Cognitive behavioral therapy may improve outcomes for anxiety-related disorders compared with control conditions up to 1 year after treatment completion, according to results of a systematic review and meta-analysis published in JAMA Psychiatry. Beyond 1 year, effects vary by specific disorder, researchers noted.
“Anxiety-related disorders are characterized by a chronic course, thus sustainable treatment effects are important,” Eva A. M. van Dis, MSc, of the department of clinical psychology at Utrecht University in the Netherlands, and colleagues wrote. “The results of this meta-analysis suggest that, on average, CBT was associated with moderate symptom reductions in anxiety disorders, PTSD and [obsessive-compulsive disorder] until 12 months after treatment completion. After 12 months, these effects were still present for [generalized anxiety disorder], [social anxiety disorder] and PTSD, but not for [panic disorder with or without agoraphobia].”
According to van Dis and colleagues, meta-analytic evidence on long-term outcomes of CBT on anxiety-related disorders is sparse. In the present study, the researchers compared long-term outcomes of CBT with care as usual, relaxation, psychoeducation, pill placebo, supportive therapy and waiting list for OCD, PTSD and anxiety disorders. They analyzed data from 69 randomized clinical trials that included 4,118 outpatients and at least 1-month follow-up effects of CBT compared with control conditions.
They found that among the included trials — most of which were “of low quality” — CBT compared with control conditions was associated with improved outcomes after treatment completion, as well as at 1 to 6 months and 6 to 12 months for the following:
- generalized anxiety disorder (Hedges g = 0.07-0.4);
- panic disorder (Hedges g = 0.22-0.35);
- social anxiety disorder (Hedges g = 0.34-0.6);
- specific phobia (Hedges g = 0.49-0.72);
- PTSD (Hedges g = 0.59-0.72); and
- OCD (Hedges g = 0.7-0.85).
These associations remained significant after 12-months follow-up for generalized anxiety disorder, social anxiety disorder and PTSD, but not for panic disorder. Associations could not be calculated for specific phobia and OCD, according to the researchers. Among six randomized clinical trials, relapse rates after 3 to 12 months were 0% to 14% — predominantly for panic disorder.
“More high-quality randomized clinical trials on long-term treatment effects (preferably beyond 12 months after treatment completion) and relapse are warranted to facilitate more reliable long-term effect size estimations,” the researchers wrote. – by Joe Gramigna
Disclosures: The authors report no relevant financial disclosures.