Validez del Penn State Worry Questionnaire-11 en Colombia y equivalencia factorial a través de género y muestras clínicas y no clínicas

The Penn State Worry Questionnaire (PSWQ) is the gold standard measure of the unspecific worry that characterizes generalized anxiety disorder. This study aims to explore the validity of the PSWQ in Colombia and its measurement invariance across gender and clinical and nonclinical participants. An abbreviated, 11-item version of the PSWQ by Sandín, Chorot, Valiente, and Lostao (2009) was used because the negatively worded items have shown to be problematic for Spanish speakers. Additionally, research has suggested that the negatively worded items of the PSWQ lack of practical utility. The PSWQ-11 was administered to a total of 1045 participants, including a sample of nonclinical participants (N = 710) and a sample of clinical participants (N = 335). The internal consistency of the PSWQ-11 across samples was excellent. The one-factor model showed an acceptable fit to the data. Metric and scalar invariance were observed across gender and clinical and nonclinical samples. In conclusion, the PSWQ-11 seems to be a valid measure of GAD-related worry in Colombia, whereas data on factorial equivalence data warrant the comparison of scores across gender and clinical and nonclinical samples.El Penn State Worry Questionnaire (PSWQ) es la medida principal de la preocupación inespecífica que caracteriza al trastorno de ansiedad generalizada (TAG). Este estudio explora la validez del PSWQ en Colombia y su invarianza de medida entre género y participantes clínicos y no clínicos. Se utilizó la versión abreviada de 11 ítems de PSWQ propuesta por Sandín, Chorot, Valiente y Lostao (2009) porque los ítems redactados negativamente han mostrado ser problemáticos para los hispanohablantes. Adicionalmente, la investigación ha sugerido que los ítems redactados en negativa carecen de utilidad práctica. El PSWQ-11 se administró a un total de 1045 participantes, incluyendo una muestra de participantes no clínicos (N = 710) y una muestra de participantes clínicos (N = 335). La consistencia interna del PSWQ-11 a través de muestras fue excelente. El modelo de un factor mostró un ajuste aceptable a los datos. Se observó invarianza métrica y escalar a través de género y muestras clínicas y no clínicas. En conclusión, el PSWQ-11 parece ser una medida válida de la preocupación tipo TAG, mientras que los datos sobre equivalencia factorial permiten la comparación de puntuaciones a través de género y participantes clínicos y no clínicos

A RCT of a Transdiagnostic Internet-Delivered Treatment for Three Anxiety Disorders: Examination of Support Roles and Disorder-Specific Outcomes

BACKGROUND: Anxiety disorders share common vulnerabilities and symptoms. Disorder-specific treatment is efficacious, but few access evidence-based care. Administering transdiagnostic cognitive-behavioral therapy via the internet (iCBT) may increase access to evidence-based treatment, with a recent randomized controlled trial (RCT) providing preliminary support for this approach. This study extends those findings and aims to answer three questions: Is a transdiagnostic iCBT program for anxiety disorders efficacious and acceptable? Does it result in change for specific disorders? Can good clinical outcomes be obtained when guidance is provided via a Coach rather than a Clinician? METHOD: RCT (N = 131) comparing three groups: Clinician-supported (CL) vs. Coach-supported (CO) vs. waitlist control (Control). Individuals met DSM-IV criteria for a principal diagnosis of generalized anxiety disorder (GAD), social phobia (SP) or panic disorder with or without agoraphobia (Pan/Ag). Treatment consisted of an 8-lesson/10 week iCBT program with weekly contact from a Clinician or Coach, and follow-up at 3-months post-treatment. RESULTS: Outcomes for the pooled treatment groups (CL+CO) were superior to the Control group on measures of anxiety, depression and disability, were associated with medium to large effect sizes (Cohen's d = .76-1.44) (response rate = 89-100%), and were maintained at follow-up. Significant reductions were found on disorder-specific outcomes for each of the target diagnoses, and were associated with large effect sizes. CO participants achieved similar outcomes to CL participants at post-treatment, yet had significantly lower symptom severity scores on general anxiety, panic-disorder, depression and disability at follow-up (d = .45-.46). Seventy-four percent of CO and 76% of CL participants completed the program. Less than 70 minutes of Clinician or Coach time was required per participant during the program. DISCUSSION: This transdiagnostic iCBT course for anxiety appears to be efficacious, associated with significant change for three target disorders, and is efficacious when guided by either a Clinician or Coach. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12610000242022

The Spanish version of the believability of anxious feelings and Thoughts Questionnaire

Background: Cognitive fusion is suggested to play an important role in the etiology and maintenance of anxiety disorders according to Acceptance and Commitment Therapy. This study presents the psychometric data of the Spanish version of a cognitive fusion measure in the context of anxiety: the Believability of Anxious Feelings and Thoughts Questionnaire (BAFT). Method: First, we back-translated the BAFT into Spanish and then, administered it to three samples, with a total of 598 participants, in addition to other relevant anxiety measures. Results: Data were very similar to those obtained with the original BAFT version. The BAFT showed a very good internal consistency (overall a= .92) and a hierarchical factor structure with two lower-order factors and one hierarchical factor. Participants showing mild levels of anxiety symptoms scored higher on the BAFT than participants who scored below the cutoffs. BAFT scores were significantly related to anxiety symptoms and to measures of psychological inflexibility, anxiety sensitivity, and mindfulness facets. Moreover, the BAFT showed incremental validity relative to anxiety sensitivity. Conclusions: This Spanish version of the BAFT emerges as a reliable and valid measure of cognitive fusion with anxious thoughts and feelings. Versión española del Cuestionario de Credibilidad de Sentimientos y Pensamientos Ansiógenos. Antecedentes: la fusión cognitiva juega un papel importante en la etiología y mantenimiento de los trastornos de ansiedad según la Terapia de Aceptación y Compromiso. Este estudio presenta datos psicométricos de la versión española del Cuestionario de Credibilidad de Sentimientos y Pensamientos Ansiógenos (BAFT). Método: se realizó una traducción inversa del BAFT al español y se administró a tres muestras, con un total de 598 participantes, conjuntamente con otras medidas de ansiedad. Resultados: los datos fueron muy similares a los obtenidos en la versión original del BAFT. El BAFT mostró una muy buena consistencia interna (alfa promedio de .92) y una estructura jerárquica con dos factores de primer orden y un factor de segundo orden. Los participantes con niveles moderados de ansiedad puntuaron más en el BAFT que los participantes que mostraron puntuaciones inferiores. Las puntuaciones en el BAFT correlacionaron significativamente con variedad de síntomas de ansiedad y con medidas de inflexibilidad psicológica, sensibilidad a la ansiedad y facetas de mindfulness. El BAFT mostró validez incremental en relación a la sensibilidad a la ansiedad. Conclusiones: la versión española del BAFT emerge como una medida fiable y válida de fusión cognitiva con pensamientos y sentimientos ansiógenos

State-Trait Inventory for Cognitive and Somatic Anxiety: psychometric properties and experimental manipulation to evaluate sensitivity to change and predictive validity

The State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA; Ree, French, MacLeod, & Locke, 2008) is a relatively new measure of state and trait anxiety that contains somatic and cognitive anxiety subscales. The current research investigated the reliability and validity of the STICSA. In the first study, a large sample of undergraduate students completed a battery of self-report questionnaires online, including measures of anxiety, depression, personality features, and quality of life. Results of a confirmatory factor analysis provided support for a four-factor model of the STICSA (i.e., state-somatic, state-cognitive, trait-somatic, and trait-cognitive factors) as well as for a hierarchical model of the STICSA including a global anxiety factor plus four specific factors corresponding to the STICSA subscales. Pearson product-moment correlations provided evidence of the convergent and divergent validity of the STICSA. Comparisons between the validity of the STICSA and the validity of the State-Trait Anxiety Inventory (STAI; Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983) revealed advantages of the STICSA over the STAI. In the second study, a sample of undergraduate students filled out the same battery of self-report measures in small groups. Participants were then randomly assigned to either prepare a speech or watch a preview of a television documentary. Subsequently, all participants completed the state versions of the STICSA and ST AI for a second time. Results from the second study indicated that the somatic subscale of the STICSA is able to detect changes in somatic anxiety over time and provided evidence that scores on the trait version of the STICSA and its subscales are predictive of scores on the state version of the STICSA and its subscales after a social challenge. Results from both studies indicated that the somatic subscale of the STICSA measures unique aspects of anxiety which enhances the clinical utility of the STICSA

Internet-based cognitive behavior therapy for obsessive compulsive disorder: A pilot study

<p>Abstract</p> <p>Background</p> <p>Cognitive behavior therapy (CBT) is widely regarded as an effective treatment for obsessive compulsive disorder (OCD), but access to CBT therapists is limited. Internet-based CBT (ICBT) with therapist support is a way to increase access to CBT but has not been developed or tested for OCD. The aim of this study was to evaluate ICBT for OCD.</p> <p>Method</p> <p>An open trial where patients (N = 23) received a 15-week ICBT program with therapist support consisting of psychoeducation, cognitive restructuring and exposure with response prevention. The primary outcome was the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), which was assessed by a psychiatrist before and immediately after treatment. Secondary outcomes were self-rated measures of OCD symptoms, depressive symptoms, general functioning, anxiety and quality of life. All assessments were made at baseline and post-treatment.</p> <p>Results</p> <p>All participants completed the primary outcome measure at all assessment points. There were reductions in OCD symptoms with a large within-group effect size (Cohen's <it>d </it>= 1.56). At post-treatment, 61% of participants had a clinically significant improvement and 43% no longer fulfilled the diagnostic criteria of OCD. The treatment also resulted in statistically significant improvements in self-rated OCD symptoms, general functioning and depression.</p> <p>Conclusions</p> <p>ICBT with therapist support reduces OCD symptoms, depressive symptoms and improves general functioning. Randomized trials are needed to confirm the effectiveness of this new treatment format.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01348529">NCT01348529</a></p

A brief scale of pathological worry that everyone already has

Stress and Psychopatholog

Internet-Delivered Cognitive Behavioral Therapy for Generalized Anxiety Disorder in Nationwide Routine Care : Effectiveness Study

Background: Therapist-supported, internet-delivered cognitive behavioral therapy (iCBT) is efficacious for generalized anxiety disorder (GAD), but few studies are yet to report its effectiveness in routine care. Objective: In this study, we aim to examine whether a new 12-session iCBT program for GAD is effective in nationwide routine care. Methods: We administered a specialized, clinic-delivered, therapist-supported iCBT for GAD in 1099 physician-referred patients. The program was free of charge for patients, and the completion time was not predetermined. We measured symptoms with web-based questionnaires. The primary measure of anxiety was the GAD 7-item scale (GAD-7); secondary measures were, for pathological worry, the Penn State Worry Questionnaire and, for anxiety and impairment, the Overall Anxiety Severity and Impairment Scale. Results: Patients completed a mean 7.8 (SD 4.2; 65.1%) of 12 sessions, and 44.1% (485/1099) of patients completed all sessions. The effect size in the whole sample for GAD-7 was large (Cohen d=0.97, 95% CI 0.88-1.06). For completers, effect sizes were very large (Cohen d=1.34, 95% CI 1.25-1.53 for GAD-7; Cohen d=1.14, 95% CI 1.00-1.27 for Penn State Worry Questionnaire; and Cohen d=1.23, 95% CI 1.09-1.37 for Overall Anxiety Severity and Impairment Scale). Noncompleters also benefited from the treatment. Greater symptomatic GAD-7–measured relief was associated with more completed sessions, older age, and being referred from private or occupational care. Of the 894 patients with a baseline GAD-7 score ≥10, approximately 421 (47.1%) achieved reliable recovery. Conclusions: This nationwide, free-of-charge, therapist-supported HUS Helsinki University Hospital–iCBT for GAD was effective in routine care, but further research must establish effectiveness against other treatments and optimize the design of iCBT for GAD for different patient groups and individual patients.Background: Therapist-supported, internet-delivered cognitive behavioral therapy (iCBT) is efficacious for generalized anxiety disorder (GAD), but few studies are yet to report its effectiveness in routine care. Objective: In this study, we aim to examine whether a new 12-session iCBT program for GAD is effective in nationwide routine care. Methods: We administered a specialized, clinic-delivered, therapist-supported iCBT for GAD in 1099 physician-referred patients. The program was free of charge for patients, and the completion time was not predetermined. We measured symptoms with web-based questionnaires. The primary measure of anxiety was the GAD 7-item scale (GAD-7); secondary measures were, for pathological worry, the Penn State Worry Questionnaire and, for anxiety and impairment, the Overall Anxiety Severity and Impairment Scale. Results: Patients completed a mean 7.8 (SD 4.2; 65.1%) of 12 sessions, and 44.1% (485/1099) of patients completed all sessions. The effect size in the whole sample for GAD-7 was large (Cohen d=0.97, 95% CI 0.88-1.06). For completers, effect sizes were very large (Cohen d=1.34, 95% CI 1.25-1.53 for GAD-7; Cohen d=1.14, 95% CI 1.00-1.27 for Penn State Worry Questionnaire; and Cohen d=1.23, 95% CI 1.09-1.37 for Overall Anxiety Severity and Impairment Scale). Noncompleters also benefited from the treatment. Greater symptomatic GAD-7–measured relief was associated with more completed sessions, older age, and being referred from private or occupational care. Of the 894 patients with a baseline GAD-7 score ≥10, approximately 421 (47.1%) achieved reliable recovery. Conclusions: This nationwide, free-of-charge, therapist-supported HUS Helsinki University Hospital–iCBT for GAD was effective in routine care, but further research must establish effectiveness against other treatments and optimize the design of iCBT for GAD for different patient groups and individual patients.Peer reviewe

Comparing In-Person to Videoconference-Based Cognitive Behavioral Therapy for Mood and Anxiety Disorders: Randomized Controlled Trial

Background: Cognitive-behavioral therapy (CBT) has demonstrated efficacy and effectiveness for treating mood and anxiety disorders. Dissemination of CBT via videoconference may help improve access to treatment. Objective: The present study aimed to compare the effectiveness of CBT administered via videoconference to in-person therapy for a mixed diagnostic cohort. Methods: A total of 26 primarily Caucasian clients (mean age 30 years, SD 11) who had a primary Diagnostic and Statistical Manual of Mental Disorders, 4th edition text revision (DSM-IV-TR) diagnosis of a mood or anxiety disorder were randomly assigned to receive 12 sessions of CBT either in-person or via videoconference. Treatment involved individualized CBT formulations specific to the presenting diagnosis; all sessions were provided by the same therapist. Participants were recruited through a university clinic. Symptoms of depression, anxiety, stress, and quality of life were assessed using questionnaires before, after, and 6 weeks following treatment. Secondary outcomes at posttreatment included working alliance and client satisfaction.Results: Retention was similar across treatment conditions; there was one more client in the videoconferencing condition at posttreatment and at follow-up. Statistical analysis using multilevel mixed effects linear regression indicated a significant reduction in client symptoms across time for symptoms of depression (P<.001, d=1.41), anxiety (P<.001, d=1.14), stress (P<.001, d=1.81),and quality of life (P<.001, d=1.17). There were no significant differences between treatment conditions regarding symptoms of depression (P=.165, d=0.37), anxiety (P=.41, d=0.22), stress (P=.15, d=0.38), or quality of life (P=.62, d=0.13). There were no significant differences in client rating of the working alliance (P=.53, one-tailed, d=–0.26), therapist ratings of the working alliance (P=.60, one-tailed, d=0.23), or client ratings of satisfaction (P=.77, one-tailed, d=–0.12). Fisher’s Exact P was not significant regarding differences in reliable change from pre- to posttreatment or from pretreatment to follow-up for symptoms of depression (P=.41, P=.26), anxiety (P=.60, P=.99), or quality of life (P=.65, P=.99) but was significant for symptoms of stress in favor of the videoconferencing condition (P=.03, P=.035). Difference between conditions regarding clinically significant change was also not observed from pre- to posttreatment or from pretreatment to follow-up for symptoms of depression (P=.67, P=.30), anxiety (P=.99, P=.99), stress (P=.19, P=.13), or quality of life (P=.99, P=.62). Conclusions: The findings of this controlled trial indicate that CBT was effective in significantly reducing symptoms of depression, anxiety, and stress and increasing quality of life in both in-person and videoconferencing conditions, with no significant differences being observed between the two

Development and psychometric evaluation of a scrambled sentences test specifically for worry in individuals with generalised anxiety disorder

The tendency to draw negative conclusions from ambiguous information (interpretation bias) is prevalent across emotional disorders and plays a key role in the development and maintenance of pathological worry and anxious mood. Assessing interpretation bias using valid and reliable measures is central to empirical research. A commonly used measure of interpretation bias is the scrambled sentences test (SST), originally relating to depression. Given the association between interpretation bias and worry, we aimed to develop and psychometrically evaluate a new version of the SST with items pertaining to common worry domains for use in worry and anxiety research. In Studies 1–3 (analogue samples, combined N = 288), the new worry SST showed excellent construct validity (moderate-to-strong associations with worry and anxiety-related measures), and reliability (split-half and test-retest reliability). We confirmed construct validity in Study 4 (N = 215 individuals with generalised anxiety disorder). Furthermore, we demonstrated version specificity in analogue and clinical samples: the worry SST was associated with trait worry but not trait rumination, while the original depression SST largely showed the opposite pattern. Overall, the new worry SST is a psychometrically robust measure that may be especiall