Eliane Léger

Efficacy of a cognitive-behavioral treatment for generalized anxiety disorder : Evaluation in a controlled clinical trial

Recent advances in the understanding of worry have led to the development of treatments for generalized anxiety disorder (GAD). The present study tested a GAD treatment that targeted intolerance of uncertainty, erroneous beliefs about worry, poor problem orientation, and cognitive avoidance. Twenty-six primary GAD patients were randomly allocated to a treatment condition (n = 14) or a delayed treatment control condition (n = 12). Self-report, clinician, and significant other ratings assessed GAD and associated symptoms. The results show that the treatment led to statistically and clinically significant change at posttest and that gains were maintained at 6- and 12-month follow-ups. Furthermore, 20 of 26 participants (77%) no longer met GAD diagnostic criteria following treatment. With regard to the treatments underlying model, the results show that intolerance of uncertainty significantly decreased over treatment and that gains were maintained at both follow-ups. Although nonspecific factors were not significant predictors of treatment outcome, their role in the treatment of GAD requires further investigation.

Group cognitive-behavioral therapy for generalized anxiety disorder: Treatment outcome and long-term follow-up.

A recently developed cognitive-behavioral treatment for generalized anxiety disorder (GAD) targets intolerance of uncertainty by the reevaluation of positive beliefs about worry, problem-solving training, and cognitive exposure. As previous studies have established the treatments efficacy when delivered individually, the present study tests the treatment in a group format as a way to enhance its cost-benefit ratio. A total of 52 GAD patients received 14 sessions of cognitive-behavioral therapy in small groups of 4 to 6 participants. A wait-list control design was used, and standardized clinician ratings and self-report questionnaires assessed GAD symptoms, intolerance of uncertainty, anxiety, depression, and social adjustment. Results show that the treatment group, relative to the wait-list group, had greater posttest improvement on all dependent variables and that treated participants made further gains over the 2-year follow-up phase of the study.

Correction of inflated responsibility in the treatment of obsessive-compulsive disorder

This study evaluates the efficacy of a cognitive treatment for obsessive-compulsive disorder (OCD). Four patients with OCD whose major complaints were checking rituals were treated in a multiple baseline across subjects design. Cognitive correction targeted inflated responsibility, without any exposure or response prevention. All subjects reported a clinically significant decrease in interference caused by rituals, a 52-100% reduction in Y-BOCS scores, and a decrease in perceived responsibility. Therapeutic gains were maintained at follow-up (6 and 12 months) for three patients. Results suggest that cognitive therapy targeting inflated responsibility is a promising alternative to exposure-based treatment.

Cognitive-Behavioral Treatment of Generalized Anxiety Disorder Among Adolescents: A Case Series

Seven adolescents received a cognitive-behavioral treatment targeting generalized anxiety disorder. The treatment consisted of awareness training, worry interventions, and relapse prevention. The worry interventions targeted specifically intolerance of uncertainty, beliefs about worry, problem solving, and cognitive avoidance. According to the Anxiety Disorders Interview Schedule for diagnosis of generalized anxiety disorder, self-report questionnaire scores, and time spent worrying every day, three adolescents showed clinically significant change at post-test which was maintained at 6- and 12-month follow-up assessments. Minimal to moderate improvement was observed for other participants. Factors that may explain these differences are discussed.

Cognitive-behavioral treatment of Generalized Anxiety Disorder (GAD) for older adults

BACKGROUND Generalized Anxiety Disorder (GAD) is one of the most prevalent anxiety disorders among the elderly. Estimates of prevalence vary from around 3% to 12%, depending on the minimum age considered and the assessment instruments. The present study tests a GAD-specific treatment recently validated among adults (Ladouceur et al., 2000) and adapted for older adults. METHOD Eight older adults (aged from 60 to 71) were included in a single-case experimental multiple-baseline design across subjects. Assessments were conducted at pre-test, post-test and at 6- and 12-months follow-ups. The treatment consisted of awareness training, worry interventions and relapse prevention. The worry interventions targeted intolerance of uncertainty, beliefs about worry, problem-solving and cognitive avoidance. RESULTS According to daily self-monitoring of worry, ADIS-IV ratings and self-reported questionnaire scores, seven out of eight participants showed clinically significant improvement at post-test. These therapeutic gains were maintained at 6- and 12-month follow-ups. CONCLUSIONS This study shows that a cognitive-behavioral treatment that targets intolerance of uncertainty, erroneous beliefs about worry, poor problem orientation and cognitive avoidance is effective for treating GAD among elderly people.

Cognitive therapy of obsessive thoughts.

Six people with obsessive thoughts without overt compulsions received cognitive therapy based on a comprehensive cognitive-behavioral account of obsessive-compulsive behavior using techniques developed specifically for OCD ( Freeston, Rheaume, & Ladouceur, 1996 ). They were treated within a multiple-baseline, experimental single-case design supplemented by a standardized assessment battery using both clinician assessment and self-report. The treatment targeted faulty beliefs specified by the model in a flexible manner based on a case-formulation approach. Participants did not receive instructions or practice in systematic exposure and response prevention. They were encouraged to act in a way that was coherent with their new understanding of obsessive thoughts. Participants received an average of 16.2 sessions of therapy. Follow-up assessment was conducted at 6 and 12 months following the end of treatment. Using a double criteria for clinically significant change, 4 participants (66%) were improved on the Yale-Brown Obsessive-Compulsive Scale at posttreatment, and 5 (83%) were improved at 6- and 12-month follow-up. These results indicate that alternative strategies to structured exposure and response prevention can be effective. The possibility of integrating structured exposure techniques within this treatment framework is discussed.

Bad luck: an underestimated factor in the development of obsessive-compulsive disorder

Our clinical experience with patients with OCD has shown us that a sizeable proportion of patients report previous experiences such as accidents, very unusual events, or serious mistakes that in some cases may predate the onset of OCD by many years. In some cases these events, often perceived as bad luck, still appear to play a major role in supporting faulty appraisals of obsessional thoughts. In these cases it may be very useful to analyse and correct the specific learning experiences offered by these bad luck events. This article presents a series of case examples where specific events appear to have contributed to the development of faulty appraisals or at the least the patient attributes an important role to the event in the development of the disorder. We will also provide examples of some interventions that were useful in correcting the basis of these interpretations.

Applications of Cognitive Models of OCD in Clinical Practice

Publisher Summary The cognitive-behavior therapy for obsessive-compulsive disorder (OCD) based on exposure and response prevention typically produces improvement in 80% of patients. It is also accepted that a significant number of patients do not benefit through refusal, dropout, or nonresponse. The efficacy of cognitive-behavior therapy has only been established for obsessive thoughts when overt compulsions are absent. The results of two clinical trials for patients without overt compulsions are presented in this chapter. The first is a controlled trial of cognitive-behavior therapy for obsessional thoughts only. The treatment consists of exposure to the obsessional thought using tape-loop exposure and response prevention of all effortful coping strategies (neutralization). Over the last decade there has been a great deal of interest in the types of appraisals (or interpretations) and beliefs (or assumptions) that may be found among people with OCD. However, neutralization has received relatively little attention, although it plays a key role in current forms of cognitive models. Neutralizing is a response to the threat that results from the faulty appraisal of the intrusive thought, although they differ according to the type of threat that is believed to be primary.