Bethany M. Wootton

Objectives: Generalized anxiety disorder (GAD) is a common and debilitating anxiety disorder. Currently, several cognitive and/or behavioural models propose mechanisms that perpetuate GAD symptoms, but little is known about which model (and associated treatment) results in the best treatment outcomes. The aim of this study was to examine this research question using a meta‐analytic approach. Methods: Twenty‐six studies (with 34 comparisons) were included in the meta‐analysis covering six theoretical models. Within‐group effect sizes were calculated using random effects models. Planned moderator analyses were conducted to determine whether there were any significant differences between models. Results: The pooled within‐group effect size was large across all treatment groups from pre‐treatment to post‐treatment ( g = 1.591; 95% CI: 1.408–1.774); however, the treatment model used did moderate outcome ( p = 0.002). A significant difference was found between the avoidance model of worry (AMW) and the meta‐cognitive model (MCM) ( p = 0.009), as well as the AMW and the intolerance of uncertainty model (IUM) ( p < 0.001). There was no significant difference between the MCM and IUM. The within‐group effect size from pre‐treatment to follow‐up remained large across all studies ( g = 1.478; 95% CI: 1.307–1.649), and the treatment model used did not moderate outcomes at follow‐up ( p = 0.147). Conclusions: These findings demonstrate that while the short‐term treatments used in the MCM and IUM may be more effective than the AMW, there are no significant differences in long‐term outcomes. Therefore, any of the treatment approaches associated with the common GAD models are suitable for treating patients with GAD. Registration: The study was registered with the Prospero International prospective register of systematic reviews (PROSPERO) registration no. CRD42024595891.

Objectives: Internet‐delivered cognitive‐behavioural therapy (ICBT) is demonstrated to be an effective treatment for obsessive‐compulsive disorder (OCD). However, not all individuals who commence ICBT respond well to treatment and thus understanding predictors of outcome is crucial for informing best‐practice treatment planning. The aim of this study was to provide a preliminary synthesis of predictors of treatment outcomes of ICBT for OCD. Methods: Eight studies ( n = 1010; mean age range 30.05–37.08 years; 54.0%–78.3% female) were included in this review. Predictors of 1) post‐treatment severity, 2) post‐treatment change score and 3) post‐treatment remission were examined. Results: Based on the available data, significant predictors of post‐treatment severity included age, baseline OCD severity, baseline responsibility/checking symptoms, baseline ordering/symmetry symptoms, baseline avoidance, working alliance, past psychological treatment, disgust severity and change in depressive symptoms. For post‐treatment change score, significant predictors were baseline OCD severity, motivation to reduce avoidance, baseline incompleteness, working alliance, engagement with a clinician, baseline depression severity, pharmacotherapy use and disgust severity. Finally, for responder status, significant predictors included age, motivation to reduce compulsions, engagement with a clinician and past psychological treatment. Conclusions: While preliminary, these findings contribute to the emerging literature on predictors of ICBT treatment outcomes for individuals with OCD. However, given the limited literature, future research is necessary to replicate and build on these findings.

Body dysmorphic disorder (BDD) is characterised by a preoccupation with an imagined defect in physical appearance (American Psychiatric Association [APA], 2013). It is a common disorder, with a pre...

Objective: Generalised anxiety disorder (GAD) is characterised by uncontrollable worries. Cognitive behaviour therapy (CBT) is an effective treatment for GAD; however, manualised treatments rarely include interventions to target core beliefs. This study aimed to (1) explore the core beliefs about the self that are endorsed by individuals with GAD, (2) determine whether these beliefs are related to the severity of GAD symptoms, (3) examine if core beliefs about the self shift in response to CBT for GAD and (4) determine whether changes in core beliefs about the self are related to reductions in symptom severity. Method: A secondary data analysis of a randomised controlled trial with a repeated measures design examining the efficacy of videoconferencing‐delivered CBT for individuals with GAD. Seventy‐seven participants were included in the study ( M _{age =} 37.14; 84.4% female). Results: The results indicated that core beliefs about the self were commonly endorsed in GAD; however, there was no significant relationship between core beliefs about the self and baseline GAD symptom severity. There was a significant reduction in the severity of core beliefs about the self from pre‐treatment to post‐treatment ( p < .001; Cohen's d = .50) and pre‐treatment to follow‐up ( p < .001; Cohen's d = .51) despite the treatment not explicitly targeting these beliefs. There was also a significant relationship between changes in core beliefs about the self and GAD symptom severity at post‐treatment and follow‐up. Conclusions: These findings provide insight into the role of core beliefs about the self in the treatment of GAD.

Objectives: Maladaptive core beliefs, shame and low self‐compassion are found to be highly correlated with social anxiety disorder (SAD). Design: The present study is a post‐hoc exploratory study examining the efficacy of cognitive behaviour therapy (CBT) and imagery rescripting (ImR) on reducing these constructs following treatment. Methods: Seventy‐two participants participated in the study (Mage = 39.26; 62.5% female); 37 participants completed CBT and 35 participants completed ImR. Results: Strength of maladaptive core beliefs reduced from pre‐treatment to post‐treatment (CBT: d = .65; 95% CI: .17–1.11; ImR: d = .52; 95% CI: .04–.99) and pre‐treatment to 3‐month follow‐up (CBT: d = .63; 95% CI: .16–1.09; ImR: d = .51; 95% CI: .03–.98) in both treatments groups. Levels of shame reduced significantly from pre‐treatment to post‐treatment (CBT: d = .86; 95% CI: .38–1.33; ImR: d = .93; 95% CI: .43–1.41), and pre‐treatment to 3‐month follow up in both groups (CBT: d = .80; 95% CI: .32–1.26; ImR: d = .58; 95% CI: .09–1.05). Self‐compassion increased from pre‐treatment to post‐treatment (CBT: d = .78; 95% CI: .30–1.25; ImR: d = .67; 95% CI: .18–1.14) and pre‐treatment to 3‐month follow‐up in the CBT condition ( d = .71; 95% CI: .24–1.18), but not the ImR condition. Conclusion: These results suggested that both CBT and ImR improve outcomes on a number of non‐fear‐related constructs. This has important implications for the treatment of SAD.

Videoconferencing-delivered cognitive behaviour therapy (vCBT) has the potential to overcome barriers to accessing treatment for social anxiety disorder (SAD). The present study examines the efficacy and acceptability of vCBT for SAD in a randomised controlled trial. Seventy-eight participants were randomised to a vCBT condition or waitlist control group (61.8% female, 34.2% male, 3.9% non-binary; Mage = 39.19, SD = 12.28). On the Social Interaction Anxiety Scale and Social Phobia Scale-short form (SIAS-6; SPS-6), vCBT within-group analyses indicated large effect sizes from pre-treatment to post-treatment on the SIAS-6 (Cohen's d = 0.95; 95% CI: 0.45-1.41) and SPS-6 (d = 0.90; 95% CI: 0.41-1.37). The between-group effect size at post-treatment was large on the SPS-6 (d = 1.01; 95% CI: 0.51-1.47) and medium on the SIAS-6 (d = 0.55; 95% CI: 0.09-1.00). At post-treatment, 57% of participants in the vCBT condition no longer met criteria for SAD and 68% at 3-month follow-up. Benchmarking analyses indicated similar treatment effect sizes to in-person CBT for SAD. Participants rated the program as acceptable and treatment completion rates were high. The results suggest that vCBT may be a viable remote treatment option for individuals with SAD.

Background: People that access community mental health services in New South Wales (NSW) Australia, present with a complex mix of mental health issues. While the most common presentations include schizophrenia and bi-polar disorder, symptoms of social anxiety and depression are common amongst this cohort. Given the drop-out rates associated with Cognitive Behavioural Therapy, there is a growing interest in using therapeutically applied role-playing games (TA-RPGs) as an alternative. Given the current evidence for this treatment is in its infancy, there is a need to investigate the effectiveness of TA-RPGS. Objective: To evaluate the effectiveness of a cognitive behavioural therapy-infused, therapeutically applied role-playing game (Dungeons and Dragons) for consumers of two community mental health services in Sydney, Australia. Methods: In total, 33 consumers of community mental health services were quasi-randomised to either the TA-RPG 8-week intervention group or a waitlist control group receiving treatment-as-usual. The TA-RPG consisted of a specially designed game of Dungeons and Dragons that was infused with elements of cognitive behavioural therapy. All participants received treatment as usual. Primary outcome measures were changes in self-reported social anxiety and PTSD symptoms. Secondary outcome measures were changes in self-reported depression and self-esteem. Results: After 8 weeks, participants in the TA-RPG group experienced a significant reduction in self-reported symptoms of social anxiety and depression, relative to baseline. A significant increase in global self-esteem was also reported. These changes were not experienced by participants in the waitlist control group. No change in either group was observed for PTSD symptoms. Dropout rates were 17% for the intervention group. Conclusion: A CBT infused, therapeutically applied role-playing game group intervention was effective at reducing self-reported symptoms of anxiety and depression for consumers of adult community mental health services in Sydney, Australia.