The DOI matches its Crossref record; 36 of the 37 references it cites were found in a registry or an index.
Worry Exposure versus Applied Relaxation in the Treatment of Generalized Anxiety Disorder
Open accessAbstract
Background: Worry exposure (WE) is a core element of cognitive-behavioral treatment for generalized anxiety disorder (GAD). Its efficacy as a stand-alone treatment method (without further cognitive-behavioral therapy interventions) has never been tested.We aimed to examine whether WE alone is as efficacious as the empirically supported stand-alone treatment for GAD, applied relaxation (AR). Methods: In a randomized controlled study, 73 outpatients meeting DSM-IV criteria for GAD as primary diagnosis were allocated to either WE or AR or a waiting list control group; in a 2nd randomization procedure the waiting list subjects were reallocated to WE or AR. The treatment was manualized (15 sessions with WE or AR), included 6-month and 1-year follow-ups, as well as last observation carried forward and completer analyses, and was controlled for allegiance effects.The Hamilton Anxiety Rating Scale and the State-Trait Anxiety Scale were used as primary outcome measures. Self-report scales of anxiety, worrying and depression including negative metacognition about worrying and thought suppression served as secondary outcome measures. Results: The dropout rate was moderate. The pre-/posttreatment effects were high for the Hamilton Anxiety Rating Scale (standardized mean difference >1) and for the State-Trait Anxiety Inventory (standardized mean difference >0.87). The proportion of patients reaching high end state functioning was 48% (WE) and 56% (AR). WE and AR did not differ with regard to dropout rate or treatment effects. The treatment effects were stable at 6 month and 1 year follow-up. Conclusion: This is the first study to show that a stand-alone exposure in sensu technique – WE – is efficacious in the treatment of GAD. Both AR and WE seem to represent effective principles of change in GAD.
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“Prior efforts to implement exposure within GAD used techniques that induced worrisome fears via imagery (Hoyer et al., 2009; Zinbarg, Lee, & Yoon, 2007).”
From A novel theory of experiential avoidance in generalized anxiety disorder: A review and synthesis of research supporting a contrast avoidance model of worry (2011) · cites this paper as Hoyer et al., 2009
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“For example, randomized controlled trials demonstrated that AR was more efficacious than a nondirective, reflective listening therapy (Borkovec & Costello, 1993) and roughly as efficacious as cognitive therapy (Arntz, 2003; Öst & Breitholtz, 2000), cognitive behavioral therapy (Borkovec & Costello, 1993; Dugas et al., 2010), and worry exposure (Hoyer et al., 2009) in treating GAD.”
From A randomized clinical trial comparing an acceptance-based behavior therapy to applied relaxation for generalized anxiety disorder (2013) · cites this paper as Hoyer et al., 2009
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“Worry exposure (which also involved encouragement to reduce avoidance and reassurance seeking) was not significantly different from AR; both were superior to waitlist at posttreatment with maintenance of gains at 1-year follow-up [25].”
From Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts (2022) · cites this paper as [25]
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“Dass eine Behandlungskonzeption, die mittels Sorgenexposition allein auf die pathologischen Sorgen abzielt, ebenso effektiv ist, konnten wir kürzlich in einer kontrollierten Studie zeigen [Hoyer et al., 2009].”
From Wann sind Sorgen pathologisch? (2009) · cites this paper as Hoyer et al., 2009
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Bernaldo-de-Quirós, M., Labrador, F., García-Fernández, G., Fernández-Arias, I., Estupiñá, F., & Labrador-Méndez, M. (2015) · Psicothema · doi:10.7334/psicothema2014.264 · Cited by 3
“For instance, Hoyer et al. (2009) showed that the exposure technique by itself is effi cacious for GAD without having to resort to relaxation.”
BackgroundWhite, E. J., Wray, J. M., & Shepardson, R. L. (2020) · Families Systems & Health · doi:10.1037/fsh0000543 · Cited by 3
“…is an integral component of many CBT protocols for treating anxiety disorders (e.g., Tolin, 2016) and is effective as a standalone treatment (e.g., Hoyer et al., 2009) even in transdiagnostic samples (i.e., treatment of broad anxiety symptoms rather than a particular diagnosis; e.g., Boswell et…”
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Asselmann, E., Rückert, F., Kische, H., Zenker, M., Pieper, L., & Beesdo-Baum, K. (2024) · Journal of mood and anxiety disorders · doi:10.1016/j.xjmad.2024.100055 · Cited by 2
“For example, AR could reduce anxiety symptoms in patients with generalized anxiety disorder [26,27,33,5,53], panic disorder [51,56,57], agoraphobia [37,54,57], social phobia [21,48,49], and specific phobias [20,55].”
Users remain overlooked: Shared decision‐making processes for people with anxiety disorders
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“The user groups pointed out that active coping, based on exposure to anxiety-generating situations, made a significant contribution to alleviating their anxiety disorders (Barlow et al., 2000; Foa et al., 2005 ; Hoyer et al., 2009 ; Rapee et al., 2009 ).”
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Neudeck, P., & Lang, T. (2011) · Springer-Lehrbuch · doi:10.1007/978-3-642-13018-2_24 · Cited by 2
Hoyer, J., & Beesdo‐Baum, K. (2011) · Springer-Lehrbuch · doi:10.1007/978-3-642-13018-2_42 · Cited by 2
Self-citationBeesdo‐Baum, K., Zenker, M., Rückert, F., Kische, H., Pieper, L., & Asselmann, E. (2022) · Behaviour Research and Therapy · doi:10.1016/j.brat.2022.104162 · Cited by 2
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Slevison, M. (2014) · RMIT Research Repository (RMIT University Library) · doi:10.25439/rmt.27354483 · Cited by 2
Exposure therapy for anxiety disorders
Stanton, C. H., & Tolin, D. F. (2022) · Elsevier eBooks · doi:10.1016/b978-0-323-91497-0.00065-5 · Cited by 3
Generalisierte Angststörung: Diagnostik und Behandlung
Naumann, L., & Gerlach, A. L. (2014) · Psychotherapeut · doi:10.1007/s00278-014-1067-z · Cited by 1
Hoyer, J., & Knappe, S. (2020) · Springer eBooks · doi:10.1007/978-3-662-61814-1_14 · Cited by 1
Self-citationBadeja, D., Schier, F., Straka, H.-C., McGinity, M., & Hoyer, J. (2026) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2026.103150 · Cited by 1
Self-citationOn the Diagnosis, Assessment, and Treatment of Generalized Anxiety Disorder
van der Heiden, C. (2011) · Cited by 1
Disengagement Training for the Treatment of Pathological Worry: A Preliminary Test
McDermott, K. A., & Cougle, J. R. (2020) · Behavior Therapy · doi:10.1016/j.beth.2020.02.005 · Cited by 1
Panik-, Angst- und Zwangsstörungen
Härtling, S., & Hoyer, J. (2017) · Springer eBooks · doi:10.1007/978-3-662-54644-4_18 · Cited by 1
Self-citationAngst- und Sorgenmodelle in der modernen Kognitiven Verhaltenstherapie
Flückiger, C., & Hoyer, J. (2022) · PiD - Psychotherapie im Dialog · doi:10.1055/a-1686-1163 · Cited by 1
Self-citationBirdsey, N. (2020) · Clinical Case Studies · doi:10.1177/1534650120964869 · Cited by 1
“– Session 7: Having allocated worry time, (Hoyer et al., 2009) to reduce the amount of time spent worrying to give Sarah more control over her worries and identifying ways to compassionately responding to “shoulds” (Homan & Sirios, 2017) and Sarah’s inner critic.”
BackgroundHoyer, J., & Beesdo‐Baum, K. (2020) · Springer eBooks · doi:10.1007/978-3-662-61814-1_48 · Cited by 2
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Erziehungswissenschaft, F. (2012)
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“Childhood or adolescent onset GAD tends to persist throughout adulthood without treatment (Andrews et al., 2010; Dugas, Swartz, & Francis, 2004; Hoyer et al., 2009).”
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“Probablemente, porque se encuentran entre las intervenciones terapéuticas preferidas para intervenir en cuadros y síntomas altamente prevalentes de ansiedad y estrés (Conrad & Roth, 2007; Donegan & Dugas, 2012; Hoyer et al., 2009; López-Fernández, 1996a, 1996b; Ost & Breitholtz, 2000).”
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Self-citation
Metadata
- Authors
- Hoyer, J., Beesdo, K., Gloster, A. T., Runge, J., Höfler, M., & Becker, E. S.
- Affiliations
- Technische Universität Dresden (DE)
- Radboud University Nijmegen (NL)
- Venue
- Psychotherapy and Psychosomatics
- Publisher
- S. Karger AG
- Published
- 2009
- Volume
- 78
- Issue
- 2
- Pages
- 106-115
- ISSN
- 0033-3190 (ISSN-L)
- 1423-0348
- OpenAlex
- W2126294400
- Cited by
- 147
- References
- 37
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 10 · 2023: 6 · 2022: 5 · 2021: 15 · 2020: 15 · 2019: 7 · 2018: 6 · 2017: 12 · 2016: 4 · 2015: 6 · 2014: 12 · 2013: 9 · 2012: 10
- FWCI
- 14.36
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Psychotherapy and Psychosomatics (publishedVersion)
- PubMed (publishedVersion)
- edoc (University of Basel) (acceptedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Qucosa (Saxon State and University Library Dresden) (submittedVersion, other-oa)
- edoc (University of Basel)
- Funders
- Pfizer
- Deutsche Forschungsgemeinschaft
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- generalized anxiety disorder, applied relaxation, cognitive behavioral therapy, thought suppression, dropout
- MeSH terms
- Adult, Anxiety Disorders, Depressive Disorder, Female, Humans, Life Change Events, Male, Surveys and Questionnaires, Relaxation Therapy, Thinking, Diagnostic and Statistical Manual of Mental Disorders
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