An Internet-based Acceptance and Commitment Therapy intervention for older adults with anxiety complaints: study protocol for a cluster randomized controlled trial

Maartje Witlox, Vivivan Kraaij, Nadia Garnefski, Margot W M de Waal, Filip Smit, Erik Hoencamp, Jacobijn Gussekloo, Ernst T Bohlmeijer, Philip Spinhoven, Maartje Witlox, Vivivan Kraaij, Nadia Garnefski, Margot W M de Waal, Filip Smit, Erik Hoencamp, Jacobijn Gussekloo, Ernst T Bohlmeijer, Philip Spinhoven

Abstract

Background: Anxiety is among the most prevalent and disabling mental health problems in older adults. Few older adults with mild to moderately severe anxiety symptoms receive adequate interventions, putting them at risk for developing anxiety disorders, depression, and various somatic problems. Effective, low-threshold interventions should be developed. Blended care, in which a web-based intervention is combined with a limited amount of face-to-face contacts with a mental healthcare counselor at the general practice, is a promising option. The online self-help intervention "Living to the Full"-an Acceptance and Commitment Therapy (ACT) intervention-has been proven to reduce depression and anxiety in several patient groups, but has not yet been investigated in older adults. The aim of this study is to evaluate the (cost-)effectiveness of a blended form of "Living to the Full" in reducing anxiety symptoms in adults aged 55 to 75 years. Furthermore, moderators and mediators of the treatment effect are investigated.

Methods/design: The (cost-)effectiveness of the ACT intervention will be investigated in a cluster single-blind randomized controlled trial (RCT). The blended intervention will be compared to treatment-as-usual. Thirty-six mental health counselors working at general practices in the Netherlands will be randomized to deliver blended care or treatment as usual. A total of 240 participants (aged 55-75 years) with mild to moderately severe anxiety complaints (defined as a total score of 5-15 on the GAD-7) will be recruited. There are four measurements consisting of online questionnaires (primary outcome: GAD-7) and a telephone interview: before the start of the intervention; directly following the intervention (14 weeks after baseline); and six and twelve months after baseline. Possible mediator variables will be assessed multiple times basis during the intervention.

Discussion: This RCT will evaluate the effectiveness of a blended ACT intervention for older adults with anxiety symptoms. If the intervention is shown to be effective, it will be implemented, thereby improving the accessibility and quality of preventive interventions for older adults with anxiety problems.

Trial registration: Netherlands Trial Register, NTR6270 . Registered on 21 March 2017.

Keywords: Acceptance and commitment therapy; Anxiety; Anxiety complaints; Blended care; Internet; Older adults; Randomized controlled trial; Subclinical anxiety.

Conflict of interest statement

Ethics approval and consent to participate

The study is approved by the medical ethical committee of the Leiden University Medical Center (LUMC; no. P16.248). According to the medical ethical committee, the study’s consent procedure is concordance with the Dutch legislation.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Diagram of patient flow through phases of the study

References

    1. Bryant C, Jackson H, Ames D. The prevalence of anxiety in older adults: methodological issues and a review of the literature. J Affect Disord. 2008;109(3):233–250. doi: 10.1016/j.jad.2007.11.008.
    1. Wolitzky-Taylor KB, Castriotta N, Lenze EJ, Ma S, Craske MG. Anxiety disorders in older adults: a comprehensive review. Depress Anxiety. 2010;27(2):190–211. doi: 10.1002/da.20653.
    1. Diefenbach GJ, Hopko DR, Feigon S, Stanley MA, Novy DM, Beck JG, et al. ‘Minor GAD’: characteristics of subsyndromal GAD in older adults. Behav Res Ther. 2003;41:481–487. doi: 10.1016/S0005-7967(02)00130-4.
    1. Lenze EJ, Wetherell JL. Bringing the bedside to the bench, and then to the community: a prospectus for intervention research in late-life anxiety disorders. Int J Geriatr Psychiatry. 2009;24(1):1–14. doi: 10.1002/gps.2074.
    1. Wetherell JL, Kaplan RM, Kallenberg G, Dresselhaus TR, Sieber WJ, Lang AJ. Mental health treatment preferences of older and younger primary care patients. Int J Psychiatry Med. 2004;34(3):219–233. doi: 10.2190/QA7Y-TX1Y-WM45-KGV7.
    1. Voshaar RC. Lack of interventions for anxiety in older people. Br J Psychiatry. 2013;203(1):8–9. doi: 10.1192/bjp.bp.113.127639.
    1. De Beurs E, Beekman AT, van Balkom AJ, Deeg DJ, van Dyck R, van Tilburg W. Consequences of anxiety in older persons: its effect on disability, well-being and use of health services. Psychol Med. 1999;29(3):583–593. doi: 10.1017/S0033291799008351.
    1. Diefenbach GJ, Tolin DF, Gilliam CM. Impairments in life quality among clients in geriatric home care: associations with depressive and anxiety symptoms. Int J Geriatr Psychiatry. 2012;27(8):828–835. doi: 10.1002/gps.2791.
    1. Mehta KM, Simonsick EM, Penninx BW, Schulz R, Rubin SM, Satterfield S, et al. Prevalence and correlates of anxiety symptoms in well-functioning older adults: findings from the health aging and body composition study. J Am Geriatr Soc. 2003;51(4):499–504. doi: 10.1046/j.1532-5415.2003.51158.x.
    1. Gallacher J, Bayer A, Fish M, Pickering J, Pedro S, Dunstan, et al. Does anxiety affect risk of dementia? Findings from the Caerphilly prospective study. Psychosom Med. 2009;71:659–666. doi: 10.1097/PSY.0b013e3181a6177c.
    1. Yochim BP, Mueller AE, Segal DL. Late life anxiety is associated with decreased memory and executive functioning in community dwelling older adults. J Anxiety Disord. 2013;27:567–575. doi: 10.1016/j.janxdis.2012.10.010.
    1. Brenes GA, Guralnik JM, Williamson JD, Fried LP, Simpson CS, Simonsick EM, et al. The influence of anxiety on the progression of disability. J Am Geriatr Soc. 2005;53(1):34–39. doi: 10.1111/j.1532-5415.2005.53007.x.
    1. Lambiase MJM, Kubzansky LD, Thurston RC. Prospective study of anxiety and incident stroke. Stroke. 2014;45(2):438–443. doi: 10.1161/STROKEAHA.113.003741.
    1. Kawachi I, Sparrow D, Vokonas PS, Weiss ST. Symptoms of anxiety and risk of coronary heart disease: the normative aging study. Circulation. 1994;90:2225–2229. doi: 10.1161/01.CIR.90.5.2225.
    1. Smit F, Comijs H, Schoevers R, Cuijpers P, Deeg D, Beekman A. Target groups for ` the prevention of late-life anxiety. Br J Psychiatry. 2007;190:428–434. doi: 10.1192/bjp.bp.106.023127.
    1. Veer-Tazelaar PJ, Marwijk HWJ, Van Oppen P, Van Hout HPJ, Van der Horst HE, Cuijpers P, et al. Stepped-care prevention of anxiety and depression in late life. Arch Gen Psychiatry. 2009;66(3):297–304. doi: 10.1001/archgenpsychiatry.2008.555.
    1. Andrews G, Cuijpers P, Craske MG, McEvoy P, Titov N. Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS One. 2010;5(10):e13196. doi: 10.1371/journal.pone.0013196.
    1. Christensen H, Batterham P, Calear A. Online interventions for anxiety disorders. Curr Opin Psychiatry. 2014;27(1):7–13. doi: 10.1097/YCO.0000000000000019.
    1. Cuijpers P, Donker T, van Straten A, Li J, Andersson G. Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychol Med. 2010;40(12):1943–1957. doi: 10.1017/S0033291710000772.
    1. Griffiths KM, Farrer L, Christensen HR. The efficacy of internet interventions for depression and anxiety disorders: a review of randomised controlled trials. Med J Australia. 2010;192(11):S4–S11.
    1. Haug T, Nordgreen T, Ost LG, Havik OE. Self-help treatment of anxiety disorders: a meta-analysis and meta-regression of effects and potential moderators. Clin Psychol Rev. 2012;32(5):425–445. doi: 10.1016/j.cpr.2012.04.002.
    1. Lewis C, Pearce J, Bisson JI. Efficacy, cost-effectiveness and acceptability of self-help interventions for anxiety disorders: systematic review. Br J Psychiatry. 2012;200(1):15–21. doi: 10.1192/bjp.bp.110.084756.
    1. Mayo-Wilson E, Montgomery P. Media-delivered cognitive behavioural therapy and behavioural therapy (self-help) for anxiety disorders in adults. Cochrane Database Syst Rev. 2013;9:CD005330.
    1. Reger MA, Gahm GA. A meta-analysis of the effects of internet- and computer-based cognitive-behavioral treatments for anxiety. J Clin Psychol. 2009;65(1):53–75. doi: 10.1002/jclp.20536.
    1. Spek V, Cuijpers P, Nyklicek I, Riper H, Keyzer J, Pop V. Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med. 2007;37:319–328. doi: 10.1017/S0033291706008944.
    1. Dear BF, Zou JB, Ali S, Lorian CN, Johnston L, Sheehan J, et al. Clinical and cost-effectiveness of therapist-guided internet-delivered cognitive behavior therapy for older adults with symptoms of anxiety: a randomized controlled trial. Behav Ther. 2015;46(2):206–217. doi: 10.1016/j.beth.2014.09.007.
    1. Ayers CR, Sorrell JT, Thorp SR, Wetherell JL. Evidence-based psychological treatments for late-life anxiety. Psychol Aging. 2007;22(1):8–17. doi: 10.1037/0882-7974.22.1.8.
    1. Gould RL, Coulson MC, Howard RJ. Efficacy of cognitive behavioral therapy for anxiety disorders in older people: a meta-analysis and meta-regression of randomized controlled trials. J Am Geriatr Soc. 2012;60(2):218–229. doi: 10.1111/j.1532-5415.2011.03824.x.
    1. Hendriks GJ, Oude Voshaar RC, Keijsers GPJ, Hoogduin CAL, van Balkom AJLM. Cognitive-behavioural therapy for late-life anxiety disorders: a systematic review and meta-analysis. Acta Psychiat Scand. 2008;117(6):403–411. doi: 10.1111/j.1600-0447.2008.01190.x.
    1. Pinquart M, Duberstein PR. Treatment of anxiety disorders in older adults: a meta- analytic comparison of behavioral and pharmacological interventions. Am J Geriatric Psychiatry. 2007;15(8):639–651. doi: 10.1097/JGP.0b013e31806841c8.
    1. Thorp SR, Ayers CR, Nuevo R, Stoddard JA, Sorrell JT, Wetherell JL. Meta-analysis comparing different behavioral treatments for late-life anxiety. Am J Geriatric Psychiatry. 2009;17(2):105–115. doi: 10.1097/JGP.0b013e31818b3f7e.
    1. Wetherell JL, Petkus AJ, Thorp SR, Stein MB, Chavira DA, Campbell-Sills L, et al. Age differences in treatment response to a collaborative care intervention for anxiety disorders. Br J Psychiatry. 2013;203(1):65–72. doi: 10.1192/bjp.bp.112.118547.
    1. Hayes Steven C. Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy. 2004;35(4):639–665. doi: 10.1016/S0005-7894(04)80013-3.
    1. Petkus AJ, Wetherell JL. Acceptance and commitment therapy with older adults: rationale and considerations. Cogn Behav Pract. 2013;20(1):47–56. doi: 10.1016/j.cbpra.2011.07.004.
    1. Wetherell JL, Ayers CR, Stoddard JA, Ruberg J, Sorrell JT, Liu L, et al. Acceptance and commitment therapy for generalized anxiety disorder in older adults: a preliminary report. Behav Ther. 2011;42(1):127–134. doi: 10.1016/j.beth.2010.07.002.
    1. Swain J, Hancock K, Hainsworth C, Bowman J. Acceptance and commitment therapy in the treatment of anxiety: a systematic review. Clin Psychol Rev. 2013;33(8):965–978. doi: 10.1016/j.cpr.2013.07.002.
    1. A-Tjak JG, Davis ML, Morina N, Powers MB, Smits JA, Emmelkamp PM. A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychother Psychosom. 2015;84(1):30–36. doi: 10.1159/000365764.
    1. Öst Lars-Göran. The efficacy of Acceptance and Commitment Therapy: An updated systematic review and meta-analysis. Behaviour Research and Therapy. 2014;61:105–121. doi: 10.1016/j.brat.2014.07.018.
    1. Powers MB, Zum Vörde Sive Vörding MB, Emmelkamp PMG. Acceptance and commitment therapy: a Meta-analytic review. Psychother Psychosom. 2009;78:73–80. doi: 10.1159/000190790.
    1. Fledderus M, Bohlmeijer ET, Pieterse ME, Schreurs KM. Acceptance and commitment therapy as guided self-help for psychological distress and positive mental health: a randomized controlled trial. Psychol Med. 2012;42(3):485–495. doi: 10.1017/S0033291711001206.
    1. Pots WTM, Fledderus M, Meulenbeek PAM, ten Klooster PM, Schreurs KMG, Bohlmeijer ET. Acceptance and commitment therapy as a web-based intervention for depressive symptomatology: randomised controlled trial. Brit J Psychiat. 2016;208(1):69–77. doi: 10.1192/bjp.bp.114.146068.
    1. Butler J, Ciarrochi J. Psychological acceptance and quality of life in the elderly. Qual Life Res. 2007;16:607–615. doi: 10.1007/s11136-006-9149-1.
    1. Shallcross AJ, Ford BQ, Floerke VA, Mauss IB. Getting better with age: the relationship between age, acceptance, and negative affect. J Pers Soc Psychol. 2013;104(4):734–749. doi: 10.1037/a0031180.
    1. Smith A. Clinical uses of mindfulness training for older people. Behav Cogn Psychother. 2004;32:423–430. doi: 10.1017/S1352465804001602.
    1. Beekman AT, de Beurs E, van Balkom AJ, Deeg DJ, van Dyck R, van Tilburg W. Anxiety and depression in later life: co-occurrence and communality of risk factors. Am J Psychiatry. 2000;157(1):89–95. doi: 10.1176/ajp.157.1.89.
    1. Schuurmans J, Comijs H, Emmelkamp PM, Weijnen IJ, van den Hout M, van Dyck R. Long-term effectiveness and prediction of treatment outcome in cognitive behavioral therapy and sertraline for late-life anxiety disorders. Int Psychogeriatrics. 2009;21(6):1148–1159. doi: 10.1017/S1041610209990536.
    1. Campbell MK, Piaggo G, Elbourne DR, Altman DG. Consort 2010 statement: extension to cluster randomised trials. BMJ. 2012;345:e5661. doi: 10.1136/bmj.e5661.
    1. Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–1097. doi: 10.1001/archinte.166.10.1092.
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613. doi: 10.1046/j.1525-1497.2001.016009606.x.
    1. Leon AC, Olfson M, Portera L, Farber L, Sheehan DV. Assessing psychiatric impairment in primary care with the Sheehan disability scale. Int J Psychiatry Med. 1997;27(2):93–105. doi: 10.2190/T8EM-C8YH-373N-1UWD.
    1. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The mini-international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(Suppl 20):22–33.
    1. Van der Weele GM, de Waal MWM, van den Hout WB, de Craen HJM, Spinhoven P, Stijnen T, et al. Effects of a stepped-care intervention programme among older subjects who screened positive for depressive symptoms in general practice: the PROMODE randomised controlled trial. Age Aging. 2012;41(4):482–488. doi: 10.1093/ageing/afs027.
    1. Eldridge SM, Ashby D, Kerry S. Sample size for cluster randomized trials:effect of coefficient of variation of cluster size and analysis method. Int J Epidemiol. 2006;35:1292–1300. doi: 10.1093/ije/dyl129.
    1. Bohlmeijer ET, Fledderus M, Rokx TAJJ, Pieterse ME. Efficacy of an early intervention based on acceptance and commitment therapy for adults with depressive symptomatology: evaluation in a randomized controlled trial. Behav Res Ther. 2011;49(1):62–67. doi: 10.1016/j.brat.2010.10.003.
    1. Kroenke K, Spitzer RL, Williams JBW, Monahan PO, Löwe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146(5):317–325. doi: 10.7326/0003-4819-146-5-200703060-00004.
    1. Löwe B, Kroenke K, Grafe K. Detecting and monitoring depression with a two-item questionnaire (PHQ–2) J Psychosom Res. 2005;58:163–171. doi: 10.1016/j.jpsychores.2004.09.006.
    1. Kroenke K, Spitzer RL, Williams JB, Lowe B. An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics. 2009;50(6):613–621.
    1. Karyotaki E, Kleiboer A, Smit F, Turner DT, Pastor AM, Andersson G, et al. Predictors of treatment dropout in self-guided web-based interventions for depression: an 'individual patient data' meta-analysis. Psychol Med. 2015;45(13):2717–2726. doi: 10.1017/S0033291715000665.
    1. Bohlmeijer ET, Hulsbergen M. Voluit leven. Mindfulness of de kunst van het aanvaarden. Amsterdam: Boom; 2008.
    1. Bohlmeijer ET, Hulsbergen M. A beginners’ guide to mindfulness, live in the moment. Oxford: McGraw-Hill; 2015.
    1. Kelders S, Bohlmeijer ET, Pots WT, van Gemert-Pijnen JE. Comparing human and automated support for depression: fractional factorial randomized controlled trial. Behav Res Ther. 2015;72:72–80. doi: 10.1016/j.brat.2015.06.014.
    1. Kroenke K, Spitzer RL, Williams JB, Lowe B. The patient health questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. Gen Hosp Psychiatry. 2010;32(4):345–359. doi: 10.1016/j.genhosppsych.2010.03.006.
    1. Donker T, Van Straten A, Marks I, Cuijpers P. Quick and easy self-rating of generalized anxiety disorder: validity of the Dutch web-based GAD-7, GAD-2 and GAD-SI. Psychiatry Res. 2011;188:58–64. doi: 10.1016/j.psychres.2011.01.016.
    1. Löwe B, Wahl I, Rose M, Spitzer C, Glasmer H, Wingenfeld K, et al. A 4-item measure of depression and anxiety: validation and standardization of the patient health Questionnaire-4 (PHQ-4) in the general population. J Affect Disord. 2010;122:86–95. doi: 10.1016/j.jad.2009.06.019.
    1. Löwe B, Unutzer J, Callahan CM, Perkins AJ, Kroenke K. Monitoring depression treatment outcomes with the patient health Questionnaire-9. Med Care. 2004;42:1194–1201. doi: 10.1097/00005650-200412000-00006.
    1. Garnefski N, Kraaij V, Spinhoven P. CERQ: Manual for the use of the Cognitive Emotion Regulation Questionnaire. Leiderdorp: Datec; 2002.
    1. Garnefski N, Kraaij V, Spinhoven P. Negative life events, cognitive emotion regulation and emotional problems. Pers Indiv Differ. 2001;30:1311–1327. doi: 10.1016/S0191-8869(00)00113-6.
    1. Garnefski N, Kraaij V. The cognitive emotion regulation questionnaire. Eur J Psychol Assessment. 2007;23:141–149. doi: 10.1027/1015-5759.23.3.141.
    1. Omran MP. Relationships between cognitive emotion regulation strategies with depression and anxiety. O J Psych. 2011;1:106–109.
    1. Kraaij V, Pruymboom E, Garnefski N. Cognitive coping and depressive symptoms in the elderly: a longitudinal study. Aging Ment Health. 2002;6(3):275–281. doi: 10.1080/13607860220142387.
    1. Jacobs N, Kleen M, de Groot F, A-Tjak J. De Nederlandse versie van de acceptance and action questionnaire-II (AAQ-II) Gedragstherapie. 2008;41:349–361.
    1. Bond FW, Hayes SC, Baer RA, Carpenter KM, Guenole N, Orcutt HK, et al. Preliminary psychometric properties of the acceptance and action questionnaire-II: a revised measure of psychological inflexibility and experiential avoidance. Behav Ther. 2011;42(4):676–688. doi: 10.1016/j.beth.2011.03.007.
    1. Fledderus M, Voshaar MAHO, Ten Klooster PM, Bohlmeijer ET. Further evaluation of the psychometric properties of the acceptance and action questionnaire–II. Psychol Assess. 2012;24:925–936. doi: 10.1037/a0028200.
    1. Lamers SM, Westerhof GJ, Bohlmeijer ET, ten Klooster PM, Keyes CL. Evaluating the psychometric properties of the mental health continuum-short form (MHC-SF) J Clin Psychol. 2011;67(1):99–110. doi: 10.1002/jclp.20741.
    1. Bohlmeijer ET, Ten Klooster PM, Fledderus M, Veehof MM, Baer R. Psychometric properties of the five facet mindfulness questionnaire in depressed adults and development of a short form. Asmnt. 2011;18(3):308–320.
    1. Kabat-Zinn J. Full catastrophe living: Using the wisdom of your body and mind to face stress, pain and illness. New York: Hyperion; 2008.
    1. Herdman M, Gudex C, Lloyd A, Janssen MF, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L) Qual Life Res. 2011;20:1727–1736. doi: 10.1007/s11136-011-9903-x.
    1. Versteegh M, Vermeulen KM, Evers SMAA, De Wit GA, Prenger R, Stolk EA. Dutch tariff for the five-level version of EQ-5D. Value Health. 2016;19:343–352. doi: 10.1016/j.jval.2016.01.003.
    1. EuroQOL Group A new facility for measurement of health-related quality of life. Health Policy. 1990;16:199–208. doi: 10.1016/0168-8510(90)90421-9.
    1. Janssen MF, Birni E, Haagsma JA, Bonsel GJ. Comparing the standard EQ–5D three level system with a five level version. Value Health. 2008;11:275–284. doi: 10.1111/j.1524-4733.2007.00230.x.
    1. Pickard AS, De Leon MCBBA, Kohlmann T, Cella D, Rosenbloom S. Psychometric comparison of the standard EQ-5D to a 5 level version in Cancer patients. Med Care. 2007;45(3):259–263. doi: 10.1097/01.mlr.0000254515.63841.81.
    1. Hakkaart-van Roijen L, Van Straten A, Donker M, Tiemens B. Manual Trimbos/Imta Questionnaire for Costs Associated with Psychiatric Illness (TIC-P, in Dutch) Rotterdam: Erasmus University; 2002.
    1. Bouwmans C, De Jong K, Timman, Zijlstra-Vlasveld M, Van der Feltz-Cornelis C, Swan Tan S, et al. Feasibility, reliability and validity of a questionnaire on healthcare consumption and productivity loss in patients with a psychiatric disorder (TiC-P) BMC Health Serv Res. 2013;13:1–9. doi: 10.1186/1472-6963-13-217.
    1. De Brey H. A cross-national validation of the client satisfaction questionnaire: the Dutch experience. Eval Program Plann. 1983;6:395–400. doi: 10.1016/0149-7189(83)90018-6.
    1. De Wilde EF, Hendriks VM. The client satisfaction questionnaire: psychometric properties in a Dutch addict population. Eur Addict Res. 2005;11(4):157–162. doi: 10.1159/000086396.
    1. Bovier PA, Chamot E, Perneger TV. Brief scales for measurement of functional social support and psychological resources in French-speaking adults. Sozial- und Praventivmedizin. 2002;47(5):298–306. doi: 10.1007/PL00012640.
    1. Borkovec TD, Nau SD. Credibility of analogue therapy rationales. J Behav Ther Exp Psy. 1972;3:257–260. doi: 10.1016/0005-7916(72)90045-6.
    1. Addis ME, Hagtis C, Krasnow AD, Jacob K, Boume L, Mansfield A. Effectiveness of cognitive-Behavioural treatment for panic disorder versus treatment as usual in a managed care setting. J Consult Clin Psychol. 2004;72(4):625–635. doi: 10.1037/0022-006X.72.4.625.
    1. Devilly GJ, Borkovec TD. Psychometric properties of the credibility expectancy questionnaire. J Behav Ther Exp Psy. 2000;31:73–86. doi: 10.1016/S0005-7916(00)00012-4.
    1. Hüpscher LJ. Herstelverwachtingen van cliënten met een ambulante behandeling. Amsterdam: Department of Psychology and Pedagogy, VU University Amsterdam; 2007.
    1. Webb TL, Miles E, Sheeran P. Dealing with feeling: a meta-analysis of the effectiveness of strategies derived from the process model of emotion regulation. Psychol Bull. 2012;138(4):775–808. doi: 10.1037/a0027600.
    1. Aldao A, Nolen-Hoeksema S, Schweizer S. Emotion-regulation strategies across psychopathology: a meta-analytic review. Clin Psychol Rev. 2010;30(2):217–237. doi: 10.1016/j.cpr.2009.11.004.
    1. Borkovec TD, Newman MG, Pincus AL, Lytle R. A component analysis of cognitive behavioral therapy for generalized anxiety disorder and the ro1e of interpersona1 problems. J Consult Clin Psychol. 2002;70:288–298. doi: 10.1037/0022-006X.70.2.288.
    1. Ilardi S, Craighead WE. The role of nonspecific factors in cognitive-behavioral therapy for depression. Clin Psycho: Sci Pr. 1994;1:138–156.
    1. Lambert MJ, Goldstein MR. Implications for outcome research for psychotherapy integration. In: Norcross JC, editor. Handbook of psychotherapy integration. New York: Basic Books; 1992. pp. 94–129.
    1. Lambert MJ, Bergin AE. Garfie1d SL. Bergin and Garfield's handbook of psychotherapy and behaviour change. New York: John Wiley & Sons; 2004.
    1. Moradveisi L, Huibers MJ, Arntz A. The influence of patients’ attributions of the immediate effects of treatment of depression on long-term effectiveness of behavioural activation and antidepressant medication. Behav Res Ther. 2015;69:83–92. doi: 10.1016/j.brat.2015.04.007.
    1. Strunk DR, DeRubeis RJ, Chiu AW, Alvarez J. Patients’ competence in and performance of cognitive therapy skills: relation to the reduction of relapse risk following treatment for depression. J Consult Clin Psychol. 2007;75(4):523–530. doi: 10.1037/0022-006X.75.4.523.
    1. Johnson LD, Miller SD, Duncan BL. The session rating scale 3.0. Chicago: Author; 2000.
    1. Campbell A, Hemsley S. Outcome rating scale and session rating scale in psychological practice: clinical utility of ultra-brief measures. Clin Psychol. 2009;13(1):1–9. doi: 10.1080/13284200802676391.
    1. Duncan BL, Miller SD, Sparks JA, Claud DA, Reynolds LR, Brown J, et al. The session rating scale: preliminary psychometric properties of a “working” alliance measure. J Brief Therapy. 2003;3:3–12.
    1. Campbell MK, Grimshaw JM. Cluster randomised trials: time for improvement. BMJ. 1998;317:1171–1172. doi: 10.1136/bmj.317.7167.1171.
    1. Gunzler D, Chen T, Wu P, Zhang H. Introduction to mediation analysis with structural equation modeling. Shanghai Arch Psychiatry. 2013;25(6):390–394.
    1. Montfort A, Oud JHL, Satorra A. Longitudinal research with latent variables. London: Springer; 2010.
    1. Selig JP, Preacher KJ. Mediation models for longitudinal data in developmental research. Res Hum Dev. 2009;6:144–164. doi: 10.1080/15427600902911247.
    1. Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. Consolidated health economic evaluation reporting standards (CHEERS)- explanation and elaboration: a report of the ISPOR health economic evaluation publication guidelines good reporting practices task force. Value Health. 2013;16:231–250. doi: 10.1016/j.jval.2013.02.002.
    1. Kazdin AE. Mediators and mechanisms of change in psychotherapy research. Annu Rev Clin Psychol. 2007;3:1–27. doi: 10.1146/annurev.clinpsy.3.022806.091432.
    1. Marx MS, Cohen-Mansfield JC, Guralnik JM. Recruiting community-dwelling elderly at risk for physical disability into exercise research. J Aging Phys Act. 2003;11:229–241. doi: 10.1123/japa.11.2.229.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi