CBT FOR GAD

Efficacy of Cognitive-Behavioral Treatment for Generalized Anxiety Disorder

Table of Contents

Introduction3

Improving response rates to CBT for GAD4

Motivational interviewing as a pretreatment6

Method8

Patient population8

CBT treatment in brief10

NGF measurements10

Data analysis11

Results11

Effects of adding an MI pretreatment to CBT on worry18

Clinical significance of worry reduction19

Effects of adding an MI pretreatment to CBT on other symptom measures20

Effect of the MI pretreatment on homework compliance in CBT21

Discussion21

Conclusion28

References30

References30

Efficacy of Cognitive-Behavioral Treatment for Generalized Anxiety Disorder

Introduction

Generalized anxiety disorder (GAD) is a chronic and disabling mental disease, occurring four times more frequently in women than in men. It causes severe distress and interferes with daily functioning since worry is present most of the time (American Psychiatric Association, 1994). GAD is often associated with depressive illness and has increasingly become a focus of scientific interest (Fricchione, 2004, Hunt et al., 2004, Mogg et al., 2004, Stein, 2004 and Surtees et al., 2003). Apart from antidepressants, cognitive-behavioural therapy seems to be the best therapy option and has been tested recently in a manualised form in Germany (Linden et al., 2005).

The classical role attributed to the neurotrophin nerve growth factor (NGF) is its neurotrophic function within the central and peripheral nervous system where NGF acts predominantly as a survival factor during development and as a maintenance of function factor during adult life (for reviews see Hellweg et al., 1998 and Thoenen et al., 1987). Additionally there is increasing evidence that NGF has multiple immunomodulatory functions, similar to a cytokine and can be raised in stressful situations (Lang et al., 2004b and Levi-Montalcini et al., 1996). In accordance with this observation, raised NGF serum concentrations have been found in soldiers before and after their first parachute jump, thus representing an effect of acute cognitive stress (before) and also physical stress (the jump itself) on the NGF serum level (Aloe et al., 1994). In GAD apprehensive expectation is usually present, combined with physical tension and its sequelae, leaving most patients feeling chronically stressed (American Psychiatric Association, 1994). The disease is therefore a valid model for chronic stress, including cognitive as well as physical parameters.

We measured NGF serum levels in patients with diagnosed GAD according to DSM-IV (American Psychiatric Association, 1994) before and after treatment with 25 sessions of manualised cognitive-behavioural therapy (CBT) on the hypothesis of change in NGF levels with reduced subjective stress after successful treatment.

Improving response rates to CBT for GAD

In an attempt to improve response rates, investigators have developed CBT-based therapies that target core processes in GAD such as intolerance of uncertainty (Ladouceur et al., 2000), meta-cognitive factors such as erroneous beliefs about worry (Wells & King, 2006), and interpersonal problems and emotional avoidance (Newman et al., 2008). Both the intolerance of uncertainty model of Dugas and colleagues (e.g., Robichaud & Dugas, 2009) and the meta-cognitive model of Wells and colleagues (e.g., Wells & King, 2006) incorporate an explicit focus on positive and negative beliefs about worry itself. Promising findings with each of these adaptations of CBT are being reported.

In the present study, we chose to provide an initial test of the ...