Psychological treatment of generalized anxiety disorder: A meta-analysis

Clinical Psychology Review

Volumn 34, Issue 2, 2014, Pages 130-140

  Cuijpers, Pim ^a,b,c   Sijbrandij, Marit ^a,b   Koole, Sander ^a,b   Huibers, Marcus ^a,b   Berking, Matthias ^c,d   Andersson, Gerhard ^e,f  

^a VU UNIVERSITY AMSTERDAM   (Netherlands)

^b UNIVERSITY OF AMSTERDAM   (Netherlands)

^c LEUPHANA UNIVERSITY OF LÜNEBURG   (Germany)

^d PHILIPPS UNIVERSITY MARBURG   (Germany)

^e LINKÖPING UNIVERSITY   (Sweden)

^f KAROLINSKA INSTITUTE   (Sweden)

Author keywords

Cognitive behavior therapy; Comparative outcome studies; Generalized anxiety disorder; Meta analysis; Psychotherapy; Randomized trial

Indexed keywords

BIBLIOGRAPHIC DATABASE; COGNITIVE THERAPY; COMPARATIVE EFFECTIVENESS; DATA EXTRACTION; DEPRESSION; EMBASE; FOLLOW UP; GENERALIZED ANXIETY DISORDER; GROUP THERAPY; HOSPITAL ADMISSION; HUMAN; LEISURE; MEDLINE; META ANALYSIS (TOPIC); OUTCOME ASSESSMENT; PSYCHOTHERAPY; PSYCINFO; PUBLISHING; QUALITY CONTROL; RANDOMIZED CONTROLLED TRIAL (TOPIC); REVIEW; SELF REPORT; SYSTEMATIC REVIEW;

COGNITIVE BEHAVIOR THERAPY; COMPARATIVE OUTCOME STUDIES; GENERALIZED ANXIETY DISORDER; META-ANALYSIS; PSYCHOTHERAPY; RANDOMIZED TRIAL;

ANXIETY DISORDERS; COGNITIVE THERAPY; HUMANS; RELAXATION THERAPY; TREATMENT OUTCOME;

EID: 84893361841     PISSN: 02727358     EISSN: 18737811     Source Type: Journal    
DOI: 10.1016/j.cpr.2014.01.002     Document Type: Review

References (79)

1. American Psychiatric Association Diagnostic and statistical manual of mental disorders 2000, American Psychiatric Press, Washington, DC. 4th ed., text revision ed.
2. Andersson G., Paxling B., Roch-Norlund P., Östman G., Norgren A., Almlöv J., et al. Internet-based psychodynamic vs. cognitive behavioural guided self-help for generalized anxiety disorder: A randomised controlled trial. Psychotherapy and Psychosomatics 2012, 81:344-355.
3. Andrews G., Cuijpers P., Craske M.G., McEvoy P., Titov N. Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: A meta-analysis. PLoS One 2010, 5(10):e13196.
4. Arntz A. Cognitive therapy versus applied relaxation as treatment of generalized anxiety disorder. Behaviour Research and Therapy 2003, 41:633-646.
5. Bakhshani N.M., Lashkaripour K., Sadjadi S.A. Effectiveness of short term cognitive behavior therapy in patients with generalized anxiety disorder. Journal of Medical Sciences 2007, 7:1076-1081.
6. Baldwin D.S., Polkinghorn C. Evidence-based pharmacotherapy of generalized anxiety disorder. International Journal of Neuropsychopharmacology 2005, 8:293-302.
7. Barlow D.H., Cohen A.S., Waddell M.T., Vermilyea B.B., Klosko J.S., Blanchard E.B., et al. Panic and generalized anxiety disorders: Nature and treatment. Behavior Therapy 1984, 15:431-449.
8. Barlow D.H., Rapee R.M., Brown T.A. Behavioral treatment of generalized anxiety disorder. Behavior Therapy 1992, 23:551-570.
9. Behar E., Borkovec T.D. Psychotherapy outcome research. Comprehensive handbook of psychology (volume 2): Research methods 2003, 213-240. J.A. Schinka, W. Velicer (Eds.).
10. Behar E., Dobrow DiMarco I., Hekler E., Mohlman J., Staples A.M. Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of Anxiety Disorders 2009, 23:1011-1023.
11. Biswas A., Biswas D., Chattopadhyay P.K. Cognitive behaviour therapy in generalised anxiety disorder. Indian Journal of Clinical Psychology 1995, 1-10.
12. Biswas A., Chattopadhyay P.K. Predicting psychotherapeutic outcomes in patients with generalised anxiety disorder. Journal of Personality and Clinical Studies 2001, 17:27-32.
13. Borenstein M. Introduction to meta-analysis 2009, John Wiley & Sons.
14. Borkovec T.D., Costello E. Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. Journal of Consulting and Clinical Psychology 1993, 61:611-619.
15. Borkovec T.D., Mathews A.M., Chanbers A., Ebrahimi S., Nelson R. The effects of relaxation training with cognitive or nondirective therapy and the role of relaxation-induced anxiety in the treatment of generalized anxiety. Journal of Consulting and Clinical Psychology 1987, 55:883-888.
16. Borkovec T.D., Newman M.G., Pincus A.L., 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 2002, 70:288-298.
17. Bowman D., Scogin F., Patton E., Gist L. Efficacy of self-examination therapy in the treatment of generalized anxiety disorder. Journal of Counseling Psychology 1997, 44:267-273.
18. Butler G., Fennell M., Robson P., Gelder M. Comparison of behavior therapy and cognitive behavior therapy in the treatment of generalized anxiety disorder. Journal of Consulting and Clinical Psychology 1991, 59:167-175.
19. Chambless D.L., Hollon S.D. Defining empirically supported therapies. Journal of Consulting and Clinical Psychology 1998, 66:7-18.
20. Clark D.M. Anxiety states; panic and generalized anxiety. Behavior therapy for psychiatric problems; A practical guide 1990, 52-97. Oxford University Press, Oxford. K. Hawton, P. Salkovskis, J. Kirk, D.M. Clark (Eds.).
21. Cohen J. Statistical power analysis for the behavioral sciences 1988, Erlbaum, Hillsdale, NJ. 2nd ed.
22. Covin R., Ouimet A.J., Seeds P.M., Dozois D.J.A. A meta-analysis of CBT for pathological worry among clients with GAD. Journal of Anxiety Disorders 2008, 22:108-116.
23. Crits-Christoph P., Newman M.G., Rickels K., Gallop R., Gibbons M.B.C., Hamilton J.L., et al. Combined medication and cognitive therapy for generalized anxiety disorder. Journal of Anxiety Disorders 2011, 25:1087-1094.
24. Cuijpers P., Andersson G., Donker T., van Straten A. Psychological treatments of depression: Results of a series of meta-analyses. Nordic Journal of Psychiatry 2011, 65:354-364.
25. Cuijpers P., Li J., Hofmann S.G., Andersson G. Self-reported versus clinician-rated symptoms of depression as outcome measures in psychotherapy research on depression: A meta-analysis. Clinical Psychology Review 2010, 30:768-778.
26. Dugas M.J., Brillon P., Savard P., Turcotte J., Gaudet A., Ladouceur R., et al. A randomized clinical trial of cognitive-behavioral therapy and applied relaxation for adults with generalized anxiety disorder. Behavior Therapy 2010, 41:46-58.
27. Dugas M.J., Ladouceur R., Leger E., Freeston M.H., Langlois F., Provencher M.D., et al. Group cognitive-behavioral therapy for generalized anxiety disorder: Treatment outcome and long-term follow-up. Journal of Consulting and Clinical Psychology 2003, 71:821-825.
28. Durham R.C., Murphy T., Allan T., Richard K., Treviling L.R., Fenton G.W. Cognitive therapy, analytic psychotherapy and anxiety management training for generalised anxiety disorder. British Journal of Psychiatry 1994, 165:315-323.
29. Duval S., Tweedie R. Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000, 56:455-463.
30. Fava G.A., Ruini C., Rafanelli C., Finos L., Salmaso L., Mangeli L., et al. Well-being therapy of generalized anxiety disorder. Psychotherapy and Psychosomatics 2005, 74:26-30.
31. Gonçalves D.C., Byrne G.J. Interventions for generalized anxiety disorder in older adults: Systematic review and meta-analysis. Journal of Anxiety Disorders 2012, 26:1-11.
32. Haby M.M., Donnelly M., Corry J., Vos T. Cognitive behavioural therapy for depression, panic disorder and generalized anxiety disorder: A meta-regression of factors that may predict outcome. Australian and New Zealand Journal of Psychiatry 2006, 40:9-19.
33. Hayes S.C., Luoma J.B., Bond F.W., Masuda A., Lillis J. Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy 2006, 44:1-25.
34. Hedges L.V., Olkin I. Statistical methods for meta-analysis 1985, Academic Press, San Diego, CA.
35. Cochrane handbook for systematic reviews of interventions. The Cochrane collaboration 2008, (version 5.0.1 [updated September 2008]). J.P.T. Higgins, S. Green (Eds.).
36. Higgins J.P., Thompson S.G., Deeks J.J., Altman D.G. Measuring inconsistency in meta-analyses. British Medical Journal 2003, 327:557-560.
37. Hoyer J., Beesdo K., Gloster A.T., Runge J., Hofler M., Becker E.S. Worry exposure versus applied relaxation in the treatment of generalized anxiety disorder. Psychotherapy and Psychosomatics 2009, 78:106-115.
38. Hunot V., Churchill R., de Lima S., Teixeira V. Psychological therapies for generalised anxiety disorder. Cochrane Database of Systematic Reviews 2007, 1:CD001848.
39. Ioannidis J.P.A., Patsopoulos N.A., Evangelou E. Uncertainty in heterogeneity estimates in meta-analyses. British Medical Journal 2007, 335:914-916.
40. Johnston L., Titov N., Andrews G., Spence J., Dear B.F. A RCT of a transdiagnostic Internet-delivered treatment for three anxiety disorders: Examination of support roles and disorder-specific outcomes. PLoS One 2011, 6:e28079.
41. Klerman G.L., Weissman M.M., Rounsaville B.J., Chevron E.S. Interpersonal psychotherapy of depression 1984, Basic Books, New York.
42. Koszycki D., Raab K., Aldosary F., Bradwejn J. A multifaith spiritually based intervention for generalized anxiety disorder: A pilot randomized trial. Journal of Clinical Psychology 2010, 66:430-441.
43. Kraemer H.C., Kupfer D.J. Size of treatment effects and their importance to clinical research and practice. Biological Psychiatry 2006, 59:990-996.
44. Ladouceur R., Dugas M.J., Freeston M.H., Leger E., Gagnon F., Thibodeau N. Efficacy of a cognitive-behavioral treatment for generalized anxiety disorder: Evaluation in a controlled clinical trial. Journal of Consulting and Clinical Psychology 2000, 68:957-964.
45. Laupacis A., Sackett D.L., Roberts R.S. An assessment of clinically useful measures of the consequences of treatment. New England Journal of Medicine 1988, 318:1728-1733.
46. Leichsenring F., Salzer S., Jaeger U., Kachele H., Kreische R., Leweke F., et al. Short-term psychodynamic psychotherapy and cognitive-behavioral therapy in generalized anxiety disorder: A randomized, controlled trial. American Journal of Psychiatry 2009, 166:875-881.
47. Levy Berg A., Sandell R., Sandahl C. Affect-focused body psychotherapy in patients with generalized anxiety disorder: Evaluation of an integrative method. Journal of Psychotherapy Integration 2009, 19:67-85.
48. Linden M., Zubraegel D., Baer T., Franke U., Schlattmann P. Efficacy of cognitive behaviour therapy in generalized anxiety disorders. Results of a controlled clinical trial (Berlin CBT-GAD Study). Psychotherapy and Psychosomatics 2005, 74:36-42.
49. Mitte K. A meta-analysis of the efficacy of psycho- and pharmacotherapy in panic disorder with and without agoraphobia. Journal of Affective Disorders 2005, 88:27-45.
50. Mitte K. Meta-analysis of cognitive-behavioral treatments for generalized anxiety disorder: A comparison with pharmacotherapy. Psychological Bulletin 2005, 131:785-795.
51. Mohlman J., Gorenstein E.E., Kleber M., de Jesus M., Gorman J.M., Papp L.A. Standard and enhanced cognitive-behavior therapy for late-life generalized anxiety disorder: Two pilot investigations. American Journal of Geriatric Psychiatry 2003, 11:24-32.
52. Mohr D.C., Spring B., Freedland K.E., Beckner V., Arean P., Hollon S.D., et al. The selection and design of control conditions for randomized controlled trials of psychological interventions. Psychotherapy and Psychosomatics 2009, 78:275-284.
53. Öst L.G. Applied relaxation: Description of a coping technique and review of controlled studies. Behaviour Research and Therapy 1987, 25:379-409.
54. Ost L.G., Breitholtz E. Applied relaxation vs. cognitive therapy in the treatment of generalized anxiety disorder. Behaviour Research and Therapy 2000, 38:777-790.
55. Paxling B., Almlov J., Dahlin M., Carlbring P., Breitholtz E., Eriksson T., et al. Guided Internet-delivered cognitive behavior therapy for generalized anxiety disorder: A randomized controlled trial. Cognitive Behaviour Therapy 2011, 40:159-173.
56. Power K.G., Jerrom D.W.A., Simpson R.J., Mitchell M.J., Swanson V. A controlled comparison of cognitive-behaviour therapy, diazepam and placebo in the management of generalized anxiety. Behavioural Psychotherapy 1989, 17:1-14.
57. Power K.G., Simpson R.J., Swanson V., Wallace L.A., Feistner A.T.C., Sharp D. A controlled comparison of cognitive-behaviour therapy, diazepam, and placebo, alone and in combination, for the treatment of generalised anxiety disorder. Journal of Anxiety Disorders 1990, 4:267-292.
58. Robinson E., Titov N., Andrews G., McIntyre K., Schwencke G., Solley K. Internet treatment for generalized anxiety disorder: A randomized controlled trial comparing clinician vs. technician assistance. PLoS One 2010, 5:e10942.
59. Sarkar P., Rathee S.P., Neera N. Comparative efficacy of pharmacotherapy and bio-feedback among cases of generalised anxiety disorder. Journal of Projective Psychology and Mental Health 1999, 6:69-77.
60. Schoevers R.A., Deeg D.J., van Tilburg W., Beekman A.T. Depression and generalized anxiety disorder: Co-occurrence and longitudinal patterns in elderly patients. American Journal of Geriatric Psychiatry 2005, 13:31-39.
61. Siev J., Chambless D.L. Specificity of treatment effects: Cognitive therapy and relaxation for generalized anxiety and panic disorders. Journal of Consulting and Clinical Psychology 2007, 75:513-522.
62. Stanley M.A., Beck J.G., DeWitt Glassco J. Treatment of generalised anxiety in older adults: A preliminary comparison of cognitive-behavioral and supportive approaches. Behavior Therapy 1996, 27:565-581.
63. Stanley M.A., Beck J.G., Novy D.M., Averill P.M., Swann A.C., Diefenbach G.J., et al. Cognitive-behavioral treatment of late-life generalized anxiety disorder. Journal of Consulting and Clinical Psychology 2003, 71:309-312.
64. Stanley M.A., Hopko D.R., Diefenbach G.J., Bourland S.L., Rodriguez H., Wagener P. Cognitive-behavior therapy for late-life generalized anxiety disorder in primary care: Preliminary findings. American Journal of Geriatric Psychiatry 2003, 11:92-96.
65. Stanley M.A., Wilson N.L., Novy D.M., Rhoades H.M., Wagener P.D., Greisinger A.J., et al. Cognitive behavior therapy for generalized anxiety disorder among older adults in primary care: A randomized clinical trial. Journal of the American Medical Association 2009, 301:1460-1467.
66. Titov N., Andrews G., Johnston L., Robinson E., Spence J. Transdiagnostic Internet treatment for anxiety disorders: A randomized controlled trial. Behaviour Research Therapy 2010, 48:890-899.
67. Titov N., Andrews G., Robinson E., Schwencke G., Johnston L., Sollew K., et al. Clinician-assisted Internet-based treatment is effective for generalized anxiety disorder: Randomized controlled trial. Australian and New Zealand Journal of Psychiatry 2009, 43:905-912.
68. Treanor M., Erisman S.M., Salters-Pedneault K., Roemer L., Orsillo S.M. Acceptance-based behavioral therapy for GAD: Effects on outcomes from three theoretical models. Depression and Anxiety 2011, 28:127-136.
69. Tyrer P., Baldwin D. Generalised anxiety disorder. Lancet 2006, 368:2156-2166.
70. van der Heiden C., Muris P., van der Molen H.T. Randomized controlled trial on the effectiveness of metacognitive therapy and intolerance-of-uncertainty therapy for generalized anxiety disorder. Behaviour Research and Therapy 2012, 50:100-109.
71. Wells A., King P. Metacognitive therapy for generalized anxiety disorder. Journal of Behavior Therapy and Experimental Psychiatry 2006, 37:206-212.
72. Wells A., Welford M., King P., Papageorgiou C., Wisely J., Mendel E. A pilot randomized trial of metacognitive therapy vs applied relaxation in the treatment of adults with generalized anxiety disorder. Behaviour Research and Therapy 2010, 48:429-434.
73. Westen D., 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 2001, 69:875-899.
74. Westra H.A., Arkowitz H., Dozois D.J.A. Adding a motivational interviewing pretreatment to cognitive behavioral therapy for generalized anxiety disorder: A preliminary randomized controlled trial. Journal of Anxiety Disorders 2009, 23:1106-1117.
75. Wetherell J.L., Afari N., Stoddard J.A., Ruberg J., Sorrell J.T., Liu L., et al. Acceptance and commitment therapy for generalized anxiety disorder in older adults: A preliminary report. Behavior Therapy 2011, 42:127-134.
76. Wetherell J.L., Gatz M., Craske M.G. Treatment of generalized anxiety disorder in older adults. Journal of Consulting and Clinical Psychology 2003, 71:31-40.
77. White J., Keenan M., Brooks N. Stress control: A controlled comparative investigation of large group therapy for generalized anxiety disorder. Behavioural Psychotherapy 1992, 20:97-114.
78. Yonkers K.A., Dyck I.R., Warshaw M., Keller M.B. Factors predicting the course of generalised anxiety disorder. British Journal of Psychiatry 2000, 176:544-549.
79. Zinbarg R.E., Lee J.E., Yoon K.L. Dyadic predictors of outcome in a cognitive-behavioral program for patients with generalized anxiety disorder in committed relationships: A "spoonful of sugar" and a dose of non-hostile criticism may help. Behaviour Research and Therapy 2007, 45:699-713.