Cognitive behavior therapy for adult anxiety disorders in routine clinical care: a systematic review and meta-analysis
Open accessAbstract
Cognitive-behavioral therapy (CBT) has received strong research support for anxiety disorders such as panic disorder, agoraphobia, social anxiety disorder, and generalized anxiety disorder. However, less is known about how CBT performs when delivered in routine clinical care. A systematic review and meta-analysis were conducted of CBT for these anxiety disorders in adults treated in routine clinical care. Ovid MEDLINE, Embase OVID, and PsycINFO were systematically searched for articles published until May 2022. The effectiveness of CBT, methodological quality, and moderators of treatment outcome were examined, and benchmarked by meta-analytically comparing with efficacy studies for the same disorders. Sixty-six studies were included, comprising 6,113 participants. Large within-group effect sizes (ESs; Hedges’s g) were detected for anxiety measures at posttreatment (1.09) and follow-up (1.39), as well as for the secondary outcome of depression measures (0.80 at both assessment points). Attrition rate across the disorders was 15.9%. The benchmarking analysis showed that effectiveness studies had very similar ES (1.09) as efficacy studies (1.07) at posttreatment and at follow-up (1.39 vs. 1.30), and there were no significant differences in remission rates. Thus, the outcomes of effectiveness studies for these anxiety disorders are comparable with the results obtained in efficacy studies.
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Cognitive behavioral therapy (CBT) has the strongest evidence base for reducing depressive and anxious symptoms, with recent research confirming moderate to large effects on depressive disorders across more than 400 randomized controlled trials (RCTs) and large effects on anxiety symptoms across 66 RCTs.
“Cognitive behavioral therapy (CBT) has the strongest evidence base for reducing depressive and anxious symptoms, with recent research confirming moderate to large effects on depressive disorders across more than 400 randomized controlled trials (RCTs) [6] and large effects on anxiety symptoms across 66 RCTs [7].”
In current intervention studies for SAD, cognitive behavioral therapy (CBT) was the most widely used treatment paradigm.
“In current intervention studies for SAD, cognitive behavioral therapy (CBT) was the most widely used treatment paradigm [11,12,13].”
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Self-citationÖst, L., Enebrink, P., Finnes, A., Ghaderi, A., Havnen, A., Kvale, G., Salomonsson, S., & Wergeland, G. J. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104323 · Cited by 34 · see citing works
Self-citationÖst, L., Brattmyr, M., Finnes, A., Ghaderi, A., Havnen, A., Hedman‐Lagerlöf, M., Parling, T., Welch, E., & Wergeland, G. J. (2023) · International Journal of Eating Disorders · doi:10.1002/eat.24104 · Cited by 25 · see citing works
Self-citationÖst, L., Enebrink, P., Finnes, A., Ghaderi, A., Havnen, A., Kvale, G., Salomonsson, S., & Wergeland, G. J. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.03.002 · Cited by 22 · see citing works
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“For symptoms of depression, the effect sizes were 0.65 at posttreatment and 0.60 at follow-up [10].”
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Miller, R. K., O'Moore, K., Kikas, K., Matheson, J.-A. T., Whitton, A. E., Baldwin, P., Li, S., Black, M., Kampel, L., Cockayne, N., et al. (2025) · JMIR Human Factors · doi:10.2196/68789 · Cited by 3 · see citing works
“…therapy (CBT) has the strongest evidence base for reducing depressive and anxious symptoms, with recent research confirming moderate to large effects on depressive disorders across more than 400 randomized controlled trials (RCTs) [6] and large effects on anxiety symptoms across 66 RCTs [7].”
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“…Sockol, 2015; Werson et al ., 2022), anxiety disorders (Bhattacharya et al ., 2023; Carpenter et al ., 2018; Hofmann and Smits, 2008; Otte, 2011; Öst et al ., 2023), eating disorders (Keegan et al ., 2022; Linardon et al ., 2017; Linardon, 2018; Waller and Beard, 2024), substance misuse…”
Lenhard, F., Amnéus, L. W., Viklund, I., Hultstrand, T., Lundholm, L., Tegenmark, T., Skånberg, J., de la Cruz, L. F., Landén, M., & Öst, L. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.05.074 · Cited by 2 · see citing works
Self-citationHappy 100th anniversary, behavior therapy!
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Dunn, I. B. J. M. D., Power, E., Casey, L. J., & Wootton, B. M. (2025) · PLoS ONE · doi:10.1371/journal.pone.0316857 · Cited by 1 · see citing works
Öst, L., Brattmyr, M., Enebrink, P., Finnes, A., Ghaderi, A., Hansdóttir, I., Havnen, A., Njarðvík, U., Salomonsson, S., & Wergeland, G. J. (2025) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2025.2588173 · Cited by 2 · see citing works
Self-citationNorén, M., Lindqvist, K., Lilliengren, P., & Mechler, J. (2026) · BMC Psychology · doi:10.1186/s40359-026-04306-x · Cited by 1 · see citing works
“Compared to Öst’s [103] meta-analysis on CBT for anxiety disorders, which included a substantial proportion of low-risk studies (k = 8), the present sample appears to have a higher proportion of studies with moderate or unclear risk, reflecting the need for improved reporting standards in future…”
Öst, L., Andersson, E., Liberman, L. C., Fladvad, A., Havnen, A., Riise, E. N., Wahlund, T., & Wergeland, G. J. (2026) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2026.2696809 · Cited by 1 · see citing works
Self-citationBREAK FREE and Fly: A CBT School Counseling Group Curriculum for Anxiety
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“Likewise, from a systematic review of 66 studies, Ost et al. (2023) found that CBT interventions had superior results when included in routine clinical care for anxiety disorders.”
Miller, R. K., O’Moore, K., Kikas, K., Matheson, J.-A. T., Whitton, A. E., Baldwin, P. A., Li, S. H., Black, M., Kampel, L., Cockayne, N. L., et al. (2024) · doi:10.2196/preprints.68789 · Cited by 1 · see citing works
Zhou, Z., Zhou, Y., Ouyang, B., Man, S. S., & Chan, A. H. S. (2026) · Healthcare · doi:10.3390/healthcare14131978
“In current intervention studies for SAD, cognitive behavioral therapy (CBT) was the most widely used treatment paradigm [11–13].”
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Finnes, A., Johansson, M., Bernhardtz, R., & Öst, L. (2026) · BMC Psychology · doi:10.1186/s40359-026-05648-2
“Öst et al. reported mean POMRS scores in effectiveness trials for depression and anxiety disorders of 22.7 and 22.3, respectively [70, 71].”
InfluentialSelf-citation
- Authors
- Öst, L.-G., Enebrink, P., Finnes, A., Ghaderi, A., Havnen, A., Kvale, G., Salomonsson, S., & Wergeland, G. J.
- ORCID
- Venue
- Clinical Psychology: Science and Practice
- Published
- 2023-09
- Volume
- 30
- Issue
- 3
- Pages
- 272-290
- ISSN
- 0969-5893 (ISSN-L)
- 1468-2850
- OpenAlex
- W4382024001
- Cited by
- 26
- References
- 0
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 7 · 2023: 3 · 2022: 1
- FWCI
- 6.04
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Clinical Psychology Science and Practice (publishedVersion, other-oa)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- 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
- cognitive behavioral therapy, anxiety disorders, routine clinical practice, efficacy versus effectiveness, benchmarking, depression, remission, attrition, panic disorder, agoraphobia, social anxiety disorder, generalized anxiety disorder, adults
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