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ID
Source
Brief title
Health condition
Anxiety disorder: either an obsessive compulsive disorder, panic disorder and/or agoraphobia, social anxiety disorder or generalized anxiety disorder
Sponsors and support
Intervention
Outcome measures
Primary outcome
The severity of patients'symtoms and general psychological functioning will be measured by the Outcome Questionnaire-45 (OQ-45; Lambert et al., 1996).
Secondary outcome
The severity of disorder specific symptoms. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS; Goodman et al., 1989a) will be used as a clinician rated instrument in the OCD subgroup. Panic disorder with or without agoraphobia symptoms severity will be assessed with the Panic Disorder Severity Scale (PDSS; Shear et al., 1997; de Beurs, 2002). The Liebowitz Social Anxiety Scale (LSAS; Liebowitz, 1987; van Vliet, 1999) will be administered to measure social anxiety symptoms severity in the SAD subgroup. Severity of generalized anxiety disorder symptoms will be measured for the GAD subgroup by the Penn State Worry Questionnaire (PSWQ; Meyer, Miller, Metzger, & Borkovec, 1990).
Background summary
Anxiety disorders are the most common type of mental disorders with a lifetime prevalence between 4.8-31%. Cognitive behavioral therapy (CBT) is the most effective treatment for anxiety disorders and considered to be the psychological treatment of choice. However, a substantial minority of the patients are poor responders. It would be useful to identify patients that are likely to respond poorly to standard CBT before
treatment allocation. Gaining knowledge about individual differences among patients could improve the development of effective treatments for non-responders.
Previous research shows that personality characteristics such as perfectionism and intolerance of uncertainty can negatively influence treatment results. Schema therapy (ST) is an effective treatment for patients with personality disorders that poorly respond to CBT. A central concept of ST is schema modes. Schema modes are emotional states and coping responses, either adaptive or maladaptive, that are currently active.
There are four main categories of schema modes: dysfunctional child, dysfunctional parent, dysfunctional coping and health. The presence of schema modes could influence treatment sessions in a negative or positive way which is rarely examined for anxiety disorders.
Hypothetically, maladaptive schema modes could hamper successful exposure in the following ways: demanding parent mode is a state of high standards that may interfere with the patient’s ability to tolerate exposure in terms of facing high levels of anxiety, uncertainties and possible mistakes. Furthermore, high levels of maladaptive modes such as dysfunctional child modes may interfere with the realization of a good
therapeutic relationship. Thus, exposure may be more effective in a healthy adult mode in which a person realizes that absolute certainty is not achievable, mistakes are part of life and negative emotions can be tolerated. Moreover, high levels of health modes can contribute to a positive therapeutic alliance which is a consistent predictor of CBT treatment outcome.
Taken together, the presence of maladaptive modes may impede effective exposure in several ways. A sufficient level of adaptive modes may be needed for effective CBT. The present study aims to examine whether there is a predictive value of schema modes (dysfunctional child, dysfunctional parent, dysfunctional coping, health) on treatment outcome in patients with anxiety disorders receiving CBT.
Study objective
The hypothesis is that an increased level of dysfunctional modes at baseline predicts lower CBT success (i.e., smaller reduction of symptoms). The second hypothesis is that an increased level of healthy modes at baseline predicts higher CBT success (i.e. higher reduction of symptoms).
Study design
After inclusion and informed consent, participants have their first assessment (T1). Then, participants will receive treatment as usual (i.e. CBT). Immediately after completion of treatment, participants will have their second assessment (T2).
Intervention
Treatment as usual: cognitive behavioral therapy (CBT)
Inclusion criteria
- Adults between 18 and 65 years of age
- A primary diagnosis of obsessive compulsive disorder, panic disorder and/or agoraphobia, social anxiety disorder or generalized anxiety disorder, assessed with the Mini International Neuropsychiatric Interview (MINI; Overbeek, Schruers, & Griez, 1997, 1999).
- The patient is enrolled for CBT at Pro Persona anxiety department (Nijmegen, Arnhem, Ede or Tiel)
Exclusion criteria
- A psychological treatment primarily focused on personality characteristics
- Mental disorders that need acute treatment and/or harm the validity of the measurements: a current psychotic episode, substance abuse or mental retardation
- An inability to speak and understand Dutch fluently
Design
Recruitment
IPD sharing statement
Followed up by the following (possibly more current) registration
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Other (possibly less up-to-date) registrations in this register
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In other registers
| Register | ID |
|---|---|
| NTR-new | NL8299 |
| Other | Ethics Committee Faculty of Social Sciences, Radboud University Nijmegen : ECSW-2019-123 (approved) |