Interpersonal Cognitions as a Mechanism of Change in Cognitive Behavioral Therapy for Generalized Anxiety Disorder? A Multilevel Dynamic Structural Equation Model Approach

GÓMEZ PENEDO, JUAN MARTÍN ; HILPERT, PETER; GROSSE HOLTFORTH, MARTIN ; FLÜCKIGER, CHRISTOPH

Journal of Consulting and Clinical Psychology

American Psychological Association

Año: 2021 vol. 89 p. 898 - 908

0022-006X

Objective: This study aimed to investigate the effects of changes in interpersonal cognitions on outcome during cognitive behavioral therapy (CBT) for generalized anxiety disorder (GAD) and how these effectsare moderated by patients’ interpersonal problems at intake. Method: A sample of 80 adult patientsdiagnosed with GAD who were undergoing CBT within a randomized controlled trial completed aquestionnaire concerning interpersonal problems at baseline as well as measures of changes in interpersonaland self-related cognitions and in worry severity session by session. We conducted dynamic structuralequation modeling to estimate cross-lagged within-patient effects of changes in interpersonal cognitions onworry, adjusting for the effects of self-related cognitions. Furthermore, we included interpersonal problemsas a moderator of the effects of changes in interpersonal cognitions. Results: We found significant crosslaggedeffects of changes in both interpersonal cognitions and self-related cognitions on subsequent worrylevels. Greater changes in interpersonal cognitions and self-related cognitions in a given session wereassociated with lower worry levels at the beginning of the next session. When adjusting for self-relatedcognitions, the effects of changes in interpersonal cognitions on subsequent worry remained significant.However, there were no interactive effects of changes in interpersonal cognitions by patients’ interpersonalproblems on worry severity. Conclusions: The results present evidence supporting changes in interpersonalcognitions and self-related cognitions as relevant change mechanisms in CBT for GAD