Psychological treatment of generalized anxiety disorder: A meta-analysis

Cuijpers, Pim; Sijbrandij, Marit; Koole, Sander L.; Huibers, Marcus J.H.; Berking, Matthias; Andersson, Gerhard

doi:10.1016/j.cpr.2014.01.002

Cited by 402 publications

(294 citation statements)

References 66 publications

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“…The effectiveness of CBT in the treatment of anxiety disorders, and especially GAD, has been well established in the general population, [96][97][98] with improvement rates estimated between 34% and 68%. 99 A study showed that a group CBT intervention for antenatal mothers with mild to moderate anxiety symptoms resulted in significantly decreased levels of anxiety; the effect was sustained into the postpartum period.…”

Section: Cognitive Behavioral Therapymentioning

confidence: 99%

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Perinatal Generalized Anxiety Disorder: Assessment and Treatment

Misri

Abizadeh

Sanders

et al. 2015

Journal of Women's Health

102

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Perinatal generalized anxiety disorder (GAD) has a high prevalence of 8.5%-10.5% during pregnancy and 4.4%-10.8% postpartum. Despite its attendant dysfunction in the patient, this potentially debilitating mental health condition is often underdiagnosed. This overview will provide guidance for clinicians in making timely diagnosis and managing symptoms appropriately. A significant barrier to the diagnosis of GAD in the perinatal population is difficulty in distinguishing normal versus pathological worry. Because a perinatal-specific screening tool for GAD is nonexistent, early identification, diagnosis and treatment is often compromised. The resultant maternal dysfunction can potentially impact mother-infant bonding and influence neurodevelopmental outcomes in the children. Comorbid occurrence of GAD and major depressive disorder changes the illness course and its treatment outcome. Psychoeducation is a key component in overcoming denial/stigma and facilitating successful intervention. Treatment strategies are contingent upon illness severity. Cognitive behavior therapy (CBT), relaxation, and mindfulness therapy are indicated for mild GAD. Moderate/severe illness requires pharmacotherapy and CBT, individually or in combination. No psychotropic medications are approved by the FDA or Health Canada in pregnancy or the postpartum; off-label pharmacological treatment is instituted only if the benefit of therapy outweighs its risk. SSRIs/SNRIs are the first-line treatment for anxiety disorders due to data supporting their efficacy and overall favorable side effect profile. Benzodiazepines are an option for short-term treatment. While research on atypical antipsychotics is evolving, some can be considered for severe manifestations where the response to antidepressants or benzodiazepines has been insufficient. A case example will illustrate the onset, clinical course, and treatment strategies of GAD through pregnancy and the postpartum.

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Section: Cognitive Behavioral Therapymentioning

confidence: 99%

“…However, a recent meta-analysis indicated that CBT may be more effective in treatment of GAD than applied relaxation. 97 …”

Section: Relaxation Techniquesmentioning

confidence: 99%

Perinatal Generalized Anxiety Disorder: Assessment and Treatment

Misri

Abizadeh

Sanders

et al. 2015

Journal of Women's Health

102

View full text Add to dashboard Cite

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“…This finding was unexpected, not least as most interventions for anxiety and depression using CBT tend to diminish over time and are seldom present over 1 year after completing therapy. [77][78][79][80][81] There is no doubt that CBT is effective in treating both generalised anxiety and depression (these benefits often go together), 80 but the evidence that these benefits extend beyond 1-2 years is very weak, partly because so many trials have waiting list controls that curtail comparison of groups over long periods. 79,80 There is one exception to this: the CoBalT study of CBT for depression showed continuing benefits of CBT 40 months after randomisation.…”

Section: Long-term Benefit Of Cognitive-behaviour Therapy For Health mentioning

confidence: 99%

Cognitive–behaviour therapy for health anxiety in medical patients (CHAMP): a randomised controlled trial with outcomes to 5 years

Tyrer

Šalkovskis

Tyrer

et al. 2017

Health Technol Assess

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BackgroundHealth anxiety is an under-recognised but frequent cause of distress that is potentially treatable, but there are few studies in secondary care.ObjectiveTo determine the clinical effectiveness and cost-effectiveness of a modified form of cognitive–behaviour therapy (CBT) for health anxiety (CBT-HA) compared with standard care in medical outpatients.DesignRandomised controlled trial.SettingFive general hospitals in London, Middlesex and Nottinghamshire.ParticipantsA total of 444 patients aged 16–75 years seen in cardiology, endocrinology, gastroenterology, neurology and respiratory medicine clinics who scored ≥ 20 points on the Health Anxiety Inventory (HAI) and satisfied diagnostic requirements for hypochondriasis. Those with current psychiatric disorders were excluded, but those with concurrent medical illnesses were not.InterventionsCognitive–behaviour therapy for health anxiety – between 4 and 10 1-hour sessions of CBT-HA from a health professional or psychologist trained in the treatment. Standard care was normal practice in primary and secondary care.Main outcome measuresPrimary – researchers masked to allocation assessed patients at baseline, 3, 6, 12, 24 months and 5 years. The primary outcome was change in the HAI score between baseline and 12 months. Main secondary outcomes – costs of care in the two groups after 24 and 60 months, change in health anxiety (HAI), generalised anxiety and depression [Hospital Anxiety and Depression Scale (HADS)] scores, social functioning using the Social Functioning Questionnaire and quality of life using the EuroQol-5 Dimensions (EQ-5D), at 6, 12, 24 and 60 months, and deaths over 5 years.ResultsOf the 28,991 patients screened over 21 months, 5769 had HAI scores of ≥ 20 points. Improvement in HAI scores at 3 months was significantly greater in the CBT-HA group (mean number of sessions = 6) than in the standard care, and this was maintained over the 5-year period (overallp < 0.0001), with no loss of efficacy between 2 and 5 years. Differences in the generalised anxiety (p = 0.0018) and depression scores (p = 0.0065) on the HADS were similar in both groups over the 5-year period. Gastroenterology and cardiology patients showed the greatest CBT gains. The outcomes for nurses were superior to those of other therapists. Deaths (n = 24) were similar in both groups; those in standard care died earlier than those in CBT-HA. Patients with mild personality disturbance and higher dependence levels had the best outcome with CBT-HA. Total costs were similar in both groups over the 5-year period (£12,590.58 for CBT-HA; £13,334.94 for standard care). CBT-HA was not cost-effective in terms of quality-adjusted life-years, as measured using the EQ-5D, but was cost-effective in terms of HAI outcomes, and offset the cost of treatment.LimitationsMany eligible patients were not randomised and the population treated may not be representative.ConclusionsCBT-HA is a highly effective treatment for pathological health anxiety with lasting benefit over 5 years. It also improves generalised anxiety and depressive symptoms more than standard care. The presence of personality abnormality is not a bar to successful outcome. CBT-HA may also be cost-effective, but the high costs of concurrent medical illnesses obscure potential savings. This treatment deserves further research in medical settings.Trial registrationCurrent Controlled Trials ISRCTN14565822.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 50. See the NIHR Journals Library website for further project information.

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“…Although there is evidence showing the efficacy of cognitive behavioral therapy (CBT) for GAD, there is clearly room for improvement (see Cuijpers, Sijbrandij, Koole, Huibers, Berking, & Andersson, 2014;Hanrahan, Field, Jones, & Davey, 2013 for a meta-analysis) and further developments in knowledge about the etiology of GAD, as well as in its treatment, are required.…”

Section: Introductionmentioning

confidence: 99%

Metacognitive, Emotional, and Avoidance Predictors of Generalized Anxiety Disorder

Sugiura¹

2017

PSYCH

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Predictors of worrying and generalized anxiety disorder (GAD) were compared. First, variables related to a version of inner experience were examined. Specifically, we examined whether negative appraisals about worrying and emotions can be considered subfacets of the overarching construct of experiential avoidance. Second, we examined the relative predictive power of responsibility to continue thinking (i.e., beliefs about the need for prolonged thinking about stressful problems), a construct relating worrying to problemsolving. In two studies, consistent predictors of worrying and GAD were negative metacognitive beliefs, fear of emotions, and responsibility to continue thinking, even after controlling for neuroticism in Study 2. Experiential avoidance did not explain the independent variance in worry. The structural equation model that experiential avoidance explained negative appraisals about worrying and emotions did not fit the data well. Negative metacognitive beliefs evidenced strong predictive power, therefore, requiring particular attention in treatment. Nonetheless, fear of emotions and perceived need for perseverative thinking are candidate additional components that deserve continued investigation.

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Psychological treatment of generalized anxiety disorder: A meta-analysis

Cited by 402 publications

References 66 publications

Perinatal Generalized Anxiety Disorder: Assessment and Treatment

Perinatal Generalized Anxiety Disorder: Assessment and Treatment

Cognitive–behaviour therapy for health anxiety in medical patients (CHAMP): a randomised controlled trial with outcomes to 5 years

Metacognitive, Emotional, and Avoidance Predictors of Generalized Anxiety Disorder

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