Development of the Anxiety Change Expectancy Scale (ACES) and validation in college, community, and clinical samples.

This study investigated the psychometric properties of a newly developed 20-item instrument that assesses one\u27s anticipation of being able to change anxiety: the Anxiety Change Expectancy Scale (ACES). Study 1 evaluated the ACES in undergraduate university students, self-identified as experiencing difficulties with anxiety. Study 2 examined the ACES in a community sample of persons with anxiety difficulties. Study 3 tested the utility of the ACES in predicting treatment change in a group of individuals with generalized anxiety disorder participating in group cognitive behavioral therapy for anxiety. Across these samples, the ACES demonstrated excellent internal reliability (coefficient alphas=.89-.92) as well as good convergent, divergent, and factorial validity. The ACES was also significantly predictive of treatment-related changes in somatic anxiety symptoms and worry. The results of these studies provide strong support for the ACES as a reliable and valid measure of expectancies for changing anxiety

Adding a motivational interviewing pretreatment to cognitive behavioral therapy for generalized anxiety disorder: a preliminary randomized controlled trial.

Seventy-six individuals with a principal diagnosis of generalized anxiety disorder (GAD) were randomly assigned to receive either an MI pretreatment or no pretreatment (NPT), prior to receiving CBT. Significant group differences favoring the MI-CBT group were observed on the hallmark GAD symptom of worry and on therapist-rated homework compliance, which mediated the impact of treatment group on worry reduction. Adding MI pretreatment to CBT was specifically and substantively beneficial for individuals with high worry severity at baseline. There was evidence of relapse at 6-month follow-up for high severity individuals who received MI-CBT, but significant moderator effects favoring the high severity MI-CBT group were again apparent at 12-months post-treatment. Pending replication in a more controlled test, these findings suggest that MI may be a promising adjunct to CBT for GAD for those of high severity, a group which has been less responsive to CBT in past research

The validity of the brief version of the Fear of Negative Evaluation Scale.

The Fear of Negative Evaluation Scale [FNE; J. Consult. Clin. Psychol. 33 (1969) 448] is a commonly used measure of social anxiety. A brief version of the scale (FNEB) is available for convenient administration. Despite being widely advocated for use, the psychometric properties of the FNEB have not been evaluated with clinically anxious samples. The present study addressed the reliability and validity of the FNEB in a clinical sample of individuals with either social phobia (n = 82) or panic disorder (n = 99) presenting for treatment. Factor analysis supported the construct validity of the FNEB. The validity of the FNEB was further demonstrated through significant correlations with social avoidance and depression, and non-significant correlations with agoraphobic avoidance and demographic variables. The scale obtained excellent inter-item reliability (alpha = .97) and 2-week test-retest reliability (r = .94). Discriminant function analysis also supported validity of the FNEB. For example, individuals with social phobia scored significantly higher on the FNEB than those with panic disorder and a group of non-psychiatric community controls (n = 30). The FNEB was sensitive to pre- to post-CBT changes in both social anxiety and panic disorder, and changes on the FNEB correlated significantly with other measures of treatment responsiveness, such as reductions in somatic arousal, depression and other anxiety symptomatology. These research findings strongly support the validity of the FNEB and its clinical utility as an outcome measure in social anxiety treatment

Gaps in accessing treatment for anxiety and depression: challenges for the delivery of care.

Epidemiological studies have identified high prevalence rates of anxiety and depression in North America [e.g., J. of Nerv. Ment. Dis. 182 (1994) 290]. However, only a small percentage of these individuals access effective treatment. The undertreatment of anxiety and depression is a major public health issue and is associated with significant personal, social, and economic burden. This article describes the existing discrepancy between prevalence of anxiety and depression and access to effective treatment for adults and children, the contributors to this discrepancy, and suggests various means through which access to effective treatment may be enhanced. We begin with a brief overview of the prevalence and associated personal, societal, and systemic burdens of anxiety and depression. This is followed by a review of current rates of access to treatment and possible individual, provider, and systemic barriers to accessing treatment. Recommendations for bridging the gap between the high rates of these disorders and limited accessibility of effective care are then presented

Changes in self-schema structure in cognitive therapy for major depressive disorder: a randomized clinical trial.

Negative cognitive structure (particularly for interpersonal content) has been shown in some research to persist past a current episode of depression and potentially to be a stable marker of vulnerability for depression (D. J. A. Dozois, 2007; D. J. A. Dozois & K. S. Dobson, 2001a). Given that cognitive therapy (CT) is highly effective for treating the acute phase of a depressive episode and that this treatment also reduces the risk of relapse and recurrence, it is possible that CT may alter these stable cognitive structures. In the current study, patients were randomly assigned to CT+ pharmacotherapy (n = 21) or to pharmacotherapy alone (n = 21). Both groups evidenced significant and similar reductions in level of depression (as measured with the Beck Depression Inventory-II and the Hamilton Rating Scale for Depression), as well as automatic thoughts and dysfunctional attitudes. However, group differences were found on cognitive organization in favor of individuals who received the combination of CT+ pharmacotherapy. The implications of these results for understanding mechanisms of change in therapy and the prophylactic nature of CT are discussed

Changes in Core Beliefs (Early Maladaptive Schemas) and Self-Representation in Cognitive Therapy and Pharmacotherapy for Depression

Randomized clinical trials suggest that cognitive therapy (CT) is comparable to antidepressant medication for the acute treatment of depression. Compelling data also indicate that CT has an added prophylactic benefit relative to pharmacotherapy (PT). The purpose of this study was to examine cognitive change in CT for depression. Participants (N = 42) met diagnostic criteria for a current major depressive episode and were randomly assigned to CT + PT or PT. Participants completed indices of depressive symptomatology, core beliefs (i.e., early maladaptive schemas), and self-attribute redundancy before and after therapy. Self-attribute redundancy was conceptualized as a form of schema organization and operationalized as the number of similar traits that permeate different aspects of self (e.g., as a partner, friend, employee). Treatment change was evident in both groups on self-reported core belief domains, with few between-group differences. Although no group differences were found on attribute redundancy at pre-treatment, there was a significant increase in positive redundancy at post-treatment favoring CT + PT. No group differences were found for negative content. These findings suggest that something about CT may uniquely impact self-representation and that CT may operate by bolstering compensatory schemas

Stages of change in anxiety: psychometric properties of the University of Rhode Island Change Assessment (URICA) scale.

Readiness for change is increasingly cited as an important variable in the health behaviours literature, yet there remains a dearth of research related to this construct in mental health. This study examined the psychometric properties of the University of Rhode Island Change Assessment (URICA) scale in two samples. In Study 1 (n = 252), undergraduates completed the URICA and were administered measures of hopelessness, the consequences of worry, self-esteem, anxious symptomatology, and social desirability. The reliability and validity of the URICA were generally supported, although the goodness-of-fit with the intended subscales was only moderate. The Precontemplation, Contemplation and Maintenance subscales correlated as expected with ancillary measures, but the Action subscale did not. In Study 2 (n = 81), individuals with panic disorder were administered the URICA at initial assessment and following cognitive behavioural therapy. The URICA demonstrated excellent reliability, significantly predicted treatment retention and dropout, and showed modest utility for predicting treatment outcome. Confirmatory factor analysis, however, revealed an inadequate fit to the intended subscales. The implications of these findings are discussed and directions for future research highlighted