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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
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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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“CBT for GAD is well studied and is shown to be more effective than waiting list controls and somewhat more effective than non-CBT therapies, although there are very few such comparisons (Cuijpers et al. 2014; Hanrahan et al. 2013; Hunot et al. 2007; National Institute for Health and Clinical Excellence 2011).”
BackgroundDavies, S. J. C., Pearson, R. M., Stapinski, L., Bould, H., Christmas, D. M., Button, K., Skapinakis, P., Lewis, G., & Evans, J. (2015) · Psychological Medicine · doi:10.1017/s003329171500149x · Cited by 36
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“Interestingly, no significant difference in clinical response was found between CBT and supportive therapy, precluding a conclusion about which psychological therapy (specific or nonspecific) is more effective [48].”
BackgroundMethodA study on effect of yoga on emotional regulation, self-esteem, and feelings of adolescents
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“Psychological interventions can be effective for GAD, especially cognitive behavior therapy (CBT) (5) and applied relaxation (6).”
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“Meta-analyses show that CBT leads to a reduction in anxiety symptoms more so than treatment as usual or a waiting list (Mitte, 2005; Hunot et al., 2007; Covin et al., 2008).”
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“Although traditional cognitive-behavioral therapy has been shown efficacy in GAD treatment, however, symptoms of the disorder remain in more than 50% of the patients (Fisher, 2006; Hunot et al., 2007).”
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Cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD)
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“Previous studies have also reported that while psychological therapies can demonstrate an improvement in clinical outcomes, more than eight sessions achieve a greater positive response, in those with anxiety at least.(19) Furthermore, this study has demonstrated that it is possible to develop a robust model based on d…”
Efficacy of an acceptance-based group behavioral therapy for generalized anxiety disorder.
Almeida Sampaio, T. P., Jorge, R. C., Martins, D. S., Gandarela, L. M., Hayes‐Skelton, S., Bernik, M. A., & Lotufo‐Neto, F. (2020) · Depression and Anxiety · doi:10.1002/da.23021 · Cited by 23
“Furthermore, together with other unspecific variables, two factors that may have played a decisive role in the attrition rate of both groups are (a) the rule of “no more than two absences or any consecutive absences allowed,” which is more restrictive compared to most studies (Hunot et al., 2007); and (b) the lack of…”
ResultInterpersonal dysfunction and treatment outcome in GAD: A systematic review
Malivoire, B. L., Mutschler, C., & Monson, C. M. (2020) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2020.102310 · Cited by 22
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“Cognitive-behavioral therapy is an effective first-line treatment for all forms of anxiety [19,20].”
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MethodProlonged Imaginal Exposure Based on Worry Scenarios
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“%) fail to benefit at all from CBT, respond only partially, or relapse following treatment (Cuijpers et al., 2014; Hunot et al., 2007).”
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Online Mindfulness Interventions: A Systematic Review
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Metacognitions in generalized anxiety disorder: theoretical and practical perspectives
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“The PATH study serves to build upon existing health literature that explores the positive impact of CBT for survivors of IPV and those experiencing mental health challenges [48-50] within periods of transformational change associated with pregnancy, childbirth, and motherhood.”
Kent, J. A. O., Jackson, A. H., Robinson, M., Rashleigh, C., & Timulák, L. (2020) · Counselling and Psychotherapy Research · doi:10.1002/capr.12346 · Cited by 17
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Cluster-based psychological phenotyping and differences in anxiety treatment outcomes
Taylor, V. A., Roy, A., & Brewer, J. A. (2023) · Scientific Reports · doi:10.1038/s41598-023-28660-7 · Cited by 11
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Therapist-delivered distance cognitive behavioural therapy for anxiety disorders in adults
Olthuis, J. V., Watt, M. C., & Stewart, S. H. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009028 · Cited by 11
Rawat, A., Sangroula, N., Khan, A., Faisal, S., Chand, A., Yousaf, R. A., Muhammad, N., & Yousaf, H. (2023) · Cureus · doi:10.7759/cureus.39252 · Cited by 17
“CBT has been shown to bring about significant improvement in GAD, with around 50% of patients experiencing clinical improvement two years after treatment [7,8].”
BackgroundEvictions and psychiatric treatment
Bradford, A. C., & Maclean, J. C. (2023) · Journal of Policy Analysis and Management · doi:10.1002/pam.22522 · Cited by 11
Webster, S. (2012) · Journal of Nursing Education and Practice · doi:10.5430/jnep.v2n2p52 · Cited by 11
“A multiple linear regression indicated that the major determinants of patient satisfaction were emotional support and respect for patient preferences.”
BackgroundThe Place of Psychological Well-being in Cognitive Therapy
MacLeod, A. K., & Luzon, O. (2014) · Cross-Cultural Advancements in Positive Psychology · doi:10.1007/978-94-017-8669-0_3 · Cited by 10
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“Fortunately, both medical and psychosocial treatments for depression also tend to have antianxiety effects.(38) For example, selective serotonergic reuptake inhibitor medications are effective for both anxiety and depression.”
BackgroundEscitalopram for Persistent Symptoms of Generalized Anxiety Disorder After CBT
Schneier, F. R., Belzer, K. D., Kishon, R., Amsel, L., & Simpson, H. B. (2010) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e3181da4d77 · Cited by 10
“%) has been reported for previous CBT studies for GAD that did not include medication (Hunot et al., 2007).”
BackgroundMethodInfluential(2021) · The Journal of Spinal Cord Medicine · doi:10.1080/10790268.2021.1863738 · Cited by 9
Pain catastrophizing and worry about health in generalized anxiety disorder
Dugas, M. J., Marchal, K. G., Cormier, S., Bouchard, S., Gouin, J., & Shafran, R. (2023) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2843 · Cited by 12
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The implications of noncompliance for randomized trials with partial nesting due to group treatment
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“yi = αi + δri + u((2)) IG(i) + e (1) i , (2)”
BackgroundInfluentialPsychological therapies for women who experience intimate partner violence
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Evidence-based pharmacotherapy of generalized anxiety disorder
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Cognitive and Behavioral Psychotherapy in Coronary Artery Disease
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Παπαδάτου-Παστού, Μ., Goozée, R., Barley, E. A., Haddad, M., & Tzotzoli, P. (2015) · Pilot and Feasibility Studies · doi:10.1186/s40814-015-0029-8 · Cited by 8
“There is strong evidence supporting the effectiveness of CBT in addressing a range of emotional difficulties and associated behaviours [30–33].”
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“Although cognitivebehavioural therapies focussed on worry proneness and the overvaluation of worry and uncertainty may be as effective as drug treatment and may be more durable for treating anxiety disorders [46], these results remain to be confirmed in asthmatic patients [47].”
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Cognitive‐Behavioral Therapy for Anxiety Disorders
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Behavioral Health Treatment and Police Officer Safety
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Screening Assessment for Anxiety and Depression in Primary Care
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The Complexity of Evidence-Based Practice: A Case Study
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A guide to what works for anxiety disorders.
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Towards a unified worry exposure protocol for generalised anxiety disorder: A pilot study
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“Multiple psychological and psychosocial interventions are regarded as evidencebased treatment options for various psychological problems in the general population (Hunot et al., 2007; Cuijpers et al., 2008; Barth et al., 2013; Connolly Gibbons et al., 2016).”
BackgroundCreating a Safe and Caring Health Care Context for Women Who Have Sex With Women
Flemmer, N., Doutrich, D. L., Dekker, L., & Rondeau, D. F. (2012) · The Journal for Nurse Practitioners · doi:10.1016/j.nurpra.2012.01.018 · Cited by 7
The New Caucus-Race: Methodological Considerations for Meta-Analyses of Psychotherapy Outcome
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“journals (Leichsenring et al., 2017). Tolin’s (2010) search was likely not encumbered by many irrelevant studies, because his search terms were not exhaustive—rather than using a combination of key words and subject MeSH terms, he used a few simple key words that were likely too specific (e.”
BackgroundMethod
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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