Applied relaxation vs. cognitive therapy in the treatment ofgeneralized anxiety disorderLars-GoÈran OÈsta,*, Elisabeth BreitholtzbaDepartment of Psychology, Stockholm University, 106 91Stockholm, SwedenbDepartment of Neuroscience, Psychiatry UlleraÊker, University of Uppsala, Uppsala, SwedenAbstractThe present study investigated the ecacy of a coping-technique, applied relaxation (AR) andcognitive therapy (CT), in the treatment of generalized anxiety disorder. Thirty-six outpatients ful®llingthe DSM-III-R criteria for generalized anxiety were assessed with independent assessor ratings and self-report scales before and after treatment and at a 1 yr follow-up. The patients were randomized andtreated individually for 12 weekly sessions. The results showed that both treatments yielded largeimprovements, which were maintained, or furthered at follow-up. There was no dierence between ARand CT on any measure. The drop-out rate was 12% for AR and 5% for CT. The proportions ofclinically signi®cantly improved patients were 53 and 62% at post-treatment and 67 and 56% at follow-up for AR and CT, respectively. Besides aecting generalized anxiety the treatments also yielded markedand lasting changes on ratings of worry, cognitive and somatic anxiety and depression. The conclusionthat can be drawn is that both AR and CT have potential as treatments for generalized anxiety disorderbut they have to be developed further in order to increase the ecacy to the level usually seen in panicdisorder, 80±85% clinically improved. 7 2000 Published by Elsevier Science Ltd. All rights reserved.1. IntroductionGeneralized anxiety disorder (GAD) is one of the most prevalent of the anxietydisorders with a lifetime prevalence of about 5% (Wittchen, Zhao, Kessler & Eaves,1994). It is, however, a relatively underresearched disorder, both when it comes topsychopathology and treatment. One explanation for this state of aairs is the division ofBehaviour Research and Therapy 38 (2000) 777±7900005-7967/00/$ - see front matter 7 2000 Published by Elsevier Science Ltd. All rights reserved.PII: S 0005- 79 67 (9 9) 00 09 5- 9www.elsevier.com/locate/brat* Corresponding author.the DSM-II (APA, 1968) diagnosis anxiety neurosis into two separate diagnoses in DSM-III (APA, 1980), panic disorder and generalized anxiety disorder. It seems that most ofthe interest from the research community was focused on the new and more intriguingpanic disorder, while relatively little research has been carried out concerning GAD. Thismay explain why the average proportion of clinically signi®cant improvement for panicdisorder is 80±85% (Clark, 1996), while it is only about 50% for GAD (Borkovec &Newman, 1998).Over the last quarter of a century a number of dierent behavioral and cognitive behavioraltreatment methods have been tested in randomized studies for anxiety neurosis or GAD, e.g.biofeedback, progressive relaxation, applied relaxation, stress inoculation training, anxietymanagement training and cognitive therapy. Among these methods relaxation training andcognitive therapy/cognitive behavior therapy are the most frequently used (see Durham &Allan, 1993, for a review).Concerning progressive relaxation (PR) Lehrer, Woolfolk, Rooney, McCann and Carrington(1983) found it to be more eective than a wait-list control condition and also reported bettereects for PR than for meditation. LeBoeuf and Lodge (1980) found that PR was equal toelectromyography-biofeedback and Raskin, Bali and Peeke (1980) that PR was equal to EMG-biofeedback+PR. Borkovec and Mathews (1988) added PR to cognitive therapy, nondirectivetherapy and coping desensitization, respectively and reported similar results from these threeconditions. Finally, Barlow, Rapee and Brown (1992) found that PR, cognitive therapy and thecombination of these two all did better than a wait-list control condition. A development fromPR called applied relaxation (AR; OÈst, 1987) is a coping technique that has been foundeective for panic disorder (OÈst, 1988; OÈst & Westling, 1995), agoraphobia (OÈst, Westling &HellstroÈm, 1993), social phobia (OÈst, Jerremalm & Johansson, 1981) and speci®c phobia (OÈst,Johansson & Jerremalm, 1982). In GAD it has only been tested in two studies so far. Tarrierand Main (1986) used a very brief treatment, a single 1 h session and reported that threecomponents of AR did as well as the full treatment and all were better than a wait-listcondition. In one of the methodologically best studies in the GAD area Borkovec and Costello(1993) compared AR, CBT (cognitive therapy+AR) and nondirective therapy in a study where14 sessions were given during a 6-week period. AR and CBT did better than nondirectivetherapy.Cognitive therapy (without behavioral components) did as well as a broad spectrumbehavior therapy in a study by Durham and Turvey (1987), as well as progressive relaxation inthe Barlow et al. (1992) study, as well as behavior therapy and CBT in the White, Keenan andBrooks (1992) study and better than psychodynamic therapy in a study by Durham et al.(1994). Cognitive behavior therapy (a combination of cognitive therapy and various forms ofbehavioral treatments) was found to be equal to anxiety management training (Lindsey,Gamsu, McLaughlin, Hood & Espie, 1987), equal to applied relaxation (Borkovec & Costello,1993) and equal to supportive therapy in a geriatric sample (Stanley, Beck & Glassco, 1996).CBT was better than a stripped down form of behavior therapy (Butler, Fennell, Robson &Gelder, 1991) and better than nondirective therapy (Borkovec & Costello, 1993). Two studieshave compared CBT with diazepam. Power, Jerrom, Simpson, Mitchell and Swanson (1989)found CBT equal to diazepam, but better than placebo, while diazepam did not dier fromplacebo. In a larger study Power, Simpson, Swanson and Wallace (1990) found CBT to beL.-G. OÈst, E. Breitholtz / Behaviour Research and Therapy 38 (2000) 777±790778equal to the CBT+Diazepam and both were better than diazepam alone and placebo, whichdid not dier among each other.The purpose of the present study was to compare the eectiveness of applied relaxation andcognitive therapy, which has not been done previously. Barlow et al. (1992) compared CT andprogressive relaxation, while Borkovec and Costello (1993) compared CBT and appliedrelaxation. In neither case were there signi®cant dierences between the compared treatments.In our previous studies on panic disorder we found
View Full Document
Unlocking...