human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Nondirective ( ND ) , applied relaxation ( AR ) , and cognitive behavioral ( CBT ) therapies for generalized anxiety disorder ( GAD ) were compared . The latter 2 conditions were generally equivalent in outcome but superior to ND at post assessment . The 3 conditions did not differ on several process measures , and ND created the greatest depth of emotional processing . Follow-up results indicated losses in gains in ND , maintained gains in the other 2 conditions , especially CBT , and highest endstate functioning for CBT . AR and CBT thus contain active ingredients in the treatment of GAD ; support exists for further development of imagery exposure methods or cognitive therapy because of their likely role in promoting maintenance of change with this disorder . Expectancy for improvement was also associated with outcome , suggesting the need for further research on this construct for underst and ing the nature of GAD and its amelioration OBJECTIVE This report examines the impact of panic disorder and /or generalized anxiety disorder on quality of life and the implication s of these findings on nosological categories . METHOD A total of 357 subjects with a current episode of panic disorder and /or generalized anxiety disorder were diagnosed according to DSM-III-R criteria , using structured clinical interviews , as part of a prospect i ve , naturalistic , longitudinal , multicenter study of a clinical population with anxiety disorders . RESULTS There was a high degree of coexistence of anxiety disorders and major depressive disorder . Subjects with generalized anxiety disorder almost universally had other disorders , were the most likely to have at least one other anxiety disorder or major depressive disorder at intake , had the earliest age at onset , and had the worst emotional health rating . Subjects with panic disorder without agoraphobia had the most likelihood of a history of alcohol abuse . Nine percent of the subjects had a history of suicide attempts or gestures . CONCLUSIONS The subjects showed significant impairment in quality of life . The highly frequent coexistence of other anxiety disorders with generalized anxiety disorder and the overall lack of differences on many quality of life measures raise questions of nosology , particularly for generalized anxiety disorder A previous paper , Butler and Anastasiades ( Behaviour Research and Therapy 26 , 531 - 534 , 1988 ) presented evidence for three reliable predictors of response to Anxiety Management in patients with generalised anxiety disorder . It was argued there that these reflected severity of anxiety , demoralisation and depression . A second study ( Butler , Fennell , Robson & Gelder , Journal of Consulting and Clinical Psychology , 59 , 167 - 175 , 1991 ) has compared two treatments for GAD : Behaviour Therapy and Cognitive Behaviour Therapy . Data from this study is used here to answer two questions : ( i ) do the same three variables predict outcome in the second study ? The answer to this question is ' no ' ; and ( ii ) which variables contribute to prediction of outcome when these two treatments are compared ? Information presented here suggests that this depends partly on the nature of the treatment given . Outcome after behaviour therapy is predicted by initial levels of anxiety only , but the gains made are also relatively modest . Outcome after  cognitive behaviour therapy  is predicted by the degree to which ambiguous ( external ) information is interpreted as threatening . Thus a cognitive variable contributes reliably to the prediction of outcome after a cognitive treatment , but does not predict in the same way to outcome after a behavioural treatment Among a sample of 767 high utilizers of health care , 51 % were identified as distressed by an elevated score on the SCL anxiety and depression scales , the SCL somatization scale , or by their primary -care physician . These distressed high utilizers were found to have a high prevalence of chronic medical problems and significant limitation of activities caused by illness . In the prior year , they made an average of 15 medical visits and 15 telephone calls to the clinic . The Diagnostic Interview Schedule was completed on 119 distressed high utilizers r and omly assigned to an intervention group in a controlled trial of psychiatric consultation . The following DSM-III-R disorders were most common : major depression 23.5 % , dysthymic disorder 16.8 % , generalized anxiety disorder 21.8 % , and somatization disorder 20.2 % . Two thirds had a lifetime history of major depression . The examination result ed in an improved diagnostic assessment for 40 % of intervention patients and a revised treatment plan for 67 % OBJECTIVE The authors present data from a pilot research program initiated to develop , refine , and test the outcomes of CBT-GAD/PC , a version of cognitive-behavior therapy ( CBT ) that targets the needs of older adults with generalized anxiety disorder ( GAD ) in primary care ( PC ) . METHODS The study involved a small , r and omized clinical trial comparing the impact of CBT-GAD/PC to usual care ( UC ) in a sample of 12 older medical patients with GAD . RESULTS Outcome data suggested significant improvements in worry and depression after CBT-GAD/PC , relative to UC . CONCLUSION Authors discuss results in terms of the " real-world " applicability of this treatment for late-life GAD , and present implication s for future research Cognitive therapy ( CT ) and applied relaxation ( AR ) as treatments of generalized anxiety disorder ( GAD ) were compared in a sample of 45 patients of a community mental health center , r and omly allocated to condition . Patients were assessed before and after a 12-session treatment , and at one and six months follow-ups . There was a 20 % drop out from CT and 15 % from AR ( NS ) , with some drop outs being considerably improved . Both completers and intention-to-treat analyses revealed that both treatments were effective ( ESs of composite and specific measures ranging from 0.53 to 1.14 ) . At one-month follow-up AR tended to do better than CT , with CT catching up with AR at six months . Recovery rates and proportions of patients showing reliable change were comparable to other studies on AR and CT , with 55 % of CT and 53.3 % of AR patients recovered on the STAI-trait at six-month follow-up . These results confirm that both CT and AR are effective treatments for GAD , and also that there is still room for improvement BACKGROUND There have been six r and omized controlled trials of psychological therapy with generalized anxiety disorder ( GAD ) using DSM-III-R and DSM-IV . All have used the Trait version of the Spielberger State-Trait Anxiety Inventory ( STAI-T ) as one of several outcome measures . Each study , however , employed different methods of calculating the clinical significance of outcomes making it difficult to reach a balanced appraisal of the efficacy of psychological treatment . METHODS Raw data on STAI-T scores at pre- , post- and follow-up were obtained for each of the six studies ( total N = 404 ) . Jacobson methodology for defining clinical ly significant change ( criterion c , reliable change index = 8 , cut-off point = 46 ) was used to allocate each patient to one of four outcomes : worse , unchanged , improved and recovered . The proportion of patients in each category was calculated for treatment conditions in each study and also for aggregate data across types of treatment . RESULTS A recovery rate of 40 % was found for the sample as a whole with 12 of the 20 treatment conditions obtaining very modest recovery rates of 30 % or less . Two treatment approaches -- individual cognitive behavioural therapy and applied relaxation -- do relatively well with overall recovery rates at 6-month follow-up of 50 - 60 % . CONCLUSIONS Jacobson methodology , in distinguishing between improvement and recovery on a st and ardized measure of general vulnerability to anxiety , provides a stringent but clinical ly more meaningful evaluation of the efficacy of psychological therapies with GAD than has been available hitherto . Systematic focus on either excessive worry or physiological arousal gives worthwhile results In a controlled clinical trial , 57 Ss meeting DSM-III-R criteria for generalized anxiety disorder , and fulfilling an additional severity criterion , were r and omly allocated to  cognitive behavior therapy ( CBT ) , behavior therapy ( BT ) , or a waiting-list control group . Individual treatment lasted 4 - 12 sessions ; independent assessment s were made before treatment , after treatment , and 6 months later , and additional follow-up data were collected after an interval of approximately 18 months . Results show a clear advantage for CBT over BT . A consistent pattern of change favoring CBT was evident in measures of anxiety , depression , and cognition . Ss were lost from the BT group , but there was no attrition from the CBT group . Treatment integrity was double-checked in Engl and and in Holl and , and special efforts were made to reduce error variance . Possible explanations for the superiority of CBT are discussed Abstract The effects of anxiety management training were evaluated by allocating 66 generally anxious clients to either a wait list condition , non-directive counselling , or a combination of relaxation and brief cognitive therapy . Anxiety management was significantly more effective than the wait list condition on a number of relevant measures at post-treatment , but there were relatively few differencs between anxiety management and non-directive counselling , either at post-treatment or at 6 months follow-up . Those differences which were found could plausibly be explained in terms of the dem and characteristics of training in relaxation or cognitive therapy . It was concluded that anxiety management is clearly better than a non-treatment control condition , but that its superiority to plausible alternatives which lack the specific components thought to be responsible for improvement has yet to be demonstrated BACKGROUND Generalized anxiety disorder is a common condition of excessive worry and tension which tends to run a chronic course associated with significant psychiatric and medical problems . Cognitive behaviour therapy ( CBT ) has been shown to be of clinical value in about 50 % of cases with treatment gains maintained over follow-up periods ranging from 6 to 12 months . The potential value of CBT over the longer term has not been subject to rigorous investigation . METHOD Results are reported of 8 - 14 year follow-up of two r and omized controlled trials of cognitive-behaviour therapy for generalized anxiety disorder employing structured interview with an assessor blind to initial treatment condition . Comparison groups included medication and placebo in one study based in primary care , and analytical psychotherapy in the other based in secondary care . Follow-up sample s ( 30 % and 55 % of trial entrants ) were broadly representative of the original cohorts . RESULTS Overall , 50 % of participants were markedly improved of whom 30 - 40 % were recovered ( i.e. free of symptoms ) . Outcome was significantly worse for the study based in secondary care in which the clinical presentation of participants was more complex and severe . For a minority ( 30 - 40 % ) , mainly from the secondary care study , outcome was poor . Treatment with CBT was associated with significantly lower overall severity of symptomatology and less interim treatment , in comparison with non-CBT conditions , but there was no evidence that CBT influenced diagnostic status , probability of recovery or patient perceptions of overall improvement . CONCLUSIONS Both CBT and the complexity and severity of presenting problems appear to influence the long-term outcome of GAD BACKGROUND The diagnostic category of generalised anxiety disorder ( GAD ) was originally intended to describe residual anxiety states . Over the years clinical criteria have been refined in an attempt to describe a unique diagnostic entity . Given these changes , little is known about the clinical course of this newly defined disorder . This study investigates the longitudinal course , including remission and relapse rates , for patients with DSM-III-R defined GAD . METHOD Analysis of the 164 patients with GAD participating in the Harvard Anxiety Research Program . Patients were assessed with a structured clinical interview at intake and re-examined at six month intervals for two years and then annually for one to two years .  Psychiatric Status Ratings were assigned at each interview point . Kaplan-Meier curves were constructed to assess likelihood of remission . RESULTS Comorbidity was high , with panic disorder and social phobia as the most frequently found comorbid disorders . The likelihood of remission was 0.15 after one year and 0.25 after two years . The probability of becoming asymptomatic from all psychiatric symptoms was only 0.08 . CONCLUSIONS This prospect i ve study confirms the chronicity associated with GAD and extends this finding to define the one and two year remission rates for the disorder . Likelihood of remission for GAD and any other comorbid condition after one year was half the annual remission rate for GAD alone BACKGROUND Psychotherapy 's equivalence paradox is that treatments have equivalently positive outcomes despite non-equivalent theories and techniques . We compared the outcomes of contrasting approaches practised in routine care . METHOD Patients ( n = 1309 ) who received cognitive-behavioural therapy ( CBT ) , person-centred therapy ( PCT ) and psychodynamic therapy ( PDT ) at one of 58 National Health Service ( NHS ) primary and secondary care sites in the UK during a 3-year period completed the Clinical Outcomes in Routine Evaluation- Outcome Measure ( CORE-OM ) at the beginning and end of their treatment . Therapists indicated which treatment approaches were used on an End of Therapy form . We compared outcomes of six groups : three treated with CBT , PCT or PDT only , and three treated with one of these plus one additional approach ( e.g. integrative , supportive , art ) , design ated CBT+1 , PCT+1 or PDT+1 respectively . RESULTS All six groups averaged marked improvement ( pre-post effect size = 1.36 ) . Treatment approach and degree of purity ( ' only ' vs. ' + 1 ' ) each accounted for statistically significant but comparatively tiny proportions of the variance in CORE-OM scores ( respectively 1 % and 0.5 % as much as pre-post change ) . Distributions of change scores were largely overlapping . CONCLUSIONS Results for these three treatment approaches as practised routinely across a range of NHS setting s were generally consistent with previous findings 
    Output:
    
agent
Psychological therapy based on CBT principles is effective in reducing anxiety symptoms for short-term treatment of GAD .
The body of evidence comparing CBT with other psychological therapies is small and heterogeneous , which precludes drawing conclusions about which psychological therapy is more effective .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Nondirective ( ND ) , applied relaxation ( AR ) , and cognitive behavioral ( CBT ) therapies for generalized anxiety disorder ( GAD ) were compared . The latter 2 conditions were generally equivalent in outcome but superior to ND at post assessment . The 3 conditions did not differ on several process measures , and ND created the greatest depth of emotional processing . Follow-up results indicated losses in gains in ND , maintained gains in the other 2 conditions , especially CBT , and highest endstate functioning for CBT . AR and CBT thus contain active ingredients in the treatment of GAD ; support exists for further development of imagery exposure methods or cognitive therapy because of their likely role in promoting maintenance of change with this disorder . Expectancy for improvement was also associated with outcome , suggesting the need for further research on this construct for underst and ing the nature of GAD and its amelioration OBJECTIVE This report examines the impact of panic disorder and /or generalized anxiety disorder on quality of life and the implication s of these findings on nosological categories . METHOD A total of 357 subjects with a current episode of panic disorder and /or generalized anxiety disorder were diagnosed according to DSM-III-R criteria , using structured clinical interviews , as part of a prospect i ve , naturalistic , longitudinal , multicenter study of a clinical population with anxiety disorders . RESULTS There was a high degree of coexistence of anxiety disorders and major depressive disorder . Subjects with generalized anxiety disorder almost universally had other disorders , were the most likely to have at least one other anxiety disorder or major depressive disorder at intake , had the earliest age at onset , and had the worst emotional health rating . Subjects with panic disorder without agoraphobia had the most likelihood of a history of alcohol abuse . Nine percent of the subjects had a history of suicide attempts or gestures . CONCLUSIONS The subjects showed significant impairment in quality of life . The highly frequent coexistence of other anxiety disorders with generalized anxiety disorder and the overall lack of differences on many quality of life measures raise questions of nosology , particularly for generalized anxiety disorder A previous paper , Butler and Anastasiades ( Behaviour Research and Therapy 26 , 531 - 534 , 1988 ) presented evidence for three reliable predictors of response to Anxiety Management in patients with generalised anxiety disorder . It was argued there that these reflected severity of anxiety , demoralisation and depression . A second study ( Butler , Fennell , Robson & Gelder , Journal of Consulting and Clinical Psychology , 59 , 167 - 175 , 1991 ) has compared two treatments for GAD : Behaviour Therapy and Cognitive Behaviour Therapy . Data from this study is used here to answer two questions : ( i ) do the same three variables predict outcome in the second study ? The answer to this question is ' no ' ; and ( ii ) which variables contribute to prediction of outcome when these two treatments are compared ? Information presented here suggests that this depends partly on the nature of the treatment given . Outcome after behaviour therapy is predicted by initial levels of anxiety only , but the gains made are also relatively modest . Outcome after  cognitive behaviour therapy  is predicted by the degree to which ambiguous ( external ) information is interpreted as threatening . Thus a cognitive variable contributes reliably to the prediction of outcome after a cognitive treatment , but does not predict in the same way to outcome after a behavioural treatment Among a sample of 767 high utilizers of health care , 51 % were identified as distressed by an elevated score on the SCL anxiety and depression scales , the SCL somatization scale , or by their primary -care physician . These distressed high utilizers were found to have a high prevalence of chronic medical problems and significant limitation of activities caused by illness . In the prior year , they made an average of 15 medical visits and 15 telephone calls to the clinic . The Diagnostic Interview Schedule was completed on 119 distressed high utilizers r and omly assigned to an intervention group in a controlled trial of psychiatric consultation . The following DSM-III-R disorders were most common : major depression 23.5 % , dysthymic disorder 16.8 % , generalized anxiety disorder 21.8 % , and somatization disorder 20.2 % . Two thirds had a lifetime history of major depression . The examination result ed in an improved diagnostic assessment for 40 % of intervention patients and a revised treatment plan for 67 % OBJECTIVE The authors present data from a pilot research program initiated to develop , refine , and test the outcomes of CBT-GAD/PC , a version of cognitive-behavior therapy ( CBT ) that targets the needs of older adults with generalized anxiety disorder ( GAD ) in primary care ( PC ) . METHODS The study involved a small , r and omized clinical trial comparing the impact of CBT-GAD/PC to usual care ( UC ) in a sample of 12 older medical patients with GAD . RESULTS Outcome data suggested significant improvements in worry and depression after CBT-GAD/PC , relative to UC . CONCLUSION Authors discuss results in terms of the " real-world " applicability of this treatment for late-life GAD , and present implication s for future research Cognitive therapy ( CT ) and applied relaxation ( AR ) as treatments of generalized anxiety disorder ( GAD ) were compared in a sample of 45 patients of a community mental health center , r and omly allocated to condition . Patients were assessed before and after a 12-session treatment , and at one and six months follow-ups . There was a 20 % drop out from CT and 15 % from AR ( NS ) , with some drop outs being considerably improved . Both completers and intention-to-treat analyses revealed that both treatments were effective ( ESs of composite and specific measures ranging from 0.53 to 1.14 ) . At one-month follow-up AR tended to do better than CT , with CT catching up with AR at six months . Recovery rates and proportions of patients showing reliable change were comparable to other studies on AR and CT , with 55 % of CT and 53.3 % of AR patients recovered on the STAI-trait at six-month follow-up . These results confirm that both CT and AR are effective treatments for GAD , and also that there is still room for improvement BACKGROUND There have been six r and omized controlled trials of psychological therapy with generalized anxiety disorder ( GAD ) using DSM-III-R and DSM-IV . All have used the Trait version of the Spielberger State-Trait Anxiety Inventory ( STAI-T ) as one of several outcome measures . Each study , however , employed different methods of calculating the clinical significance of outcomes making it difficult to reach a balanced appraisal of the efficacy of psychological treatment . METHODS Raw data on STAI-T scores at pre- , post- and follow-up were obtained for each of the six studies ( total N = 404 ) . Jacobson methodology for defining clinical ly significant change ( criterion c , reliable change index = 8 , cut-off point = 46 ) was used to allocate each patient to one of four outcomes : worse , unchanged , improved and recovered . The proportion of patients in each category was calculated for treatment conditions in each study and also for aggregate data across types of treatment . RESULTS A recovery rate of 40 % was found for the sample as a whole with 12 of the 20 treatment conditions obtaining very modest recovery rates of 30 % or less . Two treatment approaches -- individual cognitive behavioural therapy and applied relaxation -- do relatively well with overall recovery rates at 6-month follow-up of 50 - 60 % . CONCLUSIONS Jacobson methodology , in distinguishing between improvement and recovery on a st and ardized measure of general vulnerability to anxiety , provides a stringent but clinical ly more meaningful evaluation of the efficacy of psychological therapies with GAD than has been available hitherto . Systematic focus on either excessive worry or physiological arousal gives worthwhile results In a controlled clinical trial , 57 Ss meeting DSM-III-R criteria for generalized anxiety disorder , and fulfilling an additional severity criterion , were r and omly allocated to  cognitive behavior therapy ( CBT ) , behavior therapy ( BT ) , or a waiting-list control group . Individual treatment lasted 4 - 12 sessions ; independent assessment s were made before treatment , after treatment , and 6 months later , and additional follow-up data were collected after an interval of approximately 18 months . Results show a clear advantage for CBT over BT . A consistent pattern of change favoring CBT was evident in measures of anxiety , depression , and cognition . Ss were lost from the BT group , but there was no attrition from the CBT group . Treatment integrity was double-checked in Engl and and in Holl and , and special efforts were made to reduce error variance . Possible explanations for the superiority of CBT are discussed Abstract The effects of anxiety management training were evaluated by allocating 66 generally anxious clients to either a wait list condition , non-directive counselling , or a combination of relaxation and brief cognitive therapy . Anxiety management was significantly more effective than the wait list condition on a number of relevant measures at post-treatment , but there were relatively few differencs between anxiety management and non-directive counselling , either at post-treatment or at 6 months follow-up . Those differences which were found could plausibly be explained in terms of the dem and characteristics of training in relaxation or cognitive therapy . It was concluded that anxiety management is clearly better than a non-treatment control condition , but that its superiority to plausible alternatives which lack the specific components thought to be responsible for improvement has yet to be demonstrated BACKGROUND Generalized anxiety disorder is a common condition of excessive worry and tension which tends to run a chronic course associated with significant psychiatric and medical problems . Cognitive behaviour therapy ( CBT ) has been shown to be of clinical value in about 50 % of cases with treatment gains maintained over follow-up periods ranging from 6 to 12 months . The potential value of CBT over the longer term has not been subject to rigorous investigation . METHOD Results are reported of 8 - 14 year follow-up of two r and omized controlled trials of cognitive-behaviour therapy for generalized anxiety disorder employing structured interview with an assessor blind to initial treatment condition . Comparison groups included medication and placebo in one study based in primary care , and analytical psychotherapy in the other based in secondary care . Follow-up sample s ( 30 % and 55 % of trial entrants ) were broadly representative of the original cohorts . RESULTS Overall , 50 % of participants were markedly improved of whom 30 - 40 % were recovered ( i.e. free of symptoms ) . Outcome was significantly worse for the study based in secondary care in which the clinical presentation of participants was more complex and severe . For a minority ( 30 - 40 % ) , mainly from the secondary care study , outcome was poor . Treatment with CBT was associated with significantly lower overall severity of symptomatology and less interim treatment , in comparison with non-CBT conditions , but there was no evidence that CBT influenced diagnostic status , probability of recovery or patient perceptions of overall improvement . CONCLUSIONS Both CBT and the complexity and severity of presenting problems appear to influence the long-term outcome of GAD BACKGROUND The diagnostic category of generalised anxiety disorder ( GAD ) was originally intended to describe residual anxiety states . Over the years clinical criteria have been refined in an attempt to describe a unique diagnostic entity . Given these changes , little is known about the clinical course of this newly defined disorder . This study investigates the longitudinal course , including remission and relapse rates , for patients with DSM-III-R defined GAD . METHOD Analysis of the 164 patients with GAD participating in the Harvard Anxiety Research Program . Patients were assessed with a structured clinical interview at intake and re-examined at six month intervals for two years and then annually for one to two years .  Psychiatric Status Ratings were assigned at each interview point . Kaplan-Meier curves were constructed to assess likelihood of remission . RESULTS Comorbidity was high , with panic disorder and social phobia as the most frequently found comorbid disorders . The likelihood of remission was 0.15 after one year and 0.25 after two years . The probability of becoming asymptomatic from all psychiatric symptoms was only 0.08 . CONCLUSIONS This prospect i ve study confirms the chronicity associated with GAD and extends this finding to define the one and two year remission rates for the disorder . Likelihood of remission for GAD and any other comorbid condition after one year was half the annual remission rate for GAD alone BACKGROUND Psychotherapy 's equivalence paradox is that treatments have equivalently positive outcomes despite non-equivalent theories and techniques . We compared the outcomes of contrasting approaches practised in routine care . METHOD Patients ( n = 1309 ) who received cognitive-behavioural therapy ( CBT ) , person-centred therapy ( PCT ) and psychodynamic therapy ( PDT ) at one of 58 National Health Service ( NHS ) primary and secondary care sites in the UK during a 3-year period completed the Clinical Outcomes in Routine Evaluation- Outcome Measure ( CORE-OM ) at the beginning and end of their treatment . Therapists indicated which treatment approaches were used on an End of Therapy form . We compared outcomes of six groups : three treated with CBT , PCT or PDT only , and three treated with one of these plus one additional approach ( e.g. integrative , supportive , art ) , design ated CBT+1 , PCT+1 or PDT+1 respectively . RESULTS All six groups averaged marked improvement ( pre-post effect size = 1.36 ) . Treatment approach and degree of purity ( ' only ' vs. ' + 1 ' ) each accounted for statistically significant but comparatively tiny proportions of the variance in CORE-OM scores ( respectively 1 % and 0.5 % as much as pre-post change ) . Distributions of change scores were largely overlapping . CONCLUSIONS Results for these three treatment approaches as practised routinely across a range of NHS setting s were generally consistent with previous findings 
    Output:
    