This article is an introduction to the special section of Korean Journal of Clinical Psychology on evidence-based treatments (EBTs) of anxiety and anxiety-related disorders: panic disorder, social anxiety disorder, generalized anxiety disorder, obsessive- compulsive disorder, and post-traumatic stress disorder. Criteria for EBTs or empirically supported treatments, issues concerning psychotherapy research on anxiety and anxiety-related disorders, and comments on review articles in this special section are described. Finally, methods to enhance the applicability of EBTs to clinical practice and bridge research and practice are suggested in terms of evidence-based practice.
Panic disorder is an anxiety disorder characterized by the presence of autonomic arousal symptoms in unexpected situations (panic attacks), which are accompanied by anticipatory anxiety regarding possible future attacks. Its prevalence rate is reported to be 1–4% worldwide and it ranks 11th among all diseases in terms of years lived with disability. Numerous studies have been conducted in the past 30 years and empirically validated cognitive behavior therapy for panic disorder has been developed based on the results of such studies. To this end, this review will focus on providing a brief clinical description and etiology of panic disorder, followed by an overview of the specific nature of evidence-based treatment for panic disorder. What are the core components of evidence-based treatment for panic disorder according to Korean and foreign treatment effectiveness studies and/or meta-analyses? What are the moderating or mediating factors that affect treatment effectiveness and outcomes? Furthermore, this review will summarize the current status of the effectiveness of computer- and internetbased treatment programs for panic disorder. Finally, a summary of treatment guidelines for panic disorder will be provided based on the treatment guidelines recommended by different related disciplines and organizations.
This study aimed to identify evidence-based treatments of social anxiety disorder to be used with Korean populations. To achieve this purpose, we first reviewed the clinical features of social anxiety disorder and research on evidence-based treatments (EBTs) conducted abroad. Then, we identified EBTs for use with Korean populations through the systematic review and meta-analysis of social anxiety treatment studies conducted in Korea. Thirty-three domestic social anxiety treatment studies published in academic journals between 2000 and 2017 were systematically reviewed and meta-analyzed. All studies reviewed were characterized by randomized controlled trials or controlled trials at least and included the adequate statistics needed for the calculation of effect sizes (ESs). The ESs of each of the social anxiety treatments on social anxiety outcomes, other-related outcomes, and overall outcomes were calculated for both the adult and adolescent/child groups. The analyses found that all the treatment types reviewed demonstrated large effect sizes on social anxiety and related outcomes. The analyses also found cognitive behavioral treatment (CBT) in adults and CBT and CBT combined with social skills training in adolescents and children to be well-established EBT for social anxiety disorder. The clinical implications of the research findings were discussed, and recommendations for the potential users were made.
The purpose of this study is to review recent domestic and overseas studies pertaining to psychological therapies for generalized anxiety disorder (GAD), and to offer guidelines for evidence-based treatment for GAD. Despite its high rates of comorbidity with other mental disorders and its rising worldwide prevalence, GAD has been given relatively little research attention compared to other anxiety disorders. According to overseas studies, the efficacy of Cognitive Behavioral Therapy (CBT), Applied Relaxation (AR), Psychodynamic Therapy (PDT), Meta-cognitive Therapy (MCT), Mindfulness-based Therapy (MBT), and Worry Exposure (WE) have been repeatedly verified, with strong and modest efficacy being ascribed to CBT and AR, respectively. It is difficult to definitively verify the efficacies of MBTs since most MBT studies have been open trials and preliminary studies. There has been little domestic research on the efficacy of psychotherapy for GAD, which makes it impossible to even set appropriate levels for evidence-based treatments. Instead, domestic studies are primarily focused on GAD-related factors such as IU in the general population. Thus, systematic RCTs in patients with GAD need to be conducted and accumulated before the criteria for national evidence-based treatments can be defined. In addition, Internet-based treatments and related applications, which promote an understanding of GAD and the accessibility of GAD treatments, are introduced. Finally, guidelines for evidence-based treatments of GAD based on recent research will be offered, and potentially beneficial points for future research on GAD and its treatments, as well as further implications of this study will be discussed.
This paper presents a current review of existing evidence-based treatments for Obsessive-Compulsive Disorder (OCD), with a description of “Cognitive Behavioral Therapy” (CBT), which encompasses “Exposure and Response Prevention” (ERP) and “Cognitive Therapy” (CT), and “Acceptance and Commitment Therapy” (ACT). Based on meta-analyses and systematic reviews including randomized-controlled trials (RCTs), American Psychological Association (division 12) suggests that both ERP and CT have a “strong/well-established” evidence base, and ACT has a “modest/probably efficacious” evidence base. A literature search for domestic clinical trials, however, revealed that while no RCTs had examined the efficacy of CBT or ACT for OCD, a pretest-posttest design trial had examined the efficacy of group CBT and a quasi-experimental design trial had examined computer-based CBT. Based on this evidence, CBT for OCD is deemed to have a “modest/probably efficacious” evidence base in Korea. Finally, challenges to the treatment of OCD and future directions are suggested.
The purposes of the present study are to review evidence-based treatment of posttraumatic stress disorder (PTSD) in Korea and other countries and to suggest directions for further research. First, clinical features of PTSD, diagnosis-related issues in PTSD, first- and second-line psychological interventions recommended from clinical practice guidelines of PTSD, and ICTbased therapy (e.g., internet based Cognitive Behavioral Therapy, smartphone applications, and virtual reality exposure) were reviewed. Second, 12 studies of psychological interventions for Korean trauma survivors, published in academic journals between 1997 and 2017, were investigated to identify the current status of research in Korea. Finally, recommendations were made for PTSD treatment, and future directions for research and therapeutic approaches were discussed in terms of evidence- based practice.
The purpose of the present study was to develop a Posttraumatic growth (PTG), counseling program based on Reality Therapy, and to investigate its efficacy. The PTG counseling program, developed by consists of 12 individual sessions. Outcome variables, including PTG, symptoms of posttraumatic stress disorder (PTSD), self-efficacy, internal control were assessed at pre- and post-intervention and at a 3-month follow-up. The participants were 11 trauma survivors who had experienced crime (n=3), domestic violence (n=2), loss of a loved one (n=2), separation and divorce (n=2), bullying (n=1), and spousal affair (n=1). The results of this study showed that the PTG counseling program was effective in increasing PTG as well as reducing PTSD symptoms, although it did not change self-efficacy and internal control significantly. Finally, future directions for the therapeutic approach and research are discussed.
Alcohol use disorder (AUD) can be explained by some emotion-based hypotheses such as the self-medication hypothesis and negative reinforcement model. Accordingly, the aim of this study was to explore the dynamic relationships between daily stress, emotion dysregulation and drinking motives in the prediction of impaired control to drink alcohol in a clinical male sample. Male patients with AUD (n=193) were recruited from alcohol centers of four psychiatric hospitals in South Korea. All participants completed a questionnaire that included the Hassles and Uplifts Scale, the Difficulties in Emotion Regulation Scale (DERS), the Drinking Motives Questionnaire (DMQ), and the Impaired Control Scale (ICS). The serial multiple mediation model analyses showed that daily stress resulted in impaired control through emotional dysregulation and drinking motives in order. Specifically, both emotional dysregulation and drinking motives in turn had partial mediation effects on the relationship between daily stress and impaired control on alcohol. Moreover, when drinking motives were entered as a mediator individually, the size of the indirect effect for coping motives was larger than that of enhancement motives was, suggesting that there might be no gender difference related to drinking motives. These results suggest that daily stress as a precursor indirectly influences impaired control through emotion dysregulation and drinking motives among patients with AUD. Considering the connection between stress and impaired control on alcohol via emotion dysregulation and drinking motives, future interventions need to focus on providing an individualized intervention that includes stress management and adaptive emotion regulation strategies.
Repeated failure in emotion regulation could lead to various psychopathologies. It has been reported that the expression inhibition strategy is related to the occurrence and relapse of depression. Although cognitive reactivity is the factor that predicts the relapse of depression, the reason for individual differences in reacting to sad mood is unclear. Congruent with the cognitive theory of depression, implicit measures often assess cognitive reactivity, which is usually hidden. To identify the relationship between cognitive reactivity and trait emotion regulation, the present study verified if trait emotion regulation strategies lead to differences in psychological states in the explicit level. Additionally, it measured cognitive reactivity using the IRAP program before/after mood induction at an implicit level. In the first phase, 494 undergraduate students completed the Emotion Regulation Questionnaire(ERQ), Beck's Depression Inventory(BDI), Depression, Anxiety, Stress Scale-Korean(DASSK), and Korean Leiden Depression Sensitivity-Revised(K-LEIDS-R). In the second phase, participants who agreed to participate and passed the practice criterion were divided into the cognitive reappraisal tendency group (N=22) and expression inhibition tendency group (N=18). Findings revealed that the inhibition group exhibit more depression, anxiety, stress, and cognitive reactivity than the reappraisal group did. In the implicit measure, the inhibition group exhibited a more sensitive cognitive structure to sad mood than the reappraisal group did. While the reappraisal group reacted positively to the negative situation, the inhibition group reacted negatively to the negative situation. Critically, the inhibition group exhibited lower positive emotional reaction bias, but the reappraisal group exhibited higher positive emotional reaction bias after mood induction. These results suggest that the habitual use of the expression inhibition strategy contributes more to reactivity to sad mood than the cognitive reappraisal strategy does.
Acquired capability for suicide refers to the ability to act on lethal self-injury. The aim of the study was to examine psychological factors differentiating suicide attempters from suicide ideators, with a particular focus on acquired capability of suicidality and temperament. In this cross-sectional study, a community sample of Korean adults completed self-report measures of acquired capability for suicide using the ACSS-FAD, GCSQ, and ACWRSS, impulsivity, and aggression, along with questions of lifetime history of suicidal behavior. Among the subfactors of acquired capability for suicide derived from three self-report measures, only perceived capability of the GCSQ and preparation of the ACWRSS differentiated suicide attempters from suicide ideators. The factors of fearlessness about death and pain tolerance from the ACSS-FAD and GCSQ did not predict suicide attempt among suicidal ideators. Of the temperamental factors, none was able to differentiate suicide attempters from ideators, while both suicide ideators and attempters reported higher levels of negative urgency, a tendency to act impulsively upon negative emotions, and physical aggression compared to healthy controls. The results of the study indicated that people who act on their suicidal desires have a higher level of self-perception of acquired capability of suicide, and they tend to engage in planning activities using mental rehearsal strategies. These findings highlight the need for considering one’s planning behavior and perceived capability for suicide in suicide risk assessment and follow-up.
The purpose of this study was to compare Borderline Personality Trait and Bipolar Trait, focusing on Emotional Dysregulation, Impulsivity, and Self-Destructive Behaviors. The subjects were 125 university students (34 Borderline personality trait, 57 Bipolar trait, 34 Control group). The questionnaires used in this study were the Personality Assessment Inventory – Borderline Features Scale (PAI- BOR), Hypomania Checklist-32 (HCL-32), Center for Epidemiologic Studies Depression Scale (CES-D), Difficulties in Emotion Regulation Scale (DERS), UPPS-P Impulsive Behavior Scale (UPPS-P), Binge Eating Behavior questionnaire, and Alcohol Use Disorder Identification Test-Korean version (AUDIT-K). SPSS 23.0 was used for data analysis, which included reliability analysis, descriptive statistics analysis, correlation analysis, and one-way analysis of variance (one-way ANOVA). In addition, post-hoc analysis was used to examine specific differences between groups. The results of this study were as follows. First, the correlation between emotional dysregulation and drinking was not significant, but all other variables were positively correlated. Second, the DERS and UPPS-P scores were significantly higher in the borderline personality trait compared to the bipolar trait. Self-destructive behaviors score exhibited no significant differences. Implications and limitations of this study were discussed. In addition, suggestions for future research were presented.
The purpose of this study was to explore the relationship between interpretation bias and social anxiety, and to examine the mediating role of interpretation bias in the relationships among behavioral inhibition, parenting behaviors, and social anxiety. A survey of 377 adults was conducted and it included Social Interaction Anxiety Scale, Social Phobia Scale, Korean version of the Retrospective Self-Report of Inhibition, and Korean version of the Parental Bonding Instrument, as well as a scenario measuring interpretation bias. The collected data were analyzed using a structural equation model. The results of the study were as follows: First, interpretation bias showed a fully mediated effect on the relation between behavioral inhibition and social anxiety. Second, interpretation bias showed a fully mediated effect on the relation between parenting behaviors and social anxiety. Third, a partial mediation model was proposed for a rival model, and the study model for a full mediation model exhibited the best fit with the data. The clinical implications and limitations of the study, and suggestions for future research are discussed.
This study aimed to examine the schema bias effect on a source monitoring task of negative self-descriptions. Our second purpose was to explore the relationship between source monitoring performance and depression-related variables. A total of 73 university students with higher and lower levels (±1SD) of negative automatic thoughts (ATQ-N) were included. In the first phase, participants were presented the statement that a man always speaks the truth and a woman always speaks falsely. In the second phase, statements intermixed with new self-descriptions were presented on the computer screen, and the participants were to classify each as “new,” “true,” or “false.” The results of this study can be summarized as follows: the group with higher ATQ-N tended to choose the “true” response more often, and had a higher accuracy rate for the “true” items than did the group with lower ATQ-N. Second, the rate of “false” responses was negatively correlated with rumination, while the accuracy rate for “false” items was negatively correlated with belief in automatic negative thoughts (ATQ-NB) in the higher group. The present findings suggest that the automatic processing of source information about maladaptive schema plays an important role in depression-related cognition. Finally, the limitations of this study were discussed along with suggestions for further research.
Developing a reliable and valid screening tool of depressive disorders is crucial to providing appropriate prevention and early interventions to potentially at-risk patients in the early stages. This viewpoint is similar to the new mental health paradigm initiated by the Ministry for Health & Welfare Affairs. Despite the existence of numerous screening tools for depressive disorders, the research group concluded that there is an urgent need to develop a new, valid depressive disorders screening tool that concisely and reliably measures key sub-domains of depressive disorders—suicidal risks, mania, anxiety, and somatic symptoms. As a preliminary step to pursuing this goal, we first conducted a systematic review of existing screening tools for depressive disorders, thoroughly analyzed the strengths and limitations of each tool, and summarized the theoretical foundations for the development of the new Korean screening tool for depressive disorders (K-DEP). Second, the research group introduced procedures for developing preliminary item pools for the K-DEP (a total of 383 items), administered it to 153 non-psychiatric patients, and summarized the results. Finally, we discussed the directions for the next steps in developing the K-DEP.