Efficacy of self-administered treatments for pathological academic worry: A randomized controlled trial Kate B. Wolitzky-Taylor a, b , Michael J. Telch b, * a University of California, Los Angeles, USA b Laboratory for the Study of Anxiety Disorders, Department of Psychology, University of Texas, Austin, TX 78712, USA article info Article history: Received 23 January 2010 Received in revised form 23 March 2010 Accepted 24 March 2010 Keywords: Academic worry Pathological worry GAD Worry exposure Expressive writing Audio-photic stimulation Self-help treatments Randomized clinical trial Self-administered treatments Brief treatments abstract Research on treatments for reducing pathological worry is limited. In particular, academic worry is a common theme in generalized anxiety disorder (GAD) samples as well as non-clinical student samples. Given the high cost of anxiety disorders to society, research is needed to examine the efficacy of self- administered treatments designed to reduce pathological worry. The primary goal of this study was to investigate the benefits of three self-administered interventions for reducing academic worry. College students (N ¼ 113) experiencing clinically significant academic worry were randomized to either: (a) worry exposure (WE); (b) expressive writing (EW); (c) relaxation consisting of pulsed audio-photic stimulation (APS); or (d) waitlist control (WLC). Participants were instructed to practice their interventions three times per week for one month and completed home practice logs online to track treatment adherence. Academic worry, general anxiety, and perceived stress were assessed at baseline and post- treatment. Academic worry and general anxiety were also assessed at a three-month follow-up. Those assigned to the WE and APS conditions showed significant improvement relative to EW and WLC at post-treatment. All treatment conditions showed continued improvement by follow-up, with no between- group differences. Treatment and public health implications are discussed. Ó 2010 Elsevier Ltd. All rights reserved. Generalized anxiety disorder (GAD) affects approximately 6% of the general US population and is associated with significant impairment in role and social functioning (Kessler, DuPont, Burglund, & Wittchen, 1999; Wittchen, Carter, & Pfister, 2000), high rates of medical and psychiatric comorbidity (McWilliams, Goodwin, & Cox, 1997; Kennedy & Schwab, 1997; Swendsen, Merikangas, & Canino, 1998), and increased rates of health care utilization (Barrett, Barrett, & Oxman, 1988; Wittchen & Hoyer, 2001). GAD ranks as the most common mental disorder seen in primary care settings e two times the prevalence rate in primary care compared to major depression (Wittchen, 2002). Unfortunately, only 28% of GAD patients seen in primary care facilities are correctly diagnosed by their primary care physicians, and these patients are rarely treated with empirically supported treatments for GAD (Wittchen & Hoyer, 2001). These data point to the need for brief cost-effective interventions that could be transported to primary care settings (Telch, Smits, Brown, & Beckner, 2002). The significance of academic worry It is estimated that anxiety in response to test taking and other academic concerns affects 25e30% of high-school and college students (McDonald, 2001; Wachelka & Katz, 1999). Not only is academic stress highly prevalent but studies suggest that academic stress contributes to anxiety and depression among college students (Aldwin & Greenberger, 1987; Yadusky-Holahan & Holahan, 1983). Pathological worry about work or school is commonly observed in GAD patient samples (Sanderson & Barlow, 1990) as well as sub-clinical samples (Hazlett-Stevens & Craske, 2003). Self-administered treatments for pathological worry One way to make psychological interventions more cost-effective is to utilize brief interventions that lend themselves to self- administration. The American Psychological Association’s Task Force on Self-Help Therapies noted several advantages of self-help inter- ventions: (a) they reach a large number of people, (b) they are highly cost-effective, (c) they help maximize autonomy by decreasing reli- ance on mental health professionals, and (d) they serve educative and preventive functions (Rosen, 1987). The most widely researched self-help interventions for anxiety disorders have been bibliotherapy * Corresponding author. E-mail address: telch@austin.utexas.edu (M.J. Telch). Contents lists available at ScienceDirect Behaviour Research and Therapy journal homepage: www.elsevier.com/locate/brat 0005-7967/$ e see front matter Ó 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.brat.2010.03.019 Behaviour Research and Therapy 48 (2010) 840e850