Robert Ladouceur

Generalized anxiety disorder: a preliminary test of a conceptual model

This study presents a preliminary test of a conceptual model of Generalized Anxiety Disorder (GAD) which is theoretically driven and has clear clinical implications. The models main features are intolerance of uncertainty, beliefs about worry, poor problem orientation and cognitive avoidance, Subjects were 24 GAD patients and 20 non clinical control subjects. The results show that all main components of the model were highly related to the discriminant function and that intolerance of uncertainty was pivotal in distinguishing GAD patients from non clinical subjects. Further, the discriminant function derived from these four process variables was very effective for classifying GAD patients and non clinical subjects into their respective groups. Overall, 82% of subjects were correctly classified as 18 of 24 subjects in the GAD group and 18 of 20 subjects in the non clinical group were properly identified. The results are discussed in terms of the proposed model of GAD and its clinical implications.

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.

Intolerance of Uncertainty and Problem Orientation in Worry

Worry, which is the central feature of generalized anxiety disorder (GAD), is now recognized as a truly important clinical phenomenon. The present study examines the relationship between intolerance of uncertainty and problem orientation in nonclinical worry. Subjects were 285 French-Canadian university students who completed a battery of questionnaires on a voluntary basis. The results indicate that intolerance of uncertainty and emotional problem orientation are strong predictors of trait worry, even when personal variables (age, sex) and mood state (level of anxiety, depression) have been partialed out. The findings also show that intolerance of uncertainty and emotional problem orientation both make common as well as a unique contributions to the prediction of worry. Implications for the treatment of worry are discussed and specific guidelines for reducing intolerance of uncertainty and intolerance of emotional arousal for different types of worries are suggested.

Cognitive treatment of pathological gambling.

This study evaluated the efficacy of a cognitive treatment package for pathological gambling. Sixty-six gamblers, meeting DSM-IV criteria for pathological gambling, were randomly assigned to treatment or wait-list control conditions. Cognitive correction techniques were used first to target gamblers’ erroneous perceptions about randomness and then to address issues of relapse prevention. The dependent measures used were the South Oaks Gambling Screen, the number of DSM-IV criteria for pathological gambling met by participants, as well as gamblers’ perception of control, frequency of gambling, perceived self-efficacy, and desire to gamble. Posttest results indicated highly significant changes in the treatment group on all outcome measures, and analysis of data from 6- and 12-month follow-ups revealed maintenance of therapeutic gains. Recommendations for clinical interventions are discussed, focusing on the cognitive correction of erroneous perceptions toward the notion of randomness.

Experimental manipulation of intolerance of uncertainty: a study of a theoretical model of worry.

Intolerance of uncertainty has been identified as an important variable related to worry and Generalized Anxiety Disorder (GAD) [Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: a preliminary test of a conceptual model. Behaviour Research and Therapy, 36, 215-226; Ladouceur, R., Dugas, M. J., Freeston, M. H., Rhéaume, J., Blais, F., Boisvert, J.-M., Gagnon, F., & Thibodeau, N. (1999). Specificity of Generalized Anxiety Disorder symptoms and processes. Behavior Therapy, 30, 197-207]. The goal of the present study was to clarify the relationship between this cognitive process and worry by experimentally manipulating intolerance of uncertainty. A gambling procedure was used to increase intolerance of uncertainty in one group (N = 21) and to decrease intolerance of uncertainty in another group (N = 21). The results indicate that participants whose level of intolerance of uncertainty was increased showed a higher level of worry, compared to participants whose level of intolerance of uncertainty was decreased. These results provide some initial clarifications as to the causal nature of the link between intolerance of uncertainty and worry. These results are coherent with our theoretical model of worry and GAD (Dugas et al., 1998), which stipulates that intolerance of uncertainty plays a key role in the acquisition and maintenance of excessive worry.

Intolerance of Uncertainty and Worry: Investigating Specificity in a Nonclinical Sample

The goal of this study was to explore the specificity of the relationship between intolerance of uncertainty and worry in a nonclinical sample. Three hundred and forty-seven university students completed measures of worry, obsessions/compulsions, and panic sensations. They also completed measures of process variables known to be associated with worry (intolerance of uncertainty), obsessions/compulsions (responsibility), and panic sensations (anxiety sensitivity). The results show that intolerance of uncertainty was highly related to worry, moderately related to obsessions/compulsions, and weakly related to panic sensations. Further, the relationship between intolerance of uncertainty and worry remained strong after shared variance with other study variables was removed. The findings are discussed in terms of their implications for understanding worry and preventing generalized anxiety disorder.

Cognitive—behavioral treatment of obsessive thoughts: A controlled study.

Twenty-nine patients with obsessive-compulsive disorder as diagnosed in accordance with the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised; American Psychiatric Association, 1987) who did not have overt compulsive rituals were randomly assigned to treatment and waiting-list conditions. Patients in the treatment condition received cognitive-behavioral therapy consisting of a detailed explanation of the occurrence and maintenance of obsessive thoughts, exposure to obsessive thoughts, response prevention of all neutralizing strategies, cognitive restructuring, and relapse prevention. Compared with waiting-list patients, treated patients improved significantly on measures of severity of obsessions, current functioning, self-report obsessive-compulsive symptoms, and anxiety. When waiting-list patients were subsequently treated, the combined group improved on all outcome measures. Treatment gains were maintained at 6-month follow-up. Results indicate that cognitive-behavioral therapy is effective in the treatment of patients with obsessive thoughts, a group that has often been considered resistant to treatment.

A Science-Based Framework for Responsible Gambling: The Reno Model

As social observers increasingly identify gambling-related problems as a public health issue, key stakeholders need to join together to reduce both the incidence and prevalence of gambling-related harm in the community. This position paper describes a strategic framework that sets out principles to guide industry operators, health service and other welfare providers, interested community groups, consumers and governments and their related agencies in the adoption and implementation of responsible gambling and harm minimization initiatives.

Correcting faulty appraisals of obsessional thoughts

Cognitive techniques are becoming more widely established in the treatment of obsessive-compulsive disorder (OCD). This paper extends previous work by van Oppen and Arntz (1994, Behaviour Research and Therapy, 33, 79-87) on overestimation of threat and excessive responsibility by discussing other types of appraisals that may be involved in OCD, particularly when overt compulsions are absent. Examples are given of types of intervention that may be useful to correct faulty appraisals concerning the overestimation of the importance of thoughts such as thought-action fusion, excessive responsibility, perfectionistic concerns such as the need for absolute certainty, and expectations about anxiety and its consequences.

Treatment of Gad Targeting Intolerance of Uncertainty in Two Types of Worry

This study evaluates the efficacy of a cognitive-behavioral treatment for generalized anxiety disorder (GAD) that addresses two types of worries: (a) those about situations that are amenable to problem solving, and (b) those about situations that are not. The treatment’s goal is to help patients become more tolerant of uncertainty by discriminating between both types ofworry and applying the correct strategy to each type.Amultiple baseline designwas used and subjects were 4 adults with a primary diagnosis of GAD. Treatment outcome was assessed with daily self-monitoring, self-report questionnaires, and standardized clinician ratings. At posttest and 6-month follow-up, 3 of 4 subjects no longer met diagnostic criteria for GAD and had attained high end-state functioning. At 12-month follow-up, none of the subjects met GAD diagnostic criteria but end-state functioningwas variable. The results also showthat treatment outcomewas highly related to change in intolerance of uncertainty.