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. The study was preregistered at the Netherlands Clinical Trial Registry (https://www.trialregister.nl/trial/6250

Bivariate Pearson correlations between outcome and predictor variables.

<p>Bivariate Pearson correlations between outcome and predictor variables.</p

Mediation model.

<p>The dashed line indicates that the effect of sex on psychopathology (c) is at least partially explained by the indirect effect via autonomy (a×b). The effect of sex on psychopathology that is not mediated by autonomy is signified by c’.</p

Mediation analysis analyses with sex, mediators SO (sensitivity to others), SA (self-awareness) and CMNS (capacity for managing new situations), and the disorder indices as outcome variables.

<p>Unstandardized regression coefficients (B) are reported with their standard errors (SE).</p

Autonomy-connectedness mediates sex differences in symptoms of psychopathology

<div><p>Objectives</p><p>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).</p><p>Method</p><p>Participants (<i>N</i> = 5,525) from a representative community sample in the Netherlands filled out questionnaires regarding the variables under study.</p><p>Results</p><p>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 anti-social 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.</p><p>Conclusion</p><p>Treatment of depression, anxiety, but also eating disorders and the antisocial personality disorder may benefit from a stronger focus on autonomy strengthening.</p></div

Total effects of sex, direct effects of sex, and effects of sex mediated by autonomy components.

<p>The mediated effects are tested using the Sobel z test.</p

Sex Bias in Classifying Borderline and Narcissistic Personality Disorder

This study investigated sex bias in the classification of borderline and narcissistic personality disorders. A sample of psychologists in training for a post-master degree (N = 180) read brief case histories (male or female version) and made DSM classification. To differentiate sex bias due to sex stereotyping or to base rate variation, we used different case histories, respectively: (1) non-ambiguous case histories with enough criteria of either borderline or narcissistic personality disorder to meet the threshold for classification, and (2) an ambiguous case with subthreshold features of both borderline and narcissistic personality disorder. Results showed significant differences due to sex of the patient in the ambiguous condition. Thus, when the diagnosis is not straightforward, as in the case of mixed subthreshold features, sex bias is present and is influenced by base-rate variation. These findings emphasize the need for caution in classifying personality disorders, especially borderline or narcissistic traits