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The efficacy of The Linden Method in eliminating anxiety symptoms in a cohort of anxiety sufferers

Martin Jensen. Kingston University - University of Copenhagen.

Introduction

The Linden Method is a structured Program of Guided Self-Help for the treatment of high anxiety conditions including, Generalised Anxiety Disorder, Panic Disorder, Agoraphobia, Obsessive Compulsive Disorder, Post Traumatic Stress Disorder and Anxiety Disorder related Low Mood.

Although The Linden Method was not developed to treat other disorders, patients with depressive disorder and CFS/ME have experienced significant improvements and indeed, full recovery whilst using The Linden Method.

The Linden Method utlises a multi-faceted approach incorporating education and reassurance, life structure and seamless guidance support from qualified specialists. Incorporating all programme elements compliantly modifies the neurology responsible for activating and modifying the brain structures and processes responsible for the development and perpetuation of high anxiety states. In addition, the methods used prepare the mind to recognise and respond appropriately to fear provoking catalysts in future.

 

The present study was carried out in order to investigate the efficacy of the Linden Method, in a cohort of clients, who had followed the structured programme to treat their anxiety disorders including GAD, agoraphobia, OCD, PTSD and OCD.

It was predicted, that participants post-treatment, would exhibit significantly less anxiety distress, as measured with the Generalized Anxiety Disorder -7 (GAD-7), than before initiation of treatment.

Method
The present study was conducted among clients treated with the Linden Method. Participants were initially contacted by The Linden Method specialists, who are British Association of Chartered Psychotherapists and British Psychological Society registered counselling psychotherapists and asked to participate in the study to assess the efficacy of the method in reducing or eliminating anxiety disorders. These participants were selected based on the knowledge that they had complied with the method’s directives, rules and principles.

Just as any other study involving a demonstrable effect of an intervention, it is important that people adhere to the treatment regimen. Of the 100 invitations to participate, 61 agreed to participate in the study.

Measure
To assess the levels of anxiety in participants, the Generalized Anxiety Disorder 7 (GAD-7) was implemented (Spitzer et al. 2006). GAD-7 is a self-report measure used for screening and measuring the severity of generalised anxiety. The measure has seven items, which measure the severity of various signs of generalized anxiety disorder. One such item example is: “Prior to doing the Linden Method, how often have you been bothered by the following problems?” Feeling nervous, anxious or on edge? Participants were asked to respond with the following (not at all = 0, infrequent = 1, frequently = 2, constantly = 3). Assessment is indicated by the total score, which is made up by adding together the scores for the seven items of the scale. According to the GAD-7, there are four categories or anxiety levels, ranging from minimal anxiety (score 0 – 4), mild anxiety (5 – 9), moderate anxiety (10 – 14) and severe anxiety (15 – 21).

As the aim was to assess the efficacy of the Linden Method, participants filled in the assessment of their anxiety levels, both at pre- and post treatment. This was done retrospectively, i.e. both assessments were done post-treatment. 

Analysis
Data were analysed using the IBM SPSS Statistics software package.
In order to test the hypothesis that the Linden Method would result in a significant decrease in anxiety severity, the Wilcoxon signed-rank test was chosen to analyse the data.

As the data in the analysis are ordinal, and thus non-parametric, the test is ideal when comparing two related samples, to assess whether their population mean ranks differ. It is comparable to a Student’s t-test, but used when the population cannot be assumed to be normally distributed.

Results
The mean pre- and post-treatment scores for participants in the study were 18.28 and 2.84 respectively. This indicates that a large percentage of participants had severe anxiety problems before entering the treatment programme. In contrast, post-treatment results indicate, that for the majority of participants, anxiety no longer presented as a major issue in their day-to-day life.
Below charts of the frequency distribution pre- and post treatment.

 

Figure 1. Distribution of participants Pre-Therapy

Figure 2. Distribution of participants Post-Therapy

From the frequency distributions above, it is interesting to note, that a large proportion of participants pre-treatment, had a score on the GAD-7 inventory >18, corresponding to severe anxiety, whereas post-treatment a large proportion of participants fell in the category of minimal anxiety problems (score <5).

A Wilcoxon signed-rank test showed, that adhering to the Linden Method programme for anxiety elimination, resulted in a highly significant change in the self-reported level of anxiety distress, when levels were compared pre- and post treatment, with the post-treatment group reporting less anxiety symptoms (Z= -6.802, p < .001).

Discussion
The Linden Method is designed to help anxiety sufferers completely eliminate their symptoms, and go on to live healthy and productive lives. The current study set out to assess, whether using the structured anxiety elimination programme offered by the Linden Method, would result in a significant improvement in the quality of life for the affected individuals.

The prediction of the study was, that following The Linden Method, would result in significant reduction in anxiety distress, corresponding to a decrease in the total score on the GAD-7. This hypothesis was confirmed. Participants, many of whom reported severe anxiety symptoms pre-treatment, improved significantly using the Linden Method programme for anxiety elimination. A word of caution. The results do not indicate, that people are cured of their anxiety disorder per se. Rather, participants have returned to a baseline or an appropriate level of anxiety, not unlike the normal population. Therefore, based on the data, The Linden Method appears to be a viable, relevant and recommendable alternative to other therapies used for treating severe and at times disabling anxiety conditions.

Limitations of the study
As indicated above, the data were collected retrospectively. It could be speculated, if this might have influenced the accuracy with which participants judged their symptoms pre-treatment.  Another limitation of the study is the method of inclusion of participants. One possible criticism of the recruitment approach could be, that participants were not selected randomly to take part. However, in this particular instance, it could be suggested, that the criteria of randomness is difficult to adhere to. The success of The Linden Method in treating anxiety disorders rests on a fundamental principle of compliance with its structure, rules and processes. As such, non-compliant participants would only serve to compromise the results.

A similarity can be made to drug experiments, where results and conclusions also rely on adherence to the treatment protocol. Further, questionnaires were not anonymized, which perhaps could increase the demand characteristics of the situation. In particular, it is possible but not definite, that by not being ensured anonymity, participants were more positive in their ratings, than they would have been if anonymous. Finally, the GAD-7 is a self-report measure and not to be substituted for a clinical assessment. Ideally, any future studies would include a clinical assessment by a qualified psychologist, pre- as well as post treatment.

References:
Spitzer R.L., Kroenke K., Williams J.B. and Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 22 (10), pp. 1092-1097.

*The GAD-7 score is an internationally recognized scale for determining the severity of an anxiety disorder. It ranges from 1 to 21. A score of below 5 is 'normal', a score of 5 or above represents presence of an anxiety disorder.