A Randomized Controlled Trial of Cognitive-Behavioral Therapy for Generalized Anxiety Disorder with Integrated Techniques from Emotion-focused and Interpersonal Therapies

Objective—Recent models suggest that generalized anxiety disorder (GAD) symptoms may be maintained by emotional processing avoidance and interpersonal problems. Method—This is the first randomized controlled trial to test directly whether cognitive-behavioral therapy (CBT) could be augmented with the addition of a module targeting interpersonal problems and emotional processing. Eighty-three primarily White participants (mean age = 37) with a principle diagnosis of GAD were recruited from the community. Participants were assigned randomly to CBT plus supportive listening (n = 40) or to CBT plus interpersonal and emotional processing therapy (n = 43) within a study using an additive design. Doctoral-level psychologists with full-time private practices treated participants in an outpatient clinic. Using blind assessors, participants were assessed at pretreatment, posttreatment, 6-month, 1-year, and 2-year follow-up with a composite of self-report and assessor-rated GAD symptom measures (the Penn State Worry Questionnaire; Hamilton Anxiety Rating Scale; assessor severity rating; State-Trait Anxiety Inventory-Trait Version) as well as with indices of clinically significant change. Results—Mixed models analysis of all randomized participants showed very large within-treatment effect sizes for both treatments (CI = [−.40, −.28], d = 1.86) with no significant differences at post (CI = [−.09, .07], d = .07) or 2-year follow-up (CI = [−.01, .01]), d = .12). There was also no statistical difference between compared treatments on clinically significant change based on chi-square analysis. Conclusions—Interpersonal and emotional processing techniques may not augment CBT for all GAD participants.

Michelle G. Newman, Louis G. Castonguay, Thomas D. Borkovec, Aaron J. Fisher, James F. Boswell, Lauren E. Szkodny, Samuel S. Nordberg