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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.Â
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. Â 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.