A comparison of two ultra-brief treatments for generalized anxiety disorder symptoms

Abstract

Worrying is a common experience that many people engage in occasionally without issue. However, some individuals are chronic worriers, and some develop generalized anxiety disorder (GAD) due to excessive worry (American Psychiatric Association, 2013). People with GAD experience significant distress and physiological issues, leading to high health care service utilization (Bélanger et al., 2005). Two models of GAD, the Cognitive Avoidance Model (Sibrava & Borkovec, 2006) and the Metacognitive Model (Wells, 2009), have extensive basic and applied support. In addition, a small body of research has shown that an ultra-brief treatment can decrease GAD symptoms and worry severity (Borkovec et al., 1983; McGowan & Behar, 2013). Yet, this research has used short follow-ups, and the relationships between change in symptoms and cognitive factors have not been explored. The current study tested two ultra-brief treatments based on the two models of GAD. A total of 115 participants were assigned to receive one of the treatments, or to a control condition. Participants in the control condition were assigned to one of the treatments after four weeks. Treatments were completed in less than 20 minutes. Participants completed a diagnostic interview and self-report measures at baseline, four weeks, and four months post-treatment. Participants who received treatment had large decreases on measures of GAD symptoms, worry severity, and negative affect, as well as on measures of the proposed cognitive factors, with gains maintained at four month follow-up. While the treatments were superior to the control condition, no differences were found between treatments. Negative beliefs about worry and meta-worry were related to changes in GAD symptoms and worry severity, while cognitive avoidance was related to changes in worry severity. Overall, the results indicate that these ultra-brief treatments appear well suited for use in primary care, and the findings provide support for both the Metacognitive Model and Cognitive Avoidance Model.