The efficacy of group cognitive-behavioural therapy plus duloxetine for generalised anxiety disorder versus duloxetine alone
Abstract
OBJECTIVE: To explore whether and how group cognitive-behavioural therapy (GCBT) plus medication differs from medication alone for the treatment of generalised anxiety disorder (GAD). METHODS: Hundred and seventy patients were randomly assigned to the GCBT plus duloxetine (n=89) or duloxetine group (n=81). The primary outcomes were Hamilton Anxiety Scale (HAMA) response and remission rates. The explorative secondary measures included score reductions from baseline in the HAMA total, psychic, and somatic anxiety subscales (HAMA-PA, HAMA-SA), the Hamilton Depression Scale, the Severity Subscale of Clinical Global Impression Scale, Global Assessment of Functioning, and the 12-item Short-Form Health Survey. Assessments were conducted at baseline, 4-week, 8-week, and 3-month follow-up. RESULTS: At 4 weeks, HAMA response (GCBT group 57.0% vs. control group 24.4%, p=0.000, Cohen's d=0.90) and remission rates (GCBT group 21.5% vs. control group 6.2%, p=0.004; d=0.51), and most secondary outcomes (all p<0.05, d=0.36-0.77) showed that the combined therapy was superior. At 8 weeks, all the primary and secondary significant differences found at 4 weeks were maintained with smaller effect sizes (p<0.05, d=0.32-0.48). At 3-month follow-up, the combined therapy was only significantly superior in the HAMA total (p<0.045, d=0.43) and HAMA-PA score reductions (p<0.001, d=0.77). Logistic regression showed superiority of the combined therapy for HAMA response rates [odds ratio (OR)=2.12, 95% confidence interval (CI) 1.02-4.42, p=0.04] and remission rates (OR=2.80, 95% CI 1.27-6.16, p=0.01). CONCLUSIONS: Compared with duloxetine alone, GCBT plus duloxetine showed significant treatment response for GAD over a shorter period of time, particularly for psychic anxiety symptoms, which may suggest that GCBT was effective in changing cognitive style.
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Our outcome is in line with previous research indicating that brief CBT treatments are associated with a considerable decline of GAD symptoms over a relatively short interval.
“our outcome is in line with previous research indicating that brief CBT treatments are associated with a considerable decline of GAD symptoms over a relatively short interval (Xie et al., 2019; LeBlanc et al., 2021).”
From Standard CBT versus integrative and multimodal CBT assisted by virtual-reality for generalized anxiety disorder (2022) · cites this paper as Xie et al., 2019
Cites
Hamilton, M. (1960) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp.23.1.56 · Cited by 32,817 · cited 2× · see citing works
“Additional secondary outcomes included the following: (a) level of depression (measured by the 17-item version of Hamilton Depression Scale (HAMD) (Hamilton, 1960); (b) overall illness severity [measured by the Severity Subscale of the Clinical Global Impression Scale (CGI-S)] (Guy, 1976); (c) level of disability and…”
MethodWARE, J. E., KOSINSKI, M., & KELLER, S. D. (1996) · Medical Care · doi:10.1097/00005650-199603000-00003 · Cited by 17,392 · cited 2× · see citing works
“grades); and (d) quality of life [measured by the 12-item Short-Form Health Survey (SF-12)] (Ware et al., 1996).”
MethodThe assessment of anxiety states by rating
HAMILTON, M. (1959) · British Journal of Medical Psychology · doi:10.1111/j.2044-8341.1959.tb00467.x · Cited by 11,455 · see citing works
(1976) · Medical Entomology and Zoology · Cited by 8,899 · see citing works
The theory and practice of group psychotherapy.
Gullickson, T., & Ramser, P. (1996) · Contemporary Psychology · doi:10.1037/002652 · Cited by 1,894 · see citing works
Katzman, M. A., Bleau, P., Blier, P., Chokka, P., Kjernisted, K., Van Ameringen, M., & the Canadian Anxiety Guidelines Initiative Group on behalf of the Anxiety Disorders Association of Canada/Association Canadienne des troubles anxieux and McGill University (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-s1-s1 · Cited by 1,090 · see citing works
McHugh, R. K., Whitton, S. W., Peckham, A. D., Welge, J. A., & Otto, M. W. (2013) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.12r07757 · Cited by 800 · see citing works
Cuijpers, P., Cristea, I. A., Karyotaki, E., Reijnders, M., & Huibers, M. J. H. (2016) · World Psychiatry · doi:10.1002/wps.20346 · Cited by 572 · cited 1× · see citing works
“As a result, the psychotherapeutic effect of GCBT was less likely to be overestimated (Cuijpers et al., 2016).”
BackgroundBehar, E., DiMarco, I. D., Hekler, E. B., Mohlman, J., & Staples, A. M. (2009) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2009.07.006 · Cited by 505 · cited 2× · see citing works
“Behar et al. (2009) reviewed five contemporarymodels of CBT interventions for GAD: the Avoidance Model, the Intolerance of Uncertainty Model, the Meta-Cognitive Model, the Emotion Dysregulation Model, and the Acceptance-Based Model.”
BackgroundMethodRuscio, A. M., Hallion, L. S., Lim, C. C. W., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Andrade, L. H., Borges, G., Bromet, E. J., Bunting, B., et al. (2017) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2017.0056 · Cited by 492 · see citing works
Efficacy of Cognitive Behavioral Therapy for Anxiety Disorders: A Review of Meta-Analytic Findings
Olatunji, B. O., Cisler, J. M., & Deacon, B. J. (2010) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2010.04.002 · Cited by 483 · see citing works
Ladouceur, R., Dugas, M. J., Freeston, M. H., Léger, E., Gagnon, F., & Thibodeau, N. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.68.6.957 · Cited by 446 · cited 1× · see citing works
“In terms of therapeutic content, overall, the study ensured that all the standard active components of CBT were present in the treatment protocol (Ladouceur et al., 2000; Olatunji et al., 2010).”
BackgroundHuman and economic burden of generalized anxiety disorder
Hoffman, D. L., Dukes, E. M., & Wittchen, H.-U. (2008) · Depression and Anxiety · doi:10.1002/da.20257 · Cited by 438 · see citing works
Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds, C. F. (2014) · World Psychiatry · doi:10.1002/wps.20089 · Cited by 424 · cited 1× · see citing works
“A recent meta-analysis of randomised trials that addressed this question found that, for anxiety disorders in general, combined treatment with psychotherapy and antidepressant medication is more effective than treatment with antidepressant medication alone, and the superior effects of combined treatment remained signi…”
BackgroundDugas, M. J., Ladouceur, R., Léger, E., Freeston, M. H., Langolis, F., Provencher, M. D., & Boisvert, J.-M. (2003) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.71.4.821 · Cited by 331 · cited 2× · see citing works
“Second, the group therapy format may have some advantages over individual therapy, including provision of a natural support group (not to mention greater cost efficiency) (Dugas et al., 2003; Beck & Coffey, 2005).”
BackgroundMethodCognitive-Behavioral Therapy in Groups
Bieling, P., McCabe, R. E., & Antony, M. M. (2006) · Medical Entomology and Zoology · Cited by 249 · see citing works
Wetherell, J. L., Petkus, A. J., White, K. S., Nguyen, H., Kornblith, S. J., Andreescu, C., Zisook, S., & Lenze, E. J. (2013) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2013.12081104 · Cited by 153 · see citing works
Pharmacotherapy of anxiety disorders: A critical review
Koen, N., & Stein, D. J. (2011) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2011.13.4/nkoen · Cited by 151 · see citing works
Current Considerations in the Treatment of Generalized Anxiety Disorder
Katzman, M. A. (2009) · CNS Drugs · doi:10.2165/00023210-200923020-00002 · Cited by 128 · see citing works
Hofmann, S. G., Sawyer, A. T., Korte, K. J., & Smits, J. A. J. (2009) · International Journal of Cognitive Therapy · doi:10.1521/ijct.2009.2.2.160 · Cited by 109 · see citing works
Cognitive Behavioral Treatment for Generalized Anxiety Disorder: From Science to Practice
Robichaud, M., Koerner, N., & Dugas, M. J. (2019) · doi:10.4324/9781315709741 · Cited by 97 · see citing works
Bereza, B. G., Machado, M., & Einarson, T. R. (2009) · Clinical Therapeutics · doi:10.1016/j.clinthera.2009.06.004 · Cited by 89 · see citing works
Gersh, E., Hallford, D. J., Rice, S. M., Kazantzis, N., Gersh, H., Gersh, B., & McCarty, C. A. (2017) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2017.10.001 · Cited by 82 · see citing works
David, P., Pritchett, Y., Kajdasz, D. K., Bauer, M., Jain, R., Russell, J. M., Walker, D. J., Spencer, K. A., Froud, D. M., Raskin, J., et al. (2007) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2007.01.008 · Cited by 74 · see citing works
The burden of generalized anxiety disorder in Canada
Pelletier, L., O’Donnell, S. C., McRae, L., & Grenier, J. (2017) · Health Promotion and Chronic Disease Prevention in Canada · doi:10.24095/hpcdp.37.2.04 · Cited by 71 · see citing works
Combined medication and cognitive therapy for generalized anxiety disorder
Crits-Christoph, P. F., Newman, M. G., Rickels, K., Gallop, R., Gibbons, M. B. C., Hamilton, J. L., Ring‐Kurtz, S., & Pastva, A. M. (2011) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2011.07.007 · Cited by 67 · see citing works
Yuan, M., Zhu, H., Qiu, C., Meng, Y., Zhang, Y., Shang, J., Nie, X., Ren, Z., Gong, Q., Zhang, W., et al. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-0904-8 · Cited by 60 · see citing works
Group cognitive behavioral treatment for PTSD: Treatment of motor vehicle accident survivors
Beck, J. G., & Coffey, S. F. (2005) · Cognitive and Behavioral Practice · doi:10.1016/s1077-7229(05)80049-5 · Cited by 55 · see citing works
Cognitive-Behavioral Treatment of Generalized Anxiety Disorder
Overholser, J., & Nasser, E. H. (2000) · Journal of Contemporary Psychotherapy · doi:10.1023/a:1026514712357 · Cited by 54 · see citing works
Black, D. W. (2006) · CNS Spectrums · doi:10.1017/s1092852900025827 · Cited by 48 · see citing works
Baldwin, D. S., Hou, R. H., Gordon, R., Huneke, N. T. M., & Garner, M. J. (2017) · CNS Drugs · doi:10.1007/s40263-017-0423-2 · Cited by 37 · see citing works
Hui, C., & Zhihui, Y. (2017) · Aging & Mental Health · doi:10.1080/13607863.2016.1222349 · Cited by 34 · see citing works
DiBonaventura, M., Toghanian, S., Järbrink, K., & Locklear, J. C. (2014) · ClinicoEconomics and Outcomes Research · doi:10.2147/ceor.s55429 · Cited by 29 · see citing works
Wong, S. Y., Mak, W. W., Cheung, E. Y., Ling, C. Y., Lui, W. W., Tang, W., Wong, R. L., Lo, H. H., Mercer, S., & Ma, H. S. (2011) · BMC Psychiatry · doi:10.1186/1471-244x-11-187 · Cited by 25 · see citing works
Wetherell, J. L., Stoddard, J. A., White, K. S., Kornblith, S. J., Nguyen, H., Andreescu, C., Zisook, S., & Lenze, E. J. (2010) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.2619 · Cited by 25 · see citing works
Escitalopram 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 · see citing works
Starčević, V. (2015) · Australasian Psychiatry · doi:10.1177/1039856215587233 · Cited by 9 · see citing works
THE INSTITUTE OF MEDICINE (IOM) SETS A FRAMEWORK FOR EVIDENCE-BASED STANDARDS FOR PSYCHOTHERAPY
Weissman, M. M. (2015) · Depression and Anxiety · doi:10.1002/da.22434 · Cited by 4 · see citing works
Self-Coaching: The Powerful Program to Beat Anxiety and Depression
Luciani, J. J. (2006) · Medical Entomology and Zoology · Cited by 2 · see citing works
TRANSLATING RESEARCH TO PRACTICE: TOO MUCH RESEARCH, NOT ENOUGH PRACTICE?
Roy‐Byrne, P. (2015) · Depression and Anxiety · doi:10.1002/da.22443 · Cited by 2 · see citing works
Cognitive-behavioral therapy components for generalized anxiety disorder:A Delphi Poll study
Hai, H. (2013) · Zhongguo xinli weisheng zazhi · Cited by 2 · see citing works
A group cognitive behaviour therapy program for anxiety, fear and phobias
Oei, T. P. S. (2007) · Cited by 1 · see citing works
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Bantjes, J. R., Kazdin, A. E., Cuijpers, P. J., Breet, E., Dunn‐Coetzee, M., Davids, C., Stein, D. J., & Kessler, R. C. (2021) · JMIR Mental Health · doi:10.2196/27400 · Cited by 76 · see citing works
Jiang, S.-S., Liu, X., Han, N., Zhang, H., Xie, W., Xie, Z.-J., Lu, X., Zhou, X.-Z., Zhao, Y.-Q., Duan, A.-D., et al. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04127-3 · Cited by 38 · see citing works
Popa, C. O., Sava, F. A., Muresan, S., Schenk, A., Cojocaru, C. M., Muntean, L. M., & Olah, P. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.1008981 · Cited by 14 · see citing works
“In the same way, our outcome is in line with previous research indicating that brief CBT treatments are associated with a considerable decline of GAD symptoms over a relatively short interval (Xie et al., 2019; LeBlanc et al., 2021).”
ResultLiu, J., Lv, C., Wu, D., Wang, Y., Sun, C., Cheng, C., & Yu, Y. (2021) · Gastroenterology Research and Practice · doi:10.1155/2021/5491188 · Cited by 14 · see citing works
Luo, L., Feng, B., Yang, S., Zhang, N., & Qiu, S. (2020) · Journal of International Medical Research · doi:10.1177/0300060520922679 · Cited by 12 · see citing works
Liu, J., Wang, W., Wang, Y., Wu, D., Sun, C., Lv, C., Wu, D., & Yu, Y. (2021) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000001603 · Cited by 4 · see citing works
Vaz, V. P., Costa, M. D. A., de Moraes, F., Garcia, G. A. H., & Manfro, G. G. (2022) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2804 · Cited by 1 · see citing works
Jiang, S.-S., Liu, X.-H., Han, N., Zhang, H.-J., Xie, W.-X., Xie, Z.-J., Lu, X.-Y., Zhou, X.-Z., Zhao, Y.-Q., Duan, A.-D., et al. (2022) · Figshare · doi:10.6084/m9.figshare.20342547
Jiang, S.-S., Liu, X., Han, N., Zhang, H.-J., Xie, W.-X., Xie, Z.-J., Lu, X.-Y., Zhou, X.-Z., Zhao, Y.-Q., Duan, A.-D., et al. (2022) · Figshare · doi:10.6084/m9.figshare.20342541
Jiang, S.-S., Liu, X., Han, N., Zhang, H.-J., Xie, W.-X., Xie, Z.-J., Lu, X.-Y., Zhou, X.-Z., Zhao, Y.-Q., Duan, A.-D., et al. (2022) · Figshare · doi:10.6084/m9.figshare.20342544
- Authors
- Xie, Z.-J., Han, N., Law, S., Li, Z.-W., Chen, S.-Y., Xiao, J.-P., Zhang, Y., Gao, B.-L., Jiang, S.-S., Gao, H.-M., & Huang, X.-B.
- Affiliations
- Peking University People's Hospital (CN)
- University of Toronto (CA)
- Venue
- Acta Neuropsychiatrica
- Publisher
- Cambridge University Press (CUP)
- Published
- 2019-09-03
- Volume
- 31
- Issue
- 6
- Pages
- 316-324
- ISSN
- 0924-2708 (ISSN-L)
- 1601-5215
- OpenAlex
- W2967469140
- Cited by
- 10
- References
- 42
- Citations by year
- 2022: 6 · 2021: 3 · 2020: 1
- FWCI
- 2.95
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Acta Neuropsychiatrica (publishedVersion)
- PubMed (publishedVersion)
- 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 › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- generalized anxiety disorder, group cognitive behavioral therapy, duloxetine, combined psychotherapy and pharmacotherapy, treatment response, remission, psychic anxiety, somatic anxiety, depression, quality of life
- MeSH terms
- Duloxetine Hydrochloride, Serotonin and Noradrenaline Reuptake Inhibitors, Adolescent, Adult, Aged, Anxiety Disorders, Combined Modality Therapy, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Psychotherapy, Group, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult
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