New review may ease worries of people with disabling anxiety disorder

By Kurt Ullman, Contributing Writer
Health Behavior News Service

People with generalized anxiety disorder worry — about many things at a time — to the point that it interferes with their day-to-day living. Now, a newly published review of studies suggests that a specific type of psychotherapy is effective in reducing symptoms.

“GAD is a very common and extremely disabling condition and psychological therapies are a popular and widely used treatment for anxiety disorders,” said lead author Vivien Hunot, Ph.D. “The review showed that psychological therapy using a cognitive behavioral therapy approach is effective for GAD.”

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

The review included 25 studies with 1,305 participants.

“Forty-six percent of people assigned to CBT [showed] some improvement in their anxiety symptoms at the end of treatment compared with just 14 percent assigned to a waiting list or usual care,” said Hunot, a senior research associate with the Institute of Psychiatry in London.

The studies in this review looked at cognitive behavioral therapy, a form of psychotherapy that emphasizes the important role of thinking in how we feel and what we do. Treatment involves recognizing unhelpful or destructive patterns of thinking and reacting, then modifying or replacing these with more realistic or helpful ones.

Investigators compared results for generalized anxiety disorder patients who received CBT with those on a list awaiting therapy or receiving usual therapy. Treatment as usual was defined as any appropriate medical care delivered during the course of the study, including medications and/or psychological therapy.

The investigators also compared results for patients who received CBT versus other types of psychotherapy.

CBT patients were more likely to have reduced anxiety at the end of treatment than those treated as usual or on the waiting list.

Because of the small number of studies with a wide variety of differing results, no conclusions could be made reliably when CBT was compared to other forms of therapy such as psychodynamic or supportive therapy. In addition, none of studies looked at possible long-term effects of CBT.

“CBT has been shown to be a very effective therapy for other kinds of anxiety disorders and this review adds to the evidence that this is a very effective form of therapy,” said Wayne Katon, M.D., vice-chair in the department of psychiatry and behavioral sciences at the University of Washington School of Medicine. “I think it a hopeful message that there is a brief structured therapy that works for people with GAD.”

Katon joins with the Cochrane researchers in urging caution when looking at CBT versus other forms of psychotherapy.

“When CBT was tested against waiting-list controls, the studies included in their review tended to find clear evidence of its efficacy,” Katon said. “The results were more mixed compared to supportive therapies. I would agree with the authors of the need to do more head-to-head studies comparing CBT to other forms of therapy.”

The Cochrane reviewers also found that people attending CBT-based group therapy were more likely to drop out of studies than those placed on a waiting list or receiving usual care. In contrast, people attending individual CBT sessions were less likely to drop out.

“This may suggest that group therapy is less popular than individual therapy, although since reasons for dropout were underreported in studies, we cannot be certain that lower acceptability of group therapy influenced dropout rates,” Hunot said.

“The idea of using group therapy at the outset is hard for many patients and I am not surprised at higher dropout rates for groups than individuals,” Katon said. “It does point out that the strategy of using groups for initial treatment may not work for a lot of people.”