{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T14:19:35Z","timestamp":1780582775169,"version":"3.54.1"},"reference-count":94,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2023,3,10]],"date-time":"2023-03-10T00:00:00Z","timestamp":1678406400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>Numerous randomized controlled trials (RCTs) demonstrate the efficacy of cognitive behavioral therapy (CBT), metacognitive therapy (MCT), and methods to reduce intolerance of uncertainty (IU-CBT) in the treatment of generalized anxiety disorder (GAD). However, few studies have investigated these treatments under conditions of routine clinical care. The main objective of this study was to investigate the effectiveness of psychotherapy for GAD in an outpatient setting and to identify factors influencing treatment outcome.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Fifty-nine GAD patients received naturalistic CBT (including MCT and IU-CBT) in an outpatient clinic and postgraduate training center for psychotherapy. Patients completed self-report questionnaires at the beginning and end of therapy regarding the main outcome worry as well as metacognitions, intolerance of uncertainty, depression, and general psychopathology.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Worry, negative metacognitions, intolerance of uncertainty, depression, and general psychopathology decreased significantly (<jats:italic>p\u2019s<\/jats:italic> &lt; .001) with large effect sizes for all symptoms (<jats:italic>d<\/jats:italic> = 0.83\u20131.49). A reliable change in the main outcome worry was observed in 80% of patients, and recovery occurred in 23%. Higher worry scores at posttreatment were predicted by higher pretreatment scores, female sex, and less change in negative metacognitive beliefs during treatment.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Naturalistic CBT for GAD appears to be effective in routine clinical care for worry as well as depressive symptoms, with particular benefits associated with altering negative metacognitions. However, a recovery rate of only 23% is lower than the rates reported in RCTs. Treatment needs to be improved, especially for patients with more severe GAD and for women.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0282902","type":"journal-article","created":{"date-parts":[[2023,3,10]],"date-time":"2023-03-10T18:26:23Z","timestamp":1678472783000},"page":"e0282902","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Psychological interventions for generalized anxiety disorder: Effects and predictors in a naturalistic outpatient setting"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8598-5106","authenticated-orcid":true,"given":"Clara","family":"Krzikalla","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nexhmedin","family":"Morina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanja","family":"Andor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3798-0909","authenticated-orcid":true,"given":"Laura","family":"Nohr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4997-3236","authenticated-orcid":true,"given":"Ulrike","family":"Buhlmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,3,10]]},"reference":[{"key":"pone.0282902.ref001","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1017\/S0033291705006069","article-title":"Prevalence, correlates, co-morbidity, and comparative disability of DSM-IV generalized anxiety disorder in the USA: results from the National Epidemiologic Survey on Alcohol and Related Conditions","volume":"35","author":"BF Grant","year":"2005","journal-title":"Psychol Med"},{"key":"pone.0282902.ref002","doi-asserted-by":"crossref","DOI":"10.1176\/appi.books.9780890425596","volume-title":"Diagnostic and statistical manual of mental disorders","author":"American Psychiatric Association","year":"2013","edition":"5"},{"key":"pone.0282902.ref003","doi-asserted-by":"crossref","first-page":"1606","DOI":"10.4088\/JCP.v69n1011","article-title":"Gender differences in generalized anxiety disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)","volume":"69","author":"O Vesga-L\u00f3pez","year":"2008","journal-title":"Journal of Clinical Psychiatry"},{"key":"pone.0282902.ref004","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1001\/archpsyc.62.6.617","article-title":"Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication","volume":"62","author":"RC Kessler","year":"2005","journal-title":"Arch Gen Psychiatry"},{"key":"pone.0282902.ref005","first-page":"3","volume-title":"Worry and its psychological disorders. Theory, assessment, and treatment","author":"RM Holaway","year":"2006"},{"issue":"Suppl 8","key":"pone.0282902.ref006","first-page":"4","article-title":"Patterns and correlates of generalized anxiety disorder in community samples","volume":"63","author":"RC Kessler","year":"2002","journal-title":"J Clin Psychiatry"},{"key":"pone.0282902.ref007","doi-asserted-by":"crossref","first-page":"2351","DOI":"10.1017\/S0033291713002997","article-title":"Threshold and subthreshold generalized anxiety disorder among US adolescents: Prevalence, sociodemographic, and clinical characteristics","volume":"44","author":"M Burstein","year":"2014","journal-title":"Psychol Med"},{"key":"pone.0282902.ref008","doi-asserted-by":"crossref","DOI":"10.1186\/s12888-016-0946-y","article-title":"Long-term disability in anxiety disorders","volume":"16","author":"SM Hendriks","year":"2016","journal-title":"BMC Psychiatry"},{"key":"pone.0282902.ref009","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.euroneuro.2005.04.010","article-title":"The epidemiology of generalized anxiety disorder in Europe","volume":"15","author":"R Lieb","year":"2005","journal-title":"Eur Neuropsychopharmacol"},{"key":"pone.0282902.ref010","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1002\/da.22728","article-title":"Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials","volume":"35","author":"JK Carpenter","year":"2018","journal-title":"Depress Anxiety"},{"key":"pone.0282902.ref011","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1002\/wps.20346","article-title":"How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence","volume":"15","author":"P Cuijpers","year":"2016","journal-title":"World Psychiatry"},{"key":"pone.0282902.ref012","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/16506073.2018.1560358","article-title":"Psychological and pharmacological treatments for generalized anxiety disorder (GAD): A meta-analysis of randomized controlled trials","volume":"49","author":"E Carl","year":"2020","journal-title":"Cogn Behav Ther"},{"key":"pone.0282902.ref013","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1159\/000201936","article-title":"Worry exposure versus applied relaxation in the treatment of generalized anxiety disorder","volume":"78","author":"J Hoyer","year":"2009","journal-title":"Psychother Psychosom"},{"key":"pone.0282902.ref014","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1016\/S0005-7967(02)00045-1","article-title":"Cognitive therapy versus applied relaxation as treatment of generalized anxiety disorder","volume":"41","author":"A. Arntz","year":"2003","journal-title":"Behav Res Ther"},{"key":"pone.0282902.ref015","doi-asserted-by":"crossref","first-page":"337","DOI":"10.31887\/DCNS.2015.17.3\/akaczkurkin","article-title":"Cognitive-behavioral therapy for anxiety disorders: An update on the empirical evidence","volume":"17","author":"AN Kaczkurkin","year":"2015","journal-title":"Dialogues in Clinical Neuroscience"},{"key":"pone.0282902.ref016","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1002\/9781119189909.ch10","volume-title":"Generalized anxiety disorder and worrying: A comprehensive handbook for clinicians and researcher","author":"MG Newman","year":"2020"},{"key":"pone.0282902.ref017","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1002\/9780470713143.ch20","volume-title":"Worry and its psychological disorders. Theory, assessment, and treatment","author":"PL Fisher","year":"2006"},{"key":"pone.0282902.ref018","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.cpr.2012.10.008","article-title":"A meta-analysis of cognitive therapy for worry in generalized anxiety disorder","volume":"33","author":"F Hanrahan","year":"2013","journal-title":"Clin Psychol Rev"},{"key":"pone.0282902.ref019","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1017\/S1352465800015897","article-title":"Meta-cognition and worry: A cognitive model of generalized anxiety disorder","volume":"23","author":"A Wells","year":"1995","journal-title":"Behav Cogn Psychother"},{"key":"pone.0282902.ref020","volume-title":"Metacognitive therapy for anxiety and depression","author":"A. Wells","year":"2009"},{"key":"pone.0282902.ref021","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.cbpra.2006.01.005","article-title":"Cognition about cognition: Metacognitive therapy and change in generalized anxiety disorder and social phobia","volume":"14","author":"A. Wells","year":"2007","journal-title":"Cogn Behav Pract"},{"key":"pone.0282902.ref022","doi-asserted-by":"crossref","first-page":"2211","DOI":"10.3389\/fpsyg.2018.02211","article-title":"The efficacy of metacognitive therapy: A systematic review and meta-analysis","volume":"9","author":"N Normann","year":"2018","journal-title":"Front Psychol"},{"key":"pone.0282902.ref023","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1891\/jcop.19.1.61.66326","article-title":"Cognitive-behavioral treatment for generalized anxiety disorder: Current status and future directions","volume":"19","author":"MJ Dugas","year":"2005","journal-title":"J Cogn Psychother"},{"key":"pone.0282902.ref024","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1586\/ern.12.82","article-title":"The intolerance of uncertainty construct in the context of anxiety disorders: theoretical and practical perspectives","volume":"12","author":"RN Carleton","year":"2012","journal-title":"Expert Rev Neurother"},{"key":"pone.0282902.ref025","volume-title":"Cognitive-behavioral treatment for generalized anxiety disorder: From science to practice","author":"MJ Dugas","year":"2012"},{"key":"pone.0282902.ref026","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.beth.2008.12.004","article-title":"A randomized clinical trial of cognitive-behavioral therapy and applied relaxation for adults with generalized anxiety disorder","volume":"41","author":"MJ Dugas","year":"2010","journal-title":"Behav Ther"},{"key":"pone.0282902.ref027","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.brat.2011.12.005","article-title":"Randomized controlled trial on the effectiveness of metacognitive therapy and intolerance-of-uncertainty therapy for generalized anxiety disorder","volume":"50","author":"C Van der Heiden","year":"2012","journal-title":"Behav Res Ther"},{"key":"pone.0282902.ref028","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1177\/0145445500245002","article-title":"Treatment of GAD: Targeting intolerance of uncertainty in two types of worry","volume":"24","author":"MJ Dugas","year":"2000","journal-title":"Behav Modif"},{"key":"pone.0282902.ref029","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1037\/0022-006X.68.6.957","article-title":"Efficacy of a cognitive\u2013behavioral treatment for generalized anxiety disorder: Evaluation in a controlled clinical trial","volume":"68","author":"R Ladouceur","year":"2000","journal-title":"J Consult Clin Psychol"},{"key":"pone.0282902.ref030","first-page":"59","article-title":"Experimental versus naturalistic psychotherapy research: Consequences for researchers, clinicians, policy makers and patients","volume":"31","author":"M. Desmet","year":"2013","journal-title":"Psychoanalytische Perspectieven"},{"key":"pone.0282902.ref031","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1002\/da.21937","article-title":"Generalizability of clinical trial results for generalized anxiety disorder to community samples","volume":"29","author":"N Hoertel","year":"2012","journal-title":"Depress Anxiety"},{"key":"pone.0282902.ref032","first-page":"e12266","article-title":"Evidence-based protocols: Merits, drawbacks, and potential solutions","volume":"25","author":"A Asnaani","year":"2018","journal-title":"Clin Psychol.: Sci Pract"},{"key":"pone.0282902.ref033","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1016\/j.cpr.2013.07.003","article-title":"A meta-analysis of nonrandomized effectiveness studies on outpatient cognitive behavioral therapy for adult anxiety disorders","volume":"33","author":"E Hans","year":"2013","journal-title":"Clin Psychol Rev"},{"key":"pone.0282902.ref034","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1037\/a0016032","article-title":"Cognitive-behavioral therapy for adult anxiety disorders in clinical practice: a meta-analysis of effectiveness studies","volume":"77","author":"RE Stewart","year":"2009","journal-title":"J Consult Clin Psychol"},{"key":"pone.0282902.ref035","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1080\/10503307.2017.1395921","article-title":"Effectiveness of routine psychotherapy: Method matters","volume":"29","author":"AA McAleavey","year":"2019","journal-title":"Psychother Res"},{"key":"pone.0282902.ref036","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1016\/j.brat.2004.09.006","article-title":"The clinical effectiveness of cognitive behaviour therapy: Outcome for a large sample of adults treated in routine practice","volume":"43","author":"D Westbrook","year":"2005","journal-title":"Behav Res Ther"},{"key":"pone.0282902.ref037","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyt.2019.00796","article-title":"Approaching cognitive behavior therapy for generalized anxiety disorder from a cognitive process perspective","volume":"10","author":"CR Hirsch","year":"2019","journal-title":"Front Psychiatry"},{"key":"pone.0282902.ref038","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1080\/13284207.2021.1913048","article-title":"Effectiveness of transdiagnostic group cognitive-behavioural therapy for anxiety disorders in a naturalistic clinical setting","volume":"25","author":"MYW Jiang","year":"2021","journal-title":"Clin Psychol"},{"key":"pone.0282902.ref039","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1080\/16506070802190262","article-title":"The effectiveness of cognitive behavioral therapy for generalized anxiety disorder in a frontline service setting","volume":"37","author":"SM Kehle","year":"2008","journal-title":"Cogn Behav Ther"},{"key":"pone.0282902.ref040","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.janxdis.2007.01.002","article-title":"A meta-analysis of CBT for pathological worry among clients with GAD","volume":"22","author":"R Covin","year":"2008","journal-title":"J Anxiety Disord"},{"key":"pone.0282902.ref041","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.cpr.2015.02.004","article-title":"The state of personalized treatment for anxiety disorders: A systematic review of treatment moderators","volume":"38","author":"RL Schneider","year":"2015","journal-title":"Clin Psychol Rev"},{"key":"pone.0282902.ref042","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.beth.2008.12.005","article-title":"Diagnostic comorbidity in adults with generalized anxiety disorder: Impact of comorbidity on psychotherapy outcome and impact of psychotherapy on comorbid diagnoses","volume":"41","author":"MG Newman","year":"2010","journal-title":"Behav Ther"},{"key":"pone.0282902.ref043","doi-asserted-by":"crossref","first-page":"90","DOI":"10.3109\/13651501.2013.784789","article-title":"Prevalence and clinical characteristics of remission during treatment in generalized anxiety","volume":"17","author":"M Destoop","year":"2013","journal-title":"Int J Psychiatry Clin Pract"},{"key":"pone.0282902.ref044","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/j.beth.2009.09.002","article-title":"Comorbidity and the treatment of principal anxiety disorders in a naturalistic sample","volume":"41","author":"L Davis","year":"2010","journal-title":"Behav Ther"},{"key":"pone.0282902.ref045","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1177\/0145445506298651","article-title":"The impact of written exposure on worry: a preliminary investigation","volume":"31","author":"N Goldman","year":"2007","journal-title":"Behav Modif"},{"key":"pone.0282902.ref046","doi-asserted-by":"crossref","first-page":"1876","DOI":"10.1016\/j.jpsychires.2013.09.005","article-title":"Predictors of outcome in outpatients with anxiety disorders: The Leiden routine outcome monitoring study","volume":"47","author":"A Schat","year":"2013","journal-title":"J Psychiatr Res"},{"key":"pone.0282902.ref047","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1097\/01.nmd.0000198140.02154.32","article-title":"Characteristics and predictors of full and partial recovery from generalized anxiety disorder in primary care patients","volume":"194","author":"BF Rodriguez","year":"2006","journal-title":"J Nerv Ment Dis"},{"key":"pone.0282902.ref048","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.brat.2012.10.003","article-title":"Long-term effectiveness of CBT for anxiety disorders in an adult outpatient clinic sample: A follow-up study","volume":"51","author":"J DiMauro","year":"2013","journal-title":"Behav Res Ther"},{"key":"pone.0282902.ref049","unstructured":"Wittchen H-U, Zaudig M, Fydrich T. Strukturiertes Klinisches Interview f\u00fcr DSM-IV [Structured clinical interview for DSM-IV]. G\u00f6ttingen: Hogrefe; 1997."},{"key":"pone.0282902.ref050","unstructured":"Beesdo-Baum K, Zaudig M, Wittchen H-U. Strukturiertes Klinisches Interview f\u00fcr DSM-5-St\u00f6rungen\u2014Klinische Version. Deutsche Bearbeitung des Structured Clinical Interview for DSM-5 Disorders\u2014Clinician Version [German Version of the Structured Clinical Interview for DSM-5 Disorders\u2014Clinician Version]. G\u00f6ttingen: Hogrefe; 2019."},{"key":"pone.0282902.ref051","unstructured":"World Health Organization. International statistical classification of diseases and related health problems (10th ed.). 2016. https:\/\/icd.who.int\/browse10\/2016\/en."},{"key":"pone.0282902.ref052","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1177\/001316446002000104","article-title":"A Coefficient of Agreement for Nominal Scales","volume":"20","author":"J. Cohen","year":"1960","journal-title":"Educ Psychol Meas"},{"key":"pone.0282902.ref053","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/0005-7967(90)90135-6","article-title":"Development and validation of the Penn State Worry Questionnaire","volume":"28","author":"TJ Meyer","year":"1990","journal-title":"Behav Res Ther"},{"key":"pone.0282902.ref054","first-page":"50","article-title":"Besorgnis: Ein Vergleich dreier Inventare zur Erfassung allgemeiner Sorgen [Worrying: A comparison of three questionnaires concerning everyday worries]","volume":"16","author":"J. St\u00f6ber","year":"1995","journal-title":"Zeitschrift f\u00fcr Differentielle und Diagnostische Psychologie"},{"key":"pone.0282902.ref055","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/S0005-7967(00)00113-3","article-title":"Confirmatory factor analysis of the Penn State Worry Questionnaire","volume":"40","author":"DM Fresco","year":"2002","journal-title":"Behav Res Ther"},{"key":"pone.0282902.ref056","unstructured":"Gl\u00f6ckner-Rist A, Rist F. Deutsche Version des Penn State Worry Questionnaire (PSWQ-d) [German version of the Penn State Worry Questionnaire]. Zusammenstellung sozialwissenschaftlicher Items und Skalen (ZIS); 2014."},{"key":"pone.0282902.ref057","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/S0005-7967(03)00147-5","article-title":"A short form of the Metacognitions Questionnaire: Properties of the MCQ-30","volume":"42","author":"A Wells","year":"2004","journal-title":"Behav Res Ther"},{"key":"pone.0282902.ref058","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1026\/1616-3443\/a000087","article-title":"Psychometrische G\u00fctekriterien des Metakognitionsfragebogens (Kurzversion, MKF-30) [Psychometric properties of the short German version of the Metacognitions Questionnaire (MKF-30)]","volume":"40","author":"A Arndt","year":"2011","journal-title":"Zeitschrift f\u00fcr Klinische Psychologie und Psychotherapie"},{"key":"pone.0282902.ref059","first-page":"220","volume-title":"Angstdiagnostik: Grundlagen und Testverfahren","author":"J M\u00f6bius","year":"2003"},{"key":"pone.0282902.ref060","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1016\/0191-8869(94)90048-5","article-title":"Why do people worry","volume":"17","author":"MH Freeston","year":"1994","journal-title":"Pers Individ Dif"},{"key":"pone.0282902.ref061","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1026\/1616-3443.37.3.190","article-title":"Die Bedeutung von Unsicherheitsintoleranz f\u00fcr die Generalisierte Angstst\u00f6rung: Modell\u00fcberlegungen und Entwicklung einer deutschen Version der Unsicherheitsintoleranz-Skala [The significance of intolerance of uncertainty in generalized anxiety disorder: Possible models and development of a German version of the intolerance of uncertainty scale]","volume":"37","author":"AL Gerlach","year":"2008","journal-title":"Zeitschrift f\u00fcr Klinische Psychologie und Psychotherapie"},{"key":"pone.0282902.ref062","volume-title":"Beck Depression Inventory-II (BDI-II)","author":"AT Beck","year":"1996"},{"key":"pone.0282902.ref063","unstructured":"Hautzinger M, Keller F, K\u00fchner C. Das Beck Depressionsinventar II. Deutsche Bearbeitung und Handbuch zum BDI II. Frankfurt am Main: Harcourt Test Services GmbH; 2006."},{"key":"pone.0282902.ref064","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/0272-7358(88)90050-5","article-title":"Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation","volume":"8","author":"AT Beck","year":"1988","journal-title":"Clin Psychol Rev"},{"key":"pone.0282902.ref065","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1590\/1516-4446-2012-1048","article-title":"Psychometric properties of the Beck Depression Inventory-II: a comprehensive review","volume":"35","author":"Y-P Wang","year":"2013","journal-title":"Braz J Psychiatry"},{"key":"pone.0282902.ref066","unstructured":"Derogatis LR. SCL-90-R: Administration, scoring and procedures manual. Baltimore: Clinical Psychometric Research; 1977."},{"key":"pone.0282902.ref067","unstructured":"Franke G. SCL-90-R. Symptom-Checkliste von L. R. Derogatis: Deusche Version. G\u00f6ttingen: Beltz; 2002."},{"key":"pone.0282902.ref068","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1023\/A:1008931926181","article-title":"The Symptom Check-List-90-R (SCL-90-R): A German validation study","volume":"9","author":"N Schmitz","year":"2000","journal-title":"Qual Life Res"},{"key":"pone.0282902.ref069","unstructured":"R Core Team. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2021."},{"key":"pone.0282902.ref070","article-title":"mice: Multivariate Imputation by Chained Equations in R","volume":"45","author":"S Van Buuren","year":"2011","journal-title":"J Stat Softw"},{"key":"pone.0282902.ref071","unstructured":"Robitzsch A, Grund S. miceadds: Some Additional Multiple Imputation Functions, Especially for \u2019mice\u2019. R package version 3.12\u201326. 2022. https:\/\/CRAN.R-project.org\/package=miceadds."},{"key":"pone.0282902.ref072","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1080\/01621459.1988.10478722","article-title":"A Test of Missing Completely at Random for Multivariate Data with Missing Values","volume":"83","author":"RJA Little","year":"1988","journal-title":"J Am Stat Assoc"},{"key":"pone.0282902.ref073","unstructured":"Heymans MW, Eekhout I. Applied Missing Data Analysis With SPSS and (R)Studio. Amsterdam: 2019. https:\/\/bookdown.org\/mwheymans\/bookmi\/."},{"key":"pone.0282902.ref074","doi-asserted-by":"crossref","DOI":"10.1201\/9780429492259","volume-title":"Flexible imputation of missing data","author":"S. Van Buuren","year":"2018"},{"key":"pone.0282902.ref075","volume-title":"Applied missing data analysis","author":"CK Enders","year":"2010"},{"key":"pone.0282902.ref076","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.brat.2016.11.008","article-title":"Multiple Imputation as a Flexible Tool for Missing Data Handling in Clinical Research","volume":"98","author":"CK Enders","year":"2017","journal-title":"Behav Res Ther"},{"key":"pone.0282902.ref077","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/9780470316696","volume-title":"Multiple Imputation for Nonresponse in Surveys","author":"DB Rubin","year":"1987"},{"key":"pone.0282902.ref078","doi-asserted-by":"crossref","first-page":"669","DOI":"10.3758\/s13428-020-01429-w","article-title":"Combination rules for homoscedastic and heteroscedastic MANOVA models from multiply imputed datasets","volume":"53","author":"G Vallejo","year":"2021","journal-title":"Behav Res Methods"},{"key":"pone.0282902.ref079","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1080\/00223891.2018.1530680","article-title":"Rebutting Existing Misconceptions About Multiple Imputation as a Method for Handling Missing Data","volume":"102","author":"JR Van Ginkel","year":"2020","journal-title":"J Pers Assess"},{"key":"pone.0282902.ref080","volume-title":"Discovering statistics using R","author":"AP Field","year":"2012"},{"key":"pone.0282902.ref081","volume-title":"Using multivariate statistics","author":"BG Tabachnick","year":"2019"},{"key":"pone.0282902.ref082","doi-asserted-by":"crossref","first-page":"380","DOI":"10.32614\/RJ-2019-051","article-title":"Resampling-Based Analysis of Multivariate Data and Repeated Measures Designs with the R Package MANOVA.RM","volume":"11","author":"S Friedrich","year":"2019","journal-title":"The R Journal"},{"key":"pone.0282902.ref083","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.jmva.2017.12.008","article-title":"MATS: Inference for potentially Singular and Heteroscedastic MANOVA","author":"S Friedrich","year":"2018","journal-title":"J Multivar Anal"},{"key":"pone.0282902.ref084","volume-title":"Statistical power analysis for the behavioral sciences","author":"J. Cohen","year":"1988","edition":"2"},{"key":"pone.0282902.ref085","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1037\/0022-006X.59.1.12","article-title":"Clinical significance: A statistical approach to defining meaningful change in psychotherapy research","volume":"19","author":"NS Jacobson","year":"1991","journal-title":"J Consult Clin Psychol"},{"key":"pone.0282902.ref086","unstructured":"Champely S, Ekstrom C, Dalgaard P, Gill J, Weibelzahl, Anandkumar A, et al. \u2019pwr\u2019. R package version 1.3\u20130. https:\/\/cran.r-project.org\/web\/packages\/pwr\/."},{"key":"pone.0282902.ref087","doi-asserted-by":"crossref","first-page":"133","DOI":"10.5127\/jep.007910","article-title":"Metacognitive theory and therapy for worry and generalized anxiety disorder: Review and status","volume":"1","author":"A. Wells","year":"2010","journal-title":"J Exp Psychopathol"},{"key":"pone.0282902.ref088","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1037\/0022-006X.71.4.821","article-title":"Group cognitive-behavioral therapy for generalized anxiety disorder: Treatment outcome and long-term follow-up","volume":"71","author":"MJ Dugas","year":"2003","journal-title":"J Consult Clin Psychol"},{"key":"pone.0282902.ref089","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1037\/0022-006X.74.5.908","article-title":"Benzodiazepine discontinuation among adults with GAD: A randomized trial of cognitive-behavioral therapy","volume":"74","author":"P Gosselin","year":"2006","journal-title":"J Consult Clin Psychol"},{"key":"pone.0282902.ref090","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1111\/j.1600-0447.2006.00896.x","article-title":"Generalized anxiety disorder: A 40-year follow-up study","volume":"115","author":"G Rubio","year":"2007","journal-title":"Acta Psychiatr Scand"},{"key":"pone.0282902.ref091","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/j.beth.2019.07.007","article-title":"Beyond the Constraints of an RCT: Naturalistic treatment outcomes for anxiety-related disorders","volume":"51","author":"A Asnaani","year":"2020","journal-title":"Behav Ther"},{"key":"pone.0282902.ref092","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.beth.2013.09.009","article-title":"Clinical experiences in conducting empirically supported treatments for generalized anxiety disorder","volume":"45","author":"LE Szkodny","year":"2014","journal-title":"Behav Ther"},{"key":"pone.0282902.ref093","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1080\/14733140112331385100","article-title":"An administratively created reality: Some problems with the use of self-report questionnaire measures of adjustment in counselling\/psychotherapy outcome research","volume":"1","author":"J. McLeod","year":"2001","journal-title":"Couns Psychother Res"},{"key":"pone.0282902.ref094","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.cpr.2014.01.002","article-title":"Psychological treatment of generalized anxiety disorder: A meta-analysis","volume":"34","author":"P Cuijpers","year":"2014","journal-title":"Clin Psychol Rev"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0282902","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,10]],"date-time":"2023-03-10T18:27:26Z","timestamp":1678472846000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0282902"}},"subtitle":[],"editor":[{"given":"Stephan","family":"Doering","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,3,10]]},"references-count":94,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,3,10]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0282902","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,10]]}}}