ABSTRACT This study examined the effect of holistic practices on anxiety. The study used a pre-experimental design and measured any differences in outcomes in Generalized Anxiety Disorder clients as measured by General Anxiety Disorder-7 (GAD-7) between the two following groups: 1) the experimental group who received holistic services in addition to traditional treatment such as psychotherapy and/or medication as compared to 2) the control group who received psychotherapy and/or medication alone. Pretest of GAD-7 at intake and post-tests at about 4 months into treatment were measured along with a holistic practice survey and analyzed post-hoc through SPSS data analysis. This study found that GAD-7 scores were improved, with majority of the participants involved in some sort of holistic supplemental practices. However there was no statistical correlation between the two phenomena in this small sample. More research is recommended with larger samples, as well as improved instrumentation that could vet out other possible effects on the GAD scores.

En effectiveness-studie undersökte effekten av Dugas och Robichauds (2007) behandlingsmodell för GAD på en specialistmottagning för patienter med komplicerade ångest och eller depressionstillstånd. Utöver detta undersöktes vilka övriga KBT-behandlingar för GAD som förmedlats på mottagningen. Alla patienter behandlades som en del av klinikens ordinarie verksamhet. Huvudutfallsmått var Generalized Anxiety Disorder Scale-7 (GAD-7) som mättes före och efter behandling. Därutöver mättes även grad av depressiva besvär med PHQ-9 samt grad av klinisk remission efter behandling. Behandlingsmodellens resultat för de patienter som bidragit med eftermätning (completerdata) visade en stor inomgruppseffektstorlek för GAD-7 (Cohen’s d=1,76) och 65% bedömdes även efter behandling inte längre uppfylla kriterier för GAD enligt DSM-IV. Bortfallet av data från före- till eftermätning var dock stort, vilket försvårar tolkningen av huvudutfallsmåttet. Även moderatorer för effekt undersöktes, men inga signifikanta samband mellan behandlingsutfall och tidigare visade moderatorer för effekt såsom ålder, kön eller samtidig farmakologisk behandling kunde visas. Resultaten jämförs med tidigare studier och en diskussion förs kring studiens begränsningar. / Objective: While the efficacy of Dugas and Robichauds (2007) CBT treatment model for GAD has been tested in clinical trials, it is still unclear how the treatment is received in a outpatient setting with clinically referred patients. The present effectiveness study aimed to examine the effect of Dugas and Robichauds (2007) CBT treatment on a large outpatient group (N=188) diagnosed with GAD. In addition other types of CBT treatments delivered to the outpatient group were examined, as well as potential moderators for treatment effect such as age, sex, initial GAD-7 scores and concurrent pharmacological treatment. The treatment for the outpatient group was delivered in a clinic (WeMind, www.wemind.se) specialized in treatments of depression and anxiety.  Method: The study is an analysis of gathered data from CBT treatments of GAD during a 3 year span at the clinic. Patients (N=188) diagnosed with GAD were categorized according to type of CBT treatment received and if treatment was completed with intact data. 71 patients were treated with Dugas and Robichauds (2007) CBT treatment, but 22 of these patients also received other CBT interventions at the same time. 33 patients received other kinds of CBT treatment. A large group (N=84) had missing data or did not complete treatment. Measurements taken at the beginning and end of treatment were Generalized Anxiety Disorder scale-7 (GAD-7), Public Health Questionnaire-9  (PHQ-9) and Penn State Worry Questionnaire (PSWQ). Clinical remission was measured at the end of treatment with the help of the therapists. A completeranalysis design was used with no waitlist or control group. Results: A paired samples T-test for patients treated with Dugas and Robichauds (2007) CBT treatment and measured with GAD-7 and PHQ-9 gave significant results for GAD-7, t70=13,17 (p<0.001) and PHQ-9, t67=10,25 (P<0.001). 46 of the 71 patients (65%) was assessed with clinical remission (no clinical diagnoses after treatment). Effectsize calculated with Cohen's d were GAD-7=1.76, PHQ-9=1.46 and PSWQ=1.76. Moderators were examined by calculating GAD-7 change score (difference pre-post GAD-7) and correlating the change score with age, sex, initial GAD-7 score and pharmacological treatment. Age and sex gave no significant results. Whether concurrent pharmacological treatment had an moderator effect was examined by categorizing the patients into three groups: (1) no pharmacological treatment, (2) stable pharmacological treatment and (3) changed pharmacological treatment (increased dosage or new treatment). Again no significant effect was found. One positive significant correlation was found with initial GAD-7 scores and GAD-7 change score, GAD-7, r=.66, t69=7,36 (p<0.001). Higher initial GAD-7 measurement correlated with a greater change score. Conclusions:The results indicate a large treatment effect for Dugas and Robichauds (2007) CBT treatment model for GAD in an normal outpatient setting, with clinically referred patients and treatment administered by general CBT therapists. The effect was superior compared to the group that received general CBT treatment interventions for GAD. The effect of treatment measured with GAD-7 and PHQ-9 was also drastically improved if other CBT interventions was added to the treatment model, but these interventions did not have an effect on clinical remission. Serious limitations such as a high percentage of drop outs, a completeranalysis model, no control group and no follow up data restrict the possible interpretations of the results.

Previous research has shown that Generalized Anxiety Disorder (GAD) is related to stress levels, poor sleep quality, female gender, and younger age. Therefore, the aim of this study was to examine if stress level, sleep quality, gender, and age could predict an increased risk of developing GAD. We hypothesized that increased levels of stress, poorer sleep quality, female gender and younger age predicted an increased risk of developing GAD. A quantitative data collection was performed. The questionnaire was presented on Facebook and was sent by email to contacts at “Blekinge Tekniska Högskola” and “Telenor Connexion” who then forwarded the survey to their colleagues. This self-assessment survey was based on three measuring instruments “Generalized Anxiety Disorder 7 item Scale” (GAD-7),” Karolinska Exhaustion Disorder Scale” (KEDS) and” Insomnia Severity Index” (ISI). A total of 154 participants (93 women, 61 men), were included in the study. The results from the study showed that stress level and age predicted an increased risk of suffering from GAD, where the variable stress level strongest predicted the risk of developing GAD. It could be concluded that stress level and age could predict an increased risk of developing GAD. / Tidigare forskning har visat att generaliserat ångestsyndrom (GAD) är relaterat till stress, sämre sömnkvalitet, kvinnligt kön och lägre åldrar. Därmed var syftet med föreliggande studie att undersöka om stressnivå, sömnkvalitet, kön och ålder kunde predicera en ökad risk för GAD. Studiens hypotes var att ökade nivåer av stress, sämre sömnkvalitet, kvinnligt kön och yngre ålder predicerade en ökad risk att drabbas av GAD. En kvantitativ datainsamling utfördes genom insamling från sociala medier såsom Facebook samt via email till kontaktpersoner från ”Blekinge Tekniska Högskola” och ”Telenor Connexion” som i sin tur vidarebefordrade enkäten till sina arbetskollegor. Enkäten som skickades ut var ett självskattningsformulär som baserades på de tre mätinstrumenten “Generalized Anxiety Disorder 7 item Scale” (GAD-7),” Karolinska Exhaustion Disorder Scale” (KEDS) and ”Insomnia Severity Index” (ISI). Totalt deltog 154 personer (93 kvinnor, 61 män). Resultatet från studien visade att prediktorerna stressnivå och ålder kunde predicera en ökad risk att drabbas av GAD, där stressnivå i störst utsträckning kunde predicera GAD. Sammanfattningsvis kunde man dra slutsatsen att stressnivå och ålder kunde predicera en ökad risk för att utveckla GAD.

Syftet med denna uppsats var att undersöka behandlingseffekten av studentledd psykoterapi på Umeå Universitets psykologmottagning gällande depressions- och ångestsymptom. Mer specifikt var syftet även att jämföra de två behandlingsmetoder som praktiseras på mottagningen; kognitiv beteendeterapi (KBT) och psykodynamisk terapi (PDT), samt jämföra de självskattningsinstrument för depression och ångest som ingår i mottagningens testbatteri (Patient Health Questionnaire 9-items, PHQ-9; Hospital Anxiety and Depression scale, HADS; General Anxiety Disorder 7-item scale, GAD-7). Ett ytterligare delsyfte var att beskriva mottagningens klientpopulation. Stickprovet bestod av 61 deltagare (72.1 procent kvinnor, 49.2 procent studenter, medianålder 23 år) som behandlats med antingen KBT eller PDT. För att undersöka effekterna av behandling jämfördes deltagarnas symptomskattningar före och efter behandling uppdelat på behandlingsmetod med hjälp av två-vägs variansanalys (ANOVA). Resultaten visade stora effektstorlekar för behandling gällande depression och ångest. Inga signifikanta skillnader observerades mellan behandlingsmetoder, vilket kan bero på bristande power. Diskrepans mellan instrumentens förmåga att identifiera deltagare med symptom på depression och ångest kunde ses, i synnerhet gällande depressionssymptom. I linje med rådande forskning visar studiens resultat att studentledd behandling har effekt på depression och ångest. Validiteten för de instrument som används på Psykologmottagningen bör dock undersökas närmare. Sammantaget belyser resultaten i denna studie vikten av att välja mätinstrument anpassade för den tilltänkta populationen för att kunna utvärdera behandlingseffekt.

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