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Psychological therapies for generalised anxiety disorder
Open accessAbstract
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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“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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
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“46% of patients showed clinical improvement from psychotherapeutic treatment8”
From Cluster-based psychological phenotyping and differences in anxiety treatment outcomes (2023) · cites this paper as [8]
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“smaller effect sizes in favour of CBT for GAD, as well as higher drop-out rates, have been reported among older people than among younger people; 30,32,33”
From Acceptance and commitment therapy for older people with treatment-resistant generalised anxiety disorder: The FACTOID feasibility study (2021) · cites this paper as [32]
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“The comparison between adherences to individual (Hunot, Churchill, Silva de Lima, & Teixeira, 2007) and group (Issakidis & Andrews, 2004) treatments for anxiety disorders suggests that the latter has approximately twice the attrition rate of the former.”
From Efficacy of an acceptance-based group behavioral therapy for generalized anxiety disorder. (2020) · cites this paper as Hunot, Churchill, Silva de Lima, & Teixeira, 2007
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“Individuals with anxiety disorders, such as generalized anxiety disorder (GAD), display varying responses to pharmacological agents and psychotherapeutic approaches: response rates to anti-anxiety medications vary from 30 to 68%7, while 46% of patients showed clinical improvement from psychotherapeutic treatment8.”
From Cluster-based psychological phenotyping and differences in anxiety treatment outcomes (2023) · cites this paper as [8]
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“Despite the availability of effective treatments (pharmacological [4] as well as psychological [5]) in reducing symptoms of common mental disorders, only a minority of people receive psychological treatment delivered by a mental health professional [6].”
BackgroundEfficacy of Cognitive Behavioral Therapy for Anxiety Disorders: A Review of Meta-Analytic Findings
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“However, these endorsements were based explicitly on the quantity and quality of research about CBT approaches rather than their demonstrated superiority to alternative bona fide treatments (Hunot et al. 2007).”
BackgroundResultWestra, H. A., Arkowitz, H., & Dozois, D. J. A. (2009) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2009.07.014 · Cited by 283
Andersson, E., Enander, J., Andrén, P., Hedman, E., Ljótsson, B., Hursti, T., Bergström, J., Kaldo, V., Lindefors, N., Andersson, G., et al. (2012) · Psychological Medicine · doi:10.1017/s0033291712000244 · Cited by 274
“2000) and generalized anxiety disorder (Hunot et al. 2007), and, when delivered via the internet, reduces post-traumatic stress disorder symptoms and anxiety (Litz et al.”
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van der Heiden, C., Muris, P., & van der Molen, H. T. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.12.005 · Cited by 265
Donker, T., van Straten, A., Marks, I., & Cuijpers, P. (2011) · Psychiatry Research · doi:10.1016/j.psychres.2011.01.016 · Cited by 273
“Several studies have reported effective treatments (both pharmacological and psychological) in reducing GAD-symptoms (Hoffman and Mathew, 2008; Hunot et al., 2007).”
BackgroundWestra, H. A., Constantino, M. J., & Antony, M. M. (2016) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000098 · Cited by 255
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Interventions for generalized anxiety disorder in older adults: Systematic review and meta-analysis
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Anxiety: an evolutionary approach
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Treating comorbid anxiety and depression: psychosocial and pharmacological approaches
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“, 2017) – for reducing GAD symptoms, but high rates of drop-out during CBT groups for GAD have been found (Gale and Davidson, 2007; Hunot et al., 2007).”
BackgroundIntegrated behavioral health in primary care: Step-by-step guidance for assessment and intervention.
Hunter, C. L., Goodie, J. L., Oordt, M. S., & Dobmeyer, A. C. (2016) · American Psychological Association eBooks · doi:10.1037/0000017-000 · Cited by 193
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“Such treatments have been shown to be effective,[18, 19] yet, the rate of treatment nonresponders remains higher for GAD than for other anxiety disorders.”
BackgroundTherapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults
Olthuis, J. V., Watt, M. C., Bailey, K., Hayden, J. A., & Stewart, S. H. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011565 · Cited by 150
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“Moreover, the empirical support for the efficacy of a range of different cognitive, behavioral, and interpersonal supportive interventions in PLWHA echoes that for the treatment of depression and anxiety in general clinical samples [80, 81].”
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“CBT for GAD is well studied and is shown to be more effective than wait-list, non-specific control conditions or treatment as usual (Borkovec & Ruscio, 2001; Hunot et al., 2007; National Institute for Health and Clinical Excellence, 2011).”
BackgroundNordahl, H. M., Borkovec, T. D., Hagen, R., Kennair, L. E. O., Hjemdal, O., Solem, S., Hansen, B., Haseth, S., & Wells, A. (2018) · BJPsych Open · doi:10.1192/bjo.2018.54 · Cited by 102
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“However, these treatments neither automatically reduce absenteeism or impaired work functioning, nor do they automatically increase productivity at work [13–17].”
BackgroundEffects of SSRIs on Peripheral Inflammatory Cytokines in Patients with Generalized Anxiety Disorder
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Efficacy of group psychotherapy for anxiety disorders: A systematic review and meta-analysis
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“…study pool shows substantial overlap with disorderspecific reviews on the efficacy of group therapy (SAD: Acarturk et al., 2009; Barkowski et al., 2016; Mayo-Wilson et al., 2014; Powers et al., 2008; Wersebe et al., 2013; GAD: Cuijpers et al., 2014; Hunot et al., 2007; PD: Schwartze et al., 2017).”
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“Psychological techniques are also e ff ective first-line interventions for anxiety [9].”
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“Current treatments for depression and anxiety include a range of pharmaceutical medications, psychological therapies, electro-convulsive therapy, complementary and lifestyle interventions, and a combination of these [2-10].”
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“A systematic review of several studies assessing psychotherapy in patients with GAD showed that CBT-based psychotherapy was effective in improving anxious symptoms in the short term in patients with GAD [37].”
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“Several studies have also found cognitive-behavioral therapy [15], cognitive treatments [16], and metacognitive therapy [17] to be effective.”
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Expressing findings from meta‐analyses of continuous outcomes in terms of risks
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“assessed the efficacy and acceptability of cognitive behavioural therapy (CBT) when compared with standard treatment or a waiting list placebo for patients with generalized anxiety disorder [18].”
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“Meanwhile, among anxiety disorders, CBT administered alone or in combination with pharmacotherapy have been the most widely-studied and proven efficacious treatments for anxiety symptoms (Furukawa et al. 2004; Hunot et al. 2007; Acarturk et al. 2009; Sanchez-Meca et al. 2010; Cuijpers et al. 2014).”
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“The relative efficacy of different interventions or their respective components can be separately compared in a second step [83–85].”
Contextual conditioning in rats as an animal model for generalized anxiety disorder
Luyten, L., Vansteenwegen, D., van Kuyck, K., Gabriëls, L. A., & Nuttin, B. (2011) · Cognitive Affective & Behavioral Neuroscience · doi:10.3758/s13415-011-0021-6 · Cited by 80
Riello, M., Purgato, M., Bove, C. M., MacTaggart, D., & Rusconi, E. (2020) · Royal Society Open Science · doi:10.1098/rsos.200880 · Cited by 78
“anxiety, with up to 90% of patients with anxiety disorder showing concomitant symptoms of depression, dysthymia or other psychological symptoms [39].”
BackgroundThe hidden third: improving outcome in treatment-resistant depression
Schlaepfer, T. E., Ågren, H., Monteleone, P., Gastó, C., Pitchot, W., Rouillon, F., Nutt, D., & Kasper, S. F. (2012) · Journal of Psychopharmacology · doi:10.1177/0269881111431748 · Cited by 76
“In addition to a role in treatment of depression, psychotherapy may also be of value in the treatment of comorbidities, particularly anxiety disorders (Hunot et al., 2007; Schoevers et al., 2008).”
BackgroundFarmer, R. F., & Chapman, A. L. (2008) · American Psychological Association eBooks · doi:10.1037/11664-000 · Cited by 74
Fitzgerald, J. M., Phan, K. L., Kennedy, A. E., Shankman, S. A., Langenecker, S. A., & Klumpp, H. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.05.013 · Cited by 68
“While Cognitive Behavioral Therapy (CBT) is an empirically-supported psychotherapy for this disorder, symptoms persist in upwards of 50% of patients who complete treatment (Fisher, 2006; Hunot et al., 2007; James et al., 2013).”
Burger, A., van der Does, W., Thayer, J. F., Brosschot, J., & Verkuil, B. (2019) · Biological Psychology · doi:10.1016/j.biopsycho.2019.01.014 · Cited by 56
A Comprehensive Review of the Generalized Anxiety Disorder
Mishra, A. K., & Varma, A. R. (2023) · Cureus · doi:10.7759/cureus.46115 · Cited by 68
“Compared with CBT, ST was an additional psychological treatment [39].”
MethodEilert, N., Enrique, A., Wogan, R., Mooney, O., Timulak, L., & Richards, D. (2021) · Depression and Anxiety · doi:10.1002/da.23115 · Cited by 60
Psychological Problems after Stroke and Their Management: State of Knowledge
Kneebone, I., & Lincoln, N. B. (2012) · Neuroscience & Medicine · doi:10.4236/nm.2012.31013 · Cited by 59
“Supportive and psychodynamic approaches also await investigation [46].”
BackgroundMultiplicity of data in trial reports and the reliability of meta-analyses: empirical study
Tendal, B., Nüesch, E., Higgins, J. P. T., Jüni, P., & Gøtzsche, P. C. (2011) · BMJ · doi:10.1136/bmj.d4829 · Cited by 60
Dugas, M. J., Sexton, K. A., Hebert, E. A., Bouchard, S., Gouin, J.-P., & Shafran, R. (2022) · Behavior Therapy · doi:10.1016/j.beth.2022.05.003 · Cited by 58
Tyrer, P., Salkovskis, P., Tyrer, H., Wang, D., Crawford, M. J., Dupont, S., Cooper, S., Green, J., Murphy, D., Smith, G., et al. (2017) · Health Technology Assessment · doi:10.3310/hta21500 · Cited by 59
“There is no doubt that CBT is effective in treating both generalised anxiety and depression (these benefits often go together),(80) but the evidence that these benefits extend beyond 1–2 years is very weak, partly because so many trials have waiting list controls that curtail comparison of groups over long periods.(79…”
BackgroundRole of Atypical Antipsychotics in the Treatment of Generalized Anxiety Disorder
Hershenberg, R., Grös, D. F., & Brawman‐Mintzer, O. (2014) · CNS Drugs · doi:10.1007/s40263-014-0162-6 · Cited by 63
Bourbeau, K., Moriarty, T., Ayanniyi, A., & Zuhl, M. (2020) · Behavioral Sciences · doi:10.3390/bs10070116 · Cited by 56
“[16] suggest that only 46% of individuals with generalized anxiety disorder (GAD) showed a positive response to BT [16].”
BackgroundManagement of Generalized Anxiety Disorder in Primary Care
Davidson, J. R. T., Feltner, D. E., & Dugar, A. (2010) · The Primary Care Companion to The Journal of Clinical Psychiatry · doi:10.4088/pcc.09r00772blu · Cited by 56
Zhu, Z., Zhang, L., Jiang, J., Li, W., Cao, X., Zhou, Z., Zhang, T., & Li, C. (2014) · Europe PMC (PubMed Central) · doi:10.11919/j.issn.1002-0829.214173 · Cited by 54
“This finding is consistent with previous findings.([4,7,54]) However two of the studies([40,41]) — both of which used interviewer-administered assessment tools to measure anxiety symptoms – found that the differences between the CBT and WL groups were not statistically significant.”
MethodResultMaia, A. C. C. D. O., Nardi, A. E., & Cardoso, A. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.09.023 · Cited by 58
Recent Advances in the Understanding and Treatment of Anxiety Disorders
Shearer, S. L. (2007) · Primary Care Clinics in Office Practice · doi:10.1016/j.pop.2007.05.002 · Cited by 54
“A recent Cochrane Database Review reported that 13 studies showed the effectiveness of CBT for GAD compared with treatment as usual or waiting list control; however, when compared with supportive therapy, the efficacy of CBT was less clear [96].”
Maiello, M., Losiewicz, O. M., Bui, E., Spera, V., Hamblin, M. R., Marques, L., & Cassano, P. (2019) · Photobiomodulation, photomedicine, and laser surgery · doi:10.1089/photob.2019.4677 · Cited by 47
Paul, C. L., Carey, M. L., Sanson-Fisher, R. W., Houlcroft, L. E., & Turon, H. E. (2013) · Health Education Research · doi:10.1093/her/cyt053 · Cited by 51
“Interventions such as cognitive behavioural therapy have been shown to be effective for patients with mental health conditions when delivered face-to-face or by telephone [19–21].”
BackgroundCuijpers, P. J., Cristea, I. A., Weitz, E. S., Gentili, C., & Berking, M. (2016) · Psychological Medicine · doi:10.1017/s0033291716002348 · Cited by 55
“These findings are in line with earlier meta-analyses of each of the anxiety disorders, showing that these treatments also have considerable effects on depression (Mitte, 2005; Hunot et al. 2007; Acarturk et al. 2009; Sánchez-Meca et al. 2010; Cuijpers et al. 2014).”
BackgroundMethodResultInfluentialDigital interventions in mental health: Evidence syntheses and economic modelling
Gega, L., Jankovic, D., Saramago, P., Marshall, D., Dawson, S., Brabyn, S., Nikolaidis, G. F., Melton, H., Churchill, R., & Bojke, L. (2022) · Health Technology Assessment · doi:10.3310/rcti6942 · Cited by 48
Reddy, Y. C. J., Sudhir, P. M., Manjula, M., Arumugham, S. S., & Narayanaswamy, J. (2020) · Indian Journal of Psychiatry · doi:10.4103/psychiatry.indianjpsychiatry_773_19 · Cited by 53
“Therapy formats with eight or fewer sessions are also found to be effective; however, more number of sessions may be required when addressing worry and depression.[32] Mindfulness is found to have similar effects compared to CBT and behavior therapies.”
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Ghorani, V., Alavinezhad, A., Rajabi, O., & Boskabady, M. H. (2021) · Phytomedicine · doi:10.1016/j.phymed.2021.153539 · Cited by 47
Kumar, S., Jones Bell, M., & Juusola, J. L. (2018) · PLOS ONE · doi:10.1371/journal.pone.0190554 · Cited by 47
Nonpharmacological Interventions for Anxiety and Dementia in Nursing Homes: A Systematic Review
Wilson, C. B., Arendt, L., Nguyen, M., Scott, T., Neville, C. C., & Pachana, N. A. (2019) · The Gerontologist · doi:10.1093/geront/gnz020 · Cited by 47
Personality functioning in anxiety disorders
Doering, S., Blüml, V., Parth, K., Feichtinger, K., Gruber, M., Aigner, M., Rössler-Schülein, H., Freidl, M., & Wininger, A. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1870-0 · Cited by 42
Vagal influence during worry and cognitive challenge
Hammel, J. C., Smitherman, T. A., McGlynn, F. D., Mulfinger, A. M. M., Lazarte, A. A., & Gothard, K. D. (2010) · Anxiety Stress & Coping · doi:10.1080/10615806.2010.490912 · Cited by 46
Moriana, J. A., Gálvez-Lara, M., & Corpas, J. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.03.008 · Cited by 65
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Psychological treatment of anxiety in primary care: a meta-analysis
Seekles, W., Cuijpers, P., Kok, R., Beekman, A., van Marwijk, H., & van Straten, A. (2013) · Psychological Medicine · doi:10.1017/s0033291712000670 · Cited by 41
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Psychosocial interventions for the prevention of disability following traumatic physical injury
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Co-occurring psychiatric disorders and alcoholism
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Comprehensive review of generalized anxiety disorder in primary care in Europe.
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Metadata
- 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
- 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
- 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
- bronze
- doi.org
- 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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