A controlled trial of treatments for generalized anxiety

Abstract

Treatments for chronic anxiety have received considerable interest recently. Firstly, there is a body of research which has shown problems of dependence and habituation in the long-term use of anti-anxiety drugs. A second development is that of psychological treatments for anxiety. Because of the problems involved in the use of benzodiazepines, it is important to determine whether or not psychological treatments are a reasonable alternative when treating chronic anxiety. This study was designed to test the relative effectiveness of cognitive-behavioural therapy, anxiety management training and treatment by benzodiazepines against a waiting list control. Measures were taken on both the process and outcome of treatment. The most immediate and greatest improvements in anxiety were seen in the group receiving drugs. However, these improvements reduced as the trial progressed and were minimal at the end of therapy. Both psychological treatment groups improved as the trial progressed with the most significant and consistent changes seen in the cognitive-behaviour therapy group. However, at follow-up there was no difference between the two groups receiving psychological treatments. Because of their lack of sustained improvement, over half of the group receiving drugs refused to wait without treatment until the follow-up assessment.

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

“…A number of studies showed superiority of CBT to a waiting list group (Barlow et al 1992;Butler et al 1991;Dugas et al 2003;Ladouceur et al 2000;Lindsay et al 1987;Mohlman et al 2003). Moreover, comparisons with a ''psychological placebo'', a pill placebo or comparable control group conditions showed that CBT has not only unspecific psychotherapy effects, but also specific ingredients (Borkovec et al 1987;Borkovec and Costello 1993;Linden et al 2005;Power et al 1990;Stanley et al 2003).…”

“…Standard CBT was shown to be as effective as other behavioural treatment modalities, such as ''Applied Relaxation'' (Arntz 2003;Ö st and Breitholtz 2000) or ''Anxiety Management'' (Durham et al 1994;Lindsay et al 1987). Cognitive therapy was superior to ''pure'' behaviour therapy (Butler et al 1991).…”

Cognitive-behavioral therapy for anxiety in the elderly

“…For the younger population (ie, age < 65), CBT and its variants have been shown to be superior to no treatment [25, [27][28][29][30][31]. In addition, a study by Borkovec and Costello [32] established the specific therapeutic benefit of CBT by demonstrating its superiority to nondirective treatment in patients with GAD.…”

Experimental analysis of specific treatment factors: Efficacy and practice implications

“…Lindsay, Gamsu, McLaughlin, Hood, and Espie (1987) randomly assigned 40 patients (24 women, 16 men) to one of four conditions: (a) CBT, (b) anxiety management training (AMT), (c) benzodiazepine treatment, and (d) WL control group. All treatments lasted for 1 month.…”