Promoting walking as an adjunct intervention to group cognitive behavioral therapy for anxiety disorders—A pilot group randomized trial

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Abstract

A group randomized trial of adding a home-based walking program to a standard group cognitive behavioral therapy (GCBT + EX) was compared with groups receiving GCBT and educational sessions (GCBT + ED). The study was implemented in an outpatient clinic providing GCBT for clients diagnosed with panic disorder, generalized anxiety disorder or social phobia. Pre- and post-treatment measures included the self-report depression, anxiety, and stress scale (DASS-21) and measures of physical activity. From January 2004 to May 2005, six groups were allocated to GCBT + EX (n = 38) and five to GCBT + ED (n = 36). Analysis of covariance for completed cases (GCBT + EX, n = 21; GCBT + ED, n = 20), adjusting for the group design, baseline DASS-21 scores, and anxiety diagnosis showed significant effect for GCBT + EX on depression, anxiety, and stress (regression coefficients = −6.21, −3.41, and −5.14, respectively, p < 0.05) compared to the GCBT + ED. The potential of exercise interventions as adjunct to GCBT for anxiety disorder needs to be further explored.

Section snippets

Background

Anxiety disorders are among the most common mental health conditions in most developed countries with a yearly prevalence, all diagnosis combined, as high as 17% in the US (Kessler et al., 1994) or 10% in Australia (Andrews & Hall, 1999) and an estimated lifetime prevalence of 28.8% (Kessler, Berglund, Demler, Jin, & Walters, 2005). Anxiety disorders are recurrent with an increased risk of co-morbid depressive and addictive disorders developing if they remain untreated.

Despite existing

Study design and participants

A group randomized trial was conducted from January 2004 to mid-May 2005. Participants were recruited from a free-of-charge outpatient anxiety clinic located in South Western Sydney. In the usual clinic procedures, referred clients were assessed for the presence, duration, and severity of any anxiety disorders using the Structured Clinical Interview for the DSM-IV (First, Spitzer, Gibbon, & Williams, 1997) by a psychologist trained in the use of this measure and other tools to assess co-morbid

Results

During the study period, 85 clients who were eligible for the study (Fig. 1) formed 11 groups: 6 were randomly allocated to GCBT + EX (n = 45) and 5 to receive GCBT + ED (n = 40), but only 84% of the GCBT + EX (n = 38) and 90% of the GCBT + ED (n = 36) started the treatment (i.e., attended first or second treatment meeting).

Table 1 presents the sociodemographic characteristics of the two study groups and differences in DASS-21 scores and physical activity levels at baseline. No significant differences were

Discussion

This study examined the additional benefits of incorporating a home-based walking program regulated by pedometers as an adjunct to GCBT in a public clinic specialized in treating anxiety disorders. Findings suggest that improvement in mental health outcomes were greater among those receiving the intervention, but the effect differed by anxiety diagnoses. The added benefits of the intervention were most marked for clients with social phobia, with results for clients with panic disorder or

Acknowledgments

This research was supported by the South West Sydney Area Health Research Fund and the Australian Rotary Health Research Fund. We thank the participants and staff of the anxiety clinic for their collaboration; Ajsa Mahmic for overseeing the study activities and providing administrative support; and Belinda von Hofe for overseeing the study exercise program.

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