Group autonomy enhancing treatment versus cognitive behavioral therapy for anxiety disorders: A cluster-randomized clinical trial
Kunst, Laura E.; Maas, Joyce; van Balkom, Anton J.L.M.; van Assen, Marcel A.L.M.; Kouwenhoven, Brenda; Bekker, Marrie H.J.
(2022) Depression and Anxiety, volume 39, issue 2, pp. 134 - 146
(Article)
Abstract
Background: Although cognitive behavioral therapy (CBT) is effective in the treatment of anxiety disorders, few evidence-based alternatives exist. Autonomy enhancing treatment (AET) aims to decrease the vulnerability for anxiety disorders by targeting underlying autonomy deficits and may therefore have similar effects on anxiety as CBT, but yield broader effects. Methods:
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A multicenter cluster-randomized clinical trial was conducted including 129 patients with DSM-5 anxiety disorders, on average 33.66 years of age (SD = 12.57), 91 (70.5%) female, and most (92.2%) born in the Netherlands. Participants were randomized over 15-week groupwise AET or groupwise CBT and completed questionnaires on anxiety, general psychopathology, depression, quality of life, autonomy-connectedness and self-esteem, pre-, mid-, and posttreatment, and after 3, 6, and 12 months (six measurements). Results: Contrary to the hypotheses, effects on the broader outcome measures did not differ between AET and CBT (d =.16 or smaller at post-test). Anxiety reduction was similar across conditions (d =.059 at post-test) and neither therapy was superior on long term. Conclusion: This was the first clinical randomized trial comparing AET to CBT. The added value of AET does not seem to lie in enhanced effectiveness on broader outcome measures or on long term compared to CBT. However, the study supports the effectiveness of AET and thereby contributes to extended treatment options for anxiety disorders.
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Keywords: Anxiety, Autonomy, Autonomy enhancing treatment, Autonomy-connectedness, Cognitive behavioral therapy, Transdiagnostic, Psychiatry and Mental health, Clinical Psychology
ISSN: 1091-4269
Publisher: Wiley-Blackwell
Note: Funding Information: This study was supported by ZonMw, grant number 843001703; the Center of Research on Psychological disorders and Somatic diseases (CoRPS), Tilburg University; the Tilburg Alumni Fund; GGZ inGeest; and the University of Amsterdam. ZonMw provided feedback on the study design, but was not involved in the data collection, analysis, and interpretation. The authors would like to thank Prof Dr Kees Korrelboom and Prof Dr Ger Keijsers for their help in setting up and supervising the CBT groups. The authors thank Dr Brenda den Oudsten for her contributions to the study design and advice on implementation strategies. The help of Dr Hendrik Koopman, Harmien van der Veen, Marlies van Doorn and the ADF patient association in study design implementation was essential and the authors therefore highlight their contribution. Furthermore, the authors thank Paul Lodder for his advice on randomization procedures, Prof Dr Jan Bouwens for advisory his role in the grant application and Paul Wisman, MD, for facilitating involvement of new treatment centers. The authors also thank the students who aided in data collection: Saskia Wesseling, Julia Quicker, Esther Leijten, Habiba Seabu, Mandisa Bremer, Marlou van Boxtel, and Sharona van Kuik. Above all, the authors want to express our gratitude to all therapists who were involved in participant recruitment and/or conducting therapies. Their help and expertise were crucial and we greatly value their contributions. The authors thank management, research and clinical staff of all treatment centers involved: Mentaal Beter Tilburg, GGZ Drenthe, PEP Noordwijk, GGZ inGeest, Mentaal Beter Roosendaal, Indigo the Hague, Mentaal Beter Utrecht, and Mentaal Beter – Psychologenpraktijk Van den Elshout. Finally, this study could not have taken place without the tremendous help of all clients who volunteered to participate. The authors thank them for their generous contribution. Funding Information: This study was supported by ZonMw, grant number 843001703; the Center of Research on Psychological disorders and Somatic diseases (CoRPS), Tilburg University; the Tilburg Alumni Fund; GGZ inGeest; and the University of Amsterdam. ZonMw provided feedback on the study design, but was not involved in the data collection, analysis, and interpretation. The authors would like to thank Prof Dr Kees Korrelboom and Prof Dr Ger Keijsers for their help in setting up and supervising the CBT groups. The authors thank Dr Brenda den Oudsten for her contributions to the study design and advice on implementation strategies. The help of Dr Hendrik Koopman, Harmien van der Veen, Marlies van Doorn and the ADF patient association in study design implementation was essential and the authors therefore highlight their contribution. Furthermore, the authors thank Paul Lodder for his advice on randomization procedures, Prof Dr Jan Bouwens for advisory his role in the grant application and Paul Wisman, MD, for facilitating involvement of new treatment centers. The authors also thank the students who aided in data collection: Saskia Wesseling, Julia Quicker, Esther Leijten, Habiba Seabu, Mandisa Bremer, Marlou van Boxtel, and Sharona van Kuik. Above all, the authors want to express our gratitude to all therapists who were involved in participant recruitment and/or conducting therapies. Their help and expertise were crucial and we greatly value their contributions. The authors thank management, research and clinical staff of all treatment centers involved: Mentaal Beter Tilburg, GGZ Drenthe, PEP Noordwijk, GGZ inGeest, Mentaal Beter Roosendaal, Indigo the Hague, Mentaal Beter Utrecht, and Mentaal Beter – Psychologenpraktijk Van den Elshout. Finally, this study could not have taken place without the tremendous help of all clients who volunteered to participate. The authors thank them for their generous contribution. Publisher Copyright: © 2021 The Authors. Depression and Anxiety published by Wiley Periodicals LLC
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