Thomas Borkovec, Ph.D. - US grants

Proposed research will apply outcome methodology to the evaluation of two forms of therapy for the treatment of generalized anxiety. Subjects will receive coping desensitization or cognitive therapy, each applied to somatic fear cues and subsequently, to congnitive fear cues. These two conditions will be contrasted with a progressive relaxation-only control condition. All subjects will receive two preliminary progressive relaxation sessions, followed by 10 sessions of respective therapy and two fading sessions. Four focused (meditative) relaxation sessions will occur before treatment and after each segment of the therapy sessions to assess the occurrence of relaxation-induced anxiety and to evaluate the impact of different interventions on the phenomenon. Pretreatment, posttreatment, and follow-up (6 mo. and 1 yr.) assessments will include a standardized psychiatric interview, a variety of self-report measures, and client and significant-other daily diary measures. A psychophysiological assessment session will be conducted at pretreatment and posttreatment periods to assess resting and stress reactivity responses among subtypes of general anxiety and to evaluate the impact of different interventions on laboratory stress situations. Subtypes of general anxiety will be formed on the basis of the degree of involvement of somatic vs. cognitive anxiety. This design will be separately replicated on GAD clients and community volunteers at two sites: State College, PA, and London, England.

The proposed research focuses on the psychological treatment of Generalized Anxiety Disorder and Panic Disorder. A pilot study is reported wherein progressive relaxation training plus nondirective therapy, plus cognitive therapy, and plus coping desensitization led to significant and equivalent post-therapy and follow-up improvement. Our research and that of others have yet to separate the effects of nonspecific factors and relaxation training. Study I proposes to compare nondirective therapy alone, progressive relaxation training alone, and a coping desensitization package which includes relaxation, anxiety-incompatible thought substitution, and worry management in the treatment of these anxiety states. Self-report, psychiatric assessor, and psychophsyiological assessments will be obtained at pre- and post- therapy periods, and 6- and 12-month follow-up will be conducted with self-report and assessor measures. A variety of process measures will be included to test mechanisms of treatment change.

This award provides funds to the Department of Psychology at The Pennsylvania State University to establish a Research Experiences for Undergraduates Site. Eight undergraduate psychology majors with an interest in the biological aspects of experimental psychology will be recruited to participate in this program at the completion of their sophomore year. An effort will be made to attract a majority of minority students using the techniques and contacts which have enabled the Department to train 40 minority Ph.D.s since 1969. The students selected will work as apprentices with one of five members of the faculty, all nationally known for their research and all highly experienced at training graduate students and undergraduates who have gone on to graduate school. Last year these same five faculty members received a large equipment grant from the U.S. Department of Education. Therefore, the facilities available in these laboratories for research and training in psychophysiology are the equal of any university in the country. Faculty mentors will work full-time with these students during the summer after their sophomore year, gradually exposing them to all aspects of psychophysiological research. Students will begin an independent experiment during the latter part of the summer and complete it with the help of their Penn State mentor during their junior year. Near the end of their junior year the students will present their research at a department colloquium.

This award provides support to The Pennsylvania State University to continue their Research Experience for Undergraduates Site. Eight undergraduate psychology majors with an interest in the biological aspects of experimental psychology will be recruited to participate in this program at the completion of their sophomore or junior year. An effort will be made to attract a majority of minority students using the techniques and contacts which have enabled staff to train over 40 minority Ph.D.s since 1969 and five minority students in the 1989-90 NSF REU Sites program. The students selected will work as apprentices with one of seven members of the faculty, all nationally known for their research and all highly experienced at preparing undergraduates who have gone on to graduate school. This faculty recently received a major equipment grant form the U.S. Department of Education that has provided facilities for research and training. The program is designed to have students work full-time for eight weeks in the summer, gradually exposing them to all aspects of psychophysiological research and to selected aspects of physiological psychology. Students will design an independent research project during the latter part of the summer and complete it with the help of their Penn State mentor during the following academic year. At the end of the spring semester, they will present their research results at a department colloquium. In some cases, the research will be submitted for publication or presentation at professional meetings. Every effort will be made to encourage and assist students to gain admission to graduate programs, either at Penn State or elsewhere.

The present study will compare the short-term and long-term effectiveness of self-control desensitization, self-control desensitization plus cognitive therapy, and cognitive therapy alone in the treatment of generalized anxiety disorder. Seventy-five clients will be diagnosed for primary generalized anxiety disorder by two independent psychiatric assessors using the Anxiety Disorders Interview Schedule, will complete a variety of pretherapy anxiety questionnaires and daily diaries, and will participate in a psychophysiological laboratory session which assesses peripheral and central physiological activity during several tasks of theoretical relevance to anxiety disorders. Subsequently, they will be provided 14 1.5-hour individual therapy sessions, after which posttherapy assessment will be repeated using the same psychiatric interview, questionnaires and diaries, and laboratory session. Two further therapy sessions will then be provided as fading sessions. Follow-up assessments will take place at 6 months, 12 months, and 24 months, and will include the psychiatric interview and questionnaires and diaries. The therapists will be two Ph.D. clinicians well-experienced in cognitive-behavioral treatment of anxiety disorders. A matched group of 75 nonanxious subjects will participate in the psychiatric interview and questionnaire sessions and will undergo the laboratory session, to provide normative information and as a contrast group for the physiological measures.

This award provides funds to continue a Research Experiences for Undergraduates Site in the Department of Psychology at Pennsylvania State University for another three years. Eight undergraduate psychology majors with an interest in the biological aspects of experimental psychology will be recruited to participate in this program at the completion of their sophomore or junior year. An effort will be made to attract women and minority students using the techniques and contacts which have enabled staff to train over 43 minority Ph.D.s since 1969 and ten minority students in past REU programs. The students selected will work as apprentices with one of eight members of the faculty, all nationally known for their research and all highly experienced at preparing undergraduates who have gone on to graduate school. This faculty has received a major equipment grant from the U.S. Department of Education that has provided facilities for research and training. The program is designed to have the students work full-time for eight weeks in the summer, gradually exposing them to all aspects of psychophysiological research and to selected aspects of perception and cognitive and physiological psychology. Students will design an independent research project during the latter part of the summer and complete it with the help of their Penn State mentor during the following academic year. At the end of the spring semester, they will present their research results at a department colloquium. Every effort will be made to encourage and assist students to gain admission to graduate programs.

The present study will compare the short-term and long-term effectiveness of self-control desensitization, self-control desensitization plus cognitive therapy, and cognitive therapy alone in the treatment of generalized anxiety disorder. Seventy-five clients will be diagnosed for primary generalized anxiety disorder by two independent psychiatric assessors using the Anxiety Disorders Interview Schedule, will complete a variety of pretherapy anxiety questionnaires and daily diaries, and will participate in a psychophysiological laboratory session which assesses peripheral and central physiological activity during several tasks of theoretical relevance to anxiety disorders. Subsequently, they will be provided 14 1.5-hour individual therapy sessions, after which posttherapy assessment will be repeated using the same psychiatric interview, questionnaires and diaries, and laboratory session. Two further therapy sessions will then be provided as fading sessions. Follow-up assessments will take place at 6 months, 12 months, and 24 months, and will include the psychiatric interview and questionnaires and diaries. The therapists will be two Ph.D. clinicians well-experienced in cognitive-behavioral treatment of anxiety disorders. A matched group of 75 nonanxious subjects will participate in the psychiatric interview and questionnaire sessions and will undergo the laboratory session, to provide normative information and as a contrast group for the physiological measures.

DESCRIPTION (Applicant's Abstract): Systematic, controlled therapy research on generalized anxiety disorder, a prevalent disorder characterized by chronic worry, has only recently begun. Review of extant theoretical and empirical literature including recent basic and therapy outcome research suggests that, although a combined cognitive behavioral intervention package (applied relaxation, self-control desensitization, and cognitive therapy) which targets intrapersonal anxious process is effective in treating this disorder, losses in therapeutic gains by long-term follow-up may be due to a failure of CBT to address significant interpersonal/emotional processing problems. Consequently, a CBT that includes interpersonal/emotional processing therapy techniques is likely to yield greater and more long-lasting improvements. The proposed study will therefore compare (a) the current, best available CBT package plus a reflective listening therapy element and (b) the same CBT package plus an interpersonal/emotional processing therapy element. The reflective listening element in the former condition is designed to equate the two conditions for total amount of therapy time. Outcome will be assessed at post-therapy and again at 6, 12, and 24 months after therapy. Several process measures and secondary outcome measures (including a psychophysiological laboratory session measuring central and peripheral physiological activity during theoretically relevant tasks and administered at pre-therapy and post-therapy) and the assessment of matched nonanxious control subjects will provide information regarding the nature of the psychopathology and the nature of the mechanisms of therapeutic change.

DESCRIPTION (Adapted from applicant's abstract): Systematic, controlled therapy research on generalized anxiety disorder, a prevalent disorder characterized by chronic worry, has only recently begun. Review of extant theoretical and empirical literature including recent basic and therapy outcome research suggests that, although a combined cognitive behavioral intervention package (applied relaxation, self-control desensitization, and cognitive therapy) which targets intrapersonal anxious process is effective in treating this disorder, losses in therapeutic gains by long-term follow-up may be due to a failure of CBT to address significant interpersonal/emotional processing problems. Consequently, a CBT that includes interpersonal/ emotional processing therapy techniques is likely to yield greater and more long-lasting improvements. The proposed study will therefore compare (a) the current, best available CBT package plus a supportive listening therapy element and (b) the same CBT package plus an interpersonal/ emotional processing therapy element. The supportive listening element in the former condition is designed to equate the two conditions for total amount of therapy time. Outcome will be assessed at posttherapy and again at 6, 12, and 24 months after therapy. Several process measures and secondary outcome measures (including a psychophysiological laboratory session measuring central and peripheral physiological activity during theoretically relevant tasks and administered at pretherapy and posttherapy) and the assessment of matched nonanxious control subjects will provide information regarding the nature of the psychopathology and the nature of the mechanisms of therapeutic change.