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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.
In the citing paper
“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.
In the citing paper
“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
Experimental — accuracy not yet measured
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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]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
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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
The cited source says what the claim attributes to it.
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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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Παπαδάτου-Παστού, Μ., Τουλουμάκου, Ά., & Tzotzoli, P. (2016) · Πανελλήνιο Συνέδριο Επιστημών Εκπαίδευσης · doi:10.12681/edusc.420
An Investigation of Narratives of Anxiety
Scott, C. (2016) · doi:10.1057/978-1-137-39031-8_11
Сognitive-behavioral therapy in generalized anxiety disorder
Burda, H. (2017) · Psychosomatic Medicine and General Practice · doi:10.26766/pmgp.v2i1.17 · Cited by 1
Prescribing and Dispensing of Benzodiazepines
Islam, M. M., Nielsen, S., McRae, I., Haber, P., Demirkol, A., Murnion, B. P., Wilson, H. H., & Conigrave, K. M. (2016) · Elsevier eBooks · doi:10.1016/b978-0-12-800634-4.00028-7
Psychosocial Intervention with Women
Markward, M. J. (2014) · doi:10.1093/obo/9780195389678-0128
Was hilft, wenn Sorgen außer Kontrolle geraten?
Volz, H., & Stieglitz, R. (2012) · DNP - Der Neurologe und Psychiater · doi:10.1007/s15202-012-0048-8
Mental Health in Head and Neck Cancer
Mei, C., & Sargi, Z. (2020) · Springer eBooks · doi:10.1007/978-3-030-27881-6_4 · Cited by 1
Verma, M. (2020) · University of Western Ontario Medical Journal · doi:10.5206/uwomj.v88i2.7300
Angenendt, J., Frommberger, U., & Berger, T. (2012) · Elsevier eBooks · doi:10.1016/b978-3-437-22483-6.10012-9
Sampaio, T. P. D. A. (2020) · Digital Library of Theses and Dissertations (Universidade de São Paulo) · doi:10.11606/t.47.2020.tde-28052020-192438
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American Football: Cognitive Impairment
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Football: Alcohol and Barriers to Support
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Golf: Alcohol, Anxiety and Sleep Problems
Creado, S., Hopley, P., Murray, A., & Hull, M. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108767187.009
Cricket: Mental Health Emergencies
Mahmood, H., Hopley, P., & Foster, P. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108767187.006
Johnston, A., Al-Dawoud, M., & Pattinson, C. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108767187.005
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Martins, D. S. (2020) · Digital Library of Theses and Dissertations (Universidade de São Paulo) · doi:10.11606/d.47.2020.tde-02092020-174154
Hendriks, G., van Zelst, W. H., van Balkom, A. J. L. M., Uphoff, E., Robertson, L., Keijsers, G. P. J., & Voshaar, R. C. O. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007674.pub2 · Cited by 1
Jia, R., Yu, J., Liang, D., Wu, Z., Chen, C., & Lu, G. (2021) · Research Square · doi:10.21203/rs.3.rs-666275/v1
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Mistry, A. D., McCabe, T., & Currie, A. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108767187.015
References, further reading and useful resources
Smith, G., & Rylance, R. (2018) · Wiley eBooks · doi:10.1002/9781119548584.refs
(2011) · Wiley eBooks · doi:10.1002/9781119961307.refs
Kapfhammer, H. (2011) · Springer eBooks · doi:10.1007/978-3-642-03637-8_57
Mistry, A. D., McCabe, T., & Currie, A. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108767187.001
Mistry, A. D., McCabe, T., & Currie, A. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108767187.002
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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