WPD intervention might improve effects of stress management group therapy

A randomized clinical trial published in a recent issue of Psychotherapy and Psychosomatics examines a new method for enhancing the effects of stress management therapy. Evidence is accumulating that worry is an important mediator between the experience of stressors and poor mental and somatic health.

Worrying prolongs stress-related physiology, mediates the effects of stressors on common somatoform symptoms and predicts cardiovascular morbidity. The Authors of this study tested the effectiveness of a guided self-help intervention aimed at reducing worrying. This 'worry postponement and disengagement' intervention requires people to reschedule worries to a specific moment of the day during which thinking about worry topics, in a prestructured manner, is promoted.

They tested whether this intervention reduced severe health complaints as experienced by outpatients suffering from work stress. Additionally, they investigated if this 2-week intervention enhanced a standard stress management group therapy (SMT), by delivering the intervention to patients awaiting SMT. A crucial assumption was that decreasing perseverative thoughts is a prerequisite for SMT to be fully effective.

Sixty-two patients participated, suffering from DSM-IV axis I diagnoses of adjustment disorder, unspecified somatoform disorder (burnout) or severe work problems (axis IV). Participants provided informed consent and completed the Subjective Health Complaints questionnaire (SHC) [6] , the State Trait Anxiety Inventory - trait version (STAI-T) and the Beck Depression Inventory - second version (BDI-II). They were then randomly allocated to 1 of 3 conditions: worry postponement and disengagement (WPD; n = 22), registering worry frequency and duration (worry registration; WR; n = 15) or a waitlist control condition: treatment as usual (TAU; n = 25).

Participants were asked to practice the intervention (WPD or WR) for 2 weeks, after which SMT started. Outcome measures were sent to participants at the end of SMT and at a 3-month follow-up. At the end of the investigation, the most innovative finding was that - overall - participants who had received the WPD intervention showed the largest decreases in somatoform, anxiety and - to a lesser extent - depressive symptoms. However, these effects were only apparent when WPD was compared to a waitlist control group and not when comparing the WPD intervention to the mere registering of worries. This could imply that the simple intervention of registering worries is already sufficient to improve SMT.

Clearly, more research is needed, for example into the temporal differences in the reduction of symptoms and into different pretreatment interventions. However, this preliminary study is the first to suggest that a 'pretreatment' intervention directed at a crucial pathogenic process, i.e. worry, might enhance a cognitive-behavioral group therapy.