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Cited by 158Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and DisordersTreatment of Major Depression

The DOI matches its Crossref record; 159 of the 159 references it cites were found in a registry or an index; none of the 172 sources its claims cite is checked for support yet.

World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders – Version 3. Part I: Anxiety disorders

Open access
Bandelow, Borwin, Allgulander, Christer, Baldwin, David S., Costa, Daniel Lucas da Conceição, Denys, Damiaan, Dilbaz, Nesrin, Domschke, Katharina, Eriksson, Elias, Fineberg, Naomi A., Hättenschwiler, Josef, Hollander, Eric, Kaiya, Hisanobu, Karavaeva, Tatiana, Kasper, Siegfried, Katzman, Martin, Kim, Yong-Ku, Inoue, Takeshi, Lim, Leslie, Masdrakis, Vasilios, Menchón, José M., Miguel, Euripedes C., Möller, Hans-Jürgen, Nardi, Antonio E., Pallanti, Stefano, Perna, Giampaolo, Rujescu, Dan, Starcevic, Vladan, Stein, Dan J., Tsai, Shih-Jen, Van Ameringen, Michael, Vasileva, Anna, Wang, Zhen, Zohar, Joseph·2023·The World Journal of Biological Psychiatry
DOI 10.1080/15622975.2022.2086295
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Abstract

AIM: This is the third version of the guideline of the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Posttraumatic Stress Disorders (published in 2002, revised in 2008). METHOD: A consensus panel of 33 international experts representing 22 countries developed recommendations based on efficacy and acceptability of available treatments. In total, 1007 RCTs for the treatment of these disorders in adults, adolescents, and children with medications, psychotherapy and other non-pharmacological interventions were evaluated, applying the same rigorous methods that are standard for the assessment of medications. RESULT: This paper, Part I, contains recommendations for the treatment of panic disorder/agoraphobia (PDA), generalised anxiety disorder (GAD), social anxiety disorder (SAD), specific phobias, mixed anxiety disorders in children and adolescents, separation anxiety and selective mutism. Selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are first-line medications. Cognitive behavioural therapy (CBT) is the first-line psychotherapy for anxiety disorders. The expert panel also made recommendations for patients not responding to standard treatments and recommendations against interventions with insufficient evidence. CONCLUSION: It is the goal of this initiative to provide treatment guidance for these disorders that has validity throughout the world.

Overview

Integrity signals

Registry

Crossref · 10.1080/15622975.2022.2086295

Cites

159 of 159 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

200 No basis given · 161 Not checked yet · 48 Own result · 39 Own interpretation · 21 Own method

Verify all 172 references — free account
  • Probably not a substantial claim. 99
  • It may state two separate claims as one. 114
  • The quote only partly states this claim. 6
198 of 198

  • The authors state this as an assumption.

    Patients apply for participation in a treatment study when their illness severity has reached its peak.

    “This analysis was based on the assumption that patients would apply for participation in a treatment study when their illness severity had reached its peak.”

  • The paper relies on this without support.

    Patients treated in psychotherapy trials are significantly less severely ill than patients in drug trials.

    “Patients treated in psychotherapy trials were significantly less severely ill than patients in drug trials.”

  • The paper relies on this without support.

    Anxiety disorders mostly have a waxing and waning course.

    “Mostly, anxiety disorders have a waxing and waning course.”

  • The paper relies on this without support.

    A substantial number of patients with anxiety disorders do not meet response criteria after initial standard treatment.

    “A substantial number of patients with anxiety disorders do not meet response criteria after initial standard treatment.”

  • The paper relies on this without support.

    Elderly patients may take longer to respond to treatment.

    “Elderly patients may take longer to respond.”

  • The paper relies on this without support.

    Experienced clinicians report that many treatment-resistant patients respond to a different class of medication.

    “experienced clinicians report that many treatment-resistant patients respond to a different class of medication (e.g.switching from SSRI/SNRIs to TCAs or vice versa).”

  • The paper relies on this without support.

    Combining an ongoing treatment with a second drug may be associated with increased rates of adverse effects or interactions.

    “Also, the combination may be associated with increased rates of adverse effects or interactions.”

  • The authors state this as an assumption.

    Psychotherapy and pharmacotherapy likely target different brain circuits.

    “As psychotherapy and pharmacotherapy likely target different brain circuits, from a theoretical point of view, it can be assumed that they have additive effects.”

  • The authors state this as an assumption.

    Psychotherapy and pharmacotherapy have additive effects.

    “As psychotherapy and pharmacotherapy likely target different brain circuits, from a theoretical point of view, it can be assumed that they have additive effects.”

  • The paper relies on this without support.

    Phenelzine has only been studied in one trial.

    “The irreversible MAO inhibitor phenelzine was only studied in one trial; due to possible severe interactions with food components or other drugs the drug should only be used when treatments with a higher recommendation grade have failed (LoE B/RG 3).”

  • The paper relies on this without support.

    Phenelzine has possible severe interactions with food components or other drugs.

    “The irreversible MAO inhibitor phenelzine was only studied in one trial; due to possible severe interactions with food components or other drugs the drug should only be used when treatments with a higher recommendation grade have failed (LoE B/RG 3).”

  • The paper relies on this without support.

    The evidence for the RIMA moclobemide is inconsistent.

    “The evidence for the RIMA moclobemide is inconsistent.DBPC studies did not show superiority to placebo; however, two adequately powered studies showed equal efficacy to standard treatments (LoE D/RG 4).”

  • The paper relies on this without support.

    DBPC studies did not show superiority of moclobemide to placebo.

    “The evidence for the RIMA moclobemide is inconsistent.DBPC studies did not show superiority to placebo; however, two adequately powered studies showed equal efficacy to standard treatments (LoE D/RG 4).”

  • The paper relies on this without support.

    Two adequately powered studies showed equal efficacy of moclobemide to standard treatments.

    “The evidence for the RIMA moclobemide is inconsistent.DBPC studies did not show superiority to placebo; however, two adequately powered studies showed equal efficacy to standard treatments (LoE D/RG 4).”

  • The paper relies on this without support.

    Only one underpowered comparison trial exists for mirtazapine.

    “For mirtazapine, only one underpowered comparison trial exists (LoE D/RG 4).”

  • The paper relies on this without support.

    No efficacy in the treatment of PDA was found for buspirone, propranolol, and trazodone.

    “No efficacy in the treatment of PDA was found for buspirone, propranolol and trazodone (LoE A-/RG 1-).”

  • The paper relies on this without support.

    Panic disorder typically has a waxing and waning course.

    “Typically, panic disorder has a waxing and waning course.”

  • The paper relies on this without support.

    The same doses of SSRIs are usually prescribed in maintenance treatment of panic disorder as in the acute treatment phase.

    “Regarding SSRIs, the same doses are usually prescribed in the maintenance treatment of panic disorder as in the acute treatment phase.”

  • The paper relies on this without support.

    There are no studies examining reduced doses of SSRIs in maintenance treatment.

    “There are no studies examining reduced doses of SSRIs in maintenance treatment.”

  • The paper relies on this without support.

    In most studies, SSRIs were better tolerated than TCAs.

    “In most of these studies, the SSRIs were better tolerated than the TCAs, although one analysis did not find a difference in tolerability between SSRIs and imipramine (Otto et al. 2001).”

  • The paper relies on this without support.

    There are no direct double-blind comparisons between SSRIs and benzodiazepines in the treatment of panic disorder.

    “There are no direct double-blind comparisons between SSRIs and benzodiazepines in the treatment of panic disorder.”

  • The paper relies on this without support.

    CBT has been investigated thoroughly in PDA.

    “CBT has been investigated thoroughly in PDA.”

  • The paper relies on this without support.

    CBT is the psychotherapeutic modality with the best body of evidence for PDA.

    “Although CBT is the psychotherapeutic modality with the best body of evidence for PDA, it was mostly tested against waitlist controls.”

  • The paper relies on this without support.

    CBT was mostly tested against waitlist controls.

    “Although CBT is the psychotherapeutic modality with the best body of evidence for PDA, it was mostly tested against waitlist controls.”

  • The paper relies on this without support.

    In some direct comparisons, CBT was as effective as medication, and in one study it was even more effective.

    “In some direct comparisons, CBT was as effective as me, and in one study it was even more effective.”

  • The paper relies on this without support.

    Some comparison studies showing equal efficacy were underpowered and therefore not reliable.

    “However, some of those comparison studies showing equal efficacy were underpowered and therefore not reliable.”

  • The paper relies on this without support.

    Several studies showed superiority of drug treatment over CBT.

    “On the other hand, several studies showed superiority of drug treatment over CBT.”

  • The paper relies on this without support.

    CBT was shown to be more effective than psychodynamic psychotherapy in a number of studies.

    “CBT was shown to be more effective than psychodynamic psychotherapy in a number of studies.”

  • The paper relies on this without support.

    Applied relaxation for PDA has only been shown to be more effective than progressive muscle relaxation as a control.

    “Applied relaxation for PDA has only been shown to be more effective than progressive muscle relaxation as a control.”

  • The paper relies on this without support.

    Studies comparing AR with CBT are inconclusive.

    “Studies comparing AR with CBT are inconclusive.”

  • The paper relies on this without support.

    Studies comparing AR with psychodynamic therapy show diverging results.

    “Also, studies comparing AR with psychodynamic therapy show diverging results, as they have shown inferiority, superiority or equal efficacy to psychodynamic therapy, which itself cannot be regarded as effective treatment (LoE D/RG 4).”

  • The paper relies on this without support.

    iCBT was superior to waitlist in most studies.

    “Cognitive behavioural interventions delivered via Internet (iCBT) by using computers, tablets or smartphones were superior to waitlist in most studies, more effective than an active control in one study (relaxation) and as effective as personal CBT.”

  • The paper relies on this without support.

    iCBT was more effective than an active control in one study (relaxation).

    “Cognitive behavioural interventions delivered via Internet (iCBT) by using computers, tablets or smartphones were superior to waitlist in most studies, more effective than an active control in one study (relaxation) and as effective as personal CBT.”

  • The paper relies on this without support.

    iCBT was as effective as personal CBT.

    “Cognitive behavioural interventions delivered via Internet (iCBT) by using computers, tablets or smartphones were superior to waitlist in most studies, more effective than an active control in one study (relaxation) and as effective as personal CBT.”

  • The paper relies on this without support.

    Effect sizes of iCBT interventions may be overestimated in the available studies mainly because most of the studies were not based on blinded assessments.

    “There were concerns that effect sizes of iCBT interventions may be overestimated in the available studies mainly because most of the studies were not based on blinded assessments.”

  • The paper relies on this without support.

    In only 15% of the studies, diagnoses were made in personal contact with a psychiatrist or psychologist.

    “In only 15% of the studies, diagnoses were made in personal contact with a psychiatrist or psychologist.”

  • The paper relies on this without support.

    The majority of participants had an academic background.

    “There were also concerns regarding the representativity of the studies, as the majority of participants had an academic background.”

  • The paper relies on this without support.

    For PDA, there are no comparisons of PdTh against waitlist.

    “For PDA, there are no comparisons of PdTh against waitlist.”

  • The paper relies on this without support.

    In comparison to 'no treatment' or active controls, no differences were found for PdTh.

    “In comparison to 'no treatment' or active controls, no differences were found.”

  • The paper relies on this without support.

    In one study, psychodynamic therapy was even less effective than the control treatment, relaxation.

    “In one study, psychodynamic therapy was even less effective than the control treatment, relaxation.”

  • The paper relies on this without support.

    In comparison to CBT, the majority of studies showed inferiority of PdTh.

    “In comparison to CBT, the majority of studies showed inferiority of PdTh.”

  • The paper relies on this without support.

    EMDR for PDA showed negative results.

    “EMDR for PDA showed negative results (LoE A-, RG 1-).”

  • The paper relies on this without support.

    Five studies found superiority of medication, while two studies found superiority of CBT.

    “Five studies found superiority of medication, while two studies found superiority of CBT (LoE D/RG 4).”

  • The paper relies on this without support.

    The majority of studies showed that the combination of psychotherapy plus medication was superior to psychotherapy alone.

    “The majority of studies showed that the combination of psychotherapy plus medication was superior to psychotherapy alone (LoE A/RG 1).”

  • The paper relies on this without support.

    Three studies did not demonstrate superiority of the combination over medication alone.

    “While three studies did not demonstrate superiority of the combination over medication alone, one small study found that the combination was more effective than imipramine alone (LoE B-/RG 2-).”

  • The paper relies on this without support.

    One small study found that the combination was more effective than imipramine alone.

    “While three studies did not demonstrate superiority of the combination over medication alone, one small study found that the combination was more effective than imipramine alone (LoE B-/RG 2-).”

  • The paper relies on this without support.

    In follow-up studies, patients who relapse often use treatments outside the study protocol and many resume the treatment that helped them during the study.

    “In the case of a relapse, patients will utilize all kinds of treatments outside the study protocol, and many will resume the treatment that was helpful in the treatment period.”

  • The paper relies on this without support.

    Long-lasting treatment effects seen in follow-up may be confounded by spontaneous remission or regression to the mean.

    “Also, the long-lasting treatment effects observed in the follow-up period may be superimposed on the effects of spontaneous remission or regression to the mean.”

  • The paper relies on this without support.

    Generalized anxiety disorder typically has a chronic course.

    “GAD is generally a chronic disorder and requires long-term treatment.”

  • The paper relies on this without support.

    Many patients with GAD experience a fluctuating course.

    “In many patients, GAD has a waxing and waning course.”

  • The paper relies on this without support.

    Some fears that children express are natural, transient phenomena that do not require treatment.

    “Some fears children express are a natural, transient phenomenon and do not have to be treated at all.”

  • The paper relies on this without support.

    In childhood and adolescence, major anxiety disorders like PDA or GAD are uncommon.

    “However,”

  • The paper relies on this without support.

    No studies have treated children or adolescents with pure GAD using psychotherapy.

    “there are no studies in which children or adolescents with pure GAD have been treated with psychotherapy”

  • The paper relies on this without support.

    There are almost no studies that exclusively included individuals with separation anxiety disorder.

    “There are almost no studies which exclusively included individuals with separation anxiety disorder.”

  • The paper relies on this without support.

    Several studies have been conducted with mixed samples that included children and adolescents with GAD, SAD, and separation anxiety disorders.

    “several studies have been conducted with mixed samples which included children and adolescents with GAD, SAD, and separation anxiety disorders.”

  • The paper relies on this without support.

    Hypnosis is not a validated treatment.

    “It was also superior to hypnosis, which is not a validated treatment (LoE B/RG 2).”

  • The paper relies on this without support.

    The risk of developing benzodiazepine addiction can be disregarded in occasional use.

    “The risk of developing benzodiazepine addiction can be disregarded in occasional use.”

  • The paper relies on this without support.

    It takes several weeks for psychotherapy to show sufficient effects.

    “In contrast, it takes several weeks for psychotherapy to show sufficient effects.”

  • The paper relies on this without support.

    In clinical reality, the combination of psychotherapy and pharmacotherapy is used more often than psychotherapy alone.

    “Moreover, in clinical reality, the combination is used more often than psychotherapy alone.”

  • The paper relies on this without support.

    Many efficacious and well tolerated drugs are already available for treating anxiety disorders, OCD, and PTSD.

    “The main reason may be that many efficacious and well tolerated drugs are already available for the treatment of anxiety disorders, OCD, and PTSD.”

  • The paper relies on this without support.

    It presents a great financial risk for pharmaceutical manufacturers to develop new drugs that would have to compete with available, inexpensive generic medications.

    “It presents a great financial risk for pharmaceutical manufacturers to develop new drugs that would have to compete with the available, inexpensive generic medications.”

  • The paper relies on this without support.

    Psychotherapy and pharmacotherapy have completely different modes of action.

    “Psychotherapy and pharmacotherapy have completely different modes of action and can therefore complement each other.”

  • The paper relies on this without support.

    Randomised controlled double-blind trials do not always reflect clinical reality and have shortcomings such as exclusion of comorbid, suicidal, or medically ill patients.

    “However, such studies do not always reflect clinical reality and have their shortcomings, e.g. the exclusion of comorbid, suicidal, or medically ill patients.”

  • The paper relies on this without support.

    Patients with cardiovascular, cerebrovascular and endocrine disease may have adequate and reasonable anxiety reactions associated with their somatic disease state and may also suffer from comorbid primary anxiety disorders.

    “Patients with cardiovascular, cerebrovascular and endocrine disease may have adequate and reasonable anxiety reactions associated with their somatic disease state.They may also suffer from comorbid primary anxiety disorders.”

  • The paper relies on this without support.

    TCAs can increase heart rate, increase QTC interval, induce orthostatic hypotension, slow cardiac conduction, and have quinidine-like effects on conduction within the myocardium.

    “TCAs are best avoided in patients with cardiac disease, as they can increase heart rate, increase QTC interval, induce orthostatic hypotension and slow cardiac conduction, and have significant quinidine-like effects on conduction within the myocardium.”
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Citations

Cites

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Research works printed but not linked: 16

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Metadata

Authors
Bandelow, B., Allgulander, C., Baldwin, D. S., Costa, D. L. D. C., Denys, D., Dilbaz, N., Domschke, K., Eriksson, E., Fineberg, N. A., Hättenschwiler, J., Hollander, E., Kaiya, H., Karavaeva, T., Kasper, S., Katzman, M., Kim, Y.-K., Inoue, T., Lim, L., Masdrakis, V., Menchón, J. M., Miguel, E. C., Möller, H.-J., Nardi, A. E., Pallanti, S., Perna, G., Rujescu, D., Starcevic, V., Stein, D. J., Tsai, S.-J., Van Ameringen, M., Vasileva, A., Wang, Z., & Zohar, J.
Affiliations
  • Universitätsmedizin Göttingen (DE)
  • Uppsala University (SE)
  • University of Southampton (GB)
  • Universidade de São Paulo (BR)
  • Amsterdam University Medical Centers (NL)
  • Psikiyatri Uzmanı, Üsküdar Üniversitesi Tıp Fakültesi Psikiyatri ABD, İstanbul, Turkey
  • University of Freiburg (DE)
  • University of Gothenburg (SE)
  • University of Hertfordshire (GB)
  • Treatment Center for Anxiety and Depression, Zürich, Switzerland
  • Albert Einstein College of Medicine (US)
  • Kyoto Prefectural University of Medicine (JP)
  • V. M. Bekhterev National Medical Research Center for Psychiatry and Neurology, Ministry of Health, Federal State Budgetary Institution of Higher Education, St. Petersburg State Pediatric Medical University, St. Petersburg, Russia
  • Medical University of Vienna (AT)
  • Adler (CA)
  • Korea University (KR)
  • Tokyo Medical University (JP)
  • Singapore General Hospital (SG)
  • National and Kapodistrian University of Athens (GR)
  • Bellvitge University Hospital (ES)
  • Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
  • Ludwig-Maximilians-Universität München (DE)
  • Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
  • University of Florence (IT)
  • Humanitas University (IT)
  • Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, University of Sydney, Sydney, Australia
  • South African Medical Research Council (ZA)
  • Taipei Veterans General Hospital (TW)
  • Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
  • North-Western State Medical University named after I.I. Mechnikov (RU)
  • Shanghai Jiao Tong University (CN)
  • Sheba Medical Center (IL)
Corresponding author
Bandelow, Borwin
ORCID
Venue
The World Journal of Biological Psychiatry
Publisher
Informa UK Limited
Published
2022-07-28
Volume
24
Issue
2
Pages
79-117
ISSN
  • 1562-2975 (ISSN-L)
  • 1814-1412
DOI
10.1080/15622975.2022.2086295
OpenAlex
W4288446792
Cited by
158
References
158
Citations by year
2026: 38 · 2025: 55 · 2024: 40 · 2023: 23 · 2022: 2
FWCI
27.61
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • The World Journal of Biological Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • ePrints Soton (University of Southampton) (acceptedVersion)
  • Pure Amsterdam UMC (submittedVersion, other-oa)
  • University of Hertfordshire Research Archive (University of Hertfordshire) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • GoeScholar The Publication Server of the Georg-August-Universität Göttingen (Georg-August-Universität Göttingen) (submittedVersion, cc-by)
Funders
  • Sunovion
  • European College of Neuropsychopharmacology
  • Servier
  • H. Lundbeck A/S
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Disorders
  • Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
Keywords
anxiety disorders, pharmacotherapy, panic disorder, agoraphobia, generalized anxiety disorder, social anxiety disorder, specific phobia, separation anxiety disorder, selective mutism, children and adolescents, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, cognitive behavioral therapy, treatment guidelines, treatment-resistant anxiety
MeSH terms
Adolescent, Adult, Anxiety, Anxiety Disorders, Biological Psychiatry, Child, Humans, Obsessive-Compulsive Disorder, Stress Disorders, Post-Traumatic, Selective Serotonin Reuptake Inhibitors

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