The relative efficacy of bona fide cognitive behavioral therapy and applied relaxation for generalized anxiety disorder at follow-up: A longitudinal multilevel meta-analysis.
Abstract
Objective This meta-analysis examined the relative efficacy of bona fide psychotherapy conditions in generalized anxiety disorder (GAD) from posttreatment to follow-up in adults. Methods Omnibus tests of relative efficacy across bona fide psychotherapies for primary and secondary outcomes were conducted. Longitudinal multilevel subgroup analyses investigated, (a) applied relaxation versus cognitive behavioral therapy (CBT) without applied relaxation and (b) well-established CBT versus augmented integrative CBT. Results In total, 54 repeated effect sizes nested in 23 studies were included in this meta-analysis. Omnibus test of relative efficacy indicated no significant differences among the bona fide psychotherapy contrasts in primary and some differences in secondary outcomes. When contrasting applied relaxation with CBT without applied relaxation, negligible relative efficacy differences were found at each assessment time. There were small efficacy differences in favor of augmented integrative CBT in comparison to well-established CBT. Conclusion Small relative efficacy differences were found between bona fide psychotherapies in GAD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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The Flückiger et al. (2022) meta-analysis, which included only bona fide psychotherapy studies, found no significant differences between CBT and AR across three assessment periods.
“In their analyses, no significant differences emerged between CBT and AR across three assessment periods (post-treatment, 5–11 month follow-ups, and > 12 month follow-up).”
From Do treatment responders maintain their gains following a randomized clinical trial comparing an acceptance-based behavior therapy to applied relaxation for generalized anxiety disorder? (2025) · cites this paper as Flückiger et al. (2022)
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Self-citationVîslă, A., Allemand, M., & Flückiger, C. (2022) · Journal of Clinical Psychology · doi:10.1002/jclp.23407 · Cited by 10 · see citing works
Self-citationBraus, N., Flückiger, C., Wichmann, J., Frankman, C., Lang, A., & Hunger‐Schoppe, C. (2024) · Psychotherapy Research · doi:10.1080/10503307.2024.2394192 · Cited by 7 · see citing works
Self-citationProbst, G., Vîslă, A., & Flückiger, C. (2022) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2022.102635 · Cited by 6 · see citing works
Self-citationFlückiger, C., Barkham, M., & Penedo, J. M. G. (2026) · Psychotherapy Research · doi:10.1080/10503307.2026.2653992 · Cited by 6 · see citing works
Self-citationTao, Y., Chen, K., Li, D., Yin, K., Li, Y., Long, J., & Hui, L. (2023) · Frontiers in Neurology · doi:10.3389/fneur.2022.1085684 · Cited by 6 · see citing works
Asselmann, E., Zenker, M., Rückert, F., Kische, H., Pieper, L., & Beesdo‐Baum, K. (2023) · PLoS ONE · doi:10.1371/journal.pone.0286750 · Cited by 6 · see citing works
Probst, G. H., Penedo, J. M. G., & Flückiger, C. (2025) · Behaviour Research and Therapy · doi:10.1016/j.brat.2025.104758 · Cited by 4 · see citing works
Self-citationFlückiger, C., Willutzki, U., Holtforth, M. G., & Wampold, B. E. (2024) · Die Psychotherapie · doi:10.1007/s00278-023-00703-4 · Cited by 3 · see citing works
Self-citationBrowning, L., Rashid, I., & Javanbakht, A. (2024) · Preprints.org · doi:10.20944/preprints202409.1313.v1 · Cited by 3 · see citing works
Asselmann, E., Rückert, F., Kische, H., Zenker, M., Pieper, L., & Beesdo‐Baum, K. (2024) · Journal of Mood and Anxiety Disorders · doi:10.1016/j.xjmad.2024.100055 · Cited by 2 · see citing works
Probst, G. H., Wolf, M., Vîslă, A., & Flückiger, C. (2023) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2023.100701 · Cited by 1 · see citing works
Self-citationHayes-Skelton, S. A., Roemer, L., & Orsillo, S. M. (2025) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2024.2417423
“Although Cuijpers et al. (2014) suggest CBT may be more effective than AR in the long term, our findings are consistent with Flückiger et al. (2022) in supporting the long-term effectiveness of AR. Consistent with our findings at post-treatment and 6-month follow-up (Hayes-Skelton et al., 2013),…”
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Current Treatments for Anxiety and Trauma-Related Disorders
Szuhany, K. L., Feldman, B. H., Malgaroli, M., & Simon, N. M. (2025) · Oxford University Press eBooks · doi:10.1093/med/9780197640654.003.0042
- Authors
- Flückiger, C., Carratta, K., Del Re, A. C., Probst, G., Vîslă, A., Gómez Penedo, J. M., & Wampold, B. E.
- ORCID
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2022-04
- Volume
- 90
- Issue
- 4
- Pages
- 339-352
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- OpenAlex
- W4220958303
- Cited by
- 17
- References
- 0
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 6 · 2023: 3 · 2022: 5
- FWCI
- 3.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Swiss National Science Foundation (PZ00P1_136937; PP00P1_163702; PP00P1_190083)
- 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, cognitive behavioral therapy, applied relaxation, relative efficacy, follow-up outcomes, treatment comparison, psychotherapy outcome
- MeSH terms
- Adult, Anxiety Disorders, Humans, Psychotherapy, Cognitive Behavioral Therapy
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