{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T13:49:52Z","timestamp":1776779392502,"version":"3.51.2"},"reference-count":51,"publisher":"Cambridge University Press (CUP)","issue":"8","license":[{"start":{"date-parts":[[2013,1,9]],"date-time":"2013-01-09T00:00:00Z","timestamp":1357689600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Psychol. Med."],"published-print":{"date-parts":[[2013,8]]},"abstract":"<jats:sec id=\"S0033291712002772_sec_a1\"><jats:title>Background<\/jats:title><jats:p>Clinical trials are typically designed to test the effect of a specific treatment on a single diagnostic entity. However, because common internalizing disorders are highly correlated (\u2018co-morbid\u2019), we sought to establish a practical and parsimonious method to characterize and quantify changes in a broad spectrum of internalizing psychopathology targeted for treatment in a clinical trial contrasting two transdiagnostic psychosocial interventions.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291712002772_sec_a2\"><jats:title>Method<\/jats:title><jats:p>Alcohol dependence treatment patients who had any of several common internalizing disorders were randomized to a six-session cognitive-behavioral therapy (CBT) experimental treatment condition or a progressive muscle relaxation training (PMRT) comparison treatment condition. Internalizing psychopathology was characterized at baseline and 4 months following treatment in terms of the latent structure of six distinct internalizing symptom domain surveys.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291712002772_sec_a3\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>Exploratory structural equation modeling (ESEM) identified a two-factor solution at both baseline and the 4-month follow-up: Distress (measures of depression, trait anxiety and worry) and Fear (measures of panic anxiety, social anxiety and agoraphobia). Although confirmatory factor analysis (CFA) demonstrated measurement invariance between the time-points, structural models showed that the latent means of Fear and Distress decreased substantially from baseline to follow-up for both groups, with a small but statistically significant advantage for the CBT group in terms of Distress (but not Fear) reduction.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291712002772_sec_a4\" sec-type=\"conclusion\"><jats:title>Conclusions<\/jats:title><jats:p>The approach demonstrated in this study provides a practical solution to modeling co-morbidity in a clinical trial and is consistent with converging evidence pointing to the dimensional structure of internalizing psychopathology.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0033291712002772","type":"journal-article","created":{"date-parts":[[2013,1,9]],"date-time":"2013-01-09T14:02:44Z","timestamp":1357740164000},"page":"1611-1623","source":"Crossref","is-referenced-by-count":12,"title":["Modeling and treating internalizing psychopathology in a clinical trial: a latent variable structural equation modeling approach"],"prefix":"10.1017","volume":"43","author":[{"given":"M. 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