Citation: Westen, D., & Morrison, K. (2001). A multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: an empirical examination of the status of empirically supported therapies. Journal of Consulting and Clinical Psychology, 69(6), 875-899.

This meta-analysis draws a distinction between initial response and sustained efficacy and attempts to determine the sustained efficacy of evidence-based treatments. This is particularly useful in their examination of GAD, for which a sizable percentage of clients experience significant improvements even before seeing a therapist for the first time. The analysis included five controlled studies of GAD which generally excluded comorbid conditions and had high completion rates.

The analysis found a clinically meaningful effect size for a majority of clients meeting criteria for GAD, although the majority of these clients retained “mild but clinically significant” symptoms after treatment. Data to determine the sustained efficacy of the examined EBTs, however, are unavailable. The authors point out the serious questions that this lack of data raises about the status of current evidence-based treatments for GAD. Whereas EBTs for panic disorder show promising results, those for depression demonstrate sustained efficacy of only 25-30% over 12-24 months. Until long term follow-up data is available for GAD EBTs, their recommendation as empirically supported interventions remains dubious.

This five-year study was designed to explore potential avenues for increasing the efficacy of CBT by extending its duration, measuring the efficacy of two components—cognitive therapy (CT) and applied relaxation and self-control desensitization (SCD)—of the CBT therapy being used, and by measuring interpersonal factors contributing to the success of failure of the treatment.

Although previous research has demonstrated that CBT is more effective than its individual parts over a short duration, these researchers found that each of the components they studied became as effective as the full CBT over the course of a 16-week treatment. Furthermore, they found no improvement in the treatment outcomes of the group receiving both therapeutic components, indicating that an extended duration is unlikely to improve outcomes.

The study found a strong association between some interpersonal behaviors—such as being domineering, vindictive, or nonassertive—and retention of symptoms at followup. The researchers conclude that complementary interpersonal therapy may improve the efficacy of CBT, and cite some existing research which corroborates this theory.

Citation: Borkovec, T. D., Newman, M. G., Pincus, A. L., & Lytle, R. (2002). A component analysis of cognitive-behavioral therapy for generalized anxiety disorder and the role of interpersonal problems. Journal of Consulting and Clinical Psychology, 70(2), 288-298.

Some of the common problems that have been identified in GAD sufferers, according to the CPA, include intolerance of uncertainty, inadequate approaches to problem-solving, and the belief that worry is an effective way to deal with problems. In response to these cognitive deficits, therapists commonly utilize psychoeducational tactics, cognitive interventions such as reappraisal of unrealistic beliefs, exposure experiences geared towards the development of tolerance for anxiety-provoking situations, emotion-regulation approaches, problem-solving skills development, and preparation for inevitable periods of increased anxiety. The CPA found that a greater number of these components being used in therapy was predictive of a better treatment outcome, while comparisons between individual components showed little difference. They also found that the addition of treatment components focused on increasing the client’s overall sense of psychological well-being is associated with better outcomes.

There is no current evidence to support routine combination of CBT with drug therapy, according to the CPA.

Citation: Canadian Psychiatric Association (2006). Clinical practice guidelines: Management of anxiety disorders. Canadian Journal of Psychiatry, 51(Suppl 2), 51S-55S.

The analysis found CBT to be a highly effective treatment for GAD, “reducing not only the main symptoms of anxiety but also the associated depressive symptoms and subsequently improving quality of life.” Mitte determined that CBT was at least as effective as benzodiazapenes, and approximately as effective as SSRIs and azapirones (such as buspirone) while being far better tolerated than any of these three pharmacological treatments. It is concluded that, although methodological variations make it impossible to determine which of the  GAD treatments considered is the best, CBT is a valuable alternative to pharmacotherapy for treating GAD.

Citation:  Mitte, K. (2005). Meta-analysis of cognitive-behavioral treatments for generalized anxiety disorder : A comparison with pharmacotherapy. Psychological Bulletin, 131(5), 785-795.

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