*4.3.1 Psychometric instruments*

The symptomatic questionnaire SCL-90-R is a Russian adaptation of N. Tarabarina [55]. In our research the following scales were used: DEP, depression; ANX, anxiety; and GSI, general severity index, a measure of the overall psychological distress. The Spielberger State-Trait Anxiety Inventory (STAI) is a Russian adaptation of Hanin [56]. The following tools were also used: Beck's depression inventory (BDI) [57]; Sheehan Clinical Anxiety Rating Scale (ShARS) [58]; and Five-Factor Mindfulness Questionnaire (FFMQ) [59], its short version. The FFMQ was adapted for Russian-speaking population by the authors. The Mindful Attention Awareness Scale (MAAS) [60] was adapted to Russian-speaking population by the authors.

#### *4.3.2 Statistical instruments*

The statistical analysis was made with the use of the program "Statistica 10." The following data were compared, using this program: (1) Initial data of the therapeutic group and the waiting-list control (WLC) group. (2) Initial data of the WLC group and the data of the WLC group at the beginning of the therapy. (3) Initial data of the primary therapeutic group and the WLC group at the point of the beginning of the therapy. (4) Initial and final data of the combined therapeutic group and the data from the WLC group (initial and at the point of the beginning of the therapy). (5) Initial and final data of the subgroup of monopsychotherapy (MPT) and the subgroup of psychotherapy with gradual discontinuation of psychopharmacotherapy (PT + PPT). (6) Initial and final data of the subgroup of PD and the subgroup of GAD.

Gender and demographic and psychometric characteristics were used in the statistical analysis. The methods of descriptive statistics (M, SD) and nonparametric statistics (Wilcoxon's test, Mann–Whitney test) were used. To evaluate the effect size, Cohen's unbiased d-index was used [61, 62] (d ≤ 0.20, small effect size; d ≤ 0.50, moderate effect size; d ≤ 0. 80, large effect size). The effect size was calculated using a pooled standard deviation. χ<sup>2</sup> was used to compare the degree of improvement between groups.

### **4.4 Results**

#### *4.4.1 Baseline characteristics of the main and control groups*

Patients' gender and demographic and diagnostic characteristics are presented in **Tables 2** and **3**. Apart from the type of anxiety disorder, the presence of the accompanying psychopharmacotherapy at the beginning of the treatment was taken into consideration.

Twenty-nine participants (55.8%) were diagnosed with PD (11 of them were taking psychopharmacological medications at the beginning of the therapy); 23 participants (44.2%) had GAD as the main diagnosis (9 of them were taking


*Primary therapeutic group—group that began therapy right after the screening; WLC group—waiting list control group; PPT—number of subjects with psychopharmacotherapy.*

#### **Table 2.**

*Patient characteristics.*

psychopharmacological medications at the beginning of the therapy). The basic clinical, demographic, and clinical-psychometric criteria of the main and control groups were compared using the Mann–Whitney test and χ<sup>2</sup> test for independent samples. The two groups did not show significant differences in all the parameters, but STAI-S score (which was significantly different in the groups of MPT and PT + PPT (p = 0.01)) and SCL-90 ANX (p = 0.03) and ShARS (p = 0.007) scores were significantly different in the PD and GAD groups (**Tables 1** and **2**). That fact witnesses a general success of the randomization.

The duration of the illness till the moment of the beginning of the treatment was also significantly different in the groups of MPT and PT + PPT (18.1 months and 112.8 months, accordingly; p < 0.0001). The mean duration of psychopharmacotherapy before the treatment in the group PT + PPT was 37.6 months. In all these cases (except 2) during this period the patients received more than two different psychopharmacological courses. These data allow us to call the PT + PPT group a therapy-resistant group.
