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Cited by 319Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and ApplicationsDigital Mental Health Interventions

Psychological therapies for generalised anxiety disorder

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Hunot, Vivien, Churchill, Rachel, Teixeira, Vanessa, Silva de Lima, Mauricio·2007·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd001848.pub4PMC PMC7025441
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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.

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  • Previous studies support the efficacy of traditional and newer CBT approaches for generalized anxiety disorder in predominantly non-Hispanic White populations.

    “These results are in line with previous studies that support the efficacy of traditional and newer CBT approaches for GAD in predominantly non-Hispanic White populations (Borkovec et al., 2004; Butler et al., 2006; Hunot, Churchill, Teixeira, & Silva de Lima, 2007; Orsillo & Roemer, 2011; Otte, 2011; Roemer & Orsillo, 2009).”

    From Randomized pilot trial of cognitive-behavioral therapy and acceptance-based behavioral therapy in the treatment of Spanish-speaking Latino primary care patients with generalized anxiety disorder (2021) · cites this paper as Hunot, Churchill, Teixeira, & Silva de Lima, 2007

    The Authors’ conclusions and Interventions sections support the efficacy of CBT for short-term treatment of GAD and describe several CBT approaches. The review does not establish that the studied populations were predominantly non-Hispanic White; its Participants section reports age and gender but not that racial or ethnic composition. Its newer acceptance-based treatment appears among ongoing studies, not as evidence of efficacy. (LLM, conf=0.86)

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  • Evidence suggests lower efficacy of CBT for GAD in older people than in working-age adults.

    “evidence of lower efficacy of CBT for GAD in older people than in working-age adults suggests that an alternative form of psychological intervention may be required.”

    From Acceptance and commitment therapy for older people with treatment-resistant generalised anxiety disorder: The FACTOID feasibility study (2021) · cites this paper as [32]

    The age-group analyses (Participant age group; d) Adults vs elderly; pages not provided) report smaller reductions in anxiety and depression symptoms among elderly participants than adults receiving psychological therapies using a CBT approach. They also report a similar magnitude of clinical response in the two age groups, so the unqualified claim of lower CBT efficacy overstates the findings. (LLM, conf=0.86)

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  • CBT gains for GAD are maintained at 6- or 12-month follow-up.

    “there is evidence that these gains are maintained at 6- or 12-month follow-up (Covin et al ., 2008; Hunot et al ., 2007; van Dis et al ., 2020)”

    From Effectiveness and predictors of group cognitive behaviour therapy outcome for generalised anxiety disorder in an out-patient hospital setting (2024) · cites this paper as Hunot et al., 2007

    In “Cognitive Behavioural Therapy vs Supportive Therapy” (page not provided), the review reports that CBT’s advantage in anxiety symptoms remained significant at six months. At 12 months, that difference was no longer significant; the authors’ “Implications for practice” also state that evidence for longer-term effectiveness is lacking. The source therefore supports a limited six-month finding, not an unqualified claim that gains are maintained at six or 12 months. (LLM, conf=0.88)

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  • CBT leads to greater reductions in anxiety symptoms with moderate to large effect sizes compared with non-specific therapy, waitlist, and placebo conditions (Hedges' g = 0.39-1.01).

    “CBT leads to greater reductions in anxiety symptoms with moderate to large effect sizes (Hedges ' g = 0.39 -1.01; Carpenter et al ., 2018; Hunot et al ., 2007; van Dis et al ., 2020)”

    From Effectiveness and predictors of group cognitive behaviour therapy outcome for generalised anxiety disorder in an out-patient hospital setting (2024) · cites this paper as Hunot et al., 2007

    The review reports greater short-term reductions in anxiety symptoms with CBT for people with generalised anxiety disorder: SMD −0.40 versus supportive therapy and −1.00 versus treatment as usual or waiting list. It does not report the cited Hedges’ g range of 0.39–1.01, and its conclusions are limited to short-term treatment of GAD. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • The preference for traditional treatment dose may be due to lack of awareness that brief interventions are as equally efficacious as more traditional treatment dosage.

    “The preference for traditional treatment dose may be due to the lack of awareness that brief interventions are as equally efficacious as more traditional treatment dosage (Hunot et al., 2007).”

    From Treatment histories, barriers, and preferences for individuals with symptoms of generalized anxiety disorder (2024) · cites this paper as Hunot et al., 2007

    The ‘Number of therapy sessions’ section reports that eight or fewer sessions appeared similarly effective to more than eight against usual care or waiting list, but cautions that the brief-treatment studies were small and of very low methodological quality. It also reports that, against supportive therapy, CBT showed a benefit only with more than eight sessions. The review does not address whether lack of awareness explains a preference for traditional treatment doses. (LLM, conf=0.88)

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Cites

2 retracted

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1 of the 134 references couldn’t be matched to a known paper.

Research works printed but not linked: 5

  1. [32]32. Clarke M, Oxman AD, editors. Cochrane Reviewers' Handbook 4.1.5. Oxford: Update So ware, 2002.
  2. [36]36. Deeks J. Are you sure that's a standard deviation? (part 1). Cochrane News 1997;10:11-2.
  3. [56]56. Jacobson NS, Truax P. Methods for defining and determining the clinical significance of treatment effects in mental health reserach: current status, new applications and future directions. Journal of Consulting and Clinical Psychology 1991;59:12-19.
  4. [62]62. Kessler RC, McGonagle KA, Zao S, Nelson CB, Hughes M, Eshleman S, et al. Lifetime and 12-month prevalence of DSM-III- R psychiatry disorders in the United States. Archives of General Psychiatry 1994;51(1):8-19.
  5. [97]97. Ryle, A. Cognitive-analytic therapy: Active participation in chanrge, a new integration in brief psychotherapy. Chichester: Wiley, 1990.

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Authors
Hunot, V., Churchill, R., Teixeira, V., & Silva de Lima, M.
Affiliations
  • University of Bristol (GB)
  • Rua Três de Maio, 916 Pelotas Brazil 96010-620
  • Genentech; US Medical Affairs; 1 DNA Way South San Francisco California USA 94080-4990
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2007-01-24
Volume
2015
Issue
6
Pages
CD001848-CD001848
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd001848.pub4
PMC
PMC7025441
OpenAlex
W2113361241
Cited by
315
References
134
Citations by year
2026: 1 · 2025: 4 · 2024: 18 · 2023: 13 · 2022: 13 · 2021: 17 · 2020: 41 · 2019: 12 · 2018: 14 · 2017: 15 · 2016: 17 · 2015: 18 · 2014: 19 · 2013: 21 · 2012: 26
FWCI
2.18
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Université de Sherbrooke
  • Medical Research Council
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords
generalized anxiety disorder, psychotherapy, cognitive behavioral therapy, psychodynamic psychotherapy, supportive therapy, usual care, waiting lists, anxiety reduction, clinical response, depressive symptoms, worry, non-directive therapy, treatment efficacy comparison, non-pharmacological treatment, adults, long-term follow-up, relapse
MeSH terms
Adult, Anxiety Disorders, Behavior Therapy, Humans, Psychotherapy, Randomized Controlled Trials as Topic

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