Comparing the Effectiveness of Modular Cognitive-‎Behavioral Therapy, ‎‏‏Pharmacotherapy (Paroxetine), and Their Combination in Intolerance of Uncertainty and Meta-Worry‎ among Female University Students with Generalized Anxiety Disorder

Kaveiy, Mahdieh; Toozandejani, Hassan; Taher, Mahboobeh; Zendehdel, Ahmad

doi:10.30483/rijm.2023.254446.1263

Comparing the Effectiveness of Modular Cognitive-‎Behavioral Therapy, ‎‏‏Pharmacotherapy (Paroxetine), and Their Combination in Intolerance of Uncertainty and Meta-Worry‎ among Female University Students with Generalized Anxiety Disorder

Document Type : Original Article

Authors

¹ Department of Psychology, Faculty of Humanities, Shahrood Branch, ‎Islamic Azad University, Shahrood, Iran

² Department of Psychology, Faculty of Humanities, Neyshabur Branch, Islamic ‎Azad University, Neyshabur, Iran‎

³ Department of Psychology, Shahrood branch, Islamic Azad University, Shahrood, Iran‎

10.30483/rijm.2023.254446.1263

Abstract

Background: This study aimed to compare the effectiveness of pharmacotherapy and modular cognitive-behavioral therapy, ‎‏‏as well as their combination, in intolerance of uncertainty and meta-worry‎ among female university students with generalized anxiety disorder.

Objectives: Paying attention to psychological, cognitive-behavioral and biological dimensions in patients with generalization anxiety disorder causes continuity of therapeutic effects.

Methods: The present study was a ‎semi-experimental ‎research. The statistical population comprised all female students of the Islamic Azad University of Mashhad, of which 60 people were selected by a convenience sampling method and were randomly assigned to three experimental groups and one control group. All groups were initially pretested; afterward, the first experimental group received modular cognitive-behavioral therapy during ten 90-minute sessions; the second experimental group received pharmacotherapy and one daily dose of paroxetine; and the third experimental group received combination therapy; however, the control group was placed on the waiting list. At the end of the treatment period and three months thereafter, the participants were given a post-test and a follow-up test. The required data were collected through questionnaires, namely Freeston Intolerance of Uncertainty Scale and Wells Anxious Thoughts Inventory. The data were analyzed in SPSS-24 software using the repeated measures analysis of variance.

Results: The results demonstrated that all three therapeutic approaches compared to the control group were effective in reducing intolerance of uncertainty and meta-worry. However, the combination therapy was significantly superior to any of the two treatment approaches alone (P<0.05).

Conclusion: Considering the biological and psychological underpinnings of generalized anxiety disorder, the combination of psychological and drug therapies seems to be a more effective approach to improving anxiety states.

Keywords

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

References

1. Cardaciotto LA. Assessing Mind Fullness: The Development of a Bi - Dimensional Measure of Awareness and Acceptance. [PhD thesis]. Drexel University; 2015.

2. Mo'meni F, Shahidi Sh, Mutabi F, Heydari M. Comparing the effectiveness of cognitive-behavioral group therapy and mindfulness-based cognitive therapy in women with generalized anxiety disorder. Clinical Psychology Studies. 2018;8(32):93-111.

3. Zhou Y, Cao Z, Yang M, Xi X, Guo Y, Fang M, et al. Comorbid generalized anxiety disorder and its association with quality of life in patients with major depressive disorder. Scientific Reports. 2017;7(1):40511. https://doi.org/10.1038/srep40511 PMid:28098176 PMCid:PMC5241829

4. Dimaggio G, Shahar G. Behavioral activation as a common mechanism of change across different orientations and disorders. Psychotherapy. 2017;54(3):221. https://doi.org/10.1037/pst0000117 PMid:28737419

5. Roseman AS, Cully JA, Kunik ME, Novy DM, Rhoades HM, Wilson NL, et al. Treatment response for late-life generalized anxiety disorder: moving beyond symptom-based measures. The Journal Of Nervous And Mental Disease. 2011;199(10):811. https://doi.org/10.1097/NMD.0b013e31822feda6 PMid:21964278 PMCid:PMC3187557

6. Arco L. A case study in treating chronic comorbid obsessive-compulsive disorder and depression with behavioral activation and pharmacotherapy. Psychotherapy. 2015;52(2):278. https://doi.org/10.1037/pst0000018 PMid:25985047

7. Blood GW, Blood IM. Long-term consequences of childhood bullying in adults who stutter: Social anxiety, fear of negative evaluation, self-esteem, and satisfaction with life. Journal of fluency disorders. 2016;50:72-84. https://doi.org/10.1016/j.jfludis.2016.10.002 PMid:27865231

8. Fancourt D, Perkins R, Ascenso S, Carvalho LA, Steptoe A, Williamon A. Effects of group drumming interventions on anxiety, depression, social resilience and inflammatory immune response among mental health service users. PloS One. 2016;11(3):e0151136. https://doi.org/10.1371/journal.pone.0151136 PMid:26974430 PMCid:PMC4790847

9. Dalaham, L. The compersion effect of Beahaioral Actination Group Therapy and Sedative Drougs on Depression and Anxiety for Breast cancer woman. Journal Anxiety Disorder. 2012;279:315.

10. Hazlett-Stevens H. Psychological approaches to generalized anxiety disorder: A clinician's guide to assessment and treatment. New York: Springer; 2008. https://doi.org/10.1007/978-0-387-76870-0

11. Kaplan H, Sadock B. Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC: American psychiatric association; 2013.

12. Gollan JK, Connolly M, Buchanan A, Hoxha D, Rosebrock L, Cacioppo J, et al. Neural substrates of negativity bias in women with and without major depression. Biological Psychology. 2015;109:184-91. https://doi.org/10.1016/j.biopsycho.2015.06.003 PMid:26073417

13. Kim EH, Crouch TB, Olatunji BO. Adaptation of behavioral activation in the treatment of chronic pain. Psychotherapy. 2017;54(3):237-244. https://doi.org/10.1037/pst0000112 PMid:28661164

14. Salkovskis PM, Jones DR, Clark DM. Respiratory Control in the Treatment of Panic Attacks: Replication and Extension with Concurrent Measurement of Behaviour and pCO2. The British Journal of Psychiatry. 1986 May;148(5):526-32. https://doi.org/10.1192/bjp.148.5.526 PMid:3096411

15. Letzring TD, Rone CC, Colman DE. Implications of fear of negative evaluation, state anxiety, and implied level of target-dominance on perceptions of personality traits. The Journal of Social Psychology. 2016;156(6):581-93. https://doi.org/10.1080/00224545.2016.1140117 PMid:26757355

16. Robichaud M, Dugas MJ. Cognitive-behavioral treatment for generalized anxiety disorder: From science to practice. Routledge; 2012. https://doi.org/10.4324/9780203891964

17. Chung H, Gale J. Family functioning and self-differentiation: A cross-cultural examination. Contemporary Family Therapy. 2009;31:19-33. https://doi.org/10.1007/s10591-008-9080-4

18. van Kessel K, Moss-Morris R, Willoughby E, Chalder T, Johnson MH, Robinson E. A randomized controlled trial of cognitive behavior therapy for multiple sclerosis fatigue. Psychosomatic medicine. 2008;70(2):205-13. https://doi.org/10.1097/PSY.0b013e3181643065 PMid:18256342

19. Koerner N, Dugas MJ. A cognitive model of generalized anxiety disorder: The role of intolerance of uncertainty. Worry and its psychological disorders: Theory, assessment and treatment; 2006. https://doi.org/10.1002/9780470713143.ch12

20. Meeten F, Dash SR, Scarlet ALS, Davey GCL. Investigating the effect of uncertainty on catastrophic worry and meed. Journal of Behavior Research and Therapy. 2012;50(11:690- 698. https://doi.org/10.1016/j.brat.2012.08.003 PMid:22982084

21. Rogers P, Qualter P, Phelps G, Gardner K. Belief in the paranormal, coping and emotional intelligence. Personality and individual differences. 2012;41(6):1089-105. https://doi.org/10.1016/j.paid.2006.04.014

22. Wells A, Matthews G. Attention and emotion (Classic edition): A clinical perspective. New York: Psychology Press;1994.

23. Wells A. Emotional disorders and metacognition: Innovative cognitive therapy. John Wiley & Sons; 2005.

24. Wells A. Cognition about cognition: Metacognitive therapy and change in generalized anxiety disorder and social phobia. Cognitive and Behavioral Practice. 2007;14(1):18-25. https://doi.org/10.1016/j.cbpra.2006.01.005

25. Wells A, Carter K. Further tests of a cognitive model of generalized anxiety disorder: Metacognitions and worry in GAD, panic disorder, social phobia, depression, and nonpatients. Behavior Therapy. 2001;32(1):85-102. https://doi.org/10.1016/S0005-7894(01)80045-9

26. Southam-Gerow M, Chorpita BF. Fears and anxieties. Assessment of child disorders; 2007.

27. Taba'e Emami SH, Nouri A, Malekpour M, Abedi A. The effectiveness of cognitive-behavioral training of mothers in changing maternal behavior and insecure attachment of the child. Journal of Clinical Psychology. 2011;3(3):7-16.

28. Walsh SP, White KM. Me, my mobile, and I: The role of self‐and prototypical identity influences in the prediction of mobile phone behavior. Journal of Applied Social Psychology. 2007;37(10):2405-34. https://doi.org/10.1111/j.1559-1816.2007.00264.x

29. Weisz JR, Chorpita BF, Kendall PC. Mod squad" for youth psychotherapy. Child and adolescent therapy: Cognitive-behavioral procedures; 2011.

30. Bodden DH, Bögels SM, Nauta MH, De Haan E, Ringrose J, Appelboom C, et al. Child versus family cognitive-behavioral therapy in clinically anxious youth: An efficacy and partial effectiveness study. Journal of the American Academy of Child & Adolescent Psychiatry. 2008;47(12):1384-94. https://doi.org/10.1097/CHI.0b013e318189148e PMid:18981932

31. Mousavi SA. Effective Cognitive Behavior Therapy for Depression Women in Boushehr City, Iran; 2010.

32. Ben-Porath DD. Dialectical behavior therapy applied to parent skills training: Adjunctive treatment for parents with difficulties in affect regulation. Cognitive and Behavioral Practice. 2010 Nov 1;17(4):458-65. https://doi.org/10.1016/j.cbpra.2009.07.005

33. Silverman SK, Davis HA. Teacher Efficacy. Psychology of Classroom Learning: An Encyclopedia . New York: Macmillan Reference; 2009.

34. Silvia PJ, Beaty RE, Nusbaum EC. Verbal fluency and creativity: General and specific contributions of broad retrieval

ability (Gr) factors to divergent thinking. Intelligence. 2013;41(5):328-40. https://doi.org/10.1016/j.intell.2013.05.004

35. Victor AM, Bernat DH, Bernstein GA, Layne AE. Effects of parent and family characteristics on treatment outcome of anxious children. Journal of anxiety disorders. 2007;21(6):835-48. https://doi.org/10.1016/j.janxdis.2006.11.005 PMid:17161582 PMCid:PMC2442036

36. Neville HA, Lilly RL, Duran G, Lee RM, Browne L. Construction and initial validation of the color-blind racial attitudes scale (CoBRAS). Journal of counseling psychology. 2000;47(1):59. https://doi.org/10.1037/0022-0167.47.1.59

37. Aqshari A, Amiri SH, Neshat Doust HT, Rezaei F. Comparing the effectiveness of emotion-focused cognitive-behavioral group therapy (ECBT) and cognitive-behavioral group therapy (CBT) in children with social anxiety disorder. Urmia Medical Journal. 2015;26(123):194-204.

38. Spiel Berger, C.D., Von der Embse N, Barterian J, Segool N. Test anxiety interventions for children and adolescents: A systematic review of treatment studies from 2000-2010. Psychology in the Schools. 2013;50(1):57-71. https://doi.org/10.1002/pits.21660

39. Gratz KL, Weiss NH, Tull MT. Examining emotion regulation as an outcome, mechanism, or target of psychological treatments. Current opinion in psychology. 2015;3:85-90. https://doi.org/10.1016/j.copsyc.2015.02.010 PMid:25859561 PMCid:PMC4386282

40. Ordaz SJ, Fritz BL, Forbes EE, Luna B. The influence of pubertal maturation on antisaccade performance. Developmental science. 2018;21(3):e12568. https://doi.org/10.1111/desc.12568 PMid:28557196 PMCid:PMC5709236

41. Becker SP. External validity of children's self-reported sleep functioning: associations with academic, social, and behavioral adjustment. Sleep Medicine. 2014;15(9):1094-100. https://doi.org/10.1016/j.sleep.2014.06.001 PMid:25091534

42. Dhani P. Implications of Emotional Intelligence. Shroff Publishers & Distributors; 2017.

43. Kanuri N, Taylor CB, Cohen JM, Newman MG. Classification models for subthreshold generalized anxiety disorder in a college population: Implications for prevention. Journal of Anxiety Disorders. 2015;34:43-52. https://doi.org/10.1016/j.janxdis.2015.05.011 PMid:26119139 PMCid:PMC6707508

44. Chorpita BF, Taylor AA, Francis SE, Moffitt C, Austin AA. Efficacy of modular cognitive behavior therapy for childhood anxiety disorders. Behavior Therapy. 2004;35(2):263-87. https://doi.org/10.1016/S0005-7894(04)80039-X

45. Eisen AR, Silverman WK. Prescriptive treatment for generalized anxiety disorder in children. Behavior Therapy. 1998;29(1):105-21. https://doi.org/10.1016/S0005-7894(98)80034-8

46. Song MF, Hu LL, Liu WJ, Liu Y, Tao XY, Wang TT, et al. Modified suanzaorentang had the treatment effect for generalized anxiety disorder for the first 4 weeks of paroxetine medication: a pragmatic randomized controlled study. Evidence-Based Complementary and Alternative Medicine. 2017;2017. https://doi.org/10.1155/2017/8391637 PMid:28553362 PMCid:PMC5434311

47. Izadpanah Kakhak MR, Samari AA, Toozandehjani H. The Relationship between Positive Emotional Styles with Life Expectancy and Mediation of Quality of Life in Older Men. Iranian journal of educational sociology. 2019;2(3):167-74. https://doi.org/10.29252/ijes.2.3.167

48. Ramezani M. The effectiveness of modular cognitive-behavioral therapy in the symptoms of generalized anxiety disorder and intolerance of uncertainty among female students studying at Islamic Azad University of Mashhad. [Master's Thesis]. Azad University, Neyshabur Branch; 2018.

49. Doustkam M. Efficacy of modular cognitive-behavioral therapy on facial expression bias and fear of negative evaluation in Paranoid students. Psychological Achievements. 2021;25:91-110.

50. Toozandehjani H, Abhar Zanjani F. The effectiveness of modular cognitive-behavioral therapy in clinical syndrome and self-control of psychosomatic patients with skin allergies. New Advances in Psychology Educational Sciences and Education. 2019;17:119-126.

51. Spence SH, Rapee RM. The etiology of social anxiety disorder: An evidence-based model. Behaviour Research and Therapy. 2016;86:50-67. https://doi.org/10.1016/j.brat.2016.06.007 PMid:27406470

52. Sadock BJ. Kaplan & Sadock's synopsis of psychiatry: behavioral sciences/clinical psychiatry. Philadelphia, PA: Wolters Kluwer; 2015.

53. Irons C, Lad S. Using compassion focused therapy to work with shame and self-criticism in complex trauma. Australian Clinical Psychologist. 2017;3(1):1743.

54. Abolqasemi SH. Comparison of cognitive-behavioral therapy, pharmacotherapy, combination method and placebo in the treatment of generalized anxiety. [PhD Thesis]. Tehran: Islamic Azad University, Science and Research Branch; 2003.

55. Mehryar H. Psycho social factors in patients with duo denal ulcer. Iranian Journal of psychiatry and clinical psychology.1999;5(2):79-92.

56. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of internal medicine. 2006;166(10):1092-7. https://doi.org/10.1001/archinte.166.10.1092 PMid:16717171

57. Abbasi M, Bagian Koleh Marz MJ, Qasemi Jovine R, Dargahi SH. Comparison of hypochondriasis‎, social anxiety and cognitive avoidance in mothers of students with and

without specific learning disabilities. Exceptional education.2015;15(6):(134):6-14.

58. Wells A. The metacognitive model of GAD: Assessment of meta-worry and relationship with DSM-IV generalized anxiety disorder. Cognitive therapy and research. 2005;29:107-21. https://doi.org/10.1007/s10608-005-1652-0

59. Spada MM, Wells A. Metacognitions, emotion and alcohol use. Clinical Psychology & Psychotherapy. 2005 Mar;12(2):150-5. https://doi.org/10.1002/cpp.431

60. Taherifar Z, Fati L, Gharaei B. A model for predicting social phobia in university students based on cognitive-behavioral components. Iranian Journal of Psychiatry and Clinical Psychology. 2010;16(1):34-45

61. Freeston MH, Rheaume J, Letart H, Dugase MJ, Ladouceur R. Why do people worry? Personality and Individual Difference. 1994;17:791-802 https://doi.org/10.1016/0191-8869(94)90048-5

62. Fahimi S, Alilou M, Rahim Khanli M, Fakhari A, Pour Sharifi H. Intolerance of uncertainty as a predisposing feature of generalized anxiety, obsessive-compulsive and panic disorders. Journal of Behavioral Sciences Research. 2015;11(4):233-244.

63. Shiran Khorasani Z. Comparing the effectiveness of training modular cognitive-behavioral skills and the quality of life skills in intolerance of uncertainty, generalized anxiety disorder symptoms and motivational beliefs of students with test anxiety. [PhD Thesis]. Khorasan Razavi, Islamic Azad University, Neyshabur Branch; 2019.

64. Arkes J. The temporal effects of divorces and separations on children's academic achievement and problem behavior. Journal of divorce & remarriage. 2015;56(1):25-42. https://doi.org/10.1080/10502556.2014.972204 PMid:25580066 PMCid:PMC4286357

65. Mineka S, Zinbarg R. A contemporary learning theory perspective on the etiology of anxiety disorders: it's not what you thought it was. American psychologist. 2006;61(1):10. https://doi.org/10.1037/0003-066X.61.1.10 PMid:16435973

66. Reuther ET, Davis III TE, Moree BN, Matson JL. Treating selective mutism using modular CBT for child anxiety: A case study. Journal of Clinical Child & Adolescent Psychology. 2011;40(1):156-63. https://doi.org/10.1080/15374416.2011.533415 PMid:21229452

67. Razurel C, Kaiser B, Antonietti JP, Epiney M, Sellenet C. Relationship between perceived perinatal stress and depressive symptoms, anxiety, and parental self-efficacy in primiparous mothers and the role of social support. Women & Health. 2017;57(2):154-72. https://doi.org/10.1080/03630242.2016.1157125 PMid:26909523

68. Farchione TJ, Boswell JF, Wilner JG. Behavioral activation strategies for major depression in transdiagnostic cognitive-behavioral therapy: An evidence-based case study. Psychotherapy. 2017;54(3):225. https://doi.org/10.1037/pst0000121 PMid:28922002

Razavi International Journal of Medicine

Article View: 478
PDF Download: 354

Comparing the Effectiveness of Modular Cognitive-‎Behavioral Therapy, ‎‏‏Pharmacotherapy (Paroxetine), and Their Combination in Intolerance of Uncertainty and Meta-Worry‎ among Female University Students with Generalized Anxiety Disorder

References

Volume 11, Issue 1
February 2023
Pages 46-56

Files

Share

How to cite

Statistics

Comparing the Effectiveness of Modular Cognitive-‎Behavioral Therapy, ‎‏‏Pharmacotherapy (Paroxetine), and Their Combination in Intolerance of Uncertainty and Meta-Worry‎ among Female University Students with Generalized Anxiety Disorder

References

Volume 11, Issue 1February 2023Pages 46-56

Files

Share

How to cite

Statistics

Volume 11, Issue 1
February 2023
Pages 46-56