Abstract
Despite the substantial evidence that supports the efficacy of cognitive-behavioral therapy for the treatment of anxiety and related disorders, our understanding of mechanisms of change throughout treatment remains limited. The goal of the current study was to examine changes in experiential avoidance across treatment in a sample of participants (N = 179) with heterogeneous anxiety disorders receiving various cognitive-behavioral therapy protocols. Univariate latent growth curve models were conducted to examine change in experiential avoidance across treatment, followed by parallel process latent growth curve models to examine the relationship between change in experiential avoidance and change in anxiety symptoms. Finally, bivariate latent difference score models were conducted to examine the temporal precedence of change in experiential avoidance and change in anxiety. Results indicated that there were significant reductions in experiential avoidance across cognitive-behavioral treatment, and that change in experiential avoidance was significantly associated with change in anxiety. Results from the latent difference score models indicated that change in experiential avoidance preceded and predicted subsequent changes in anxiety, whereas change in anxiety did not precede and predict subsequent changes in experiential avoidance. Taken together, these results provide additional support for reductions in experiential avoidance as a transdiagnostic mechanism in cognitive-behavioral therapy.
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Notes
Number of treatment sessions in the Unified Protocol condition were based on the recommended number of sessions in each SDP to control for number of sessions across active treatment conditions.
Additional univariate LGMs examined reductions in EA (MEAQ total score and MEAQ-DA subscale) within the Unified Protocol and Single Disorder Protocol conditions separately, and indicated that there were significant reductions in EA (MEAQ total score and MEAQ-DA) within each treatment condition, and no significant differences between the Unified Protocol and Single Disorder Protocol conditions.
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The authors thank Sarah A. Hayes-Skelton for her statistical consultation.
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This work was supported by National Institute of Mental Health Grant No. MH090053 awarded to the last author.
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Dr. Barlow receives royalties from Oxford University Press (which includes royalties for all five treatment manuals included in this study), Guilford Publications Inc., Cengage Learning, and Pearson Publishing. Grant monies for various projects including this one come from the National Institute of Mental Health, the National Institute of Alcohol and Alcohol Abuse, and Colciencias (Government of Columbia Initiative for Science, Technology, and Health Innovation). Consulting and honoraria during the past several years have come from the Agency for Healthcare Research and Quality, the Foundation for Informed Medical Decision Making, the Department of Defense, the Renfrew Center, the Chinese University of Hong Kong, Universidad Católica de Santa Maria (Arequipa, Peru), New Zealand Psychological Association, Hebrew University of Jerusalem, Mayo Clinic, and various American Universities and Institutes. Drs. Farchione and Sauer-Zavala receive royalties from Oxford University Press (for one of the treatment manuals included in this study). The other authors do not have any disclosures to report.
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Eustis, E.H., Cardona, N., Nauphal, M. et al. Experiential Avoidance as a Mechanism of Change Across Cognitive-Behavioral Therapy in a Sample of Participants with Heterogeneous Anxiety Disorders. Cogn Ther Res 44, 275–286 (2020). https://doi.org/10.1007/s10608-019-10063-6
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DOI: https://doi.org/10.1007/s10608-019-10063-6