Group Cognitive-Behavioral Therapy for Reducing Anxiety in Middle-Aged Women
Abstract
Middle-aged women are susceptible to experiencing anxiety, which, if left untreated, can lead to decreased productivity and hinder social interactions, ultimately impacting overall well-being. This study aimed to investigate the effectiveness of cognitive-behavioral group therapy in alleviating anxiety in middle-aged women. The research design employed a quasi-experimental approach with a one-group pre-test-post-test design and follow-up assessment. The participants included seven middle-aged women aged between 53 and 60 years (mean age = 56.71). They were selected based on screening results using the DASS42 anxiety scale, which indicated severe and very severe anxiety. Data collection consisted of pre-test, post-test, and follow-up assessments using the Beck Anxiety Inventory (BAI). Data were analyzed using the repeated measures ANOVA method. The results of the data analysis revealed an F-value of 120, p < .001, indicating significant differences between the pre-test, post-test, and follow-up assessments. Specifically, significant differences were found between pre-test and post-test (p < .001), pre-test and follow-up (p < .001), and post-test and follow-up (p < .001) results. These findings demonstrate the effectiveness of cognitive-behavioral group therapy in reducing anxiety among middle-aged women. Therefore, cognitive-behavioral group therapy emerges as a viable intervention for addressing anxiety in this demographic.
Keywords
References
Abrams, L. R., Finlay, J. M., & Kobayashi, L. C. (2021). Job Transitions and Mental Health Outcomes Among U.S. Adults Aged 55 and Older During the COVID-19 Pandemic. The Journals of Gerontology: Series B, 77(7), e106–e116. https://doi.org/10.1093/geronb/gbab060
Allen, M. (2017). The SAGE Encyclopedia of Communication Research Methods. SAGE Publications, Inc. eBooks. https://doi.org/10.4135/9781483381411
Altamura, A. C., Camuri, G., & Dell'Osso, B. (2013). Duration of untreated illness and duration of illness in anxiety disorders: assessment and influence on outcome. Modern trends in pharmacopsychiatry, 29, 111–118. https://doi.org/10.1159/000351950
Baker, H., Lawrence, P. F., Karalus, J., Creswell, C., & Waite, P. (2021). The Effectiveness of Psychological Therapies for Anxiety Disorders in Adolescents: A Meta-Analysis. Clinical Child and Family Psychology Review, 24(4), 765–782. https://doi.org/10.1007/s10567-021-00364-2
Balsamo, M., Cataldi, F., Carlucci, L., & Fairfield, B. (2018). Assessment of anxiety in older adults: A review of self-report measures. Clinical Interventions in Aging, 13, 573–593. https://doi.org/10.2147/CIA.S114100
Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in clinical neuroscience, 19(2), 93–107. https://doi.org/10.31887/DCNS.2017.19.2/bbandelow
Bansal, P., Chaudhary, A., Soni, R. K., Sharma, S., Gupta, V. K., & Kaushal, P. (2015). Depression and anxiety among middle-aged women: A community-based study. Journal of family medicine and primary care, 4(4), 576–581. https://doi.org/10.4103/2249-4863.174297
Beck, A. T., & Steer, R. A. (1993). Beck Anxiety Inventory Manual. San Antonio: Harcourt Brace and Company.
Beck, A. T., Brown, G., Epstein, N., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893-897.
Bhattacharya, S., Goicoechea, C., Heshmati, S., Carpenter, J. K., & Hofmann, S. G. (2023). Efficacy of cognitive behavioral therapy for anxiety-related disorders: A meta-analysis of recent literature. Current psychiatry reports, 25(1), 19–30. https://doi.org/10.1007/s11920-022-01402-8
Broeke, T. G., & Tobi, H. (2021). Mapping validity and validation in modelling for interdisciplinary research. Quality & Quantity, 55(5), 1613–1630. https://doi.org/10.1007/s11135-020-01073-8
Budhia, M., Neogi, R., & Rathi, M. (2022). Empty nest syndrome: its prevalence and predictors in middle aged adults in Eastern India: Category: Oral paper presentation. Indian Journal of Psychiatry, 64(3), S577. https://doi.org/10.4103/0019-5545.341672
Bunnell, B. E., Kazantzis, N., Paige, S. R., Barrera, J., Thakkar, R. N., Turner, D., & Welch, B. M. (2021). Provision of care by "Real World" telemental health providers. Frontiers in Psychology, 12, 653-652. https://doi.org/10.3389/fpsyg.2021.653652
Christensen, A. B., Wahrén, S., Reinholt, N., Poulsen, S., Hvenegaard, M., Simonsen, E., & Arnfred, S. (2021). Despite the differences, We were all the same. Group cohesion in diagnosis-specific and transdiagnostic CBT groups for anxiety and depression: A qualitative study. International Journal of Environmental Research and Public Health, 18(10), 5324. https://doi.org/10.3390/ijerph18105324
Clark, D. A. (2013). Cognitive restructuring. The wiley handbook of cognitive behavioral therapy. John Wiley & Sons, Ltd.
Clark, D.A. (2014). Cognitive restructuring. In: the wiley handbook of cognitive behavioral therapy, First Edition. John Wiley & Sons, Ltd.
Courtney, M. (2018). Repeated measures analysis of variance. In: The SAGE encyclopedia of educational research, measurement, and evaluation. SAGE Publications, Inc., https://doi.org/10.4135/9781506326139
Cranmer, G.A. (2017). One-Geoup pre-test-posttest design. In: The SAGE encyclopedia of communication research methods. SAGE Publications, Inc. eBooks. https://doi.org/10.4135/9781483381411
Crum J. (2021). Understanding mental health and cognitive restructuring with ecological neuroscience. Frontiers in Psychiatry, 12, 1-7. https://doi.org/10.3389/fpsyt.2021.697095
de Oliveira, C., Saka, M., Bone, L., & Jacobs, R. (2023). The role of mental health on workplace productivity: A critical review of the literature. Applied health economics and health policy, 21(2), 167–193. https://doi.org/10.1007/s40258-022-00761-w
Erikson, E. H. (1993). Childhood and society (2nd ed.). W. W. Norton & Company.
Fadilah, R. (2015). Pengaruh metoda ruqyah terhadap penurunan derajat kecemasan (penelitian quasi experimental pada pasien di ruqyah x cabang Bandung). TAZKIYA (Journal of Psychology), 3(1), 101-112. https://doi.org/ 10.15408/tazkiya.v20i1.9196
Gautam, M., Tripathi, A., Deshmukh, D., & Gaur, M. (2020). Cognitive behavioral therapy for depression. Indian Journal of Psychiatry, 62(2), S223–S229. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_772_19
Guo, T., Su, J., Hu, J., Aalberg, M., Zhu, Y., Teng, T., & Zhou, X. (2021). Individual vs. Group Cognitive Behavior Therapy for Anxiety Disorder in Children and Adolescents: A Meta-Analysis of Randomized Controlled Trials. Frontiers in psychiatry, 12, 674267. https://doi.org/10.3389/fpsyt.2021.674267
Haller, H., Breilmann, P., Schröter, M., Dobos, G., & Cramer, H. (2021). A systematic review and meta-analysis of acceptance- and mindfulness-based interventions for DSM-5 anxiety disorders. Scientific reports, 11(1), 20385. https://doi.org/10.1038/s41598-021-99882-w
Hanrahan, F., Field, A. P., Jones, F. W., & Davey, G. C. L. (2013). A meta-analysis of cognitive therapy for worry in generalized anxiety disorder. Clinical Psychology Review, 33(1), 120–132. https://doi.org/10.1016/j.cpr.2012.10.008
Hasheminasab, M., Babapour Kheiroddin, J., Mahmood Aliloo, M., & Fakhari, A. (2015). Acceptance and Commitment Therapy (ACT) For Generalized Anxiety Disorder. Iranian journal of public health, 44(5), 718–719.
Hayes-Skelton, S. A., Roemer, L., Orsillo, S. M., & Borkovec, T. D. (2013). A contemporary view of applied relaxation for generalized anxiety disorder. Cognitive Behaviour Therapy, 42(4), 292–302. https://doi.org/10.1080/16506073.2013.777106
Hopper, S. I., Murray, S. L., Ferrara, L. R., & Singleton, J. K. (2019). Effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults: a quantitative systematic review. JBI database of systematic reviews and implementation reports, 17(9), 1855–1876. https://doi.org/10.11124/JBISRIR-2017-003848
Huda, N., Lin, Y. K., Shaw, M. K., Hsu, Y. Y., & Chang, H. J. (2022). Psychometric properties and cross-cultural adaptation of the Indonesian version of the Brief COPE in a sample of advanced cancer patients. PloS One, 17(11), e0275083. https://doi.org/10.1371/journal.pone.0275083
Jackson, M. J. (2020). 2019 Wilkins–Bernal–Medawar lectureLife begins at 40: the demographic and cultural roots of the midlife crisis. Notes and Records, 74(3), 345–364. https://doi.org/10.1098/rsnr.2020.0008
Julian L. J. (2011). Measures of anxiety: State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Arthritis Care & Research, 63 Suppl 11(0 11), S467–S472. https://doi.org/10.1002/acr.20561
Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in Clinical Neuroscience, 17(3), 337–346. https://doi.org/10.31887/DCNS.2015.17.3/akaczkurkin
Kang, H. J., Bae, K. Y., Kim, S. W., Shin, H. Y., Shin, I. S., Yoon, J. S., & Kim, J. M. (2017). Impact of anxiety and depression on physical health condition and disability in an Elderly Korean Population. Psychiatry investigation, 14(3), 240–248. https://doi.org/10.4306/pi.2017.14.3.240
Keefe, J. R., McCarthy, K. J., Dinger, U., Zilcha-Mano, S., & Barber, J. P. (2014). A meta-analytic review of psychodynamic therapies for anxiety disorders. Clinical Psychology Review, 34(4), 309–323. https://doi.org/10.1016/j.cpr.2014.03.004
Kendall, P. C., Ney, J. S., Maxwell, C. A., Lehrbach, K. R., Jakubovic, R. J., McKnight, D. S., & Friedman, A. L. (2023). Adapting CBT for youth anxiety: Flexibility, within fidelity, in different settings. Frontiers in Psychiatry, 14, 1067047. https://doi.org/10.3389/fpsyt.2023.1067047
Kinser, P. A., & Robins, J. L. (2013). Control group design: enhancing rigor in research of mind-body therapies for depression. Evidence-based Complementary and Alternative Medicine : eCAM, 2013, 140467. https://doi.org/10.1155/2013/140467
Knapp T. R. (2016). Why Is the One-Group pre-test-Posttest Design Still Used?. Clinical nursing research, 25(5), 467–472. https://doi.org/10.1177/1054773816666280
Lai, H. L., Chen, C. I., Lu, C. Y., & Huang, C. Y. (2021). Cognitive behavioral therapy plus coping management for depression and anxiety on improving sleep quality and health for patients with breast cancer. Brain Sciences, 11(12), 1614. https://doi.org/10.3390/brainsci11121614
Lamoureux-Lamarche, C., Berbiche, D., & Vasiliadis, H. M. (2022). Health care system and patient costs associated with receipt of minimally adequate treatment for depression and anxiety disorders in older adults. BMC psychiatry, 22(1), 175. https://doi.org/10.1186/s12888-022-03759-9
Levermore, A. (2016). Managing Stress in 8th Grade: CBT and Relaxation Techniques in Small Group Therapy. https://www.semanticscholar.org/paper/Managing-Stress-in-8th-Grade%3A-CBT-and-Relaxation-in-Levermore/7fb51cd79622a10fb71da83e249efe9fb7429028
Magnon, V., Dutheil, F., & Vallet, G. T. (2021). Benefits from one session of deep and slow breathing on vagal tone and anxiety in young and older adults. Scientific Reports, 11(1), 19267. https://doi.org/10.1038/s41598-021-98736-9
Mahoney, C. (2013). Self-monitoring to enhancce the effectiveness of a treatment for anxiety. [Unpublished doctoral dissertation], Northeastern University.
Malay, S., & Chung, K. C. (2013). The choice of controls for providing validity and evidence in clinical research. Plastic and Reconstructive Surgery, 130(4), 959–965. https://doi.org/10.1097/PRS.0b013e318262f4c8
Maleki, A., Ravanbakhsh, M., Saadat, M., Bargard, M. S., & Latifi, S. M. (2022). Effect of breathing exercises on respiratory indices and anxiety level in individuals with generalized anxiety disorder: a randomized double-blind clinical trial. Journal of physical therapy science, 34(4), 247–251. https://doi.org/10.1589/jpts.34.247
Malivoire, B. L., & Koerner, N. (2022). Interpersonal dysfunction in individuals high in chronic worry: relations with interpersonal problem-solving. Behavioural and cognitive psychotherapy, 50(2), 142–157. https://doi.org/10.1017/S1352465821000436
Marmarosh, C. L., Sandage, S., Wade, N., Captari, L. E., & Crabtree, S. (2022). New horizons in group psychotherapy research and practice from third wave positive psychology: A practice-friendly review. Research in Psychotherapy (Milano), 25(3), 643. https://doi.org/10.4081/ripppo.2022.643
Mayo-Wilson, E., Dias, S., Mavranezouli, I., Kew, K., Clark, D. M., Ades, A. E., & Pilling, S. (2014). Psychological and pharmacological interventions for social anxiety disorder in adults: A systematic review and network meta-analysis. The Lancet. Psychiatry, 1(5), 368–376. https://doi.org/10.1016/S2215-0366(14)70329-3
McLean, K. C., & Syed, M. U. (2015). The Oxford Handbook of Identity Development. Oxford Library of Psychology.
Muntingh, A. D., van der Feltz-Cornelis, C. M., van Marwijk, H. W., Spinhoven, P., Penninx, B. W., & van Balkom, A. J. (2011). Is the beck anxiety inventory a good tool to assess the severity of anxiety? A primary care study in the Netherlands Study of Depression and Anxiety (NESDA). BMC Family Practice, 12, 66. https://doi.org/10.1186/1471-2296-12-66
Nakao, M., Shirotsuki, K., & Sugaya, N. (2021). Cognitive–behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies. Biopsychosocial
Medicine. https://doi.org/10.1186/s13030-021-00219-w
Oh, H., Park, K., Yoon, S., Kim, Y., Lee, S. H., Choi, Y. Y., & Choi, K. H. (2018). Clinical utility of beck anxiety inventory in clinical and nonclinical Korean samples. Frontiers in Psychiatry, 9, 666. https://doi.org/10.3389/fpsyt.2018.00666
Oliveira, P., PorfÃrio, C., Pires, R., Silva, R., Carvalho, J. C., Costa, T., & Sequeira, C. (2022). Psychoeducation Programs to Reduce Preoperative Anxiety in Adults: A Scoping Review. International journal of environmental research and public health, 20(1), 327. https://doi.org/10.3390/ijerph20010327
Olmstead, T. A., Graff, F. S., Ames-Sikora, A., McCrady, B. S., Gaba, A., & Epstein, E. E. (2019). Cost-effectiveness of individual versus group female-specific cognitive behavioral therapy for alcohol use disorder. Journal of substance abuse treatment, 100, 1–7. https://doi.org/10.1016/j.jsat.2019.02.001
Ortega-Donaire, L., Álvarez-García, C., López-Franco, M. D., & Sanz-Martos, S. (2023). Effectiveness of guided breathing and social support for the reduction of pre-exam anxiety in University Students: A factorial study. Healthcare (Basel, Switzerland), 11(4), 574. https://doi.org/10.3390/healthcare11040574
Otte C. (2011). Cognitive behavioral therapy in anxiety disorders: current state of the evidence. Dialogues in Clinical Neuroscience, 13(4), 413–421. https://doi.org/10.31887/DCNS.2011.13.4/cotte
Prasko, J., Krone, I., Burkauskas, J., Vanek, J., Abeltina, M., Juskiene, A., Sollar, T., Bite, I., Slepecky, M., & Ociskova, M. (2022). Homework in cognitive behavioral supervision: Theoretical background and clinical application. Psychology Research and Behavior Management, 15, 3809–3824. https://doi.org/10.2147/PRBM.S382246
Rahman, M. A., Balakrishnan, R., Reza, M. S., & Chowdhury, Q. (2021). Benefits of Radiotherapy with Indigenous Tools Aiding Deep Inspiration Breath Holding Technique Compared to Free Breathing Technique among Breast Cancer Patients in Bangladesh. Advances in Breast Cancer Research, 10(03), 75–86. https://doi.org/10.4236/abcr.2021.103006
Rajabi, M., Bakhshani, N., Saravani, M. R., Foroughi, A., & Bagian, M. J. (2016). Effectiveness of Cognitive-Behavioral Group Therapy on Coping Strategies and in Reducing Anxiety, Depression, and Physical Complaints in Student Victims of Bullying. International Journal of High Risk Behaviors and Addiction, 6(2). https://doi.org/10.5812/ijhrba.41463
Reddy, Y. C. J., Sudhir, P. M., Manjula, M., Arumugham, S. S., & Narayanaswamy, J. C. (2020). Clinical practice guidelines for cognitive-behavioral therapies in anxiety disorders and obsessive-compulsive and related disorders. Indian Journal of Psychiatry, 62(2), S230–S250. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_773_19
Remes, O., Brayne, C., Van Der Linde, R. M., & Lafortune, L. (2016). A systematic review of reviews on the prevalence of anxiety disorders in adult populations. Brain and Behavior, 6(7), e00497. https://doi.org/10.1002/brb3.497
Saldivia, S., Aslan, J., Cova, F., Bustos, C., Inostroza, C., & Castillo-Carreño, A. (2023). Life satisfaction, positive affect, depression and anxiety symptoms, and their relationship with sociodemographic, psychosocial, and clinical variables in a general elderly population sample from Chile. Frontiers in psychiatry, 14, 1203590. https://doi.org/10.3389/fpsyt.2023.1203590
Santrock, J.W. Essentials of Life-Span Development 7th Editions. McGraw-Hill.
Saporovskaia, M. V., Kryukova, T. L., Voronina, M. E., Tikhomirova, E. V., Samokhvalova, A. G., & Khazova, S. A. (2021). A Decrease in Psycho-Emotional Health in Middle-Aged Russian Women Associated with Their Lifestyle. International journal of environmental research and public health, 18(2), 388. https://doi.org/10.3390/ijerph18020388
Sarkhel, S., Singh, O. P., & Arora, M. (2020). Clinical practice guidelines for psychoeducation in psychiatric disorders general principles of psychoeducation. Indian Journal of Psychiatry, 62(Suppl 2), S319–S323. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_780_19
Skjernov, M., Fink, P., Fallon, B., Rasmussen, F., & Simonsen, E. (2018). Feasibility study of group cognitive behavioral therapy for severe health anxiety. Journal of cognitive psychotherapy, 32(4), 223–240. https://doi.org/10.1891/0889-8391.32.4.223
Solhi, M., Pirouzeh, R., & Zanjari, N. (2022). Perspectives on healthy aging in middle age: Evidence for health promotion interventions. Journal of education and health promotion, 11, 5. https://doi.org/10.4103/jehp.jehp_972_20
Thapa, D. K., Watson, R., Kornhaber, R., & Cleary, M. (2018). Migration of adult children and mental health of older parents ‘left behind’: An integrative review. PLOS ONE, 13(10), e0205665. https://doi.org/10.1371/journal.pone.0205665
The Jamovi Project (2022). Jamovi. (Version 2.3) [Computer Software]. Retrieved from https://www.jamovi.org.
Thimm, J. C., & Antonsen, L. (2014). Effectiveness of cognitive behavioral group therapy for depression in routine practice. BMC psychiatry, 14, 292. https://doi.org/10.1186/s12888-014-0292-x
Traeger, L. (2013). Cognitive Behavioral Therapy (CBT). In: Gellman, M.D., Turner, J.R. (eds) Encyclopedia of Behavioral Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1005-9_165
Wang, X., Zhao, G., Di, J., Wang, L., & Zhang, X. (2022). Prevalence and risk factors for depressive and anxiety symptoms in middle-aged Chinese women: a community-based cross-sectional study. BMC Women's Health, 22(1). https://doi.org/10.1186/s12905-022-01908-6
Widyana, R., Sumiharso., & Safitri, R.M. (2020). Psychometric properties of internet-administered version of depression, anxiety and stress scales (DASS-42) in sample Indonesian adult. Talent Development & Excellence, 12 (2s), 1422-1434.
Wilmer, M. T., Anderson, K., & Reynolds, M. (2021). Correlates of quality of life in anxiety disorders: Review of recent research. Current psychiatry reports, 23(11), 77. https://doi.org/10.1007/s11920-021-01290-4
Wilmots, E., Midgley, N., Thackeray, L., Reynolds, S., & Loades, M. (2020). The therapeutic relationship in cognitive behaviour therapy with depressed adolescents: A qualitative study of good-outcome cases. Psychology and Psychotherapy, 93(2), 276–291. https://doi.org/10.1111/papt.12232
Wolgensinger L. (2015). Cognitive behavioral group therapy for anxiety: recent developments. Dialogues in clinical neuroscience, 17(3), 347–351. https://doi.org/10.31887/DCNS.2015.17.3/lwolgensinger
Wu, Y., Lei, P., Ye, R., Sunil, T. S., & Zhou, H. (2019). Prevalence and risk factors of depression in middle-aged and older adults in urban and rural areas in China: a cross-sectional study. The Lancet, 394, S53. https://doi.org/10.1016/s0140-6736(19)32389-x
DOI: 10.15408/tazkiya.v12i1.32225
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
