Predictors of relapse and recurrence following cognitive behavioural therapy for anxiety-related disorders: a systematic review
Abstract
Cognitive behavioural therapy (CBT) is an effective psychological treatment for anxiety-related disorders (anxiety disorders, post-traumatic stress disorder, and obsessive-compulsive disorder). However, relapse of anxiety symptoms is common following completion of treatment. This study aimed to identify predictors of relapse of anxiety after CBT for adult (18+) patients to enable the identification of “at-risk” patients who could potentially benefit from relapse prevention interventions. A systematic review and meta-analysis were conducted, including studies found in PsycINFO, PubMed, Scopus, and Web of Science, and through hand-searches of references lists and reverse citations. Nine studies met eligibility criteria (N = 532 patients). On average, 23.8% of patients experienced relapse following completion of CBT. A total of 21 predictors were identified and grouped into seven categories: residual symptoms; personality disorders; medication; clinical features; stressful life-events; degree of improvement; and demographics. A meta-analysis of residual symptoms as a predictor of relapse yielded a moderate but non-significant-pooled effect size (r = 0.35; 95% CI −0.21, 0.74, p =.08). Further research with adequately powered samples and standardised operationalisations of relapse are required to identify robust predictors.
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Knowledge of the long-term effects of CBT is urgently needed.
“knowledge of the long-term effects of CBT is urgently needed [16, 18]”
The literature supports that anxiety symptoms commonly return post-treatment.
“The literature supports that anxiety symptoms commonly return post-treatment (Levy et al., 2021;Lorimer et al., 2021).”
From Exploring anxiety, uncertainty perception, treatment experiences and coping strategies: An interpretative phenomenological analysis. (2025) · cites this paper as Lorimer et al., 2021
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- Authors
- Lorimer, B., Kellett, S., Nye, A., & Delgadillo, J.
- Affiliations
- University of Sheffield (GB)
- Corresponding author
- Lorimer, Ben
- Venue
- Cognitive Behaviour Therapy
- Publisher
- Informa UK Limited
- Published
- 2020-09-21
- Volume
- 50
- Issue
- 1
- Pages
- 1-18
- ISSN
- 1650-6073 (ISSN-L)
- 1651-2316
- OpenAlex
- W3087035895
- Cited by
- 62
- References
- 39
- Citations by year
- 2026: 9 · 2025: 11 · 2024: 11 · 2023: 13 · 2022: 9 · 2021: 9
- FWCI
- 1.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Cognitive Behaviour Therapy (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- Economic and Social Research Council (ES/R500975/1)
- 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, relapse, recurrence, anxiety disorders, post-traumatic stress disorder, obsessive-compulsive disorder, relapse prevention, predictors of relapse, residual symptoms, personality disorders, life events, medication, treatment outcomes
- MeSH terms
- Anxiety Disorders, Humans, Recurrence, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome
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