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J Consult Clin Psychol. 2012 Jun;80(3):490-6. doi: 10.1037/a0028132. Epub 2012 Apr 16.

Generalized anxiety disorder: a comparison of symptom change in adults receiving cognitive-behavioral therapy or applied relaxation.

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  • 1Department of Psychology, Concordia University, Montreal, Quebec, Canada.



Generalized anxiety disorder (GAD) is characterized by excessive worry and somatic symptoms of anxiety (e.g., restlessness, muscle tension). Several psychological treatments lead to significant reductions in GAD symptoms by posttreatment. However, little is known about how GAD symptoms change over time. Our main goal was to examine how GAD symptoms changed in relation to one another during 2 distinct but efficacious psychological treatments: cognitive-behavioral therapy (CBT) and applied relaxation (AR). Specifically, we asked whether change in worry accounted for change over time in somatic anxiety (or the reverse) to the same degree in CBT and AR.


We examined data from 57 individuals with GAD enrolled in a randomized controlled trial. Self-report measures of worry and somatic anxiety were obtained daily during treatment.


Although the direction of influence between changes in worry and somatic anxiety was bidirectional to some extent in both treatments, a significant difference was also observed: Change in worry accounted for subsequent change in somatic anxiety to a greater extent in CBT than in AR.


These findings allowed us to identify differences in a mechanism of change in GAD symptoms during 2 treatments and to provide some support for the idea that similarly efficacious treatments may produce symptom change via different mechanisms in a manner that is consistent with the theoretical rationales on which the treatments are based.

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