Group autonomy enhancing treatment versus cognitive behavioral therapy for anxiety disorders: A cluster-randomized clinical trial

Background: Although cognitive behavioral therapy (CBT) is effective in the treatment of anxiety disorders, few evidence-based alternatives exist. Autonomy enhancing treatment (AET) aims to decrease the vulnerability for anxiety disorders by targeting underlying autonomy deficits and may therefore have similar effects on anxiety as CBT, but yield broader effects. Methods: A multicenter cluster-randomized clinical trial was conducted including 129 patients with DSM-5 anxiety disorders, on average 33.66 years of age (SD = 12.57), 91 (70.5%) female, and most (92.2%) born in the Netherlands. Participants were randomized over 15-week groupwise AET or groupwise CBT and completed questionnaires on anxiety, general psychopathology, depression, quality of life, autonomy-connectedness and self-esteem, pre-, mid-, and posttreatment, and after 3, 6, and 12 months (six measurements). Results: Contrary to the hypotheses, effects on the broader outcome measures did not differ between AET and CBT (d =.16 or smaller at post-test). Anxiety reduction was similar across conditions (d =.059 at post-test) and neither therapy was superior on long term. Conclusion: This was the first clinical randomized trial comparing AET to CBT. The added value of AET does not seem to lie in enhanced effectiveness on broader outcome measures or on long term compared to CBT. However, the study supports the effectiveness of AET and thereby contributes to extended treatment options for anxiety disorders

Autonomy-connectedness mediates sex differences in symptoms of psychopathology

Objectives: This study aimed to examine if autonomy-connectedness, capacity for self-governance under the condition of connectedness, would mediate sex differences in symptoms of various mental disorders (depression, anxiety, eating disorders, antisocial personality disorder). Method: Participants (N = 5,525) from a representative community sample in the Netherlands filled out questionnaires regarding the variables under study. Results: Autonomy-connectedness (self-awareness, SA; sensitivity to others, SO; capacity for managing new situations, CMNS) fully mediated the sex differences in depression and anxiety, and partly in eating disorder -(drive for thinness, bulimia, and body dissatisfaction) and antisocial personality disorder characteristics. The mediations followed the expected sex-specific patterns. SO related positively to the internalizing disorder indices, and negatively to the anti-social personality disorder. SA related negatively to all disorder indices; and CMNS to all internalizing disorder indices, but positively to the anti-social personality disorder. Conclusion: Treatment of depression, anxiety, but also eating disorders and the antisocial personality disorder may benefit from a stronger focus on autonomy strengthening

Depression among Turkish and Moroccan immigrant populations in Northwestern Europe: a systematic review of prevalence and correlates

Background: This systematic review aimed to synthesize the prevalence and correlates of depressive disorders and symptoms of Turkish and Moroccan immigrant populations in Northwestern Europe, formulating evidence-informed recommendations for clinical practice. Methods: We conducted a systematic search in PsycINFO, MEDLINE, Science Direct, Web of Knowledge, and Cochrane databases for records up to March 2021. Peer-reviewed studies on adult populations that included instruments assessing prevalence and/or correlates of depression in Turkish and Moroccan immigrant populations met inclusion criteria and were assessed in terms of methodological quality. The review followed the relevant sections of the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting (PRISMA) guideline. Results: We identified 51 relevant studies of observational design. Prevalence of depression was consistently higher among people who had an immigrant background, compared to those who did not. This difference seemed to be more pronounced for Turkish immigrants (especially older adults, women, and outpatients with psychosomatic complaints). Ethnicity and ethnic discrimination were identified as salient, positive, independent correlates of depressive psychopathology. Acculturation strategy (high maintenance) was related to higher depressive psychopathology in Turkish groups, while religiousness appeared protective in Moroccan groups. Current research gaps concern psychological correlates, second- and third-generation populations, and sexual and gender minorities. Conclusion: Compared to native-born populations, Turkish immigrants consistently showed the highest prevalence of depressive disorder, while Moroccan immigrants showed similar to rather moderately elevated rates. Ethnic discrimination and acculturation were more often related to depressive symptomatology than socio-demographic correlates. Ethnicity seems to be a salient, independent correlate of depression among Turkish and Moroccan immigrant populations in Northwestern Europe

Symptom manifestation and treatment effectiveness, -obstacles and -facilitators in Turkish and Moroccan groups with depression in European countries: A systematic review

Background: This study examined the state of the art relevant for clinical practice on symptom manifestation of depression or depression-related idioms of distress, the treatment effectiveness and obstacles and facilitators for therapeutic success in Turkish and Moroccan immigrant populations with depression in Europe. Methods: We conducted a systematic search in PsycINFO, MEDLINE, Science Direct, Web of Knowledge, and Cochrane databases (1970-31 July 2017). Peer-reviewed studies, with adult populations, and an instrument assessing depressive symptoms met inclusion criteria and were evaluated following quality guidelines. Results: We included 13 studies on symptom manifestation, 6 on treatment effectiveness, and 17 on obstacles and facilitators, published between 2000 and 2017, from Germany, the Netherlands, Austria and Sweden (n Turkish individuals = 11,533; n Moroccan individuals = 5278; n native individuals = 303,212). Both ethnic groups more often reported combined mood and somatic symptoms (and anxiety in the case of Turkish groups) than natives, and had higher levels of symptoms. There was no report on effectiveness of pharmacotherapy and there was weak evidence of the effectiveness of examined psychological treatments for depression in Turkish groups. No treatment has been examined in Moroccan groups. Salient obstacles to therapeutic success were socioeconomic problems, higher level of psychological symptoms at baseline, and negative attitudes towards psychotherapy. Possible facilitators were interventions attuned to social, cultural and individual needs. Results were most representative of first generation, low SES Turkish immigrant patients, and Moroccan-Dutch members of the general populations. Conclusion: Turkish and Moroccan immigrants with depression presented a comorbid symptom profile with more intertwined depressive and somatic complaints. There were indications that the available therapies are insufficient for Turkish groups, but the current evidence is scarce and heterogeneous, and RCTs suffer from methodological limitations

The role of sex and gender in anxiety disorders: Being scared “like a girl”?

Anxiety disorders are among the most prevalent mental disorders, and women are at much higher risk to develop an(y) anxiety disorder. Women seem to experience more severe and long-lasting symptoms than men. Sex differences regarding etiology can be best understood from a vulnerability-stress perspective. A different exposure to psychosocial stressors and an increased biologic and/or psychologic vulnerability toward anxiety in women may contribute to the sex differences in anxiety disorders. Evidently, these findings have implications for both the diagnosis and treatment of patients with anxiety disorders. Therapists should be aware of gender bias during the diagnostic process and be sensitive for self-reporting bias (i.e., the reluctance to report “female-like” symptoms by men). Research on sex differences with respect to treatment is lacking and gender-related knowledge has rarely been integrated into clinical interventions. Interventions aimed at transdiagnostic factors that have been shown to relate to sex differences in anxiety seem rather promising and have the potential to enhance the care for both men and women with anxiety disorders

Group autonomy enhancing treatment versus cognitive behavioral therapy for anxiety disorders: A cluster-randomized clinical trial

Background: Although cognitive behavioral therapy (CBT) is effective in the treatment of anxiety disorders, few evidence-based alternatives exist. Autonomy enhancing treatment (AET) aims to decrease the vulnerability for anxiety disorders by targeting underlying autonomy deficits and may therefore have similar effects on anxiety as CBT, but yield broader effects. Methods: A multicenter cluster-randomized clinical trial was conducted including 129 patients with DSM-5 anxiety disorders, on average 33.66 years of age (SD = 12.57), 91 (70.5%) female, and most (92.2%) born in the Netherlands. Participants were randomized over 15-week groupwise AET or groupwise CBT and completed questionnaires on anxiety, general psychopathology, depression, quality of life, autonomy-connectedness and self-esteem, pre-, mid-, and posttreatment, and after 3, 6, and 12 months (six measurements). Results: Contrary to the hypotheses, effects on the broader outcome measures did not differ between AET and CBT (d =.16 or smaller at post-test). Anxiety reduction was similar across conditions (d =.059 at post-test) and neither therapy was superior on long term. Conclusion: This was the first clinical randomized trial comparing AET to CBT. The added value of AET does not seem to lie in enhanced effectiveness on broader outcome measures or on long term compared to CBT. However, the study supports the effectiveness of AET and thereby contributes to extended treatment options for anxiety disorders