Abstract
Rationale
There is considerable evidence showing that individuals with generalised anxiety disorder (GAD) selectively process threat-related information, e.g. they have a bias to interpret ambiguous information in a threat-related manner. Cognitive theories of anxiety, which provide the basis of cognitive-behaviour therapy, propose that such processing biases play an important role in causing and maintaining anxiety.
Objectives
Given that treatment with selective serotonin re-uptake inhibitors (SSRIs) appears to be effective for GAD, we examined whether it is successful in removing cognitive bias.
Methods
The clinical group included 19 patients with a diagnosis of GAD, and the control group consisted of a non-clinical sample of volunteers, matched for age, gender and years in education. The patients were assessed on measures of interpretative bias (homophone task), anxiety and depression before being prescribed an SSRI (paroxetine or citalopram). After 4 weeks, the cognitive task and mood measures were repeated in the patient group.
Results
Prior to treatment, the GAD group showed a significantly greater level of threat-related interpretive bias than controls. Following SSRI treatment, there were significant reductions in both interpretive bias and in anxiety levels in the GAD group. Furthermore, individuals who showed greater clinical improvement (e.g. reflected by reduced anxiety scores) showed a correspondingly greater reduction in their cognitive bias.
Conclusion
The results suggest that SSRIs are effective in modifying both subjective anxiety levels and threat-related interpretive bias.
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Notes
The results from the initial session are comparable with those from previous studies. For example, homophone bias scores for GAD and control groups were 85% and 70%, respectively, in Mathews et al.’s (1989) study, compared with 81% and 71% in the present study. As noted by Mathews et al. all means were greater than 50%, indicating that the threat meaning tended to be dominant for all participants, which is likely to reflect a simple word frequency effect. More importantly, the results indicate that degree of dominance of threat meanings is greater in anxious patients than in normal controls.
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Acknowledgements
We thank Christel Buis and Andrew Mayers for their help with some of the MINI structured interviews and rating scale assessments. Karin Mogg holds a Wellcome Senior Research Fellowship in Basic Biomedical Science.
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Mogg, K., Baldwin, D.S., Brodrick, P. et al. Effect of short-term SSRI treatment on cognitive bias in generalised anxiety disorder. Psychopharmacology 176, 466–470 (2004). https://doi.org/10.1007/s00213-004-1902-y
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DOI: https://doi.org/10.1007/s00213-004-1902-y