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Cited by 70Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and ApplicationsPsychological Treatments and Disorders

Enduring effects of psychological treatments for anxiety disorders: Meta-analysis of follow-up studies

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Bandelow, Borwin, Sagebiel, Anne, Belz, Michael, Görlich, Yvonne, Michaelis, Sophie, Wedekind, Dirk·2018·The British Journal of Psychiatry
DOI 10.1192/bjp.2018.49
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Abstract

Background: It is a widespread opinion that after treatment with psychotherapy, patients with anxiety disorders maintain their gains beyond the active treatment period, whereas patients treated with medication soon experience a relapse after treatment termination. Aims: We aimed to provide evidence on whether enduring effects of psychotherapy differ from control groups. Method: We searched 93 randomised controlled studies with 152 study arms of psychological treatment (cognitive–behavioural therapy or other psychotherapies) for panic disorder, generalised anxiety disorder and social anxiety disorder that included follow-up assessments. In a meta-analysis, pre-post effect sizes for end-point and all follow-up periods were calculated and compared with control groups (medication: n = 16 study arms; pill and psychological placebo groups: n = 17 study arms). Results: Gains with psychotherapy were maintained for up to 24 months. For cognitive–behavioural therapy, we observed a significant improvement over time. However, patients in the medication group remained stable during the treatment-free period, with no significant difference when compared with psychotherapy. Patients in the placebo group did not deteriorate during follow-up, but showed significantly worse outcomes than patients in cognitive–behavioural therapy. Conclusions: Not only psychotherapy, but also medications and, to a lesser extent, placebo conditions have enduring effects. Long-lasting treatment effects observed in the follow-up period may be superimposed by effects of spontaneous remission or regression to the mean. Declaration of interest: In the past 12 months and in the near future, Dr Bandelow has been/will be on the speakers/advisory board for Hexal, Mundipharma, Lilly, Lundbeck, Pfizer and Servier. Dr Wedekind was on the speakers' board of AstraZeneca, Essex Pharma, Lundbeck and Servier. All other authors have nothing to declare.

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  • Patients' responses and favorable progression could largely be explained by changes in quality of life, social support, and/or particular life events occurring at the same time as the treatment.

    “In particular, patients' responses and their favorable progression could largely be explained by changes in quality of life, social support, and/or particular life events occurring at the same time as the treatment (Bandelow et al., 2018; Bowling et al., 2012).”

    From Patients´ and Therapists´ Reports of Psychotherapy Outcomes: Similarities and Differences (2023) · cites this paper as Bandelow et al., 2018

    The Discussion says favorable follow-up outcomes may reflect spontaneous remission, regression to the mean, or other treatments patients use after stopping the original treatment. It does not identify changes in quality of life, social support, or particular life events as explanations, nor does it place those factors during treatment. Page numbers are unavailable in our copy. (LLM, conf=0.85)

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  • Cognitive-behavior therapy (CBT) is considered the gold standard therapy for anxiety disorders and is recommended as the first-line treatment for GAD.

    “Cognitive-behavior therapy (CBT), which is considered to be the gold standard therapy for anxiety disorders, is recommended as the first-line treatment for GAD.”

    From A Multisite Non-Inferiority Randomized Controlled Trial of the Efficacy of Cognitive-Behavior Therapy for Generalized Anxiety Disorder Delivered by Videoconference (2022) · cites this paper as [8]

    The Abstract says CBT is the most-studied psychotherapy for anxiety disorders, including GAD. The Enduring effects section says some guidelines prefer CBT over medication, but the paper does not call CBT the gold standard or state that it is recommended as first-line treatment specifically for GAD. (LLM, conf=0.85)

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  • CBT's efficacy and effectiveness for GAD has been extensively demonstrated.

    “Indeed, its efficacy and effectiveness for GAD has been extensively demonstrated [8,9,10,11].”

    From A Multisite Non-Inferiority Randomized Controlled Trial of the Efficacy of Cognitive-Behavior Therapy for Generalized Anxiety Disorder Delivered by Videoconference (2022) · cites this paper as [8]

    The introductory passage (page unavailable) says psychological therapies have shown efficacy for GAD and identifies CBT as the most-studied psychotherapy. The Selection of studies and Results sections describe randomized follow-up studies that include GAD and report sustained CBT gains, but the results pool three anxiety disorders and do not establish effectiveness in routine GAD care. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Clinical practice guidelines recommend psychological and pharmacological interventions for anxiety-related disorders.

    “Clinical practice guidelines recommendpsychologicalandpharmacologicalinterventionsfor anxiety-related disorders”

    From Long-term Outcomes of Cognitive Behavioral Therapy for Anxiety-Related Disorders: A Systematic Review and Meta-analysis (2020) · cites this paper as [10]

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Research works printed but not linked: 3

  1. [8]8. Mavissakalian M, Michelson L, Dealy RS. Pharmacological treatment of agora- phobia: imipramine versus imipramine with programmed practice. Br J Psychiatry 1983; 143: 348-55.
  2. [11]11. Liebowitz MR, Heimberg RG, Schneier FR, Hope DA, Davies S, Holt CS, et al. Cognitive-behavioral group therapy versus phenelzine in social phobia: long- term outcome. Depress Anxiety 1999; 10(3): 89-98.
  3. [17]17. Liebowitz MR. Social phobia. Mod Probl Pharmacopsychiatry 1987; 22: 141-73.

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Authors
Bandelow, B., Sagebiel, A., Belz, M., Görlich, Y., Michaelis, S., & Wedekind, D.
Affiliations
Universitätsmedizin Göttingen (DE)
Corresponding author
Bandelow, Borwin
ORCID
Venue
The British Journal of Psychiatry
Publisher
Royal College of Psychiatrists
Published
2018-04-30
Volume
212
Issue
6
Pages
333-338
ISSN
  • 0007-1250 (ISSN-L)
  • 1472-1465
DOI
10.1192/bjp.2018.49
OpenAlex
W2802512234
Cited by
70
References
26
Citations by year
2026: 9 · 2025: 4 · 2024: 8 · 2023: 12 · 2022: 15 · 2021: 7 · 2020: 8 · 2019: 3 · 2018: 4
FWCI
0.88
Type
journal article
Language
en
Open access
Licence
www.cambridge.org/core/terms (unspecified)
Locations
  • The British Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
AstraZeneca
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 Disorders
Keywords
anxiety disorders, maintenance of treatment effects, cognitive behavioral therapy, psychotherapy, panic disorder, generalized anxiety disorder, social anxiety disorder, placebo, spontaneous regression, regression to the mean, long-term follow-up
MeSH terms
Anxiety Disorders, Follow-Up Studies, Humans, Psychotherapy, Anti-Anxiety Agents, Outcome Assessment, Health Care

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