A randomized trial of brief cognitive-behavioral therapy for prevention of generalized anxiety disorder.

Sir: Given its high prevalence and cost to society, generalized anxiety disorder (GAD) is a mental health problem that merits investigation of etiology, treatment, and prevention. We conducted a pilot study to investigate the efficacy of a preventative psychoeducational workshop for GAD with college students at risk for developing the disorder. Participants were determined to be " at risk " for developing GAD if they manifested subclinical levels of GAD symptoms on the PSWQ as defined by a score that fell in the range between the cutoff score (62) recommended to identify people with GAD and 2 standard deviations below this cutoff score, 43. 2 The workshop was carried out over two 120-minute meetings during which education about anxiety and worry were provided and cognitive-behavioral strategies (e.g., self-monitoring, cognitive restructuring , progressive muscle relaxation, worry exposure, problem orientation/problem solving) for managing both were taught. Participants (N = 72; 48 women, 24 men) were randomly assigned to either an intervention (workshop, N = 35) or a no-treatment control condition (N = 37). An integral aspect of prevention research is examining the rate of incidence of a disorder over time in the sample of interest. We used the Generalized Anxiety Disorder Questionnaire-IV 3 to provide dichoto-mous data regarding presence or absence of GAD 1 year after workshop participation. Results. Five participants (14%) in the control condition developed GAD by 12 months postintervention compared with 1 participant (3%) in the intervention condition. Fisher exact test of significance suggested different rates of GAD for at-risk participants in the intervention and control conditions (p = .11, 1-tailed). Because this analysis of our pilot study approached statistical significance, we determined that, in order to obtain statistical power of .80, a minimum 89 participants per condition would be required in a future study. Thus, although the sample size in our pilot study was too small to make a definitive judgment about prevention of GAD, more individuals in the control condition developed clinically significant symptoms by 12 months after baseline assessment than did individuals in the intervention condition. Future GAD prevention research should address a number of factors in order to best ensure that incidence of the disorder is indeed prevented in a given sample. It is clear that certain conceptual and methodological issues, such as identification of risk factors (e.g., subclinical levels of psychopathology); empirically based, cost-efficient interventions; and participant-selection criteria, are imperative to consider when designing …