Susan M. Orsillo

To examine the maintenance effects of acceptance-based behavior therapy (ABBT) and applied relaxation (AR) for generalized anxiety disorder (GAD) 46 adults (69.6% female, 82.6% White) with high end-state functioning following an RCT comparing ABBT to AR were re-assessed at 12- and 24-month follow-up. End-state functioning was based on post-treatment scores within one standard deviation of the mean on three of five outcome measures [Clinician Severity Rating (CSR), Hamilton Anxiety, Penn State Worry Questionnaire (PSWQ), Depression Anxiety Stress Scale stress subscale (DASS-Stress), and State-Trait Anxiety Inventory (STAI)]. At 12 months, 93.8% of high endstate responders in ABBT and 95.5% in AR had maintained gains. At 24 months, 71.4% of responders from ABBT and 83.3% from AR maintained gains. Mixed-effects regression models revealed a significant effect for Time and Condition for DASS-Stress but not for Condition X Time. There was also a significant time effect for PSWQ, indicating PSWQ and DASS-Stress scores increased across follow-up. The rate of increase did not differ across conditions. Non-significant, small effects were found for all other outcomes indicating that symptoms did not significantly change across follow-up regardless of condition. While the results are limited by dropout rates, clients receiving ABBT or AR appear to maintain gains over long-term follow-up.

Los Estados Unidos. Narrow et al., (2002) combinando datos del Programa de Área de Captación Epidemiológica (ECA) del Instituto Nacional de Salud Mental y de la Encuesta Nacional de Comorbilidad (NCS), estimaron de forma conservadora que la prevalencia en un año de cualquier trastorno de ansiedad era del 13,1% para los adultos entre 18 y 54 años. Estos trastornos tienden a ser crónicos. Las tasas de remisión a los tres años oscilan entre el 16 y el 23% para la fobia social, el trastorno de ansiedad generalizada, la agorafobia y el trastorno de pánico con agorafobia (Keller, 2000, en Barlow, 2002). En un estudio longitudinal, en los primeros 22 meses tras el inicio de un episodio, solo el 18% de los individuos diagnosticados con trastorno de pánico y agorafobia, y alrededor del 43% de los que padecían trastorno de pánico sin agorafobia, se habían recuperado, en comparación con aproximadamente el 80% de los que padecían trastorno depresivo mayor (Hirschfeld, 1996). El estado funcional de los pacientes con trastornos de ansiedad está también deteriorado, como demuestran las tasas más elevadas de dependencia económica, desempleo (p.ej., Leon et al., 1995), peor calidad de vida (Massion et al., 1993) y mayor riesgo de suicidio consumado (Allgulander, 1994)...

There is growing awareness of a mental health ‘crisis’ among graduate students [Evans, T. M., Bira, L., Gastelum, J. B., Weiss, L. T., & Vanderford, N. L. (2018). Evidence for a mental health crisis in graduate education. Nature Biotechnology, 36(3), 282–284. doi:10.1038/nbt.4089]. Despite a paucity of research exploring potential differences in psychological distress across ethnic and racial groups, there is at least some evidence that students who identify as African American/Black, Hispanic/Latinx, American Indian/Alaska Natives, and Native Hawaiians/Pacific Islanders, underrepresented minority students (URM), report more depressive symptoms [e.g., Harvard Chan Mental Health Student Alliance. ( 2017 Harvard Chan Mental Health Student Alliance. (2017). Mental wellness of students at Harvard Chan. https://cdn1.sph.harvard.edu/wp-content/uploads/sites/1745/2017/05/MHSA-Needs-Assessment-Report-2017.pdf [Google Scholar] ). Mental wellness of students at Harvard Chan. Retrieved from https://cdn1.sph.harvard.edu/wp-content/uploads/sites/1745/2017/05/MHSA-Needs-Assessment-Report-2017.pdf] and a lower sense of belongingness in graduate school [e.g., Clark, C. R., Mercer, S. H., Zeigler-Hill, V., & Dufrene, B. A. (2012). Barriers to the success of ethnic minority students in school psychology graduate programs. School Psychology Review, 41(2), 176–192. doi:10.1080/02796015.2012.12087519] compared to their racial and ethnic majority peers. We explored whether URM students’ opportunities to engage in doctoral work consistent with intrinsic, altruistic or extrinsic career values, and congruity between values importance and affordances would contribute to psychosocial well-being, belongingness, and program satisfaction. URM doctoral students (n = 436) completed an anonymous online survey including the Values Congruity Questionnaire (VC), Campus Connectedness Scale (CCS), and Depression, Anxiety, and Stress Scales (DASS-21). Opportunities to engage in doctoral work consistent with altruistic, intrinsic, and extrinsic values were associated with lower depression and a higher sense of belongingness. Incongruity between the importance of altruistic values and perceived affordances was associated with higher depression and a lower sense of program belongingness and satisfaction. Although URM psychological functioning is determined by multiple factors, providing values consistent opportunities within graduate programs could increase belongingness, program satisfaction and psychosocial wellness.

The primary method of training for individual licensed mental health professionals is continuing education (CE). Despite the promise of CE as a vehicle for training clinicians in evidence-based practices, only a handful of studies have examined the efficacy of trainings delivered in the CE context. Moreover, these studies have focused on a few very specific therapeutic approaches. There is a growing body of evidence supporting Acceptance-based Behavior Therapy (ABBT) as a treatment for generalized anxiety disorder (GAD) and related disorders. Training workshops aimed at disseminating ABBT are regularly conducted across and outside the United States, yet the effectiveness of these trainings is unknown. The goal of this study was to examine learning outcomes among licensed mental health professionals following a six-hour CE training in ABBT. Data were collected at baseline, post-training, and at three-month follow-up. Participants demonstrated a statistically significant increase in learning on an ABBT Knowledge Questionnaire and in their coded responses to client scenarios from baseline to follow-up, although there was a significant decline in knowledge between post and follow-up. Beyond baseline ABBT knowledge, attitude towards evidence-based practice was the only predictor of change in knowledge over time.

Effective interventions for generalized anxiety exist, but barriers to treatment prevent their broad dissemination. Commercially available self-help materials may help bridge this gap, but few have been empirically evaluated. This study compared self-reported change in generalized anxiety symptomology and associated problems between community members with excessive worry who were randomly assigned to receive the Worry Less, Live More: The Mindful Way through Anxiety Workbook (n = 35) and those in a delayed condition (n = 29). Participants in the workbook condition reported significantly greater reductions between baseline and 11-week follow-up in self-reported worry (η² =.15), general anxiety/tension (η² =.13), and anxiety (η² =.24) than those in the delayed condition, although no statistically significant differences across condition on changes in depression, functional impairment or acceptance were detected. This pilot study provides support for continued research examining the efficacy of acceptance-based behavioral therapy delivered in a self-help format.

Background: High rates of substance use among college students have been associated with a wide range of detrimental consequences. Psychological inflexibility, characterized by both experiential avoidance and a disconnection with personally meaningful values, is proposed to contribute to the development and maintenance of substance misuse. Objectives: This study explored the unique contribution of experiential avoidance and four different values dimensions (i.e., importance, consistency, effort, and intrinsic motivation) on substance use and related problems accounting for the known predictors of gender and drinking motives. Method: Zero-inflated regression was used to analyze predictors of substance use and related problems among 233 college students. Results: Controlling for gender and drinking motives, stronger values importance was predictive of lower rates of alcohol use problems. Less behavioral consistency with values predicted marijuana abstinence, less frequent use of marijuana, and less frequent use of illicit drugs. Although there was little evidence for a unique association between experiential avoidance and substance use or substance-related problems in this sample, coping and enhancement motives predicted alcohol use problems and illicit drug use. Conclusion/Importance: These findings offer preliminary support for prevention and intervention efforts aimed at enhancing engagement in values activities and reducing substance use as a form of affect regulation in this population.