An Integrated, Acceptance-Based Behavioral Approach for Depression With Social Anxiety: Preliminary Results

May combine two claims.

Depression-SAD comorbidity results in greater severity of symptoms, poorer functioning, and a greater presence of comorbid substance use disorders compared with depression without SAD.

“Depression-SAD comorbidity results in greater severity of symptoms, poorer functioning, and a greater presence of comorbid substance use disorders compared with depression without SAD (Dalrymple & Zimmerman, 2007; Nelson et al., 2000; Stein et al., 2001).”

• cites Dalrymple & Zimmerman, 2007 sourcePartly supported

  The Results report poorer social functioning, greater severity on several clinical measures, and more current alcohol abuse or dependence among patients with MDD-SAD. They also state that the groups did not differ significantly in substance abuse or dependence overall. The Discussion cautions that the greater severity may reflect additional comorbidity rather than SAD itself, so the claim overstates both the substance-use finding and causality. (LLM, conf=0.90)

  Experimental — accuracy not yet measured
• cites Nelson et al., 2000 sourceNot checked — no full text of the source
• cites Stein et al., 2001 sourceNot checked — no full text of the source

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

Social anxiety disorder is one of the most common comorbid anxiety disorders with depression, with rates as high as 30% in clinical samples.

“Social anxiety disorder (SAD) is one of the most common comorbid anxiety disorders with depression, particularly in clinical samples where rates are as high as 30% (Belzer & Schneier, 2004; Brown, Campbell, Lehman, Grisham, & Mancill, 2001; Dalrymple & Zimmerman, 2007).”

• cites Belzer & Schneier, 2004 sourceNot checked — no full text of the source
• cites Brown, Campbell, Lehman, Grisham, & Mancill, 2001 sourceNot checked — no full text of the source
• cites Dalrymple & Zimmerman, 2007 sourceSupported

May combine two claims.

Comorbid SAD in pharmacotherapy studies is associated with a poorer course of illness, treatment-resistant depression, and a greater number and earlier onset of depressive recurrences compared with patients without comorbid SAD.

“This comorbidity pattern may also affect treatment outcomes, with pharmacotherapy studies indicating that comorbid SAD is associated with a poorer course of illness (Mulder, Joyce, Frampton, Luty, & Sullivan, 2006), treatment-resistant depression (Souery et al., 2007), and a greater number and earlier onset of depressive recurrences compared with patients without comorbid SAD (Holma, Holma, Melart”

• cites Mulder, Joyce, Frampton, Luty, & Sullivan, 2006 sourceNot checked — no full text of the source
• cites Souery et al., 2007 sourceSupported
• cites Holma, Holma, Melartin, Rytsala, & Isometsa, 2008 sourceNot checked — no full text of the source

May combine two claims.

Preliminary efficacy of ACT has been demonstrated for a variety of psychological problems, including depression and SAD separately.

“Preliminary efficacy of ACT has been demonstrated for a variety of psychological problems, including depression and SAD separately (see Hayes et al., 2006, for a review).”

• cites Hayes et al., 2006 sourceSupported

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

The AAQ-II possesses good internal consistency, reliability, and validity, with Cronbach's α = .79.

“Research suggests that this measure possesses good internal consistency, reliability, and validity (Bond et al., 2011; Cronbach’s α = .79).”

• cites Bond et al., 2011 sourcePartly supported

  The General Discussion reports promising evidence for the AAQ-II’s reliability and validity, and the Measurement invariance section reports support for its internal consistency. But the General Discussion gives a mean Cronbach’s alpha of .84 across six samples (.78–.88); .79 is its 12-month test–retest reliability, not its alpha. (LLM, conf=0.92)

  Experimental — accuracy not yet measured

May combine two claims.

Results showed significant improvement in symptoms, functioning, and processes from pre- to post-treatment, as well as high satisfaction with the treatment.

“Results showed significant improvement in symptoms, functioning, and processes from pre- to post-treatment, as well as high satisfaction with the treatment.”

May combine two claims.

Completer analyses showed behavioral avoidance reductions early in treatment, while larger depressive symptom reductions appeared later.

“For instance, results from the completer analyses showed that reductions in behavioral avoidance occurred early in treatment (from pre- to mid-treatment), yet greater reductions in depressive symptoms appeared to occur in the latter half of treatment.”

May combine two claims.

LSAS avoidance scores decreased significantly from pre- to mid-treatment (p < .001) and from pre- to post-treatment (p = .006).

“The LSAS avoidance ANOVA also was significant, with scores decreasing from pre- to mid-treatment (p < .001) and pre- to post-treatment (p = .006).”

May combine two claims.

Among completers, 43.8% (7/16) showed reliable change on LSAS fear and 50% (8/16) on LSAS avoidance.

“Reliable change was experienced by 43.8% (7/16) of treatment completers on the LSAS fear subscale, and 50% (8/16) of completers on the LSAS avoidance subscale.”

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

Most patients (86.7%; n = 26) were prescribed an SSRI or SNRI at study entry.

“The majority (86.7%; n = 26) of patients were prescribed a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) at the beginning of the study”

May combine two claims.

Among completers, 62.5% (10/16) showed reliable change on QIDS-C, rising to 88.9% (8/9) among those with initial moderate-to-severe depression.

“Overall, 62.5% (10/16) of completers experienced reliable change on the QIDS-C; this percentage increased to 88.9% (8/9) when considering only those with initial moderate-to-severe depression.”

May combine two claims.

AAQ-II scores decreased significantly from mid- to post-treatment (p = .05) and from pre- to post-treatment (p = .003).

“Scores on the AAQ-II significantly decreased from mid- to post-treatment (p = .05) and pre- to post-treatment (p = .003)”

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

Patients had on average nearly four current or partial remission diagnoses (M = 3.6, SD = 1.4).

“On average, patients had nearly 4 total current or partial remission diagnoses (M = 3.6, SD = 1.4)”

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

Five patients (13.5%) also met criteria for dysthymia, indicating double depression.

“5 patients (13.5%) had an additional dysthymia diagnosis (i.e., met criteria for “double depression”; see Table 2).”

May combine two claims.

In the ITT sample, 26.7% (8/30) showed reliable change on QIDS-C, and 43.8% (7/16) of the moderate-to-severe subgroup did so.

“In the ITT sample, reliable change was experienced by 26.7% (8/30) on the QIDS-C, and 43.8% (7/16) of the subsample with initial moderate-to-severe depression.”

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

The mean age of onset for social anxiety disorder was earlier than that for depression.

“As shown in Table 2, the mean onset of SAD was earlier than the mean onset of depression.”

May combine two claims.

Pre- to post-treatment changes in depression and social anxiety correlated with each other and, in some cases, with WHODAS and QOLI changes.

“Pre- to post-treatment changes in depression and SAD correlated with each other, as well as with the WHODAS and QOLI in some cases.”

May combine two claims.

Patients were highly confident recommending the treatment to a friend with depression (M = 7.4, SD = 1.7) or social anxiety disorder (M = 7.5, SD = 1.9).

“and they were highly confident in recommending the treatment to a friend with depression (M = 7.4, SD = 1.7) or SAD (M = 7.5, SD = 1.9).”

May combine two claims.

QIDS-C scores decreased significantly from pre- to post-treatment (p < .001) and from mid- to post-treatment (p = .005).

“The overall QIDS-C ANOVA was significant, with pairwise comparisons showing that scores decreased from pre- to post-treatment (p < .001) and mid- to post-treatment (p = .005).”

May combine two claims.

Baseline severity was high, with most patients having recurrent depression, a current episode longer than two years, and poor functioning.

“Baseline severity of the sample was high, with the majority having recurrent depression, chronic current episode duration (defined as greater than 2 years), and poor functioning.”

May combine two claims.

Completer pre- to post-treatment effect sizes were large for symptom and process measures and medium-to-large for QOLI and WHODAS.

“completer pre- to post-treatment effect sizes were large for the symptom and process measures, and medium-to-large for the QOLI and WHODAS.”

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

Thirty-eight participants were eligible and 31 started treatment.

“As shown in Figure 1, 38 participants were eligible, and 31 began treatment.”

May combine two claims.

Patients were highly confident that treatment would address their depression (M = 7.3, SD = 1.3) and social anxiety (M = 7.3, SD = 1.4).

“They also were highly confident that the treatment would sufficiently address their depression (M = 7.3, SD = 1.3) and social anxiety (M = 7.3, SD = 1.4)”

May combine two claims.

In ITT analyses, SPAI showed a marginal pre- to mid-treatment difference (p = .06) and QIDS-SR showed no pre- to post-treatment difference (p = .19).

“The ITT pairwise comparisons showed a marginal difference on the SPAI from pre- to mid-treatment (p = .06), and the QIDS-SR showed no difference from pre- to post-treatment (p = .19).”

May combine two claims.

BADS scores increased significantly from pre- to mid-treatment (p < .001) and from pre- to post-treatment (p = .005).

“significant increases on the BADS occurred from pre- to mid-treatment (p < .001) and pre- to post-treatment (p = .005).”

May combine two claims.

QIDS-SR scores decreased significantly only from pre- to post-treatment (p = .01), with a marginal mid- to post-treatment difference (p = .06).

“The QIDS-SR decreased significantly from pre- to post-treatment (p = .01) only, with a marginal difference from mid- to post-treatment (p = .06).”

May combine two claims.

SPAI scores decreased significantly at all three time points (pre-mid p = .05; mid-post p = .004; pre-post p = .002).

“The ANOVA on the SPAI was significant, with scores decreasing at all three time points (pre- to mid-treatment p = .05; mid- to post-treatment p = .004; pre- to post-treatment p = .002).”

May combine two claims.

LSAS fear scores decreased significantly from pre- to mid-treatment and from pre- to post-treatment (both p < .001).

“As shown in Table 3, the overall ANOVA on the LSAS fear was significant, with fear significantly decreasing from pre- to mid-treatment (p < .001) and pre- to post-treatment (p < .001).”

May combine two claims.

The proportion of completers with very low quality of life fell from 82.4% to 50%, while those with average quality of life rose from 11.8% to 37.5%.

“Furthermore, the percentage of completers classified as having “very low” quality of life decreased from 82.4% to 50% after 16 sessions, and those with “average” quality of life increased from 11.8% to 37.5%.”

May combine two claims.

Pre- to post-treatment changes on AAQ-II and BADS correlated with each other and with changes in depression, social anxiety, functioning, and quality of life.

“In addition, pre- to post-treatment changes on the AAQ-II and BADS were correlated with each other, and both were correlated with pre- to post-treatment changes in depression, social anxiety, functioning, and quality of life.”

May combine two claims.

ITT pre- to post-treatment effect sizes were medium for most measures, large for BADS, and small for QIDS-SR, WHODAS, and AAQ-II.

“The ITT pre- to post-treatment effect sizes were medium for most of the measures, but large for the BADS and small for the QIDS-SR, WHODAS, and AAQ-II (see Table 3).”

May combine two claims.

The overall ITT ANOVA for AAQ-II was significant, but no pairwise comparisons were significant.

“Although the overall ITT ANOVA for the AAQ-II was significant, none of the pairwise comparisons were significant.”

May combine two claims.

ITT pairwise results were similar to completer results, with marginal mid- to post-treatment differences for LSAS fear and avoidance (p = .06 and .07).

“Results from the ITT pairwise comparisons were similar to the completer results, although there were marginal differences from mid- to post-treatment for the LSAS fear and avoidance subscales in the ITT analyses (p = .06 and .07, respectively).”

May combine two claims.

Significant changes occurred in psychological flexibility and behavioral activation, which should continue to be examined as potential mechanisms.

“Furthermore, significant changes were found in the process measures of psychological flexibility and BA, and these variables should continue to be examined as potential mechanisms of action in this treatment.”

May combine two claims.

A re-analysis of the first ACT for depression study found that ACT resulted in greater reductions in depressive symptoms compared with cognitive therapy, and cognitive defusion at post-treatment mediated this differential treatment effect at follow-up.

“A recent re-analysis of the data (Zettle, Rains, & Hayes, 2011) found that ACT resulted in greater reductions in depressive symptoms compared with cognitive therapy, and cognitive defusion at post-treatment mediated this differential treatment effect at follow-up.”

• cites Zettle, Rains, & Hayes, 2011 sourceNot checked — no full text of the source

May combine two claims.

A recent open trial of 12 weeks of ACT integrated with exposure for 19 individuals with generalized SAD showed large effect size improvements from pre- to post-treatment in SAD severity, functioning, quality of life, and behavioral role-play task performance.

“For example, a recent open trial examined the efficacy of 12 weeks of ACT integrated with exposure for 19 individuals with generalized SAD (Dalrymple & Herbert, 2007).”

• Also stated in: § Introduction · plain

  “Results showed large effect size improvements from pre- to post-treatment in SAD severity, functioning, quality of life, and behavioral role-play task performance.”

• cites Dalrymple & Herbert, 2007 sourceNot checked — no full text of the source

May combine two claims.

In a 1-year follow-up after treatment termination, patients with SAD and comorbid depression experienced an increase in SAD symptom severity, whereas patients without comorbid depression experienced further alleviation in SAD symptoms.

“Marom and colleagues (2009) continued to follow patients for 1 year after treatment termination and found that patients with SAD and comorbid depression experienced an increase in SAD symptom severity over the follow-up period, whereas patients without comorbid depression experienced further alleviation in SAD symptoms.”

• cites Marom et al., 2009 sourceNot checked — no full text of the source

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

Depression and social anxiety disorder are highly comorbid, and this comorbidity is linked to greater symptom severity and functional impairment than either condition alone.

“Depression and social anxiety disorder (SAD) are highly comorbid, resulting in greater severity and functional impairment compared with each disorder alone.”

May combine two claims.

Social anxiety disorder often goes under-recognized and consequently under-treated in these individuals.

“Unfortunately, SAD often goes under-recognized in these individuals and consequently is under-treated (Grant et al., 2005; Zimmerman & Chelminski, 2003).”

• cites Grant et al., 2005 sourceNot checked — no full text of the source
• cites Zimmerman & Chelminski, 2003 sourceNot checked — no full text of the source

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

Therapists were the first author or advanced clinical psychology doctoral students trained and supervised weekly by the first author.

“Therapists were the first author (K.L.D.) or advanced clinical psychology doctoral students trained and supervised weekly by the first author.”

May combine two claims.

These results support the preliminary acceptability, feasibility, and effectiveness of this treatment in a typical outpatient psychiatry practice.

“These results support the preliminary acceptability, feasibility, and effectiveness of this treatment in a typical outpatient psychiatry practice, and suggest that further research on this treatment in larger randomized trials is warranted.”

• AssumptionRests on an assumption: The outpatient psychiatry practice sample is representative of typical outpatient psychiatric practice.
• AssumptionRests on an assumption: Pre-post improvements reflect the effects of the treatment rather than natural course or concurrent pharmacotherapy.

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

Diagnosticians were trained as part of the MIDAS Project, which provides extensive training and monitoring throughout the study to minimize rater drift.

“They were trained as part of the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) Project, which provides extensive training and monitoring throughout the study to minimize rater drift.”

May combine two claims.

In that trial, large effect size changes also occurred in experiential avoidance, and earlier changes in experiential avoidance predicted later changes in symptoms.

“Large effect size changes also occurred in experiential avoidance, and earlier changes in experiential avoidance predicted later changes in symptoms.”

• cites Dalrymple & Herbert, 2007 sourceNot checked — no full text of the source

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

The first author has received formal training in and practiced ACT, BA, and exposure therapy for the past 13 years, with the past 8 years being within the outpatient practice of the current study.

“The first author has received formal training in and practiced ACT, BA, and exposure therapy for the past 13 years, with the past 8 years being within the outpatient practice of the current study.”

May combine two claims.

Residualized change scores were used because they control for measurement error and initial differences between patients.

“Residualized change scores were used as they control for measurement error and initial differences between patients (Steketee & Chambless, 1992).”

• cites Steketee & Chambless, 1992Not matched

  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), S3 (load-bearing).

ACT's broader focus on psychological inflexibility across emotional problems may suit patients with severe or chronic problems.

“For example, it could be that ACT’s broader approach of addressing psychological inflexibility that underlies a range of emotional problems is particularly well-suited to someone who is experiencing severe or chronic problems.”

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

Eligibility was confirmed using the SCID and SIDP.

“The SCID and SIDP were used to confirm study eligibility.”

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

A post-treatment qualitative interview was conducted by an independent assessor.

“Finally, a post-treatment qualitative interview was conducted by an independent assessor”

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

Completer and intention-to-treat analyses using last observation carried forward were conducted to check consistency of results.

“Completer and intention-to-treat (ITT) analyses (using the last observation carried forward method) were conducted to examine the consistency of results; only ITT results that differed from completer analyses are reported in detail.”

May combine two claims.

Depression effect sizes were lower than some efficacy studies but within the range of 0.87-2.60 reported in CBT for depression studies.

“A similar pattern was found for depression outcomes, with effect sizes being lower than some efficacy studies (e.g., 2.0 in Elkin et al., 1989), but still within the range (0.87–2.60 across CBT for depression studies; see Hans & Hiller, 2013).”

• cites Elkin et al., 1989Not matched

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

• cites Hans & Hiller, 2013 sourceNot checked — no full text of the source

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

The WHO-DAS has demonstrated adequate psychometric properties, with Cronbach's α = .94.

“It has also demonstrated adequate psychometric properties (Chwastiak & Von Korff, 2003; McKibbin, Patterson, & Jeste, 2004; Cronbach’s α = .94).”

• cites Chwastiak & Von Korff, 2003 sourceNot checked — no full text of the source
• cites McKibbin, Patterson, & Jeste, 2004 sourceNot checked — no full text of the source

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

The BADS has preliminary psychometric data suggesting good reliability and validity, with Cronbach's α = .77 in the current study.

“Preliminary psychometric data on the BADS suggest that it demonstrates good reliability and validity (Cronbach’s α in the current study = .77).”

• cites Kanter, Mulick, Busch, Berlin, & Martell, 2007 sourceNot checked — no full text of the source

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

The LSAS has good psychometric properties, with Cronbach's α = .88 for fear and avoidance subscales.

“The Liebowitz Social Anxiety Scale (LSAS; Liebowitz, 1987) is a clinician-rated, well-established measure assessing social anxiety fear and avoidance separately, with good psychometric properties (Heimberg et al., 1999; Cronbach’s α = .88 for fear and avoidance subscales).”

• cites Liebowitz, 1987Not matched

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

• cites Heimberg et al., 1999 sourceNot checked — no full text of the source

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

The QOLI has demonstrated good psychometric properties, with Cronbach's α = .72 for importance and satisfaction items.

“The Quality of Life Inventory (QOLI; Frisch, Cornell, Villanueva, & Retzlaff, 1992) assesses importance and satisfaction in a variety of domains such as health and work, and has demonstrated good psychometric properties (Frisch et al., 1992; Cronbach’s α = .72 for importance and satisfaction items).”

• cites Frisch, Cornell, Villanueva, & Retzlaff, 1992 sourceNot checked — no full text of the source

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

The QIDS-SR and QIDS-C have demonstrated highly acceptable psychometric properties, with Cronbach's alphas of 0.62 and 0.78 in the current study.

“Both versions have demonstrated highly acceptable psychometric properties (Trivedi et al., 2004; Cronbach’s alphas were 0.62 for the QIDS-SR and 0.78 for the QIDS-C in the current study).”

• cites Trivedi et al., 2004 sourceNot checked — no full text of the source

May combine two claims.

The QIDS-C reliability was set at 0.85 and the LSAS fear and avoidance subscales at 0.92 for reliable change calculations.

“The reliability estimate used to calculate RCIs was 0.85 for the QIDS-C (Trivedi et al., 2004), and 0.92 for the LSAS fear and avoidance subscales (Heimberg et al., 1999).”

• cites Trivedi et al., 2004 sourceNot checked — no full text of the source
• cites Heimberg et al., 1999 sourceNot checked — no full text of the source

May combine two claims.

A recent meta-analysis found large depression effect sizes (1.06-1.13) and moderate-to-large secondary outcome effect sizes (0.7-0.9).

“Similar findings were reported in a recent meta-analysis (Hans & Hiller, 2013), which found large effect sizes for depression (1.06–1.13), and moderate-to-large effect sizes for secondary outcomes (0.7–0.9).”

• cites Hans & Hiller, 2013 sourceNot checked — no full text of the source

May combine two claims.

Symptom reduction is not emphasized in ACT but often occurs, perhaps through movement toward values-consistent behavior.

“Although symptom reduction is not emphasized in ACT, it often occurs perhaps as a result of movement toward values-consistent behaviors.”

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

The SPAI has demonstrated good psychometric properties, with current Cronbach's α = .98.

“Self-report SAD symptoms were assessed with the Social Phobia and Anxiety Inventory (SPAI; Turner, Beidel, Dancu, & Stanley, 1989), which also has demonstrated good psychometric properties (Beidel, Borden, Turner, & Jacob, 1989; current Cronbach’s α = .98).”

• cites Turner, Beidel, Dancu, & Stanley, 1989 sourceNot checked — no full text of the source
• cites Beidel, Borden, Turner, & Jacob, 1989 sourceNot checked — no full text of the source

May combine two claims.

Effect sizes for social anxiety were lower than some CBT efficacy studies but remained within the range of 0.51-1.08 reported in meta-analyses.

“Although effect sizes were somewhat lower compared with some CBT efficacy studies for SAD (e.g., 1.94 in Herbert et al., 2005), they still were well within the range (0.51–1.08 across meta-analyses of CBT for SAD studies; see Rodebaugh, Holaway, & Heimberg, 2004).”

• cites Herbert et al., 2005 sourceNot checked — no full text of the source
• cites Rodebaugh, Holaway, & Heimberg, 2004 sourceNot checked — no full text of the source

May combine two claims.

Discontinuation may reflect the nature of social anxiety, as dropouts left after Session 4 on average and had higher pre-treatment SPAI scores.

“Yet another likely explanation is that discontinuation could be due to the nature of social anxiety, as evidenced by the fact that those who dropped out did so after Session 4 on average (after exposure was initiated), and they had higher pre-treatment scores on the SPAI.”

May combine two claims.

No follow-up assessment was conducted, so maintenance of improvements is unknown.

“Furthermore, although multiple assessment points were used, there was no follow-up assessment period, and thus it is unknown whether the obtained improvements would be maintained over a longer period of time.”

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

Because all patients sought medication at a psychiatry practice, attrition may relate to their beliefs about the cause of their problems.

“Given that all patients were specifically seeking medication treatment at a psychiatry practice, the high attrition could be related to patients’ beliefs about the cause of their problems (e.g., biological vs. environmental/behavioral).”

May combine two claims.

The moderate-to-severe subgroup showed significant decreases only from pre- to post-treatment, suggesting that the lack of pre- to mid-treatment change was not solely a floor effect.

“This subgroup showed significant decreases only from pre- to post-treatment, suggesting that a lack of significant change from pre- to mid-treatment may not be attributable solely to a floor effect.”

May combine two claims.

The findings provide preliminary support for the acceptability, feasibility, and effectiveness of an integrated acceptance-based behavioral therapy for comorbid depression and social anxiety disorder.

“In conclusion, findings from the current study provide preliminary support for the acceptability, feasibility, and effectiveness of an integrated, acceptance-based behavioral therapy designed to address depression and SAD comorbidity.”

May combine two claims.

Other effectiveness studies have found higher attrition than efficacy studies, averaging 25%-30% and reaching 68%.

“Other effectiveness studies also have found higher attrition rates relative to efficacy studies, with rates averaging 25% to 30% and reaching as high as 68% (Hans & Hiller 2013; Lincoln et al., 2005).”

• cites Hans & Hiller 2013 sourceNot checked — no full text of the source
• cites Lincoln et al., 2005Not matched

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

May combine two claims.

The sample was small and the trial was open, so results are preliminary and it is unclear how specific they are to this treatment.

“The sample was small and this was an open trial; therefore, results are preliminary and it is unknown to what degree the results are specific to this particular treatment.”

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

Treatment was delivered in a typical outpatient psychiatry practice, which increased external validity.

“In addition, the treatment was conducted in a typical outpatient psychiatry practice, thereby increasing external validity.”

• AssumptionRests on an assumption: The sample from a routine psychiatric practice is representative enough to support applicability to real-world clinical settings.

May combine two claims.

Two thirds of those waiting patients were taking antidepressants, benzodiazepines, or both, suggesting that improvement after CBT was added was not due to medication alone.

“Two thirds of those patients were receiving antidepressants, benzodiazepines, or both during this 6-month period, suggesting that the improvement obtained after CBT was added was not due to medication alone.”

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

Because the completer sample was small, ITT values were used for correlations, which may have introduced bias.

“Due to the small size of the completer sample, ITT values were used for the correlations on the residualized gain scores between the measures. However, this may have created bias”

May combine two claims.

Patients treated in a routine psychiatric practice showed significant improvements in social anxiety severity, depression severity, quality of life, and functioning over 16 sessions.

“Patients who were treated at a routine psychiatric practice showed significant improvements in social anxiety severity, depression severity, quality of life, and functioning over the course of 16 sessions”

May combine two claims.

These patients may see avoidance as futile and be more open to an acceptance-based approach than less chronic patients.

“Thus, these patients may have an acute sense of the futility of avoidance strategies compared with individuals with less chronic problems, and may be more receptive toward an acceptance-based approach.”

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

The study had strengths including self-report and independent assessor measures, multiple assessment points, and measures of processes, quality of life, and functioning.

“The current study possesses several strengths, such as use of self-report and independent assessor measures, use of assessments at multiple time points, and use of measures assessing processes, quality of life, and functioning.”

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

A floor effect from pre- to mid-treatment could explain non-significant findings during that period.

“This could have created a floor effect from pre- to mid-treatment, which could account for non-significant findings during that time period due to less time to observe significant changes.”

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

High comorbidity may have contributed to the high attrition rate, though reasons for many patients remain unclear.

“Therefore, it is possible that the high comorbidity of the sample contributed to the high attrition rate, although it is unclear at this time what the reasons were for many of the patients (especially those who never started).”

May combine two claims.

The odds of remission are higher with combined treatment for depression than with pharmacotherapy alone, with the highest odds ratio 2.36 after four months.

“For example, the odds of achieving remission is higher with combined treatment for depression relative to pharmacotherapy alone (with the highest odds ratio of 2.36 after 4 months of treatment; Oestergaard & Møldrup, 2011)”

• cites Oestergaard & Møldrup, 2011 sourceNot checked — no full text of the source

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

Patients who view their problems as biological may be more motivated for medication only and may discontinue psychotherapy.

“For example, those who believe the cause to be biological may be more motivated to receive medication treatment only, and thus may discontinue psychotherapy (Meyer & Garcia-Roberts, 2007).”

• cites Meyer & Garcia-Roberts, 2007 sourceNot checked — no full text of the source