Efficacy of a transdiagnostic treatment for excessive worry in youth: A randomised trial of brief Behavioural Activation

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Around 25% of adolescents report excessive and uncontrollable worry and many adult high worriers report that their excessive worry began in late adolescence (Kerts &Woodruff-Borden, 2011). Younger adults (16-29 years of age) report a higher frequency of worry than older adults about school or work, finances and social interactions (Goncalves & Byrne, 2012). Worry functions as a cognitive avoidance response, suppressing images and somatic activation and preventing the individual from emotional processing of fear that is important for successful habituation and extinction (Stapinski, Abbott, & Rapee, 2010). Such avoidance brings initial relief but results in anxiety maintenance. Worry is an essential feature of Generalised Anxiety Disorder (GAD) and is a presenting characteristic across all anxiety disorders and depressive disorders (Starcevic, et al., 2007). Thus, worry presents an ideal target for transdiagnostic treatment that targets the common features across anxiety and depression. To target worry as a transdiagnostic process, Chen et al. (2013) developed and evaluated a transdiagnostic approach targeting avoidance strategies in adult worriers by using Behavioural Activation treatment. Behavioural Activation (BA) was originally developed to address avoidance in depression (Addis & Martell, 2004) and its efficacy has been shown in a number of randomised controlled trials. When applied to worry, BA is expected to break down patterns of anxious avoidance through repeated exposure to goal orientated behaviours. Viewing worry as a form of avoidance, BA encourages clients to identify avoidance patterns and increase alternate behaviours in the face of worry-provoking situations (Chen, et al., 2013). Compared to more complex treatment packages, two key advantages of BA are: 1) it is simpler to deliver (Hopko, et al., 2003); and 2) it is efficacious, even when delivered by mental health professionals with minimal training (Ekers, et al., 2011). This simplicity is especially appealing for treating young people as some researchers have criticised that the “extreme comprehensiveness” of the CBT protocol is a primary problem for youth and recommended a low-intensity intervention (Hollon, Garber, & Shelton, 2005). The effect of BAW on anxiety and depression has been demonstrated in our pilot trial (Chen et al., 2013) within a community sample of adults. Findings revealed that participants who received an 8-week group based BAW showed significantly greater reduction in worry, depression and characteristics such as cognitive avoidance, intolerance of uncertainty and problem-solving orientation than the waitlist. Twice as many individuals showed clinically significant reductions in excessive worry after BAW compared to the waitlist. These results provide promising support for BAW as a practical transdiagnostic treatment for worry. Hence the current project aims to investigate the efficacy of BAW in young people. Recent developments in cognitive models of worry and treatments for youth are mostly based on adult research (Vasey, 1993) and studies have demonstrated the applicability of the cognitive model or processes in adults to youth (Laugesen, Dugas, & Bukowski, 2003). However, differences in cognitive, social, and emotional development between adolescents and adults must be taken into account (Vasey, 1993). The present project will examine whether BAW is superior to a waitlist control condition in improving worry in anxious and depressed youths after an 8-week treatment/waitlist and a 3-month follow-up. We will also compare the effect of BAW vs. waitlist on a series of secondary outcomes (i.e., distress, behavioural activation, intolerance of uncertainty, life impairment).

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