Cognitive-Behavioral Therapy for Adult Anxiety Disorders in Clinical Practice: A Meta-Analysis of Effectiveness Studies

Journal of Consulting and Clinical Psychology

Volumn 77, Issue 4, 2009, Pages 595-606

  Stewart, Rebecca E ^a   Chambless, Dianne L ^a  

^a UNIVERSITY OF PENNSYLVANIA   (United States)

Author keywords

anxiety disorders; clinical practice; cognitive behavioral therapy; dissemination; effectiveness

Indexed keywords

ADULT; ANXIETY DISORDER; ARTICLE; CLINICAL FEATURE; CLINICAL PRACTICE; COGNITIVE THERAPY; CORRELATION ANALYSIS; EFFECT SIZE; GENERALIZED ANXIETY DISORDER; HUMAN; OBSESSIVE COMPULSIVE DISORDER; PANIC; POSTTRAUMATIC STRESS DISORDER; SAMPLE SIZE; SOCIAL PHOBIA; STATISTICAL ANALYSIS; TREATMENT OUTCOME; TREATMENT RESPONSE;

ADULT; AGED; ANXIETY DISORDERS; BENCHMARKING; COGNITIVE THERAPY; FEMALE; HUMANS; MALE; MIDDLE AGED; RANDOMIZED CONTROLLED TRIALS AS TOPIC; TREATMENT OUTCOME;

EID: 67949105162     PISSN: 0022006X     EISSN: None     Source Type: Journal    
DOI: 10.1037/a0016032     Document Type: Article

References (97)

1. Addis M.E., Hatgis C., Krasnow A.D., Jacob K., Bourne L., and Mansfield A. Effectiveness of cognitive-behavioral treatment for panic disorder versus treatment as usual in a managed care setting. Journal of Consulting and Clinical Psychology 72 (2004) 625-635
2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. (1994), Author, Washington, DC
3. Antony M.M., Orsillo S.M., and Roemer L. Practitioner's guide to empirically-based measures of anxiety (2001), Kluwer Academic/Plenum, New York
4. Argras W.S., and Berkowitz R. Clinical research in behavior therapy: Halfway there?. Behavior Therapy 11 (1980) 472-488
5. Arntz A. Cognitive therapy versus applied relaxation as treatment of generalized anxiety disorder. Behaviour Research and Therapy 41 (2003) 633-646
6. Bados A., Balaguer G., and Saldaña C. The efficacy of cognitive-behavioral therapy and the problem of drop-out. Journal of Clinical Psychology 63 (2007) 585-592
7. Bakker A., Spinhoven P., van Balkom A.J.L.M., Vleugel L., and van Dyke R. Cognitive therapy by allocation versus cognitive therapy by preference in the treatment of panic disorder. Psychotherapy and Psychosomatics 69 (2000) 240-243
8. Barlow D.H., Gorman J.M., Shear M.K., and Woods S.W. Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. Journal of the American Medical Association 19 (2000) 2529-2536
9. Barlow D., Rapee R.M., and Brown T. Behavioral treatment of generalized anxiety disorder. Behavior Therapy 23 (1992) 551-570
10. Blomhoff S., Haug T.T., Hellstrom K., Holme I., Humble M., Madsbu H.P., et al. Randomized controlled general practice trial of sertraline, exposure therapy and combined treatment in generalized social phobia. British Journal of Psychiatry 179 (2001) 23-30
11. Borkovec T.D., and Costello E. Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. Journal of Consulting and Clinical Psychology 61 (1993) 611-619
12. Borkovec T.D., Newman M.G., Pincus A.L., and Lytle R. A component analysis of cognitive-behavioral therapy for generalized anxiety disorder and the role of interpersonal problems. Journal of Consulting and Clinical Psychology 70 (2002) 288-298
13. Burke M., Drummond L.M., and Johnston D.W. Treatment choice for agoraphobic women: Exposure or cognitive-behaviour therapy?. British Journal of Clinical Psychology 36 (1997) 409-420
14. Chambless D.L., and Hollon S.D. Defining empirically supported therapies. Journal of Consulting and Clinical Psychology 66 (1998) 7-18
15. Chambless D.L., and Ollendick T.H. Empirically supported psychological interventions: Controversies and evidence. Annual Review of Psychology 52 (2001) 685-716
16. Chambless D.L., Tran G.Q., and Glass C.R. Predictors of response to cognitive-behavioral group therapy for social phobia. Journal of Anxiety Disorders 11 (1997) 221-239
17. Clark D.M., Ehlers A., Hackmann A., McManus F., Fennell M., Grey N., et al. Cognitive therapy versus exposure and applied relaxation in social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology 74 (2006) 569-578
18. Cohen J. Statistical power analysis for the behavioral sciences (1998), Erlbaum, Hillsdale, NJ
19. Crits-Christoph P., Baranackie K., Kurcias J., Beck A.T., Carroll K., Perry K., et al. Meta-analysis of therapist effects in psychotherapy outcome studies. Psychotherapy Research 1 (1991) 81-91
20. Davidson J.R.T., Foa E.B., Huppert J.D., Keefe F.J., Franklin M.E., Compton J.S., et al. Fluoxetine, comprehensive cognitive behavioral therapy, and placebo in generalized social phobia. Archives of General Psychiatry 61 (2004) 1005-1013
21. Deacon B.J., and Abramowitz J.S. Cognitive and behavioral treatments for anxiety disorders: A review of meta-analytic findings. Journal of Clinical Psychology 60 (2004) 429-441
22. Deacon B., and Abramowitz J. A pilot study of two-day cognitive-behavioral therapy for panic disorder. Behaviour Research and Therapy 44 (2006) 807-817
23. Dunlap W.P., Cortina J.M., Vaslow J.B., and Burke M.J. Meta-analysis of experiments with matched groups or repeated measures designs. Psychological Methods 2 (1996) 170-177
24. Durham R.C., Fisher P.L., Dow M.G.T., Sharp D., Power K.G., Swan J.S., and Morton R.V. Cognitive behaviour therapy for good and poor prognosis generalized anxiety disorder: A clinical effectiveness study. Clinical Psychology and Psychotherapy 11 (2004) 145-157
25. Ellis, T. E., & Lehman, G. L. (1994). A naturalistic outcome study of group cognitive behavioral treatment for panic disorder. Paper presented at the 28th Annual Convention of the Association for Advancement of Behavior Therapy, San Diego, CA.
26. Feske U. Treatment of low-income and African-American women with posttraumatic stress disorder: A case series. Behavior Therapy 32 (2001) 585-601
27. Foa E.B., Dancu C.V., Hembree E.A., Jaycox L.H., Meadows E.A., and Street G.P. Comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. Journal of Consulting and Clinical Psychology 67 (1999) 194-200
28. Foa E.B., Hembree E.A., Cahill S.P., Rauch S.A.A., Riggs D.S., Feeny N.C., et al. Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. Journal of Consulting and Clinical Psychology 73 (2005) 953-964
29. Franklin M.E., Abramowitz J.S., Kozak M.J., Levitt J.T., and Foa E.B. Effectiveness of exposure and ritual prevention for obsessive-compulsive disorder: Randomized compared with nonrandomized samples. Journal of Consulting and Clinical Psychology 69 (2000) 594-602
30. Friedman S., Braunstein J.W., and Halpern B. Cognitive behavioral treatment of panic disorder and agoraphobia in a multiethnic urban outpatient clinic: Initial presentation and treatment outcome. Cognitive and Behavioral Practice 13 (2006) 282-292
31. Friedman S., Smith L.C., Halpern B., Levine C., Paradis C., Viswanathan R., et al. Obsessive-compulsive disorder in a multi-ethnic urban outpatient clinic: Initial presentation and treatment outcome with exposure and ritual prevention. Behavior Therapy 34 (2003) 397-410
32. García-Palacios A., Botella C., Robert C., Baños R., Perpiñá C., Quero S., and Ballester R. Clinical utility of cognitive-behavioural treatment for panic disorder. Results obtained in different settings: A research center and a public mental health care unit. Clinical Psychology and Psychotherapy 9 (2002) 373-383
33. Gaston J.E., Abbott M.J., Rapee R.M., and Neary S.A. Do empirically supported treatments generalize to private practice? A benchmark study of a cognitive-behavioural group treatment programme for social phobia. British Journal of Clinical Psychology 45 (2006) 33-48
34. Gillespie K., Duffy M., Hackmann A., and Clark D.M. Community based cognitive therapy in the treatment of post-traumatic disorder following the Omagh bomb. Behaviour Research and Therapy 40 (2002) 345-357
35. Hahlweg K., Fiegenbaum W., Frank M., Schroeder B., and von Witzleben I. Short- and long-term effectiveness of an empirically supported treatment for agoraphobia. Journal of Consulting and Clinical Psychology 69 (2001) 375-382
36. Hedges L.V. Distribution theory for Glass's estimator of effect size and related estimators. Journal of Educational Statistics 6 (1981) 107-128
37. Hedges L.V., and Olkin I. Statistical methods for meta-analysis (1985), Academic Press, Orlando, FL
38. Heldt E., Manfro G.G., Kipper L., Blaya C., Maltz S., Isolan L., et al. Treating medication-resistant panic disorder: Predictors and outcome of cognitive-behavior therapy in a Brazilian public hospital. Psychotherapy and Psychosomatics 72 (2003) 43-48
39. Herbert J.D., Gaudiano B.A., Rheingold A.A., Myers V.H., Dalrymple K., and Nolan E.M. Social skills training augments the effectiveness of cognitive behavioral group therapy for social anxiety disorder. Behavior Therapy 36 (2005) 125-138
40. Herbert J.D., Rheingold A.A., Gaudiano B.A., and Myers V.H. Standard versus extended cognitive behavior therapy for social anxiety disorder: A randomized-controlled trial. Behavioural and Cognitive Psychotherapy 32 (2004) 131-147
41. Higgins J.P.T., and Thompson S.G. Quantifying heterogeneity in a meta-analysis. Statistics in Medicine 21 (2002) 1539-1558
42. Hoagwood K., Hibbs E., Brent D., and Jensen P. Introduction to the special section: Efficacy and effectiveness in studies of child and adolescent psychotherapy. Journal of Consulting and Clinical Psychology 63 (1995) 683-687
43. Hunsley J., and Lee C.M. Research-informed benchmarks for psychological treatments, efficacy studies, effectiveness studies, and beyond. Professional Psychology: Research and Practice 38 (2007) 21-33
44. Hunt C., and Andrews G. Long-term outcome of panic disorder and social phobia. Journal of Anxiety Disorders 12 (1998) 395-406
45. Jacobson N.S., and Christensen A. Studying the effectiveness of psychotherapy: How well can clinical trials do the job?. American Psychologist 51 (1996) 1031-1039
46. Kenardy J.A., Dow M.G.T., Johnston D.W., Newman M.G., Thomson A., and Taylor C.B. A comparison of delivery methods of cognitive-behavioral therapy for panic disorder: An international multicenter trial. Journal of Consulting and Clinical Psychology 71 (2003) 1068-1075
47. Levitt J.T., Malta L.S., Martin A., Davis L., and Cloitre M. The flexible application of a manualized treatment for PTSD symptoms and functional impairment related to the 9/11 World Trade Center attack. Behaviour Research and Therapy 45 (2007) 1419-1433
48. Light R.J., Singer J.D., and Willett J.B. The visual presentation and interpretation of meta-analyses. In: Cooper H., and Hedges L.V. (Eds). The handbook of research synthesis (1994), Russell Sage Foundation, New York 439-453
49. Lincoln T.M., Rief W., Hahlweg K., Frank M., von Witzleben I., Schroeder B., and Fiegenbaum W. Effectiveness of an empirically supported treatment for social phobia in the field. Behaviour Research and Therapy 41 (2003) 1251-1269
50. Linden M., Zubraegel D., Franke U., and Schlattmann P. Efficacy of cognitive behaviour therapy in generalized anxiety disorders. Psychotherapy and Psychosomatics 74 (2005) 36-42
51. Lipsey M.W., and Wilson D.B. Practical meta-analysis (2001), Sage, Thousand Oaks, CA
52. Marom S., Gilboa-Schechtman E., Aderka I.M., Weizman A., and Hermesh H. Impact of depression on treatment effectiveness and gains maintenance in social phobia: A naturalistic study of cognitive behavior group therapy. Depression and Anxiety 26 (2009) 289-300
53. Martinsen E.W., Olsen T., Tønset E., Nyland K., and Aarre T.F. Cognitive-behavioral group therapy for panic disorder in the general clinical setting: A naturalistic study with 1-year follow-up. Journal of Clinical Psychiatry 59 (1998) 437-442
54. McEvoy P.M. Effectiveness of cognitive behavioural group therapy for social phobia in a community clinic: A benchmarking study. Behaviour Research and Therapy 45 (2007) 3030-3040
55. McLean P.D., Whittal M.L., Thordarson D.S., Taylor S., Söchting I., Koch W.J., et al. Cognitive versus behavior therapy in the group treatment of obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology 69 (2001) 205-214
56. Mortberg E., Berglund G., and Sundin O. Intensive cognitive behavioural group treatment of social phobia: A pilot study. Cognitive Behaviour Therapy 34 (2005) 41-49
57. Mortberg E., Karlsson A., Fyring C., and Sundin O. Intensive cognitive-behavioral group treatment (CBGT) of social probia: A randomized controlled study. Anxiety Disorders 20 (2006) 646-660
58. Norberg M.M., Calamari J.E., Cohen R.J., and Riemann B.C. Quality of life in obsessive-compulsive disorder: An evaluation of impairment and a preliminary analysis of the ameliorating effects of treatment. Depression and Anxiety 25 (2008) 248-259
59. Norton P.J., and Price E.C. A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders. The Journal of Nervous and Mental Disease 195 (2007) 521-531
60. Orwin R.G. A fail-safe N for effect size in meta-analysis. Journal of Educational Statistics 8 (1983) 157-159
61. Öst L., and Westling B.E. Applied relaxation versus cognitive behavior therapy in the treatment of panic disorder. Behavior Research and Therapy 33 (1995) 145-158
62. Persons J.B., and Silberschatz G. Are results of randomized controlled trials useful to psychotherapists?. Journal of Counseling and Clinical Psychology 66 (1998) 126-135
63. Resick P.A., Nishith P., Weaver T.L., Astin M.C., and Feuer C.A. A comparison of cognitive-processing therapy with prolonged exposure and a waiting list condition for the treatment of chronic posttraumatic stress disorder in female rape victims. Journal of Consulting and Clinical Psychology 70 (2002) 867-879
64. Rosenberg N.K., and Hougaard E. Cognitive-behavioural group treatment of panic disorder and agoraphobia in a psychiatric setting: A naturalistic study of effectiveness. Nordic Journal of Psychiatry 59 (2005) 198-204
65. Rosenthal R. The "file drawer problem" and tolerance for null results. Psychological Bulletin 86 (1979) 638-641
66. Rosenthal R., and Rosnow R.L. Essentials of behavioral research: Methods and data analysis. 2nd ed. (1991), McGraw-Hill, New York
67. Rothbaum B.O. Behavioral treatment of obsessive-compulsive disorder in a naturalistic setting. Cognitive and Behavioral Practice 7 (2000) 262-270
68. Sanderson W.C., Raue P.J., and Wetzler S. The generalizability of cognitive behavior therapy for panic disorder. Journal of Cognitive Psychotherapy: An International Quarterly 12 (1998) 323-330
69. Schulte D., Kunzel R., Pepping G., and Schulte-Bahrenberg T. Tailor-made versus standardized therapy of phobic patients. Advances in Behaviour Research and Therapy 14 (1992) 67-92
70. Schultz P.M., Resick P.A., Huber L.C., and Griffin M.G. The effectiveness of cognitive processing therapy for PTSD with refugees in a community setting. Cognitive and Behavioral Practice 13 (2006) 322-331
71. Seligman M.E.P. The effectiveness of psychotherapy: The Consumer Reports study. American Psychologist 50 12 (1995) 965-974
72. Shadish W.R., Matt G.E., Navarro A.M., and Phillips G. The effects of psychological therapies under clinically representative conditions: A meta-analysis. Psychological Bulletin 126 (2000) 512-529
73. Sharp D.M., Power K.G., and Swanson V. Reducing therapist contact in cognitive behaviour therapy for panic disorder and agoraphobia in primary care: Global measures of outcome in a randomized controlled trial. British Journal of General Practice 40 (2000) 963-968
74. Sharp D.M., Power K.G., and Swanson V. A comparison of the efficacy and acceptability of group versus individual cognitive behaviour therapy in the treatment of panic disorder and agoraphobia in primary care. Clinical Psychology and Psychotherapy 11 (2004) 73-82
75. Sholomskas D.E., Syracuse-Siewert G., Rounsaville B.J., Ball S.A., Nuro K.F., and Carroll K.M. We don't train in vain: A dissemination trial of three strategies of training clinicians in cognitive-behavioral therapy. Journal of Consulting and Clinical Psychology 73 (2005) 106-115
76. Shrout P.E., and Fleiss J.L. Intraclass correlations: Uses in assessing rater reliability. Psychological Bulletin 86 (1979) 420-428
77. Stangier U., Heidenreich T., Peitz M., Lauterbach W., and Clark D.M. Cognitive therapy for social phobia: Individual versus group treatment. Behaviour Research and Therapy 41 (2003) 991-1007
78. Stanley M.A., Hopko D.R., Diefenbach G.J., Bourland S.L., Rodriguez H., and Wagener P. Cognitive-behavior therapy for late-life generalized anxiety disorder in primary care. American Journal of Geriatric Psychiatry 11 (2003) 92-96
79. Stirman S.W., DeRubeis R.J., Crits-Christoph P., and Brody P.E. Are samples in randomized controlled trials of psychotherapy representative of community outpatients? A new methodology and initial findings. Journal of Consulting and Clinical Psychology 71 (2003) 963-972
80. Stirman S.W., DeRubeis R.J., Crits-Christoph P., and Rothman A. Can the randomized controlled trial literature generalize to nonrandomized patients?. Journal of Consulting and Clinical Psychology 73 (2005) 127-135
81. Tolin D.F., Hannan S., Maltby N., Diefenbach G.J., Worhunsky P., and Brady R.E. A randomized controlled trail of self-directed versus therapist-directed cognitive-behavioral therapy for obsessive-compulsive disorder patients with prior medication trials. Behavior Therapy 38 (2007) 179-191
82. Tolin D.F., Maltby N., Diefenbach G.J., Hannan S.E., and Worhunsky P. Cognitive-behavioral therapy for medication nonresponders with obsessive-compulsive disorder: A wait-list-controlled open trial. Journal of Clinical Psychiatry 65 (2004) 922-931
83. U.S. Census Bureau. Profile of general demographic characteristics: 2000 census of population and housing, United States (2001). http://www.census.gov/population/www/socdemo/race/race.html Retrieved February 16, 2009, from http://www.census.gov/population/www/socdemo/race/race.html
84. Van Noppen B., Steketee G., McCorkle B.H., and Pato M. Group and multifamily behavioral treatment for obsessive compulsive disorder: A pilot study. Journal of Anxiety Disorders 11 (1997) 431-446
85. Van Oppen P., de Haan E., van Balkom A.J.L.M., Spinhoven P., Hoogduin K., and van Dyck R. Cognitive therapy and exposure in vivo in the treatment of obsessive compulsive disorder. Behavior Research and Therapy 33 (1995) 379-390
86. Wade W.A., Treat T.A., and Stuart G.L. Transporting an empirically supported treatment for panic disorder to a service clinic setting: A benchmarking strategy. Journal of Consulting and Clinical Psychology 66 (1998) 231-239
87. Warren, R., Strand, J., & Thomas, J. C. (2008). Panic control treatment in private practice: Immediate and long term results. Manuscript in preparation
88. Warren R., and Thomas J.C. Cognitive-behavior therapy of obsessive-compulsive disorder in private practice: An effectiveness study. Anxiety Disorders 15 (2001) 277-285
89. Weisz J.R., and Addis M.E. The research-practice tango and other choreographic challenges: Using and testing evidence-based psychotherapies in clinical care settings. In: Goodheart C.D., Kazdin A.E., and Sternberg R.J. (Eds). Evidence-based psychotherapy: Where practice and research meet (2006), American Psychological Association, Washington, DC 179-206
90. Weisz J.R., Donenberg G.R., Han S.S., and Weiss B. Bridging the gap between laboratory and clinic in child and adolescent psychotherapy. Journal of Consulting and Clinical Psychology 63 (1995) 699-701
91. Weisz J.R., Weiss B., and Donenberg G.R. The lab versus the clinic: Effects of child and adolescent psychotherapy. American Psychologist 47 (1992) 1578-1585
92. Westbrook D., and Kirk J. The clinical effectiveness of cognitive behaviour therapy: Outcome for a large sample of adults treated in routine practice. Behaviour Research and Therapy 43 (2005) 1243-1261
93. Westen D., and Morrison K. 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 (2001) 875-899
94. Westen D., Novotny C.M., and Thompson-Brenner H. The empirical status of empirically supported psychotherapies: Assumptions, findings, and reportings in controlled clinical trials. Psychological Bulletin 4 (2004) 631-663
95. Wetzel C., Bents H., and Florin I. High-density exposure therapy for obsessive-compulsive inpatients: A 1-year follow-up. Psychotherapy and Psychosomatics 68 (1999) 186-192
96. White J., and Keenan M. Stress control: A controlled comparative investigation of large group therapy for generalized anxiety disorder. Behavioural Psychotherapy 20 (1992) 97-114
97. Whittal M.L., Thordarson D.S., and McLean P.D. Treatment of obsessive-compulsive disorder: Cognitive behavior therapy vs. exposure and response prevention. Behaviour Research and Therapy 43 (2005) 1559-1576