Effectiveness of the Attacking Anxiety and Depressionä program when used in structured group treatment for adult anxiety and affective disorders

Study Description

Purpose: The purpose of this study was to evaluate the effectiveness of the Attacking Anxiety and Depressionä self help program when used with a clinical population of diagnoses anxiety disorders. The results are compared with a sample of anxiety disorders receiving "treatment as usual" in outpatient settings. The results are also compared to those observed in a sample of individuals using the materials in a purely self-help manner.

Study sample: Thirty two adult anxiety and affective disorders treated at the Group Health Cooperative HMO in Madison Wisconsin.

Treatment method: Structured group treatment using Attacking Anxiety and Depression ä materials.

Comparison group: Sample of 1,734 adult patients suffering from symptoms of anxiety and depression (332 diagnosed with anxiety disorders; 1,402 with depressive disorders). These patients were treated by licensed mental health professionals in geographically diverse outpatient settings across the continental U.S.

Outcomes assessment instrument: OQ-45

Results

Severity of symptoms: The mean OQ-45 score at the initiation of treatment was 82. A score of this elevation indicates significant symptoms and other difficulties in living, and is well above the cutoff score (63) that differentiates a clinical from a non-clinical sample.

Magnitude of improvement: The average improvement for this sample was 15 points on the OQ-45. This compares very favorably the results from the comparison groups, which averaged 10 points.

Direct comparison of average change scores can be misleading. Analysis of large samples has consistently demonstrated that patients with higher levels of distress tend to show greater benefit from treatment. Unless both samples are matched for severity, it is difficult to make a direct comparison. A useful technique for viewing differences in outcomes that overcomes this problem is to plot the graph of the relationship of severity at intake to numbers of points improvement. Each point on the graph represents the average improvement experienced by patients with a given score at intake.

The graph on the left compares the results of patients in this study with the sample of anxiety and affective disorders receiving "treatment as usual". As can be seen from the graph, the Attacking Anxiety and Depression treatment group shows substantially greater benefit at all levels of severity. For the anxiety disorders, the difference tends to increase with the severity of symptoms. The differences between the study sample and comparison groups are significant at the 99% confidence level.

Discussion

The patients participating in this study showed considerable benefit from the treatment, particularly when compared to a sample of anxiety and affective disorders receiving "treatment as usual" from a large sample of mental health professionals broadly distributed geographically.

In a soon to be published study¹, Finch, Lambert & Brown report the results of a naturalistic study of the Attacking Anxiety and Depressionä program used in a purely self-help manner. In this study, 176 individuals who had purchased the program through normal retail channels (infomercials, etc.) completed and returned the OQ-45 at two and four, and/or two and six week intervals. The average improvement by the end of six weeks was 16 points, comparable to the results from the current study.

The study reported by Finch et al. was drawn from a sample of arguably highly motivated individuals who had paid for the materials, completed the lessons, and mailed in OQ-45s as requested. The present study addresses the question if similar results can be achieved with a sample of diagnosed patients treated in a clinical setting.

The results of the current study suggest that patients using the Attacking Anxiety and Depressionä program in a structured group setting experience similar benefit to the motivated sample using the self help materials. These results indicate that the Attacking Anxiety and Depressionä program may be an extremely useful in the cost-effective treatment of anxiety and affective disorders in clinical settings.

¹ Finch, A.E., Lambert, M.J. & Brown, J.; Attacking Anxiety: A Naturalistic Study of a Multi-Media Self-Help Program; Journal of Clinical Psychology; appearing summer of 1999.

Jeb Brown, Ph.D.
jebbrown@clinical-informatics.com
http://www.clinical-informatics.com