Who gets the most out of cognitive behavioral therapy for anxiety disorders? The role of treatment dose and patient engagement.
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OBJECTIVE: The present study explored treatment dose and patient engagement as predictors of treatment outcome in cognitive behavioral therapy (CBT) for anxiety disorders. METHOD: Measures of high versus low treatment dose and high versus low patient engagement in CBT were compared as predictors of 12- and 18-month outcomes for patients being treated for anxiety disorders with CBT (with or without concurrent pharmacotherapy) in primary care settings as part of a randomized controlled effectiveness trial of the Coordinated Anxiety Learning and Management (CALM) intervention. Measures of dose (attendance, exposure completion) and engagement in CBT (homework adherence, commitment) were collected throughout treatment, and blinded follow-up phone assessments of outcome measures (12-item Brief Symptom Inventory, Patient Health Questionnaire 8, Sheehan Disability Scale) were completed at 12 and 18 months. Propensity score weighting controlled for baseline differences in demographics and symptom severity between patients with high and low dose and engagement. These analyses included the 439 patients who selected CBT as treatment modality. RESULTS: Completing exposures, having high attendance, and being more adherent to completing homework predicted better outcomes across all measures at 12 and 18 months, and high CBT commitment predicted better outcomes on all measures at 18 months. CONCLUSIONS: This study found that higher treatment dose and patient engagement in CBT for anxiety disorders were stable and robust predictors of greater reductions in anxiety symptoms, depression symptoms, and functional disability.
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The exposure component is considered a key active ingredient of CBT for anxiety disorders.
“with the exposure component considered to be a key active ingredient (Glenn et al., 2013)”
From Stakeholder Perceptions of the Barriers to Receiving and Delivering Exposure-Based Cognitive Behavioral Therapy for Anxiety Disorders in Adult Community Mental Health Settings (2019) · cites this paper as Glenn et al., 2013
Exposure is likely the most active ingredient in CBT for anxiety disorders.
“likely the most active ingredient in CBT for anxiety disorders (i.e., exposure; Glenn, Golinelli, Rose et al., 2013; Longmore & Worrell, 2007).”
From Stakeholder Perceptions of the Barriers to Receiving and Delivering Exposure-Based Cognitive Behavioral Therapy for Anxiety Disorders in Adult Community Mental Health Settings (2019) · cites this paper as Glenn, Golinelli, Rose et al., 2013
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“Furthermore, as greater attendance and homework completion has been associated with superior outcomes in CBT for anxiety more broadly (Glenn et al., 2013), it logically follows that families with complex circumstances or those undergoing stressful life events may not find the treatment as beneficial as it may practica…”
Background
- Authors
- Glenn, D., Golinelli, D., Rose, R. D., Roy-Byrne, P., Stein, M. B., Sullivan, G., Bystritksy, A., Sherbourne, C., & Craske, M. G.
- Affiliations
- University of California, Los Angeles (US)
- RAND Corporation (US)
- University of California San Diego (US)
- Mental Illness Research, Education and Clinical Centers (US)
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2013-08
- Volume
- 81
- Issue
- 4
- Pages
- 639-649
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- PMC
- PMC3990403
- OpenAlex
- W1982171454
- Semantic Scholar
- c592dbcc26a7d7701dc19aa93402b1d00b53f9b7
- Cited by
- 166
- References
- 64
- Citations by year
- 2026: 5 · 2025: 14 · 2024: 15 · 2023: 16 · 2022: 16 · 2021: 17 · 2020: 18 · 2019: 13 · 2018: 9 · 2017: 14 · 2016: 9 · 2015: 12 · 2014: 7 · 2013: 1
- FWCI
- 13.07
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (U01 MH057858; K24 MH065324, U01 MH058915, U01 MH070022, U01 MH070018, U01MH057835; K24 MH64122)
- 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
- cognitive behavioral therapy, anxiety disorders, treatment dose, patient engagement, homework adherence, exposure therapy, treatment attendance, predictors of treatment outcome, primary care, depressive symptoms, functional disability, pharmacotherapy
- MeSH terms
- Adult, Aged, Anxiety Disorders, Combined Modality Therapy, Dose-Response Relationship, Drug, Female, Follow-Up Studies, Humans, Male, Middle Aged, Patient Compliance, Prognosis, Cognitive Behavioral Therapy, Single-Blind Method, Treatment Outcome
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