Testing Worries in Real Life: A New Treatment for Generalised Anxiety

Generalised anxiety disorder (GAD) is not always easy to treat. Over the past three decades, researchers have developed sophisticated multicomponent treatments, yet these appear to be less effective than treatments for other anxiety disorders. A team led by Dugas tested a more focused alternative: Behavioral Experiments for Intolerance of Uncertainty.

Sixty adults with GAD took part, with an average age of 34.60 years. Thirty were randomly assigned to treatment and thirty to a wait-list. Treatment ran for 12 weekly 1-hour sessions in which participants learned to use behavioural experiments to test their catastrophic beliefs about uncertainty.

The treatment group did better than the wait-list group on all outcomes, including GAD severity, worry, depression, somatic anxiety and intolerance of uncertainty. Once the wait-listed participants received treatment, the combined group showed large and significant decreases on all outcomes. Gains were maintained or increased over the 12-month follow-up.

The authors describe the approach as promising, noting it may be as efficacious as more comprehensive evidence-based psychological treatments for GAD. The approach was focused. The results were broad.

If worry is wearing you down, effective help exists. A conversation with a psychologist or your GP is a good first step.

What the study did

Generalised anxiety disorder (GAD) has been the subject of three decades of treatment development, and the resulting multicomponent treatments have produced encouraging results. They still appear to be less efficacious than treatments for other anxiety disorders. Dugas and colleagues therefore tested a newly developed, highly focused treatment called Behavioral Experiments for Intolerance of Uncertainty.

The randomised controlled trial included 60 participants, 51 women and 9 men, with a mean age of 34.60 years (range 19 to 67). Thirty were randomised to treatment and thirty to a wait-list control. Treatment consisted of 12 weekly 1-hour sessions. In those sessions, participants learned to use behavioural experiments to test their catastrophic beliefs about uncertainty.

Assessments took place before treatment, midway, and after treatment, with further follow-up at 6 and 12 months. The primary outcome was the severity of GAD. Secondary outcomes were worry, depression, somatic anxiety and intolerance of uncertainty.

What it found

Using growth curve modelling, the team reported three main results. First, the treatment group was superior to the wait-list group in change from pre- to posttest on all outcomes. Second, once the wait-listed participants received treatment, the combined sample showed large and significant decreases on all outcomes. Third, treatment gains were either maintained or increased over the 12-month follow-up.

Why it matters

Intolerance of uncertainty is the focus of this treatment, and the participants practised testing their feared predictions through behavioural experiments. The results suggest that a highly focused treatment can produce meaningful change across a range of outcomes, from worry itself to depression and somatic anxiety.

The authors consider the new treatment a promising option for adults with GAD, because it may be as efficacious as more comprehensive evidence-based psychological treatments for GAD. A focused approach may be easier to learn and to deliver, although the abstract does not test that directly.

Limits

The word "may" in the authors' conclusion is worth keeping. The trial compared treatment with a wait-list rather than with another active therapy, so it does not show that the new approach is better than, or even equal to, established treatments. The claim about comparable efficacy is a suggestion. It is not a demonstrated result. The sample of 60 people is also modest, and most participants were women.

Reading the results in context

The design of the trial is worth a closer look. After the first comparison, participants in the wait-list group went on to receive treatment as well. This allowed the researchers to look at the combined sample, and in that larger group they found large and significant decreases on all outcomes. It is a useful check. The same pattern of improvement appeared in people who had first waited.

The follow-up findings carry weight for a condition that tends to be long-standing. Assessments at 6 and 12 months showed treatment gains were either maintained or increased. People did not simply improve and then slip back.

It is also notable that the treatment targets intolerance of uncertainty directly, rather than combining many techniques. The outcomes that improved were not limited to worry. Depression, somatic anxiety and intolerance of uncertainty itself were all included among the secondary outcomes, and the treatment group was superior on all outcomes from pre- to posttest.

Seeking help

Persistent worry can feel like an unchangeable part of who you are, but it responds to treatment. If worry about uncertainty is affecting your sleep, work or relationships, please speak with a psychologist or your GP about the support available.