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Meta-Analysis
. 2007 Jan 24;2007(1):CD001848.
doi: 10.1002/14651858.CD001848.pub4.

Psychological therapies for generalised anxiety disorder

V Hunot  1 , R Churchill, M Silva de Lima, V Teixeira
Affiliations
Meta-Analysis

Psychological therapies for generalised anxiety disorder

V Hunot et al. Cochrane Database Syst Rev. .

Abstract

Background: Generalised anxiety disorder (GAD) is a highly prevalent condition, characterised by excessive worry or anxiety about everyday events and problems. The effectiveness and effectiveness of psychological therapies as a group has not yet been evaluated in the treatment of GAD.

Objectives: To examine the efficacy and acceptability of psychological therapies, categorised as cognitive behavioural therapy (CBT), psychodynamic therapy and supportive therapy, compared with treatment as usual/waiting list (TAU/WL) and compared with one another, for patients with GAD.

Search strategy: We searched the Cochrane Depression, Anxiety & Neurosis Group (CCDAN) Controlled Trials Register and conducted supplementary searches of MEDLINE, PsycInfo, EMBASE, LILACS and controlledtrials.com in February 2006. We searched reference lists of retrieved articles, and contacted trial authors and experts in the field for information on ongoing/completed trials.

Selection criteria: Randomised and quasi-randomised controlled trials conducted in non-inpatient settings, involving adults aged 18-75 years with a primary diagnosis of GAD, assigned to a psychological therapy condition compared with TAU/WL or another psychological therapy.

Data collection and analysis: Data on patients, interventions and outcomes were extracted by two review authors independently, and the methodological quality of each study was assessed. The primary outcome was anxiety reduction, based on a dichotomous measure of clinical response, using relative risk (RR), and on a continuous measure of symptom reduction, using the standardised mean difference (SMD), with 95% confidence intervals.

Main results: Twenty five studies (1305 participants) were included in the review, of which 22 studies (1060 participants) contributed data to meta-analyses. Based on thirteen studies, psychological therapies, all using a CBT approach, were more effective than TAU/WL in achieving clinical response at post-treatment (RR 0.63, 95%CI 0.55 to 0.73), and also in reducing anxiety, worry and depression symptoms. No studies conducted longer-term assessments of CBT against TAU/WL. Six studies compared CBT against supportive therapy (non-directive therapy and attention-placebo conditions). No significant difference in clinical response was indicated between CBT and supportive therapy at post-treatment (RR 0.86, 95%CI 0.70 to 1.06), however significant heterogeneity was indicated, which was partly explained by the number of therapy sessions.

Authors' conclusions: Psychological therapy based on CBT principles is effective in reducing anxiety symptoms for short-term treatment of GAD. The body of evidence comparing CBT with other psychological therapies is small and heterogeneous, which precludes drawing conclusions about which psychological therapy is more effective. Further studies examining non-CBT models are required to inform health care policy on the most appropriate forms of psychological therapy in treating GAD.

PubMed Disclaimer

Conflict of interest statement

MSL took up a position with Eli Lilly in 2003.

Please note that the current version of this review contravenes Cochrane's commercial sponsorship policy (revised 2014). The protocol for this review is being re‐written and publication of the new review is scheduled for 2016/17.

Figures

1
1
01 Clinical response.
2
2
02 Anxiety symptoms.
1.1
1.1. Analysis
Comparison 1 All psychological therapies vs Treatment as usual / waiting list, Outcome 1 Clinical response at post‐treatment.
1.2
1.2. Analysis
Comparison 1 All psychological therapies vs Treatment as usual / waiting list, Outcome 2 Reduction in anxiety symptoms at post‐treatment.
1.3
1.3. Analysis
Comparison 1 All psychological therapies vs Treatment as usual / waiting list, Outcome 3 Reduction in worry symptoms at post‐treatment.
1.4
1.4. Analysis
Comparison 1 All psychological therapies vs Treatment as usual / waiting list, Outcome 4 Reduction in depression symptoms at post‐treatment.
1.5
1.5. Analysis
Comparison 1 All psychological therapies vs Treatment as usual / waiting list, Outcome 5 Improvement in social functioning at post‐treatment.
1.6
1.6. Analysis
Comparison 1 All psychological therapies vs Treatment as usual / waiting list, Outcome 6 Improvement in quality of life at post‐treatment.
1.7
1.7. Analysis
Comparison 1 All psychological therapies vs Treatment as usual / waiting list, Outcome 7 Attrition for any reason at post‐treatment.
2.1
2.1. Analysis
Comparison 2 Cognitive behavioural therapy vs Psychodynamic therapy, Outcome 1 Clinical response at post‐treatment.
2.2
2.2. Analysis
Comparison 2 Cognitive behavioural therapy vs Psychodynamic therapy, Outcome 2 Reduction in anxiety symptoms at post‐treatment.
2.4
2.4. Analysis
Comparison 2 Cognitive behavioural therapy vs Psychodynamic therapy, Outcome 4 Reduction in depression symptoms at post‐treatment.
2.5
2.5. Analysis
Comparison 2 Cognitive behavioural therapy vs Psychodynamic therapy, Outcome 5 Improvement in social functioning at post‐treatment.
2.7
2.7. Analysis
Comparison 2 Cognitive behavioural therapy vs Psychodynamic therapy, Outcome 7 Attrition for any reason at post‐treatment.
2.8
2.8. Analysis
Comparison 2 Cognitive behavioural therapy vs Psychodynamic therapy, Outcome 8 Clinical response at 6 month follow‐up.
2.9
2.9. Analysis
Comparison 2 Cognitive behavioural therapy vs Psychodynamic therapy, Outcome 9 Reduction in anxiety symptoms at 6 month follow‐up.
3.1
3.1. Analysis
Comparison 3 Cognitive behavioural therapy vs Supportive therapy, Outcome 1 Clinical response at post‐treatment.
3.2
3.2. Analysis
Comparison 3 Cognitive behavioural therapy vs Supportive therapy, Outcome 2 Reduction in anxiety symptoms at post‐treatment.
3.3
3.3. Analysis
Comparison 3 Cognitive behavioural therapy vs Supportive therapy, Outcome 3 Reduction in worry symptoms at post‐treatment.
3.4
3.4. Analysis
Comparison 3 Cognitive behavioural therapy vs Supportive therapy, Outcome 4 Reduction in depression symptoms at post‐treatment.
3.5
3.5. Analysis
Comparison 3 Cognitive behavioural therapy vs Supportive therapy, Outcome 5 Improvement in social functioning at post‐treatment.
3.6
3.6. Analysis
Comparison 3 Cognitive behavioural therapy vs Supportive therapy, Outcome 6 Improvement in quality of life at post‐treatment.
3.7
3.7. Analysis
Comparison 3 Cognitive behavioural therapy vs Supportive therapy, Outcome 7 Attrition for any reason at post‐treatment.
3.8
3.8. Analysis
Comparison 3 Cognitive behavioural therapy vs Supportive therapy, Outcome 8 Treatment response at 6 month follow‐up.
3.9
3.9. Analysis
Comparison 3 Cognitive behavioural therapy vs Supportive therapy, Outcome 9 Reduction in anxiety symptoms at 6 month follow‐up.
3.10
3.10. Analysis
Comparison 3 Cognitive behavioural therapy vs Supportive therapy, Outcome 10 Reduction in anxiety symptoms at 12 month follow‐up.
4.1
4.1. Analysis
Comparison 4 Cognitive therapy vs Behavioural therapy, Outcome 1 Clinical response at post‐treatment.
4.2
4.2. Analysis
Comparison 4 Cognitive therapy vs Behavioural therapy, Outcome 2 Reduction in anxiety symptoms at post‐treatment.
4.3
4.3. Analysis
Comparison 4 Cognitive therapy vs Behavioural therapy, Outcome 3 Reduction in worry symptoms at post‐treatment.
4.4
4.4. Analysis
Comparison 4 Cognitive therapy vs Behavioural therapy, Outcome 4 Reduction in depression symptoms at post‐treatment.
4.7
4.7. Analysis
Comparison 4 Cognitive therapy vs Behavioural therapy, Outcome 7 Attrition for any reason at post‐treatment.
4.8
4.8. Analysis
Comparison 4 Cognitive therapy vs Behavioural therapy, Outcome 8 Treatment response at 6 month follow‐up.
4.9
4.9. Analysis
Comparison 4 Cognitive therapy vs Behavioural therapy, Outcome 9 Reduction in anxiety symptoms at 6 month follow‐up.
4.10
4.10. Analysis
Comparison 4 Cognitive therapy vs Behavioural therapy, Outcome 10 Reduction in anxiety symptoms at 12 month follow‐up.
See this image and copyright information in PMC

Update of

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References to studies awaiting assessment

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References to ongoing studies

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