title: Changes in risk-taking over the course of an internet-delivered cognitive behavioral therapy treatment for generalized anxiety disorder.
abstract: It has been proposed that a persistent and pervasive tendency to avoid risks is involved in the development and maintenance of clinically significant anxiety. Few studies, however, have examined the clinical implications of risk-aversion, and particularly the association between risk-aversion and treatment outcome. The current study investigated how risk-aversion in specific domains (Social and Recreational) related to treatment outcome in a clinical sample of patients with generalized anxiety disorder (GAD) undergoing internet-delivered cognitive-behavioral therapy (CBT). We hypothesized that: (i) risk-taking would increase as a result of treatment and (ii) risk-taking would mediate changes in symptom severity and impairment as a result of treatment. Individuals recruited online (N=44) meeting diagnostic criteria for GAD were randomized to the treatment (n=24) or control group (n=20). Participants completed measures of symptom severity, impairment and risk-taking before and after treatment. Results partially confirmed our hypotheses, demonstrating that participants in the treatment group significantly increased social and recreational risk-taking scores relative to the control group and risk-taking mediated treatment outcome for depression, but not for anxiety symptoms. The results of this study suggest that social and recreational risk-avoidance decreases following CBT treatment, and this change may mediate treatment outcome for depression. Clinical implications of these findings are discussed.
authors.affiliation: School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia. carolyn.lorian@unsw.edu.au
authors.forename: Carolyn N
authors.initials: CN
authors.lastname: Lorian
authors.forename: Nickolai
authors.initials: N
authors.lastname: Titov
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Grisham
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology / Q000628:therapy; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003657:Decision Making; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D019114:Remote Consultation / Q000379:methods*; D012309:Risk-Taking; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome