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Published in: Journal of Contemporary Psychotherapy 4/2020

01-12-2020 | Affective Disorder | Original Paper

Study of Dialectical Behavior Therapy Versus Cognitive Behavior Therapy on Emotion Regulation and Mindfulness in Patients with Generalized Anxiety Disorder

Authors: Behrooz Afshari, Jila Hasani

Published in: Journal of Contemporary Psychotherapy | Issue 4/2020

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Abstract

Although the effectiveness of dialectical behavior therapy (DBT) in the treatment of generalized anxiety disorder (GAD) has not been addressed to date, cognitive behavior therapy (CBT) is the gold-standard psychotherapy for GAD patients. The present study investigated effects of DBT versus CBT on emotion regulation and mindfulness in GAD patients. Conducted in Iran, 68 GAD patients were randomly assigned to one of two groups: CBT or DBT. Assessment was performed at pre-treatment, post-treatment, and at 3 months follow-up. Evaluation included the Generalized Anxiety Disorder scale (GAD-7), Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I), Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI), Five Facet Mindfulness Questionnaire (FFMQ), and Difficulties in Emotion Regulation Scale (DERS). Results of the present study showed that both groups had lower scores in depression, anxiety, and emotion dysregulation and higher scores in mindfulness after the interventions, and at follow-up. During the study period, the CBT group experienced greater reductions than the DBT group in symptoms of depression and anxiety, while the DBT group experienced greater improvements than the CBT group in emotion regulation and mindfulness. Findings seem to warrant the conclusion that, although CBT reduced symptoms of depression and anxiety more than DBT, DBT was more effective in improving emotion regulation and mindfulness than CBT. Findings of the study are of significance for psychotherapy and future studies of these treatments.
Literature
go back to reference Afshari, B., Rasouli-Azad, M., & Ghoreishi, F. (2019c). Comparison of original and revised reinforcement sensitivity theory in clinically-stable schizophrenia and bipolar disorder patients. Personality and Individual Differences, 138, 321–327. Afshari, B., Rasouli-Azad, M., & Ghoreishi, F. (2019c). Comparison of original and revised reinforcement sensitivity theory in clinically-stable schizophrenia and bipolar disorder patients. Personality and Individual Differences, 138, 321–327.
go back to reference American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.
go back to reference Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., et al. (2008). Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment, 15(3), 329–342.PubMed Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., et al. (2008). Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment, 15(3), 329–342.PubMed
go back to reference Bardeen, J. R., Fergus, T. A., & Orcutt, H. K. (2012). An examination of the latent structure of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 34(3), 382–392. Bardeen, J. R., Fergus, T. A., & Orcutt, H. K. (2012). An examination of the latent structure of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 34(3), 382–392.
go back to reference Behar, E., DiMarco, I. D., Hekler, E. B., Mohlman, J., & Staples, A. M. (2009a). Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of Anxiety Disorders, 23(8), 1011–1023.PubMed Behar, E., DiMarco, I. D., Hekler, E. B., Mohlman, J., & Staples, A. M. (2009a). Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of Anxiety Disorders, 23(8), 1011–1023.PubMed
go back to reference Behar, E., DiMarco, I. D., Hekler, E. B., Mohlman, J., & Staples, A. M. (2009b). Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of Anxiety Disorders, 23(8), 1011–1023.PubMed Behar, E., DiMarco, I. D., Hekler, E. B., Mohlman, J., & Staples, A. M. (2009b). Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of Anxiety Disorders, 23(8), 1011–1023.PubMed
go back to reference Boritz, T., Barnhart, R., Eubanks, C. F., & McMain, S. (2018). Alliance rupture and resolution in dialectical behavior therapy for borderline personality disorder. Journal of Personality Disorders, 32(Supplement), 115–128.PubMed Boritz, T., Barnhart, R., Eubanks, C. F., & McMain, S. (2018). Alliance rupture and resolution in dialectical behavior therapy for borderline personality disorder. Journal of Personality Disorders, 32(Supplement), 115–128.PubMed
go back to reference Clark, D. A., & Beck, A. (2010). Cognitive theory and therapy of anxiety and depression: Convergence with neurobiological findings. Trends in Cognitive Sciences, 14(9), 418–424.PubMed Clark, D. A., & Beck, A. (2010). Cognitive theory and therapy of anxiety and depression: Convergence with neurobiological findings. Trends in Cognitive Sciences, 14(9), 418–424.PubMed
go back to reference Covin, R., Ouimet, A. J., Seeds, P. M., & Dozois, D. (2008). A meta-analysis of CBT for pathological worry among clients with GAD. Journal of Anxiety Disorders, 22(1), 108–116.PubMed Covin, R., Ouimet, A. J., Seeds, P. M., & Dozois, D. (2008). A meta-analysis of CBT for pathological worry among clients with GAD. Journal of Anxiety Disorders, 22(1), 108–116.PubMed
go back to reference Cuijpers, P., Sijbrandij, M., Koole, S., Huibers, M., Berking, M., & Andersson, G. (2014). Psychological treatment of generalized anxiety disorder: A meta-analysis. Clinical Psychology Review, 34(2), 130–140.PubMed Cuijpers, P., Sijbrandij, M., Koole, S., Huibers, M., Berking, M., & Andersson, G. (2014). Psychological treatment of generalized anxiety disorder: A meta-analysis. Clinical Psychology Review, 34(2), 130–140.PubMed
go back to reference Eisner, L., Eddie, D., Harley, R., Jacobo, M., Nierenberg, A. A., & Deckersbach, T. (2017). Dialectical behavior therapy group skills training for bipolar disorder. Behavior Therapy, 48, 557–566.PubMedPubMedCentral Eisner, L., Eddie, D., Harley, R., Jacobo, M., Nierenberg, A. A., & Deckersbach, T. (2017). Dialectical behavior therapy group skills training for bipolar disorder. Behavior Therapy, 48, 557–566.PubMedPubMedCentral
go back to reference Fisher, P. L., & Durham, R. C. (1999). Recovery rates in generalized anxiety disorder following psychological therapy: An analysis of clinically significant change in the STAI-T across outcome studies since 1990. Psychological Medicine, 29(6), 1425–1434.PubMed Fisher, P. L., & Durham, R. C. (1999). Recovery rates in generalized anxiety disorder following psychological therapy: An analysis of clinically significant change in the STAI-T across outcome studies since 1990. Psychological Medicine, 29(6), 1425–1434.PubMed
go back to reference Friese, M., Messner, C., & Schaffner, Y. J. C. (2012). Mindfulness meditation counteracts self-control depletion. Consciousness and Cognition, 21(2), 1016–1022.PubMed Friese, M., Messner, C., & Schaffner, Y. J. C. (2012). Mindfulness meditation counteracts self-control depletion. Consciousness and Cognition, 21(2), 1016–1022.PubMed
go back to reference Garnefski, N., Kraaij, V., & Spinhoven, P. J. P. (2001). Negative life events, cognitive emotion regulation and emotional problems. Personality and Individual Differences, 30(8), 1311–1327. Garnefski, N., Kraaij, V., & Spinhoven, P. J. P. (2001). Negative life events, cognitive emotion regulation and emotional problems. Personality and Individual Differences, 30(8), 1311–1327.
go back to reference Gross, J. J., & Thompson, R. A. (2007). Emotion regulation: Conceptual foundations. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 3–24). The Guilford Press. Gross, J. J., & Thompson, R. A. (2007). Emotion regulation: Conceptual foundations. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 3–24). The Guilford Press.
go back to reference Hariri, A. R., Bookheimer, S. Y., & Mazziotta, J. C. (2000). Modulating emotional responses: Effects of a neocortical network on the limbic system. NeuroReport, 11(1), 43–48.PubMed Hariri, A. R., Bookheimer, S. Y., & Mazziotta, J. C. (2000). Modulating emotional responses: Effects of a neocortical network on the limbic system. NeuroReport, 11(1), 43–48.PubMed
go back to reference Heydarinasab, L. (2013). An investigation of the validity and reliability of psychometric characteristics of five facet mindfulness questionnaire in Iranian non-clinical samples. International Journal of Behavioral Sciences, 7(3), 229–237. Heydarinasab, L. (2013). An investigation of the validity and reliability of psychometric characteristics of five facet mindfulness questionnaire in Iranian non-clinical samples. International Journal of Behavioral Sciences, 7(3), 229–237.
go back to reference Hofmann, S. G., Asmundson, G. J., & Beck, A. (2013). The science of cognitive therapy. Behavior Therapy, 44(2), 199–212.PubMed Hofmann, S. G., Asmundson, G. J., & Beck, A. (2013). The science of cognitive therapy. Behavior Therapy, 44(2), 199–212.PubMed
go back to reference Hoyer, J., & Gloster, A. T. (2009). Psychotherapy for generalized anxiety disorder: Don't worry, it works! Psychiatric Clinics, 32(3), 629–640.PubMed Hoyer, J., & Gloster, A. T. (2009). Psychotherapy for generalized anxiety disorder: Don't worry, it works! Psychiatric Clinics, 32(3), 629–640.PubMed
go back to reference Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Science and Practice, 10(2), 144–156. Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Science and Practice, 10(2), 144–156.
go back to reference Kaplan, B. J. (2016). Kaplan and Sadock’s Synopsis of Psychiatry Behavioral Sciences/Clinical Psychiatry. Tijdschrift voor Psychiatrie, 58(1), 78–79. Kaplan, B. J. (2016). Kaplan and Sadock’s Synopsis of Psychiatry Behavioral Sciences/Clinical Psychiatry. Tijdschrift voor Psychiatrie, 58(1), 78–79.
go back to reference Kerns, C. M., Read, K. L., Klugman, J., & Kendall, P. C. (2013). Cognitive behavioral therapy for youth with social anxiety: Differential short and long-term treatment outcomes. Journal of Anxiety Disorders, 27(2), 210–215.PubMed Kerns, C. M., Read, K. L., Klugman, J., & Kendall, P. C. (2013). Cognitive behavioral therapy for youth with social anxiety: Differential short and long-term treatment outcomes. Journal of Anxiety Disorders, 27(2), 210–215.PubMed
go back to reference Khanzadeh, M., Saeediyan, M., Hosseinchari, M., & Edrissi, F. (2012). Factor structure and psychometric properties of difficulties in emotional regulation scale. International Journal of Behavioral Sciences, 6(1), 87–96. Khanzadeh, M., Saeediyan, M., Hosseinchari, M., & Edrissi, F. (2012). Factor structure and psychometric properties of difficulties in emotional regulation scale. International Journal of Behavioral Sciences, 6(1), 87–96.
go back to reference Khesht-Masjedi, M. F., Omar, Z., & Masoleh, S. M. K. (2015). Psychometrics properties of the Persian version of beck anxiety inventory in north of Iranian adolescents. International Journal of Educational and Psychological Researches, 1(2), 145. Khesht-Masjedi, M. F., Omar, Z., & Masoleh, S. M. K. (2015). Psychometrics properties of the Persian version of beck anxiety inventory in north of Iranian adolescents. International Journal of Educational and Psychological Researches, 1(2), 145.
go back to reference Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford press. Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford press.
go back to reference Linehan, M. (2014). DBT Skills training manual. New York: Guilford Publications. Linehan, M. (2014). DBT Skills training manual. New York: Guilford Publications.
go back to reference Lobbestael, J., Leurgans, M., & Arntz, A. (2011). Inter-rater reliability of the structured clinical interview for DSM-IV Axis I disorders (SCID I) and Axis II disorders (SCID II). Clinical Psychology & Psychotherapy, 18(1), 75–79. Lobbestael, J., Leurgans, M., & Arntz, A. (2011). Inter-rater reliability of the structured clinical interview for DSM-IV Axis I disorders (SCID I) and Axis II disorders (SCID II). Clinical Psychology & Psychotherapy, 18(1), 75–79.
go back to reference Löwe, B., Decker, O., Müller, S., Brähler, E., Schellberg, D., Herzog, W., et al. (2008). Validation and standardization of the generalized anxiety disorder screener (GAD-7) in the general population. Medical Care, 46(3), 266–274.PubMed Löwe, B., Decker, O., Müller, S., Brähler, E., Schellberg, D., Herzog, W., et al. (2008). Validation and standardization of the generalized anxiety disorder screener (GAD-7) in the general population. Medical Care, 46(3), 266–274.PubMed
go back to reference Majid, S. A., Seghatoleslam, T., Homan, H., Akhvast, A., & Habil, H. (2012). Effect of mindfulness based stress management on reduction of generalized anxiety disorder. Iranian Journal of Public Health, 41(10), 24. Majid, S. A., Seghatoleslam, T., Homan, H., Akhvast, A., & Habil, H. (2012). Effect of mindfulness based stress management on reduction of generalized anxiety disorder. Iranian Journal of Public Health, 41(10), 24.
go back to reference Marganska, A., Gallagher, M., & Miranda, R. (2013). Adult attachment, emotion dysregulation, and symptoms of depression and generalized anxiety disorder. American Journal of Orthopsychiatry, 83(1), 131–141.PubMed Marganska, A., Gallagher, M., & Miranda, R. (2013). Adult attachment, emotion dysregulation, and symptoms of depression and generalized anxiety disorder. American Journal of Orthopsychiatry, 83(1), 131–141.PubMed
go back to reference Meygoni, A. K. M., & Ahadi, H. (2012). Declining the rate of major depression: Effectiveness of dialectical behavior therapy. Procedia-Social and Behavioral Sciences, 35, 230–236. Meygoni, A. K. M., & Ahadi, H. (2012). Declining the rate of major depression: Effectiveness of dialectical behavior therapy. Procedia-Social and Behavioral Sciences, 35, 230–236.
go back to reference Naeinian, M. R., Shaeiri, M. R., Sharif, M., & Hadian, M. (2011). To study reliability and validity for a brief measure for assessing generalized anxiety disorder (GAD-7). Clinical Psychology & Personality, 2(4), 41–50. Naeinian, M. R., Shaeiri, M. R., Sharif, M., & Hadian, M. (2011). To study reliability and validity for a brief measure for assessing generalized anxiety disorder (GAD-7). Clinical Psychology & Personality, 2(4), 41–50.
go back to reference Newman, M. G., Castonguay, L. G., Borkovec, T. D., Fisher, A. J., & Nordberg, S. S. (2008). An open trial of integrative therapy for generalized anxiety disorder. Psychotherapy: Theory, Research, Practice, Training, 45(2), 135. Newman, M. G., Castonguay, L. G., Borkovec, T. D., Fisher, A. J., & Nordberg, S. S. (2008). An open trial of integrative therapy for generalized anxiety disorder. Psychotherapy: Theory, Research, Practice, Training, 45(2), 135.
go back to reference Novick-Kline, P., Turk, C. L., Mennin, D. S., Hoyt, E. A., & Gallagher, C. (2005). Level of emotional awareness as a differentiating variable between individuals with and without generalized anxiety disorder. Journal of Anxiety Disorders, 19(5), 557–572.PubMed Novick-Kline, P., Turk, C. L., Mennin, D. S., Hoyt, E. A., & Gallagher, C. (2005). Level of emotional awareness as a differentiating variable between individuals with and without generalized anxiety disorder. Journal of Anxiety Disorders, 19(5), 557–572.PubMed
go back to reference Preston, A. R., & Eichenbaum, H. (2013). Interplay of hippocampus and prefrontal cortex in memory. Current Biology, 23(17), R764–R773.PubMed Preston, A. R., & Eichenbaum, H. (2013). Interplay of hippocampus and prefrontal cortex in memory. Current Biology, 23(17), R764–R773.PubMed
go back to reference Renna, M. E., Quintero, J. M., Soffer, A., Pino, M., Ader, L., Fresco, D. M., et al. (2018). A pilot study of emotion regulation therapy for generalized anxiety and depression: Findings from a diverse sample of young adults. Behavior Therapy, 49(3), 403–418.PubMed Renna, M. E., Quintero, J. M., Soffer, A., Pino, M., Ader, L., Fresco, D. M., et al. (2018). A pilot study of emotion regulation therapy for generalized anxiety and depression: Findings from a diverse sample of young adults. Behavior Therapy, 49(3), 403–418.PubMed
go back to reference Salguero, J. M., Ramos-Cejudo, J., & García-Sancho, E. (2019). Metacognitive beliefs and emotional dysregulation have a specific contribution on worry and the emotional symptoms of generalized anxiety disorder. Journal of Cognitive Therapy, 12(3), 179–190. Salguero, J. M., Ramos-Cejudo, J., & García-Sancho, E. (2019). Metacognitive beliefs and emotional dysregulation have a specific contribution on worry and the emotional symptoms of generalized anxiety disorder. Journal of Cognitive Therapy, 12(3), 179–190.
go back to reference Salters-Pedneault, K., Roemer, L., Tull, M. T., Rucker, L., & Mennin, D. S. (2006). Evidence of broad deficits in emotion regulation associated with chronic worry and generalized anxiety disorder. Cognitive Therapy and Research, 30(4), 469–480. Salters-Pedneault, K., Roemer, L., Tull, M. T., Rucker, L., & Mennin, D. S. (2006). Evidence of broad deficits in emotion regulation associated with chronic worry and generalized anxiety disorder. Cognitive Therapy and Research, 30(4), 469–480.
go back to reference Sharifi, V., Assadi, S. M., Mohammadi, M. R., Amini, H., Kaviani, H., Semnani, Y., et al. (2009). A persian translation of the structured clinical interview for diagnostic and statistical manual of mental disorders: Psychometric properties. Comprehensive Psychiatry, 50(1), 86–91.PubMed Sharifi, V., Assadi, S. M., Mohammadi, M. R., Amini, H., Kaviani, H., Semnani, Y., et al. (2009). A persian translation of the structured clinical interview for diagnostic and statistical manual of mental disorders: Psychometric properties. Comprehensive Psychiatry, 50(1), 86–91.PubMed
go back to reference Stein, D. J., Ives-Deliperi, V., & Thomas, K. G. (2008). Psychobiology of mindfulness. CNS Spectrums, 13(9), 752–756.PubMed Stein, D. J., Ives-Deliperi, V., & Thomas, K. G. (2008). Psychobiology of mindfulness. CNS Spectrums, 13(9), 752–756.PubMed
go back to reference Turk, C. L., Heimberg, R. G., Luterek, J. A., Mennin, D. S., Fresco, D.(2005). Emotion dysregulation in generalized anxiety disorder: A comparison with social anxiety disorder. 29(1), 89–106. Turk, C. L., Heimberg, R. G., Luterek, J. A., Mennin, D. S., Fresco, D.(2005). Emotion dysregulation in generalized anxiety disorder: A comparison with social anxiety disorder. 29(1), 89–106.
go back to reference Ulusoy, M., Sahin, N. H., & Erkmen, H. (1998). The Beck anxiety inventory: Psychometric properties. Journal of Cognitive Psychotherapy, 12(2), 163–172. Ulusoy, M., Sahin, N. H., & Erkmen, H. (1998). The Beck anxiety inventory: Psychometric properties. Journal of Cognitive Psychotherapy, 12(2), 163–172.
go back to reference Van Dijk, S. (2013). DBT made simple: A step-by-step guide to dialectical behavior therapy. Oakland: New Harbinger Publications. Van Dijk, S. (2013). DBT made simple: A step-by-step guide to dialectical behavior therapy. Oakland: New Harbinger Publications.
go back to reference Wells, A. (2002). GAD, meta-cognition, and mindfulness: An information processing analysis. Clinical Psychology: Science and Practice, 9(1), 95–100. Wells, A. (2002). GAD, meta-cognition, and mindfulness: An information processing analysis. Clinical Psychology: Science and Practice, 9(1), 95–100.
go back to reference Wells, A. (2004). A cognitive model of GAD. Generalized Anxiety Disorder: Advances in Research and Practice, 28, 164–186. Wells, A. (2004). A cognitive model of GAD. Generalized Anxiety Disorder: Advances in Research and Practice, 28, 164–186.
go back to reference Wells, A., & Carter, K. (2014). Generalized anxiety disorder. The handbook of adult clinical psychology (pp. 447–481). Abingdon: Routledge. Wells, A., & Carter, K. (2014). Generalized anxiety disorder. The handbook of adult clinical psychology (pp. 447–481). Abingdon: Routledge.
go back to reference Wagner, E. E., Rathus, J. H., Miller, A. L., & Baer, R. (2006). Mindfulness in dialectical behavior therapy (DBT) for adolescents. Mindfulness-based treatment approaches clinician’s guide to evidence base and applications (pp. 167–189). San Diego: Elsevier. Wagner, E. E., Rathus, J. H., Miller, A. L., & Baer, R. (2006). Mindfulness in dialectical behavior therapy (DBT) for adolescents. Mindfulness-based treatment approaches clinician’s guide to evidence base and applications (pp. 167–189). San Diego: Elsevier.
go back to reference Westen, D., & Bradley, R. (2005). Empirically supported complexity: Rethinking evidence-based practice in psychotherapy. Current Directions in Psychological Science, 14(5), 266–271. Westen, D., & Bradley, R. (2005). Empirically supported complexity: Rethinking evidence-based practice in psychotherapy. Current Directions in Psychological Science, 14(5), 266–271.
go back to reference Whisman, M. A., Perez, J. E., & Ramel, W. (2000). Factor structure of the beck depression inventory—second edition (BDI-ii) in a student sample. Journal of Clinical Psychology, 56(4), 545–551.PubMed Whisman, M. A., Perez, J. E., & Ramel, W. (2000). Factor structure of the beck depression inventory—second edition (BDI-ii) in a student sample. Journal of Clinical Psychology, 56(4), 545–551.PubMed
Metadata
Title
Study of Dialectical Behavior Therapy Versus Cognitive Behavior Therapy on Emotion Regulation and Mindfulness in Patients with Generalized Anxiety Disorder
Authors
Behrooz Afshari
Jila Hasani
Publication date
01-12-2020
Publisher
Springer US
Published in
Journal of Contemporary Psychotherapy / Issue 4/2020
Print ISSN: 0022-0116
Electronic ISSN: 1573-3564
DOI
https://doi.org/10.1007/s10879-020-09461-9

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