title: Mediated moderation in combined cognitive behavioral therapy versus component treatments for generalized anxiety disorder.
abstract: OBJECTIVE
  This study examined (a) duration of generalized anxiety disorder (GAD) as a moderator of cognitive behavioral therapy (CBT) versus its components (cognitive therapy and self-control desensitization) and (b) increases in dynamic flexibility of anxious symptoms during the course of psychotherapy as a mediator of this moderation. Degree of dynamic flexibility in daily symptoms was quantified as the inverse of spectral power due to daily to intradaily oscillations in four-times-daily diary data (Fisher, Newman, & Molenaar, 2011).
  
  
  METHODS
  This was a secondary analysis of the data of Borkovec, Newman, Pincus, and Lytle (2002). Seventy-six participants with a principle diagnosis of GAD were assigned randomly to combined CBT (n = 24), cognitive therapy (n = 25), or self-control desensitization (n = 27).
  
  
  RESULTS
  Duration of GAD moderated outcome such that those with longer duration showed greater reliable change from component treatments than they showed from CBT, whereas those with shorter duration fared better in response to CBT. Decreasing predictability in daily and intradaily oscillations of anxiety symptoms during therapy reflected less rigidity and more flexible responding. Increases in flexibility over the course of therapy fully mediated the moderating effect of GAD duration on condition, indicating a mediated moderation process.
  
  
  CONCLUSIONS
  Individuals with longer duration of GAD may respond better to more focused treatments, whereas those with shorter duration of GAD may respond better to a treatment that offers more coping strategies. Importantly, the mechanism by which this moderation occurs appears to be the establishment of flexible responding during treatment.
authors: Department of Psychology, The Pennsylvania State University, University Park, PA 16802-3103, USA. mgn1@psu.edu
authors: Michelle G
authors: MG
authors: Newman
authors: Aaron J
authors: AJ
authors: Fisher
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology; D000328:Adult; D001008:Anxiety Disorders / Q000503:physiopathology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods* / Q000592:standards; D003887:Desensitization, Psychologic / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
references: Annu Rev Clin Psychol. 2013;9:275-97
references: 23537486
references: J Consult Clin Psychol. 1991 Feb;59(1):12-9
references: 2002127
references: J Abnorm Psychol. 2001 Feb;110(1):49-58
references: 11261399
references: Psychol Med. 1998 Sep;28(5):1149-57
references: 9794022
references: J Consult Clin Psychol. 1998 Dec;66(6):939-47
references: 9874907
references: J Neurol Neurosurg Psychiatry. 1960 Feb;23:56-62
references: 14399272
references: J Consult Clin Psychol. 1999 Aug;67(4):583-9
references: 10450630
references: J Consult Clin Psychol. 1971 Oct;37(2):228-34
references: 5116681
references: J Consult Clin Psychol. 1979 Jun;47(3):453-8
references: 528713
references: J Abnorm Psychol. 2003 Nov;112(4):558-77
references: 14674869
references: Annu Rev Clin Psychol. 2007;3:1-27
references: 17716046
references: Psychiatry Res. 1994 Aug;53(2):191-202
references: 7824679
references: J Consult Clin Psychol. 2000 Aug;68(4):549-55
references: 10965629
references: J Consult Clin Psychol. 1983 Apr;51(2):171-82
references: 6341426
references: Behav Res Ther. 1990;28(6):487-95
references: 2076086
references: J Consult Clin Psychol. 2011 Apr;79(2):171-81
references: 21443321
references: Arch Gen Psychiatry. 2002 Oct;59(10):877-83
references: 12365874
references: J Consult Psychol. 1967 Apr;31(2):109-18
references: 5342732
references: Arch Gen Psychiatry. 1975 Aug;32(8):995-1008
references: 239666
references: Gen Hosp Psychiatry. 2002 May-Jun;24(3):156-63
references: 12062140
references: J Pers Soc Psychol. 1986 Dec;51(6):1173-82
references: 3806354
references: J Consult Clin Psychol. 2011 Aug;79(4):552-63
references: 21707138
references: J Consult Clin Psychol. 1993 Aug;61(4):611-9
references: 8370856
references: J Consult Clin Psychol. 2002 Apr;70(2):288-98
references: 11952187
references: Behav Res Ther. 1992 Jan;30(1):33-7
references: 1540110
references: J Consult Clin Psychol. 2007 Jun;75(3):409-421
references: 17563158
references: Arch Gen Psychiatry. 1993 Apr;50(4):251-6
references: 8466385
references: Behav Ther. 2010 Mar;41(1):59-72
references: 20171328
references: Br J Med Psychol. 1959;32(1):50-5
references: 13638508
references: J Clin Psychiatry. 2001;62 Suppl 11:37-42; discussion 43-5
references: 11414549