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A Randomised Controlled Trial of Acceptance and Commitment Therapy and Cognitive-Behaviour Therapy for Generalised Anxiety Disorder

Published online by Cambridge University Press:  21 May 2014

Elbina Avdagic ,
Shirley A. Morrissey  and
Mark J. Boschen
Elbina Avdagic
Affiliation:
School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia
Shirley A. Morrissey*
Affiliation:
School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia
Mark J. Boschen
Affiliation:
School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia
*
Address for correspondence: Associate Professor Shirley Morrissey, School of Applied Psychology and Griffith Health Institute, Griffith University, Gold Coast QLD 4222, Australia. Email: [email protected]
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Abstract

The study examined the relative efficacy of group acceptance and commitment therapy (ACT) for generalised anxiety disorder (GAD) compared to group cognitive-behavioural therapy (CBT). Fifty-one individuals with GAD were randomly allocated to a 6-week intervention, either ACT or CBT. Participants were assessed at pre-treatment, post-treatment, and 3-month follow-up on symptom measures, quality of life, and process measures. Data from 38 participants (19 in each group) were available at post-assessment, indicating significant improvements on all measures for both treatment conditions. Treatment gains were maintained at follow-up, with significant further improvements in anxiety, depression and stress symptoms for both groups. While no between-group differences were found at treatment completion, a significant interaction indicating steeper reduction in worrying symptoms (d = .79) from pre- to post-assessment was found for the ACT group compared to the CBT group. Furthermore, in relation to worrying, at treatment completion 78.9% of participants in the ACT group achieved reliable change compared to 47.4% of participants in the CBT group. However, both groups showed equivalent reliable change rates of 60% at the follow-up assessment. The results suggest that group ACT was as efficacious as group CBT. While participants in the ACT group maintained treatment gains at follow-up, participants in the CBT group continued to improve between post-assessment and follow-up.

Keywords

ACTCBTRCTGADworryinganxiety
Type
Standard Papers
Information
Behaviour Change , Volume 31 , Issue 2 , June 2014 , pp. 110 - 130
Copyright
Copyright © The Author(s), published by Cambridge University Press on behalf of Australian Academic Press Pty Ltd 2014 

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References

Arch, J.J., Eifert, G.H., Davies, C., Vilardaga, J.C.P., Rose, R.D., & Craske, M.G. (2012). Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders. Journal of Consulting and Clinical Psychology, 80 (5), 750–765. doi:10.1037/a0028310CrossRefGoogle ScholarPubMed
Americal Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington DC: Author.Google Scholar
Ballenger, J.C., Davidson, J.R.T., Lecrubier, Y., Nutt, D.J., Borkovec, T.D., Rickels, K., . . . Wittchen, H.-U. (2001). Consensus statement on generalized anxiety disorder from the International Consesus Group on Depression and Anxiety. Journal of Clinical Psychiatry, 62(Suppl. 11), 53–58.Google Scholar
Bond, F.W., & Bunce, D. (2003). The role of acceptance and job control in mental health, job satisfaction, and work performance. Journal of Applied Psychology, 88 (6), 1057–1067. doi: 10.1037/0021-9010.88.6.1057CrossRefGoogle ScholarPubMed
Borkovec, T.D., & Ruscio, A.M. (2001). Psychotherapy for generalized anxiety disorder. Journal of Clinical Psychiatry, 62(Suppl. 11), 37–42.Google ScholarPubMed
Boschen, M.J. (2008). Publication trends in individual anxiety disorders: 1980–2015. Journal of Anxiety Disorders, 22, 570–575. doi:10.1016/j.janxdis.2007.04.004Google Scholar
Brown, T.A., & Barlow, D.H. (1992). Coromobidity among anxiety disorders: implications for treatment and DSM-IV. Journal of Consulting and Clinical Psychology, 60, 835–844.Google Scholar
Brown, T.A., Barlow, D.H., & Liebowitz, M.R. (1994). The empirical basis of generalized anxiety disorder. The American Journal of Psychiatry, 151 (9), 1272–1280.Google Scholar
Brown, T.A., Di Nardo, P.A., Lehman, C.L., & Campbell, L.A. (2001). Reliability of the DSM-IV anxiety and mood disorders: Implications for the classification of emotional disorders. Journal of Abnormal Psychology, 110 (1), 49–58.Google Scholar
Buhr, K., & Dugas, M.J. (2002). The intolerance of uncertainty scale: Psychometric properties of the English version. Behaviour Research and Therapy, 40 (8), 931–945. doi:10.1016/S0005-7967(01)00092-4Google Scholar
Covin, R., Ouimet, A.J., Seeds, P.M., & Dozois, D.J.A. (2008). A meta-analysis of CBT for pathological worry among clients with GAD. Journal of Anxiety Disorders, 22 (1), 108–116. doi:10.1016/j.janxdis.2007.01.002Google Scholar
Devilly, G.J. (2004). The Effect Size Generator for Windows: Version 2.3 [computer program]. Melbourne, Australia: Centre for Neuropsychology, Swinburne University.Google Scholar
Di Nardo, P.A., Brown, T.A., & Barlow, D.H. (1994). Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV). New York: Graywind.Google Scholar
Eifert, G.H., & Forsyth, J.P. (2005). Acceptance and commitment therapy for anxiety disorders: A practitioner's treatment guide to using mindfulness, acceptance, and values-based behavior change strategies. Oakland, CA: New Harbinger Publications.Google Scholar
Erickson, T.M., & Newman, M.G. (2005). Cognitive behavioral psychotherapy for generalized anxiety disorder: A primer. Expert Review of Neurotherapeutics, 5, 247–257.CrossRefGoogle ScholarPubMed
Forman, E.M., Herbert, J.D., Moitra, E., Yeomans, P.D., & Geller, P.A. (2007). A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behavior Modification, 31 (6), 772–799. doi:10.1177/0145445507302 202Google Scholar
Forman, E.M., Shaw, J.A., Goetter, E.M., Herbert, J.D., Park, J.A., & Yuen, E.K. (2012). Long-term follow-up of a randomized controlled trial comparing acceptance and commitment therapy and standard cognitive behavior therapy for anxiety and depression. Behavior Therapy, 43 (4), 801–811. doi:10.1016/j.beth.2012.04.004Google Scholar
Forsyth, J.P., & Eifert, G.H. (2007). The mindfulness and acceptance workbook for anxiety: A guide to breaking free from anxiety, phobias and worry using acceptance and commitment therapy. Oakland, CA: New Harbinger Publications.Google Scholar
Frish, M.B. (1994). Manual and treatment guide for the Quality of Life Inventory. Minneapolis, MN: Pearson Assessment.Google Scholar
Frish, M.B., Cornwell, J., Villanueva, M., & Retzlaff, P.J. (1992). Clinical validation of the Quality of Life Inventory: A measure of life satisfaction of use in treatment planning and outcome assessment. Psychological Assessment 4 (1), 92–101.Google Scholar
Glaser, N.M., Blackledge, J.T., Shepherd, L.M., & Deane, F.P. (2009). Brief group ACT for anxiety. In Blackledge, J.T., Ciarrochi, J., & Deane, F.P. (Eds.), Acceptance and commitment therapy: Contemporary theory research and practice (pp. 175–200). Brisbane, Australia: Australian Academic Press.Google Scholar
Gould, R.A., Safren, S.A., Washington, D.O., & Otto, M.W. (2004). A meta-analytic review of cognitive-behavioral treatments. In Heimberg, R.G., Turk, C.A., & Mennin, D.S. (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 248–264). New York: Guilford Press.Google Scholar
Hayes, S.C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy, 35 (4), 639–665. doi:10.1016/S0005-7894(04)80013-3Google Scholar
Hayes, S.C., Strosahl, S., & Wilson, K. (1999). Acceptance and commitment therapy: An experiential approach to behavioural change. New York: Guilford Press.Google Scholar
Hayes, S.C., Strosahl, S., Wilson, K.G., Bissett, R.T., Pistorelo, J., Toarmino, D., . . . McCurry, S.M. (2004). Measuring experiential avoidance: A preliminary test of a working model. The Psychological Record, 54 (4), 553–578.Google Scholar
Hayes-Skelton, S.A., Roemer, L., & Orsillo, S.M. (2013). A randomized clinical trial comapring an acceptance-based behavior therapy to applied relaxation for generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 81, 761–773. doi:10.1037/a0032871Google Scholar
Herbert, J.D., & Forman, E.M. (2013). Caution: The differences between CT and ACT may be larger (and smaller) than they appear. Behavior Therapy, 44, 218–223. doi:/10.1016/j.beth.2009.09.005CrossRefGoogle ScholarPubMed
Holowka, D.W., Dugas, M.J., Francis, K., & Laugesen, N. (2000, November). Measuring beliefs about worry: A psychometric evaluation of the Why Worry-II Questionnaire. Poster session presented at the annual convention of the Association for Advancement of Behavior Therapy, New Orleans, LA.Google Scholar
Jacobson, N.S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59 (1), 12–19. doi:10.1037/0022-006X.59.1.12CrossRefGoogle ScholarPubMed
Kazdin, A. (2002). Research design in clinical psychology (4th ed). Boston: Allyn & Bacon.Google Scholar
Kessler, R.C., Walters, E.E., & Wittchen, H.U. (2004). Epidemiology. In Heimberg, R.G., Turk, C.L., & Mennin, D.S. (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 29–50). New York: Guilford.Google Scholar
Lovibond, S.H., & Lovibond, P.F. (1995). Manual for the Depression Anxiety Stress Scales (2nd ed.). Sydney, Australia: Psychology Foundation.Google Scholar
McGrath, K.B., Forman, E.M., del Mar Cabiya, M., Hoffman, K.L., Marques, K., Moitra, E., & Zabell, J.A. (2005, November). Development and validation of the Drexel University ACT/CBT Therapist Adherence Rating Scale. Poster presented at the annual meeting of the Association for Behavior and Cognitive Therapies. Washington, DC.Google Scholar
Meyer, T.J., Miller, M.L., Metzger, R.L., & Borkovec, T.D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28 (6), 487–495.Google Scholar
Moher, D., Schulz, K.F., & Douglas, A. (2001). The CONSORT statement: Revised recommendations for improving the quality of reports of parallel-group randomised trials. The Journal of American Medical Association, 285 (15), 1981–1991. doi:10.1001/jama.285.15.1987Google Scholar
Molina, S., & Borkovec, T.D. (1994). The Penn State Worry Questionnaire: Psychometric properties and associated characteristics. In Davey, G. & Tallis, F. (Eds.), Worrying: Perspectives on theory, assessment and treatment (pp. 265–283). New York: Wiley.Google Scholar
Newman, M.G., Castonguay, L.G., Borkovec, T.D., Fisher, A.J., & Nordberg, S.S. (2008). An open trial of integrative therapy for generalized anxiety disorder. Psychotherapy: Theory, Research, Practice, Training, 45 (2), 135–147. doi:10.1037/0033-3204.45.2.135Google Scholar
Öst, L-.G. (2008). Efficacy of the third wave of behavioral therapies: A systematic review and meta-analysis. Behaviour Research and Therapy, 46, 296–321. doi:10.1016/j.brat.2007.12.005Google Scholar
Powers, M.B., Zum Vörde Sive Vörding, M.A., & Emmelkamp, P.M. G. (2009). Acceptance and commitment therapy: A meta-analytic review. Psychotherapy and Psychosomatics, 78 (2), 73–80. doi:10.1159/000190790CrossRefGoogle ScholarPubMed
Roemer, L., & Orsillo, S.M. (2005). An acceptance-based behavior therapy for generalized anxiety disorder. In Orsillo, S.M. & Roemer, L. (Eds.), Acceptance and mindfulness based approaches to anxiety: Conceptuallization and treatment (pp. 213–240). New York: Springer Science and Business Media.Google Scholar
Roemer, L., & Orsillo, S.M. (2007). An open trial of an acceptance-based behavior therapy for generalized anxiety disorder. Behavior Therapy, 38 (1), 72–85. doi:10.1016/j.beth.2006.04.004Google Scholar
Roemer, L., Orsillo, S.M., & Salters-Pedneault, K. (2008). Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: Evaluation in a randomized controlled trial. Journal of Consulting and Clinical Psychology, 76 (6), 1083–1089. doi:10.1037/a0012720Google Scholar
Sexton, K.A., & Dugas, M.J. (2008). The Cognitive Avoidance Questionnaire: Validation of the English translation. Journal of Anxiety Disorders, 22 (3), 355–370. doi:10.1016/j.janxdis.2007.04.00Google Scholar
Westen, D., & Morrison, K. (2001). A multidimensional meta-analysis of treatment for depression, panic, and generalized anxiety disorder: An empirical exemination of the status of empiricaly supported therapies. Journal of Consulting and Clinical Psychology, 69, 875–899.CrossRefGoogle Scholar
Wetherell, J.L., Liu, L., Patterson, T.L., Afari, N., Ayers, C.R., Thorp, S.R., . . . Petkus, A.J. (2011). Acceptance and commitment therapy for generalized anxiety disorder in older adults: A preliminary report. Behavior Therapy, 42 (1), 127–134. doi: 10.1016/j.beth.2010.07.002Google Scholar
Wittchen, H.-U., & Hoyer, J. (2001). Generalized anxiety disorder: Nature and course.Journal of Clinical Psychiatry, 62, 15–19.Google Scholar
Yonkers, K.A., Warshaw, M.G., Massion, A.O., & Keller, M.B. (1996). Phenomenology and course of generalised anxiety disorder. The British Journal of Psychiatry, 168, 308–313.Google Scholar
Zinbarg, R.E., Craske, M.G., Barlow, D.H., & O’Leary, T. (1993). Mastery of your anxiety and worry, therapist guide. San Antonio, TX: Psychological Corporation.Google Scholar