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Cognitive-behavioral therapy is effective for generalized anxiety disorder (GAD), but only about 50% of GAD patients achieve remission with the standard CBT approach. Some investigators have hypothesized that interpersonal conflict within the patient’s committed relationship is an important factor in maintaining GAD symptoms. To learn more, these investigators conducted a randomized, controlled treatment study of 18 GAD patients in committed relationships.
The researchers videotaped, rated, and coded each couple’s interactions for levels and types of criticism before the GAD patients underwent CBT or were placed on a wait list. CBT was delivered in 12 sessions over 16 weeks and involved cognitive restructuring, imagery exposure, and relaxation training. Results confirmed efficacy for CBT, with a remission rate of 62% among recipients. After 16 weeks, wait-list patients received the same CBT package and showed similar improvement. Thus, the investigators combined results to examine the effects of marital communication on outcome.
Findings showed that pretreatment levels of partner’s hostility and nonhostile criticism together accounted for 41% of the variance in the main outcome measure (overall end-state functioning). Hostility was associated with worse outcome, and nonhostile criticism was associated with better GAD outcome.
Zinbarg RE et al. Dyadic predictors of outcome in a cognitive-behavioral program for patients with generalized anxiety disorder in committed relationships: A “spoonful of sugar” and a dose of non-hostile criticism may help. Behav Res Ther 2007 Apr; 45:699-713.
Comment
Although this is a small study, its results are consistent with a growing literature suggesting that interpersonal problems affect CBT outcome. CBT therapists might consider augmenting treatment with an interpersonal intervention aimed at both reducing devaluation and hostility and increasing nonhostile criticism — the kind of communication that entails neutral or positively toned, honest disagreement.