A pragmatic randomized controlled trial of group transdiagnostic cognitive-behaviour therapy for anxiety disorders in primary care: study protocol

Pasquale Roberge, Martin D Provencher, Patrick Gosselin, Helen-Maria Vasiliadis, Isabelle Gaboury, Annie Benoit, Martin M Antony, Nils Chaillet, Janie Houle, Catherine Hudon, Peter J Norton, Pasquale Roberge, Martin D Provencher, Patrick Gosselin, Helen-Maria Vasiliadis, Isabelle Gaboury, Annie Benoit, Martin M Antony, Nils Chaillet, Janie Houle, Catherine Hudon, Peter J Norton

Abstract

Background: Anxiety disorders are the most common mental disorders in community settings, and they are associated with significant psychological distress, functional and social impairment. While cognitive behaviour therapy (CBT) is the most consistently efficacious psychological treatment for anxiety disorders, barriers preclude widespread implementation of CBT in primary care. Transdiagnostic group CBT (tCBT) focuses on cognitive and behavioural processes and intervention strategies common to different anxiety disorders, and could be a promising alternative to conventional CBT. This study aims to examine the effectiveness of a transdiagnostic group CBT for anxiety disorders program as a complement to treatment-as-usual (TAU) in primary mental health care.

Methods/design: The trial is a multicentre pragmatic randomized controlled trial with a pre-treatment, post-treatment, and follow-up at 4, 8 and 12-months design. Treatment and control groups. a) tCBT (12 weekly 2-h group sessions following a manualized treatment protocol); b) TAU for anxiety disorders. Inclusion criteria comprise meeting DSM-5 criteria for primary Panic Disorder, Agoraphobia, Social Anxiety Disorder and/or Generalized Anxiety Disorder. Patients are recruited in three regions in the province of Quebec, Canada. The primary outcome measures are the self-reported Beck Anxiety Inventory and the clinician-administered Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5); secondary outcome measures include treatment responder status based on the ADIS-5, and self-reported instruments for specific anxiety and depression symptoms, quality of life, functioning, and service utilisation.

Statistical analysis: Intention-to-treat analysis. A mixed effects regression model will be used to account for between- and within-subject variations in the analysis of the longitudinal effects of the intervention.

Discussion: This rigorous evaluation of tCBT in the real world will provide invaluable information to decision makers, health care managers, clinicians and patients regarding the effectiveness of the intervention. Widespread implementation of tCBT protocols in primary care could lead to better effectiveness, efficiency, access and equity for the large number of patients suffering from anxiety disorders that are currently not obtaining evidence-based psychotherapy.

Trial registration: ClinicalTrials.gov: NCT02811458 .

Keywords: Access to psychotherapy; Anxiety disorders; Cognitive behaviour therapy; Cost/effectiveness; Evidence-based practice; Group treatment; Pragmatic trial; Primary care; Psychotherapy; Transdiagnostic.

Conflict of interest statement

Ethics approval and consent to participate

In coherence with Quebec’s new multicentre ethical evaluation modalities, the research protocol was submitted to the principal ethics review board (Comité d’éthique de la recherche du Centre intégré universitaire de santé et de services sociaux de l’Estrie – Centre hospitalier universitaire de Sherbrooke, #MP-22-2016-570) and to the boards of the other insitutions for review (Comité d’éthique de la recherche de l’lnstitut Universitaire en santé mentale de Quebec, #2017–166; Comité scientifique et d’éthique de la recherche – CISSS de Laval, #2016–2017 / C54). All participants complete a consent form and will be informed of the results of the trial, if desired. Research staff sign a confidentiality agreement. The protection of data is conform to the ERB guidelines. Previous studies on tCBT showed no risk to the safety of participants. The research staff is trained to carry out the initial assessment of suicidal risk and emergency, and if there is any doubt about safety, they will establish contact with the primary care physician or hospital emergency department. Therapists are rigorously trained for the intervention, and the patients will continue their usual care for the duration of the study.

Consent for publication

Not applicable.

Competing interests

PJN receives royalties from Guilford Press for sales of “Group Cognitive Therapy of Anxiety: A Transdiagnostic Treatment Manual” [59]. The authors declare that they have no other 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
Flow of participants

References

    1. Kessler RC, Ruscio AM, Shear K, Wittchen HU. Epidemiology of anxiety disorders. Curr Top Behav Neurosci. 2010;2:21–35. doi: 10.1007/7854_2009_9.
    1. Baxter AJ, Scott KM, Vos T, Whiteford HA. Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychol Med. 2013;43(5):897–910. doi: 10.1017/S003329171200147X.
    1. American Psychiatric Association . Diagnostic and statistical manual of mental disorders. 5. Arlington: American Psychiatric Publishing; 2013.
    1. Brown TA, Campbell LA, Lehman CL, Grisham JR, Mancill RB. Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. J Abnorm Psychol. 2001;110(4):585–599. doi: 10.1037/0021-843X.110.4.585.
    1. Lamers Femke, van Oppen Patricia, Comijs Hannie C., Smit Johannes H., Spinhoven Philip, van Balkom Anton J. L. M., Nolen Willem A., Zitman Frans G., Beekman Aartjan T. F., Penninx Brenda W. J. H. Comorbidity Patterns of Anxiety and Depressive Disorders in a Large Cohort Study. The Journal of Clinical Psychiatry. 2011;72(03):341–348. doi: 10.4088/JCP.10m06176blu.
    1. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatr. 2005;62(6):617–627. doi: 10.1001/archpsyc.62.6.617.
    1. Conway KP, Compton W, Stinson FS, Grant BF. Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: results from the National Epidemiologic Survey on alcohol and related conditions. J Clin Psychiatry. 2006;67(2):247–257. doi: 10.4088/JCP.v67n0211.
    1. Scott K.M., Bruffaerts R., Tsang A., Ormel J., Alonso J., Angermeyer M.C., Benjet C., Bromet E., de Girolamo G., de Graaf R., Gasquet I., Gureje O., Haro J.M., He Y., Kessler R.C., Levinson D., Mneimneh Z.N., Oakley Browne M.A., Posada-Villa J., Stein D.J., Takeshima T., Von Korff M. Depression–anxiety relationships with chronic physical conditions: Results from the World Mental Health surveys. Journal of Affective Disorders. 2007;103(1-3):113–120. doi: 10.1016/j.jad.2007.01.015.
    1. Greenberg PE, Sisitsky T, Kessler RC, Finkelstein SN, Berndt ER, Davidson JR, Ballenger JC, Fyer AJ. The economic burden of anxiety disorders in the 1990s. J Clin Psychiatry. 1999;60(7):427–435. doi: 10.4088/JCP.v60n0702.
    1. Andlin-Sobocki P, Wittchen HU. Cost of anxiety disorders in Europe. Eur J Neurol. 2005;12(Suppl 1):39–44. doi: 10.1111/j.1468-1331.2005.01196.x.
    1. Kroenke K, Spitzer RL, Williams JB, Monahan PO, Lowe 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. Baxter AJ, Vos T, Scott KM, Ferrari AJ, Whiteford HA. The global burden of anxiety disorders in 2010. Psychol Med. 2014;44(11):2363–2374. doi: 10.1017/S0033291713003243.
    1. Chisholm D, Sweeny K, Sheehan P, Rasmussen B, Smit F, Cuijpers P, Saxena S. Scaling-up treatment of depression and anxiety: a global return on investment analysis. Lancet Psychiatry. 2016;3(5):415–424. doi: 10.1016/S2215-0366(16)30024-4.
    1. Horton R. Launching a new movement for mental health. Lancet. 2007;370(9590):806. doi: 10.1016/S0140-6736(07)61243-4.
    1. World Health Organization and the World Organization of Family Doctors . WHO/Wonca joint report: integrating mental health into primary care - a global perspective. Geneva: World Health Organization and the World Organization of Family Doctors (Wonca); 2008.
    1. Roberge P, Fournier L, Duhoux A, Nguyen CT, Smolders M. Mental health service use and treatment adequacy for anxiety disorders in Canada. Soc Psychiatry Psychiatr Epidemiol. 2011;46(4):321–330. doi: 10.1007/s00127-010-0186-2.
    1. Prins MA, Verhaak PF, Smolders M, Laurant MG, van der Meer K, Spreeuwenberg P, van Marwijk HW, Penninx BW, Bensing JM. Patient factors associated with guideline-concordant treatment of anxiety and depression in primary care. J Gen Intern Med. 2010;25(7):648–655. doi: 10.1007/s11606-009-1216-1.
    1. Stein MB, Roy-Byrne PP, Craske MG, Campbell-Sills L, Lang AJ, Golinelli D, Rose RD, Bystritsky A, Sullivan G, Sherbourne CD. Quality of and patient satisfaction with primary health care for anxiety disorders. J Clin Psychiatry. 2011;72(7):970–976. doi: 10.4088/JCP.09m05626blu.
    1. Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ, Bruffaerts R, de Girolamo G, de Graaf R, Gureje O, et al. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet. 2007;370(9590):841–850. doi: 10.1016/S0140-6736(07)61414-7.
    1. Young AS, Klap R, Shoai R, Wells KB. Persistent depression and anxiety in the United States: prevalence and quality of care. Psychiatr Serv. 2008;59(12):1391–1398. doi: 10.1176/ps.2008.59.12.1391.
    1. Fernández A., Haro J. M., Martinez-Alonso M., Demyttenaere K., Brugha T. S., Autonell J., De Girolamo G., Bernert S., Lépine J. P., Alonso J. Treatment adequacy for anxiety and depressive disorders in six European countries. British Journal of Psychiatry. 2007;190(02):172–173. doi: 10.1192/bjp.bp.106.023507.
    1. Roberge P, Fournier L, Menear M, Duhoux A. Access to psychotherapy for primary care patients with anxiety disorders. Can Psychol. 2014;55(2):60–67. doi: 10.1037/a0036317.
    1. National Institute for Health and Clinical Excellence . NICE clinical guideline 123. Quick reference guide. Common mental health disorders. London: National Institute for Health and Clinical Excellence; 2011.
    1. Katzman Martin A, Bleau Pierre, Blier Pierre, Chokka Pratap, Kjernisted Kevin, Van Ameringen Michael. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry. 2014;14(Suppl 1):S1. doi: 10.1186/1471-244X-14-S1-S1.
    1. McHugh RK, Whitton SW, Peckham AD, Welge JA, Otto MW. Patient preference for psychological vs pharmacologic treatment of psychiatric disorders: a meta-analytic review. J Clin Psychiatry. 2013;74(6):595–602. doi: 10.4088/JCP.12r07757.
    1. Olfson M, Marcus SC. National patterns in antidepressant medication treatment. Arch Gen Psychiatry. 2009;66(8):848–856. doi: 10.1001/archgenpsychiatry.2009.81.
    1. Butler AC, Chapman JE, Forman EM, Beck AT. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev. 2006;26(1):17–31. doi: 10.1016/j.cpr.2005.07.003.
    1. Cuijpers P, Cristea IA, Karyotaki E, Reijnders M, Huibers MJ. How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence. World Psychiatry. 2016;15(3):245–258. doi: 10.1002/wps.20346.
    1. Norton PJ, Price EC. A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders. J Nerv Ment Dis. 2007;195(6):521–531. doi: 10.1097/01.nmd.0000253843.70149.9a.
    1. Roberge P, Hudon C, Pavilanis A, Beaulieu MC, Benoit A, Brouillet H, Boulianne I, De Pauw A, Frigon S, Gaboury I et al: A qualitative study of perceived needs and factors associated with the quality of care for common mental disorders in patients with chronic diseases: the perspective of primary care clinicians and patients. BMC Fam Pract 2016, 17(1):134.
    1. Bennett-Levy J, Richards DA, Farrand P, Christensen H, Griffiths KM, Kavanagh DJ, Williams C. Oxford guide to low intensity CBT interventions. New York: Oxford University Press; 2010.
    1. Roberge P, Marchand A, Reinharz D, Savard P. Cognitive-behavioral treatment for panic disorder with agoraphobia: a randomized, controlled trial and cost-effectiveness analysis. Behav Modif. 2008;32(3):333–351. doi: 10.1177/0145445507309025.
    1. Roy-Byrne P, Craske MG, Sullivan G, Rose RD, Edlund MJ, Lang AJ, Bystritsky A, Welch SS, Chavira DA, Golinelli D, et al. Delivery of evidence-based treatment for multiple anxiety disorders in primary care: a randomized controlled trial. JAMA. 2010;303(19):1921–1928. doi: 10.1001/jama.2010.608.
    1. Norton PJ, Philipp LM. Transdiagnostic approaches to the treatment of anxiety disorders: a quantitative review. Psychotherapy. 2008;45(2):214–226. doi: 10.1037/0033-3204.45.2.214.
    1. Shafran R, Clark DM, Fairburn CG, Arntz A, Barlow DH, Ehlers A, Freeston M, Garety PA, Hollon SD, Ost LG, et al. Mind the gap: improving the dissemination of CBT. Behav Res Ther. 2009;47(11):902–909. doi: 10.1016/j.brat.2009.07.003.
    1. Guimond A-J, Provencher MD, Bélair M. Traitements cognitifs-comportementaux transdiagnostiques des troubles anxieux : recension des écrits. Revue québécoise de psychologie. 2013;34(2):265–293.
    1. Barlow DH, Allen LB, Choate ML. Toward a unified treatment for emotional disorders. Behav Ther. 2004;35(2):205–230. doi: 10.1016/S0005-7894(04)80036-4.
    1. Norton PJ, Roberge P. Transdiagnostic therapy. Psychiatr Clin North Am. 2017;40(4):675–687. doi: 10.1016/j.psc.2017.08.003.
    1. Norton PJ. Toward a clinically-oriented model of anxiety disorders. Cogn Behav Ther. 2006;35(2):88–105. doi: 10.1080/16506070500441561.
    1. Norton PJ, Paulus DJ. Transdiagnostic models of anxiety disorder: theoretical and empirical underpinnings. Clin Psychol Rev. 2017;56:122–137. doi: 10.1016/j.cpr.2017.03.004.
    1. Clark DA. Cognitive behavioral therapy for anxiety and depression: possibilities and limitations of a transdiagnostic perspective. Cogn Behav Ther. 2009;38(Suppl 1):29–34. doi: 10.1080/16506070902980745.
    1. Craske MG. Transdiagnostic treatment for anxiety and depression. Depress Anxiety. 2012;29(9):749–753. doi: 10.1002/da.21992.
    1. McManus F, Shafran R, Cooper Z. What does a transdiagnostic approach have to offer the treatment of anxiety disorders? Br J Clin Psychol. 2010;49(Pt 4):491–505. doi: 10.1348/014466509X476567.
    1. McEvoy PM, Nathan P, Norton PJ. Efficacy of transdiagnostic treatments: a review of published outcome studies and future research directions. J Cogn Psychother. 2009;23(1):20–33. doi: 10.1891/0889-8391.23.1.20.
    1. Norton PJ, Barrera TL, Mathew AR, Chamberlain LD, Szafranski DD, Reddy R, Smith AH. Effect of transdiagnostic cbt for anxiety disorders on comorbid diagnoses. Depress Anxiety. 2013;30(2):168–173. doi: 10.1002/da.22018.
    1. Newby JM, McKinnon A, Kuyken W, Gilbody S, Dalgleish T. Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clin Psychol Rev. 2015;40:91–110. doi: 10.1016/j.cpr.2015.06.002.
    1. Pearl SB, Norton PJ. Transdiagnostic versus diagnosis specific cognitive behavioural therapies for anxiety: a meta-analysis. J Anxiety Disord. 2017;46:11–24. doi: 10.1016/j.janxdis.2016.07.004.
    1. Reinholt N, Krogh J. Efficacy of transdiagnostic cognitive behaviour therapy for anxiety disorders: a systematic review and meta-analysis of published outcome studies. Cogn Behav Ther. 2014;43(3):171–184. doi: 10.1080/16506073.2014.897367.
    1. Norton PJ. Group cognitive-behavioral therapy of anxiety: a Transdiagnostic treatment manual. New York: Guilford; 2012.
    1. Norton PJ, Hope DA. Preliminary evaluation of a broad-spectrum cognitive-behavioral group therapy for anxiety. J Behav Ther Exp Psychiatry. 2005;36(2):79–97. doi: 10.1016/j.jbtep.2004.07.002.
    1. Norton PJ. A randomized clinical trial of transdiagnostic cognitve-behavioral treatments for anxiety disorder by comparison to relaxation training. Behav Ther. 2012;43(3):506–517. doi: 10.1016/j.beth.2010.08.011.
    1. Ministère de la Santé et des Services sociaux . Plan d'action en santé mentale: La force des liens 2005–2010. Québec: Gouvernement du Québec; 2005.
    1. Chan AW, Tetzlaff JM, Gotzsche PC, Altman DG, Mann H, Berlin JA, Dickersin K, Hrobjartsson A, Schulz KF, Parulekar WR, et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013;346:e7586. doi: 10.1136/bmj.e7586.
    1. Brown TA, Barlow DH. Anxiety and related disorders interview schedule for DSM-5 - adult and lifetime version: clinician manual: Oxford University Press; 2014.
    1. Dubois B, Touchon J, Portet F, Ousset PJ, Vellas B, Michel B. "the 5 words": a simple and sensitive test for the diagnosis of Alzheimer's disease. Presse Med. 2002;31(36):1696–1699.
    1. Norton PJ. Anxiety treatment program therapist Fidelity measure (unpublished document, available from author) 2009.
    1. Norton PJ, Barrera TL. Transdiagnostic versus diagnosis-specific cbt for anxiety disorders: a preliminary randomized controlled noninferiority trial. Depress Anxiety. 2012;29(10):874–882. doi: 10.1002/da.21974.
    1. Norton PJ. An open trial of a transdiagnostic cognitive-behavioral group therapy for anxiety disorder. Behav Ther. 2008;39(3):242–250. doi: 10.1016/j.beth.2007.08.002.
    1. Hunsley J, Mash EJ. A guide to assessments that work. New York: Oxford University Press; 2008.
    1. Kessler RC, Barber C, Beck A, Berglund P, Cleary PD, McKenas D, Pronk N, Simon G, Stang P, Ustun TB, et al. The World Health Organization health and work performance questionnaire (HPQ) J Occup Environ Med. 2003;45(2):156–174. doi: 10.1097/01.jom.0000052967.43131.51.
    1. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56(6):893–897. doi: 10.1037/0022-006X.56.6.893.
    1. Freeston MH, Ladouceur R, Thibodeau N, Gagnon F, Rhéaume J. L'inventaire d'anxiété de Beck : Propriétés psychométriques d'une traduction française. L'Encéphale. 1994;20(1):47–55.
    1. Oei TP, McAlinden NM. Changes in quality of life following group CBT for anxiety and depression in a psychiatric outpatient clinic. Psychiatry Res. 2014;220(3):1012–1018. doi: 10.1016/j.psychres.2014.08.036.
    1. Barlow DH, Farchione TJ, Bullis JR, Gallagher MW, Murray-Latin H, Sauer-Zavala S, Bentley KH, Thompson-Hollands J, Conklin LR, Boswell JF, et al. The unified protocol for Transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: a randomized clinical trial. JAMA Psychiatry. 2017;74(9):875–884. doi: 10.1001/jamapsychiatry.2017.2164.
    1. Connor KM, Davidson JR, Churchill LE, Sherwood A, Foa E, Weisler RH. Psychometric properties of the social phobia inventory (SPIN). New self-rating scale. Br J Psychiatry. 2000;176:379–386. doi: 10.1192/bjp.176.4.379.
    1. Radomsky AS, Ashbaugh AR, Saxe ML, Ouimet AJ, Golden ER, Lavoie SL, O'Connor KP. Psychometric properties of the French and English versions of the social phobia inventory. Can J Behav Sci. 2006;38(4):354–360. doi: 10.1037/cjbs2006021.
    1. Meyer TJ, Miller ML, Metzger RL, Borkovec TD. Development and validation of the Penn State worry questionnaire. Br J Clin Psychol. 1990;28:487–495.
    1. Gosselin P, Dugas M-J, Ladouceur R, Freeston M-H. Évaluation des inquiétudes : validation d’une traduction française du Penn State Worry Questionnaire. L'Encephale. 2001;27.
    1. Shear MK, Brown TA, Barlow DH, Money R, Sholomskas DE, Woods SW, Gorman JM, Papp LA. Multicenter collaborative panic disorder severity scale. Am J Psychiatr. 1997;154(11):1571–1575. doi: 10.1176/ajp.154.11.1571.
    1. Houck PR, Spiegel DA, Shear MK, Rucci P. Reliability of the self-report version of the panic disorder severity scale. Depress Anxiety. 2002;15(4):183–185. doi: 10.1002/da.10049.
    1. Chambless DL, Sharpless BA, Rodriguez D, McCarthy KS, Milrod B, Khalsa SR, Barber JP. Psychometric properties of the mobility inventory for agoraphobia: convergent, discriminant, and criterion-related validity. Behav Ther. 2011;42(4):689–699. doi: 10.1016/j.beth.2011.03.001.
    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. Morin CM. Insomnia: psychological assessment and management. New York: Guilford Press; 1993.
    1. Blais FC, Gendron L, Mimeault V, Morin CM. Evaluation of insomnia: validity of 3 questionnaires. Encephale. 1997;23(6):447–453.
    1. Sheehan DV, Harnett-Sheehan K, Raj BA. The measurement of disability. Int Clin Psychopharmacol. 1996;11(Suppl 3):89–95. doi: 10.1097/00004850-199606003-00015.
    1. Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol group. Ann Med. 2001;33(5):337–343. doi: 10.3109/07853890109002087.
    1. Moriarty DG, Zack MM, Kobau R. The Centers for Disease Control and Prevention's healthy days measures - population tracking of perceived physical and mental health over time. Health Qual Life Outcomes. 2003;1:37. doi: 10.1186/1477-7525-1-37.
    1. Bayliss EA, Ellis JL, Steiner JF. Subjective assessments of comorbidity correlate with quality of life health outcomes: initial validation of a comorbidity assessment instrument. Health Qual Life Outcomes. 2005;3:51. doi: 10.1186/1477-7525-3-51.
    1. Poitras M-E, Fortin M, Hudon C, Haggerty J, Almirall J. Validation of the disease burden morbidity assessment by self-report in a French-speaking population. BMC Health Serv Res. 2012;12:35. doi: 10.1186/1472-6963-12-35.
    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. Coulombe S, Radziszewski S, Trépanier SG, Provencher H, Roberge P, Hudon C, Meunier S, Provencher M, Houle J. Mental health self-management questionnaire: development and psychometric properties. J Affect Disord. 2015;181:41–49. doi: 10.1016/j.jad.2015.04.007.
    1. Sherbourne C, Stewart A. The MOS social support survey. Soc Sci Med. 1991;32:705–714. doi: 10.1016/0277-9536(91)90150-B.
    1. Anderson D, Bilodeau B, Deshaies G, Gilbert M, Jobin J. French-Canadian validation of the MOS social support survey. Can J Cardiol. 2005;21(10):867–873.
    1. Smith AH, Paulus DJ, Norton PJ. Transdiagnostic assessment of anxiety symptoms using the anxiety disorder diagnostic questionnaire - weekly version. Anxiety Stress Coping. 2017;30(1):96–106. doi: 10.1080/10615806.2016.1186272.
    1. Norton PJ, Robinson CM. Development and evaluation of the anxiety disorder diagnostic questionnaire. Cogn Behav Ther. 2010;39(2):137–149. doi: 10.1080/16506070903140430.
    1. Horvath AO, Greenberg LS. Development and validation of the working Alliance inventory. J Couns Psychol. 1989;36(2):223–233. doi: 10.1037/0022-0167.36.2.223.
    1. Corbière M, Bisson J, Lauzon S, Ricard N. Factorial validation of a French short-form of the working Alliance inventory. Int J Methods Psychiatr Res. 2006;15(1):36–45. doi: 10.1002/mpr.27.
    1. Tracey TJ, Kokotovic AM. Factor structure of the working alliance inventory. Psychol Assess. 1989;1(3):207–210. doi: 10.1037/1040-3590.1.3.207.
    1. Devilly GJ, Borkovec TD. Psychometric properties of the credibility/expectancy questionnaire. J Behav Ther Exp Psychiatry. 2000;31(2):73–86. doi: 10.1016/S0005-7916(00)00012-4.
    1. Stokes JP. Toward an understanding of cohesion in personal change groups. Int J Group Psychother. 1983;33:449–467. doi: 10.1080/00207284.1983.11491345.
    1. Bell BA, Morgan G, Schoeneberger J, Loudermilk B, Kromrey J, Ferron J. Dancing the sample-size limbo with mixed models: how low can you go? (paper 197–2010) Seattle: SAS Global Forum; 2010.
    1. Watts SE, Turnell A, Kladnitski N, Newby JM, Andrews G. Treatment-as-usual (TAU) is anything but usual: a meta-analysis of CBT versus TAU for anxiety and depression. J Affect Disord. 2015;175:152–167. doi: 10.1016/j.jad.2014.12.025.
    1. Oei TP, Boschen MJ. Clinical effectiveness of a cognitive behavioral group treatment program for anxiety disorders: a benchmarking study. J Anxiety Disord. 2009;23(7):950–957. doi: 10.1016/j.janxdis.2009.06.004.
    1. James S. Approximate multinormal probabilities applied to correlated multiple endpoints in clinical trials. Stat Med. 1991;10(7):1123–1135. doi: 10.1002/sim.4780100712.
    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. Plummer F, Manea L, Trepel D, McMillan D. Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis. Gen Hosp Psychiatry. 2016;39:24–31. doi: 10.1016/j.genhosppsych.2015.11.005.
    1. Kroenke K, Spitzer RL, Williams JB. The patient health questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41:1284–1292. doi: 10.1097/01.MLR.0000093487.78664.3C.
    1. Ewing JA. Detecting alcoholism. The CAGE questionnaire. J Am Med Assoc. 1984;252:1905–1907. doi: 10.1001/jama.1984.03350140051025.
    1. Rueff B, Crnac J, Darne B. Dépistage de malades «alcooliques» par l'autoquestionnaire systématique DETA: parmi des consultants hospitaliers. Presse Med. 1989;18(33):1654–1656.
    1. Dhalla S, Kopec JA. The CAGE questionnaire for alcohol misuse: a review of reliability and validity studies. Clin Invest Med. 2007;30(1):33–41. doi: 10.25011/cim.v30i1.447.
    1. Higgins JPT, Green S (eds.). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration; 2011. Available from .
    1. National Research Council, Panel on Handling Missing Data in Clinical Trials . The prevention and treatment of missing data in clinical trials. Washington, DC: Committee on National Statistics, Division of Behavioral and Social Sciences and Education. The National Academies Press; 2010.

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3
구독하다