All Studies · Anxiety & Stress · Keltz (2025)

Keltz (2025)

High · RCT Secondary Analysis · Secondary Analysis (RCT-derived) · n = 190
Quality Index (Adjusted QI) 0.815
0 Low < 0.56 Moderate 0.56–0.77 High ≥ 0.78 1
Study Details
ConditionGeneralized anxiety disorder (GAD) — homework engagement
Clinical domainAnxiety & Stress
PopulationAdults with GAD (subsample n=190; 71% female, mean age 33 ± 13); attended ≥2 sessions and submitted ≥1 homework log
Sample sizen = 190
Country / SettingUSA (Boston, MA and New York, NY)
Protocol clusterKY-GAD Protocol
Duration12 weeks; twelve 120-min weekly group sessions + 20 min daily homework (secondary analysis of Simon 2021 RCT, NCT01912287)
Control typeActive Control
ComparatorCBT (n=90) + Stress Education attention control (n=43); 3-arm design
Outcomes & Effect Sizes
Primary outcomeHomework engagement → Treatment response (CGI-I)
Scales usedCGI-Improvement (response: CGI-I ≤2), homework compliance scale (0-6 Likert), self-reported homework days/week logs
Key resultStaff-rated homework compliance predicted response for CBT (OR=2.49, p=.005) and KY (OR=1.66, p=.049) but not SE. Self-reported days/week only marginally related to CBT response (p=.054). Response rates: CBT 70.8%, KY 54.2%, SE 33.0%.
Effect sizeOR = 1.66 (KY homework compliance → response); OR = 2.49 (CBT); OR = 1.74 (overall)
ES value1.66 (OR)
Retention190/226 (84%) met inclusion criteria (≥2 sessions + ≥1 log); dropout: 23% CBT, 26% KY, 49% SE
SafetyNot separately reported (see Simon 2021 parent trial)
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Methodological Summary

Secondary analysis of 3-arm RCT (Simon 2021, NCT01912287); logistic regression; N=190 subsample; 2-site; homework engagement as predictor of response

KY Protocol Components

Homework Engagement Analysis from KY vs CBT vs SE Trial (Simon 2021 — Secondary Analysis) PARENT TRIAL: Simon et al. (2021) — 226 adults with GAD randomized to KY (n=93), CBT (n=90), or Stress Education (n=43). SUBSAMPLE: N=190 who attended ≥2 sessions and submitted ≥1 homework log. KY HOMEWORK: Audio-guided sequence of movements coordinated with breath, followed by timed breathing with mindful awareness. Same audio recording used for each session. Prescribed 20 min/day. CBT HOMEWORK: Activities and worksheets to practice session skills. Prescribed 20 min/day. SE HOMEWORK: Audio recordings about nutrition and lifestyle. Prescribed 20 min/day. HOMEWORK MEASURES: (1) Staff-rated compliance scale (0-6 Likert), (2) Self-reported days/week from written logs. KEY FINDING: Staff-rated homework compliance predicted response for CBT (OR=2.49, p=.005) and KY (OR=1.66, p=.049), but not SE. KY and CBT showed greater overall homework engagement than SE. DROPOUT: 34% (23% CBT, 26% KY, 49% SE) dropped out prior to session 12, on average after session 10.

Quality Item Scores — 1 fail · 2 partial · 3 pass · ★ critical
★A1
3
A2
3
★B1
3
★B2
3
B3
3
B4
2
★B5
2
B6
2
★B7
2
★B8
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B9
2
JP1
3
Critical fails0
Raw QI0.861
SAF0.946
Adjusted QI0.815
Final ratingHigh