Physiological and behavioral indices of emotion dysregulation as predictors of outcome from cognitive behavioral therapy and acceptance and commitment therapy for anxiety

Carolyn D Davies; Andrea N Niles; Andre Pittig; Joanna J Arch; Michelle G Craske

doi:10.1016/j.jbtep.2014.08.002

Physiological and behavioral indices of emotion dysregulation as predictors of outcome from cognitive behavioral therapy and acceptance and commitment therapy for anxiety

J Behav Ther Exp Psychiatry. 2015 Mar:46:35-43. doi: 10.1016/j.jbtep.2014.08.002. Epub 2014 Aug 23.

Authors

Carolyn D Davies¹, Andrea N Niles², Andre Pittig³, Joanna J Arch⁴, Michelle G Craske⁵

Affiliations

¹ Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA, USA. Electronic address: cdavies@psych.ucla.edu.
² Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
³ Department of Psychology, University of Mannheim, Mannheim, Germany.
⁴ Department of Psychology and Neuroscience, University of Colorado, Boulder, Boulder, CO, USA.
⁵ Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA, USA. Electronic address: craske@psych.ucla.edu.

PMID: 25199454
DOI: 10.1016/j.jbtep.2014.08.002

Abstract

Background and objectives: Identifying for whom and under what conditions a treatment is most effective is an essential step toward personalized medicine. The current study examined pre-treatment physiological and behavioral variables as predictors and moderators of outcome in a randomized clinical trial comparing cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for anxiety disorders.

Methods: Sixty individuals with a DSM-IV defined principal anxiety disorder completed 12 sessions of either CBT or ACT. Baseline physiological and behavioral variables were measured prior to entering treatment. Self-reported anxiety symptoms were assessed at pre-treatment, post-treatment, and 6- and 12-month follow-up from baseline.

Results: Higher pre-treatment heart rate variability was associated with worse outcome across ACT and CBT. ACT outperformed CBT for individuals with high behavioral avoidance. Subjective anxiety levels during laboratory tasks did not predict or moderate treatment outcome.

Limitations: Due to small sample sizes of each disorder, disorder-specific predictors were not tested. Future research should examine these predictors in larger samples and across other outcome variables.

Conclusions: Lower heart rate variability was identified as a prognostic indicator of overall outcome, whereas high behavioral avoidance was identified as a prescriptive indicator of superior outcome from ACT versus CBT. Investigation of pre-treatment physiological and behavioral variables as predictors and moderators of outcome may help guide future treatment-matching efforts.

Keywords: Acceptance and commitment therapy; Behavioral avoidance; Cognitive behavioral therapy; Heart rate variability; Treatment outcome.

MeSH terms

Acceptance and Commitment Therapy
Adult
Analysis of Variance
Anxiety / psychology*
Anxiety / rehabilitation*
Cognitive Behavioral Therapy / methods*
Electrocardiography
Female
Heart Rate / physiology*
Humans
Hyperventilation / etiology
Male
Middle Aged
Outcome Assessment, Health Care
Predictive Value of Tests
Relaxation
Self Report
Severity of Illness Index
Surveys and Questionnaires
Young Adult