton, Roemer, & Orsillo, 2013 sourceSupported

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

The SIGH-A provides a reliable, valid structured format for administering the Hamilton Anxiety Rating Scale.

“Structured Interview Guide for the Hamilton Anxiety Rating Scale (SIGH-A; Shear et al., 2001) provides a reliable, valid structured format for administering the Hamilton Anxiety Rating Scale (HARS; Hamilton, 1959), a widely used 14-item interviewer administered measure of anxiety.”

• cites Shear et al., 2001 sourceSupported
• cites Hamilton, 1959 sourceNot checked — no full text of the source

May combine two claims.

In the Dugas et al. (2010) study, 22% of the initial 64 participants did not complete the 12-month assessment and 34% did not complete the 24-month assessment.

“however, it should be noted that 22% of the initial 64 participants did not complete the 12-month assessment and 34% did not complete the 24-month assessment.”

• cites Dugas et al. (2010) sourcePartly supported

  The Procedure section reports that 33 participants were offered CBT and 31 were offered applied relaxation, and that assessments were scheduled at 12 and 24 months. The passages do not report how many completed either assessment, so they do not substantiate the claimed 22% and 34% noncompletion rates. (LLM, conf=0.78)

  Experimental — accuracy not yet measured

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

It is possible that because therapists were also trained in ABBT, they modeled experiential acceptance and decentering despite not explicitly discussing it; client reports of experiential acceptance predict outcomes across both therapies, and decentering increased and led to improved symptoms across both therapies.

“It is also possible that because our therapists were also trained in ABBT, they modeled experiential acceptance and decentering despite the fact that it was not explicitly discussed; client reports of experiential acceptance do predict outcomes across both therapies in this trial (Eustis, Hayes-Skelton, Roemer, & Orsillo, 2016) and decentering increased and led to improved symtoms across both”

• cites Eustis, Hayes-Skelton, Roemer, & Orsillo, 2016 sourceSupported
• cites Hayes-Skelton, Calloway, Roemer, & Orsillo, 2015 sourceSupported

May combine two claims.

The Hayes-Skelton et al. (2013) randomized clinical trial comparing 16-session ABBT and AR found that both treatments yielded significant large treatment effects on all anxiety and depression outcomes, with no differences between treatments.

“Overall, both ABBT and AR yielded significant large treatment effects on all anxiety and depression outcomes, with no differences between the two treatments.”

• cites Hayes-Skelton, Roemer, and Orsillo (2013) sourceSupported

May combine two claims.

For all other outcomes, effects were non-significant and small, indicating that symptoms did not significantly change across follow-up regardless of condition.

“Non-significant, small effects were found for all other outcomes indicating that symptoms did not signficantly change across follow-up regardless of condition.”

May combine two claims.

The DASS-Stress model had a non-significant medium effect for Condition; the PSWQ condition effect and the Condition × Time effects in both models were non-significant small effects.

“The DASS-Stress model also had a non-significant, medium effect for Condition, but the condition effect for PSWQ and the Condition × Time effects in both models were non-significant, small effects.”

May combine two claims.

Mixed-effects regression models for PSWQ and DASS-Stress showed a significant effect for Time, with large and medium effect sizes respectively.

“The MRM models for PSWQ and DASS-Stress showed a significant (large and medium) effect for Time.”

May combine two claims.

Clients' quality of life remained stable and they showed slight (nonsignificant) improvement in number of additional diagnoses during follow-up.

“This hypothesis is further supported by the finding that clients’ quality of life remained stable and they demonstrated slight (nonsignificant) improvement in the number of additional diagnoses they met during the follow-up period.”

May combine two claims.

In the current study, clinician-rated severity improved nonsignificantly over follow-up, while self-reported worry and generalized anxiety symptoms significantly worsened.

“For example, in the current study there were differences based on the type of assessment measures used, with the clinician-rated severity improving nonsignificantly over the follow-up period and the self-reported worry and generalized anxiety symptoms significantly worsening over this period.”

May combine two claims.

Non-significant small or small-to-medium effects for Time, Condition, and Condition × Time were found on the remaining primary (CSR, SIGH-A, STAI) and secondary (BDI-II, QOLI, additional diagnoses) outcomes.

“As would be expected when assessing maintenance of gains, there were non-significant, small or small to medium effects for Time, Condition, and Condition × Time on the remaining primary (CSR, SIGH-A, and STAI) and secondary (BDI-II, QOLI, and number of additional diagnoses) outcome measures.”

May combine two claims.

At 12-month follow-up, 2 clients were receiving therapy for anxiety or depression; at 24-month follow-up, 3 clients were receiving such therapy.

“At 12-month follow-up, 2 clients were receiving therapy for anxiety or depression (1 in AR, 1 in ABBT). At 24-month follow-up, 3 clients were receiving therapy for anxiety or depression (1 in AR, 2 in ABBT).”

May combine two claims.

At the 24-month follow-up, 71.4% of ABBT responders and 83.3% of AR responders maintained their gains.

“Similarly, at 24-month follow-up, 71.4% of responders from ABBT and 83.3% of responders from AR maintained their gains.”

May combine two claims.

Medication status remained stable for 82% of ABBT and 84% of AR clients between post-treatment and 12-month follow-up, and for 85% of ABBT and 83% of AR clients between post-treatment and 24-month follow-up.

“Between post- and 12-month follow-up, the medication status of 82% of clients in ABBT and 84% of clients in AR remained stable. Between post-treatment and 24-month follow-up, the medication status of 85% of clients in ABBT and 83% of clients in AR remained stable.”

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

Meta-analyses have shown that cognitive behavioral therapies, including acceptance-based behavioral therapies, are efficacious for GAD with large effect sizes on anxiety and depressive symptoms.

“Overall, meta-analyses have revealed that cognitive behavioral therapies (CBTs), including acceptance-based behavioral therapies, are efficacious treatments for GAD (Borkovec & Ruscio, 2001; Covin, Ouimet, Seeds, & Dozois, 2008; Cuijpers et al., 2014) with large effect sizes on measures of both anxiety and depressive symptoms.”

• cites Borkovec & Ruscio, 2001Not matched

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

• cites Covin, Ouimet, Seeds, & Dozois, 2008 sourceNot checked — no full text of the source
• cites Cuijpers et al., 2014 sourceNot checked — no full text of the source

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

The results are limited by dropout rates.

“While the results are limited by dropout rates, clients receiving ABBT or AR appear to maintain gains over long-term follow-up.”

Classified as probably not a substantial claim.

Less is known about whether treatment responders maintain their gains in the long term.

“While these meta-analyses provide support that CBT is effective, less is known about whether treatment responders maintain their gains in the long-term.”

May combine two claims.

The Cuijpers et al. (2014) meta-analysis concluded that CBT may be effective and may be more effective than applied relaxation in the long term, based on four studies reporting 12-month follow-up assessments.

“In looking at longer term follow-up, the Cuijpers et al. (2014) meta-analysis concluded that CBT may be effective and may be more effective than applied relaxation (AR) in the long-term based on the four studies reporting 12-month follow-up assessments (Barlow, Brown, & Rapee, 1992; Borkovec & Costello, 1993; Dugas et al., 2010; Öst & Breitholtz, 2000).”

• cites Cuijpers et al. (2014) sourceNot checked — no full text of the source
• cites Barlow, Brown, & Rapee, 1992 sourceNot checked — no full text of the source
• cites Borkovec & Costello, 1993 sourceNot checked — no full text of the source

May combine two claims.

Clients' symptoms overall did not significantly change across the follow-up period, and there were no significant differences between the two treatments.

“These results indicate that clients’ symptoms overall did not significantly change across the follow-up period and that there were no significant differences across the two treatments.”

May combine two claims.

Clients' self-reported anxiety significantly increased from post-treatment across follow-up, and this rate of change did not differ significantly between the two treatments.

“This indicates that clients’ self-report of anxiety significantly increased from post-treatment across follow-up and that this rate of change was not significantly different across the two treatments.”

May combine two claims.

Effects observed at post-treatment were generally sustained over time across both treatments and comparable for ABBT and AR.

“The strongest, most consistent findings in this study are that the effects observed at post-treatment were generally sustained over time across both treatments and that these effects were comprabable for ABBT and AR.”

Classified as probably not a substantial claim.

Long-term follow-up studies have focused on AR and more traditional CBT rather than including acceptance-based behavioral approaches.

“Additionally, these studies of long-term follow-up, the studies focus on AR and more traditional CBT, rather than including acceptance-based behavioral approaches.”

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

The MRM analyses had 22.7% missing data for ABBT and 8.3% for AR at 12-month follow-up, and 36.4% for ABBT and 25.0% for AR at 24-month follow-up.

“These analyses had 22.7% missing for ABBT and 8.3% for AR at 12-month follow-up and 36.4% for ABBT and 25.0% for AR at 24-month follow-up.”

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

Independent assessors were post-doctoral fellows or graduate students who were unaware of treatment condition and trained in ADIS administration and scoring.

“Independent assessors were post-doctoral fellows or graduate students, unaware of treatment condition, trained in the administration and scoring of the ADIS.”

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

Diagnoses were confirmed in a consensus meeting with a doctoral-level psychologist and by therapists.

“Diagnoses were confirmed in a consensus meeting with a doctoral-level psychologist (Dr. Tim Brown) and by therapists.”

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

The DASS-Stress subscale had internal consistencies of .85 at post, .64 at 12-month, and .92 at 24-month follow-up.

“The Stress subscale had internal consistencies of .85 at post, .64 at 12-month, and .92 at 24-month follow-up.”

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

STAI internal consistencies were .92 at post, .91 at 12-month, and .94 at 24-month follow-up.

“Internal consistencies were .92 at post, .91 at 12-month, and .94 at 24-month follow-up.”

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

The PSWQ is a widely used, reliable, valid 16-item self-report measure of trait levels of worry.

“Penn State Worry Questionnaire (PSWQ: Meyer, Miller, Metzger, & Borkovec, 1990) is a widely used, reliable, valid 16-item self-report measure of trait levels of worry.”

• cites Meyer, Miller, Metzger, & Borkovec, 1990 sourceNot checked — no full text of the source

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

Clients who began medication or therapy during follow-up complicate interpretation of findings.

“Also, clients who began medication or therapy during the follow-up period complicate the interpretation of findings.”

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

For GAD, the ADIS-IV has demonstrated adequate reliability (κ = .67).

“For GAD, the ADIS-IV has demonstrated adequate reliability (κ = .67; Brown, DiNardo, Lehmann, & Cambell, 2001).”

• cites Brown, DiNardo, Lehmann, & Cambell, 2001Not matched

  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).

In the pharmacotherapy literature, patients initially diagnosed with GAD who have sustained remission are less likely to experience relapse.

“Additionally, at least in the pharmacotherapy literature, studies indicate that patients initially diagnosed with GAD who have sustained remission are less likely to experience relapse (Goodman, 2004).”

• cites Goodman, 2004Not checked — no full text of the source

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

In this sample, BDI-II internal consistencies were .85 at post, .82 at 12-month, and .94 at 24-month follow-up.

“In this sample, the internal consistencies were .85 at post, .82 at 12-month, and .94 at 24-month follow-up.”

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

In this sample, PSWQ internal consistencies were .84 at post, .87 at 12-month, and .86 at 24-month follow-up.

“In this sample, the internal consistencies were .84 at post, .87 at 12-month, and .86 at 24-month follow-up.”

May combine two claims.

Gains were generally maintained through long-term follow-up, and post-treatment primary interview-based measures and secondary outcomes were maintained.

“In this study examining the maintenance of gains following a randomized clinical trial comparing ABBT and AR, we found that gains were generally maintained through long-term follow-up and that post-treatment primary interview-based measures and secondary outcomes were maintained.”

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

The DASS-21 has separate, reliable and valid self-report scales for depression, anxiety, and stress.

“Depression Anxiety Stress Scale – 21-item version (DASS-21; Lovibond & Lovibond, 1995) has separate, reliable and valid self-report scales for depression, anxiety (i.e., anxious arousal), and stress (i.e., general anxiety and tension; Antony, Bieling et al., 1998).”

• cites Lovibond & Lovibond, 1995Not matched

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

• cites Antony, Bieling et al., 1998 sourceNot checked — no full text of the source

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

Thirty percent of ADIS interviews were scored by a second rater, with an interclass correlation of .73 between raters on CSR for GAD.

“Additionally, 30% of interviews were scored by a second rater, with an interclass correlation (ICC) between raters on CSR for GAD of .73.”

May combine two claims.

In the Barlow et al. (1992) study, at 24-month follow-up 32% of participants were considered treatment responders and 21% were considered to have high endstate functioning.

“Similarly, in the Barlow et al. (1992) study, at 24-month follow-up 32% of participant were considered treatment responders and 21% were considered to have high endstate functioning, which was defined as reaching a threshold score on three out of the following five measures: interviewer rated severity, Hamilton anxiety, daily anxiety, and two self-report measures.”

• cites Barlow et al. (1992) sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

There are still a limited number of trials with follow-up assessments, suggesting that additional research is needed.

“However, there are still a limited number of trials with follow-up assessments suggesting that additional research is needed.”

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

The STAI Trait Form Y is a reliable, valid 20-item self-report measure that assesses trait levels of anxiety.

“State-Trait Anxiety Inventory – Trait Form Y (STAI; Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983) is a reliable, valid 20-item self-report measure that assesses trait levels of anxiety.”

• cites Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983Not matched

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

May combine two claims.

Considerable missing data across follow-up, particularly at 24 months, left a relatively small final sample, which can limit generalizability.

“However, considerable missing data across follow-up time points, particularly at the 24-month follow-up, left us with a relatively small final sample, which can limit the generalizability of the results.”

May combine two claims.

Including unclassified participants, missing data at 12-month follow-up was 27.3% for ABBT and 8.3% for AR; at 24-month follow-up it was 36.4% for ABBT and 25.0% for AR.

“Including those who were unclassified, at 12-month follow-up 27.3% were missing data from ABBT and 8.3% from AR. At 24-month follow-up the missing data was 36.4% for ABBT and 25.0%.”

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

Therapists were post-doctoral fellows or advanced doctoral students supervised by the study authors.

“Therapists were post-doctoral fellows or advanced doctoral students supervised by the study authors.”

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

In this sample, SIGH-A internal consistencies were .76 at post-treatment, .88 at 12-month, and .81 at 24-month follow-up.

“In this sample, internal consistencies were .76 at post-treatment, .88 at 12-month, and .81 at 24-month follow-up.”

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

The study was conducted in compliance with the IRBs at Boston University, the University of Massachusetts Boston, and Suffolk University, and all participants provided informed consent.

“The study was conducted in compliance with the IRBs at Boston University, the University of Massachusetts Boston, and Suffolk University. All participants provided informed consent for the study.”

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

Some clients provided partial data at a time point, making high end-state functioning designations more challenging and resulting in additional missing data.

“Some clients only provided partial data at a time point, making their high end-state functioning designations more challenging and resulting in additional missing data.”

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

Therapists saw roughly equal numbers of clients in each condition.

“Therapists saw roughly equal number of clients in each condition.”

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

The sample size reduces power; effect sizes were reported and interpreted to minimize Type II error.

“The sample size also reduces power, so we report and interpret effect sizes to minimize the risk of Type II error (Kazdin, 2021).”

• cites Kazdin, 2021 sourceNot checked — no full text of the source

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

In this sample, QOLI internal consistencies were .84 at post, .86 at 12-month, and .82 at 24-month follow-up.

“Internal consistencies were .84 at post, .86 at 12-month, and .82 at 24-month follow-up in this sample.”

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

Fifteen percent of SIGH-A administrations were rated twice for interrater reliability, revealing an ICC of .89.

“Post-doctoral fellows or doctoral students, after training, administered the measure, and 15% were rated twice for interater reliability, revealing an ICC of .89.”

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

One limitation of the meta-analysis is variability in how AR was classified and whether AR was conducted as a robust treatment rather than a control condition.

“One limitation to this meta-analysis is the variability in how AR was classified and whether or not AR was conducted as a robust treatment as opposed to a control condition.”

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

Eligibility was primarily assessed by an independent assessor, and inclusion and exclusion criteria were confirmed by a study therapist.

“Eligibility was primarily assessed by an independent assessor (IA) who conducted the diagnostic assessment. However, inclusion and exclusion criteria were confirmed by a study therapist.”

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

This pattern may suggest clients began to notice additional symptoms of worry and anxiety, even though symptoms were not producing clinical levels of distress or interfering in role functioning, because clinician measures take latter into account while self-report measures do not.

“This pattern of response may suggest that clients began to notice additional symptoms of worry and anxiety, even though the symptoms were not producing clinical levels of distress or interfering in role functioning, as the clinician measures take the latter into account, while the self-report measures do not.”

May combine two claims.

Participants did not differ by condition on demographic variables or the presence of comorbid diagnoses at pre-treatment.

“Demographic characteristics of the sample are presented in Table 1; participants did not differ by condition on demographic variables or the presence of comorbid diagnoses at pre-treatment.”