Resource activation in generalized anxiety--an observer-based microprocess analysis of patients' in-session outcomes

Despite a long-standing need for patient-focused research on individuals with generalized anxiety disorder, there is little systematized knowledge about the in-session behaviors of these patients. The primary objective of this study was to describe the timing of expression of negative emotionality (level of explication) and the patients' focus on their own resources and how these indicators are associated with posttreatment outcome. Trained coders made minute-by-minute ratings of 1,100 min of video of 20 patient-therapist dialogues during Session 5. The results indicated that a higher level of explication generally observed at a later stage during the therapy sessions and the patients' focus on competencies (usually observed at an early stage) were positively associated with treatment outcome, independent of pretreatment distress, rapid response of well-being and symptom reduction, as well as the therapists' professional experience and treatment duration. However, positive reinterpretations and mentions of personal goals were negatively associated with outcome. If replicated, these results will highlight the importance of the in-session beginning phase in patients with generalized anxiety disorder.