c) 8 sessions or less vs >8 sessions Adults vs elderly Intervention was a 45page booklet on anxiety management, Contact with research staff was limited to a weekly 5 minute telephone call, with no therapy provided. The following journals will be handsearched for the next update of the review: The short-term psychodynamic treatment carried out in this study may differ in some ways from how it is usually carried out in U.S. studies (11 , 16) . Stanley MA, Federal government websites often end in .gov or .mil. The QRS consists of 23 items, including items on sample size, allocation, use of diagnostic criteria, compliance, attrition and statistical analysis. Short-Term Psychodynamic Psychotherapy and Cognitive Agreements and disagreements with other studies or reviews Treatments were carried out according to treatment manuals and included up to 30 weekly sessions. Zubragel D, Auflage, Die Generalisierte Angststrung im hheren Erwachsenenalter, The Psychological Treatment of Generalized Anxiety Disorder, Effect of Cognitive Behavioral Therapy Versus Interpersonal Psychotherapy in Patients with Major Depressive Disorder, Psychological Treatment of Cooccurring Anxiety Disorders in Clinical Practice: A Vignette Study, Psychodynamic Therapy: As Efficacious as Other Empirically Supported Treatments? Active ST vs nonactive ST The overall QRS mean score for included studies was 24.8 (SD 5.84), ranging from 13 (Woodward 1980) to 36 (Akkerman 2001). J Consult Clin Psychol 2002; 70:288298Google Scholar, 35. Am J Psychiatry 2003; 160:12231232Google Scholar, 3. Individual therapy showed a greater magnitude of effect than group therapy for both outcomes. Ten studies used the Penn State Worry Questionnaire (PSWQ), nine studies used the Beck Anxiety Inventory (BAI) and the Zung Anxiety Inventory (ZAI) was used in eight studies. Comparisons between CBT and supportive therapy show inconsistent differences between approaches. All within-group effect sizes for measures of anxiety and depression were large (0.80) according to Cohen (14) , except for the effect of short-term psychodynamic psychotherapy on the Penn State Worry Questionnaire score at follow-up (d=0.68, Table 3 ). At six month followup, two studies with a total of 67 participants contributed to the anxiety symptom outcome. The results suggest that CBT and short-term psychodynamic psychotherapy are beneficial for patients with generalized anxiety disorder. Studies that compared psychological therapies with TAU/WL were of lower methodological quality (mean QRS score of 24.6) than those comparing CBT with ST (28.3) and CT with BT (26.3). With regard to the severity of anxiety symptoms at baseline, the patients in this study were comparable to those in other treatment studies; for example, pretreatment scores on the HAM-A have ranged from 23.21 to 25.83 (34) and from 21.8 to 26.8 (35) , and scores on the State-Trait Anxiety Inventory have ranged from 57.34 to 58.43 (34) and from 49.8 to 52.2 (35) . Modality of therapies 6, Bulletin of the Menninger Clinic, Vol. d) Adults vs elderly Number of therapy sessions Fresco DM, Frankel AN, Mennin DS, Turk CL, Heimberg RG: Distinct and overlapping features of rumination and worry: the relationship of cognitive production to negative affective states. COMPARISON 01: ALL PSYCHOLOGICAL THERAPIES vs TREATMENT AS USUAL/WAITING LIST Cognitive behavioural therapy Study quality (QRS) No significant difference in attrition rates was indicated between CBT and ST for either adult or elderly participants. The difference in worry symptom mean scores between the Psychological therapies group and the TAU/WL group was highly significant, in favour of psychological therapies (SMD 0.90, 95%CI 1.16 to 0.64). Treatment Options for Generalized Anxiety Disorder Participants and settings COMPARISON 02: COGNITIVE BEHAVIOURAL THERAPY vs PSYCHODYNAMIC THERAPY 8600 Rockville Pike b) Cognitive behavioural therapy versus inactive supportive therapy 4, 20 September 2014 | Psychotherapeut, Vol. Thus, it is possible that more differences between the two treatment conditions exist but that the groups were not large enough to permit detection. It is the first true psychodynamic psychotherapy successfully captured in manual form (16) . Based on thirteen studies, psychological therapies, all using a CBT approach, were more effective than TAU/WL in achieving clinical response at posttreatment (RR 0.64, 95%CI 0.55 to 0.74), and also in reducing anxiety, worry and depression symptoms. The results presented here suggest that the outcome of short-term psychodynamic psychotherapy in generalized anxiety disorder may be further optimized by employing a stronger focus on the process of worrying. Where continuous outcome data were skewed. Generalized anxiety disorder (GAD) has also been treated with ICBT, but there are no controlled trials on guided Internet-based psychodynamic treatment (IPDT). Psychodynamic-Interpersonal Treatment of Generalized Anxiety Patterson TL. For attrition rates, adult patients assigned to psychological therapies were less likely to drop out of studies than patients in the TAU/WL condition, and in contrast, elderly patients attending for psychological therapies were more likely to drop out of studies than patients in TAU/WL, suggesting some ambivalence by the elderly towards attendance for psychological therapy. The most frequently used clinicianrated outcome measure used for anxiety symptoms was the Hamilton Anxiety Scale (HAMA) (13 studies), and the most commonly used selfreport scale was the Trait subscale of the Spielberger StateTrait Inventory (STAIT) (16 studies). This specific difference between the treatments may explain the superiority of CBT on the Penn State Worry Questionnaire and, in part, on the State-Trait Anxiety Inventory measure of trait anxiety; the latter also contains several items related to worrying. So even if the field had agreed on a margin of equivalence, conducting a true equivalence study would require a very large study group, far exceeding the N of 57 in the trial by Leichsenring et al. Mohlman J, Based on five studies (220 participants), the review shows that patients assigned to CT were more likely to show clinical response than patients assigned to BT. 4. Based on 12 studies (330 participants), patients who completed CBT showed a greater reduction in anxiety symptoms at posttreatment than patients in TAU/WL, together with a greater reduction in worry and depression symptoms. Repeated-measures ANOVAs testing for differences between posttherapy and follow-up scores did not reveal significant main effects of time or significant time-by-group interactions (p>0.24). Please note that the current version of this review contravenes Cochrane's commercial sponsorship policy (revised 2014). For studies where the number of participants showing clinical response were not presented in the original articles, but means and standard deviations were reported for continuous symptomatology scales, the number of responders was calculated and imputed from continuous data using a validated statistical method (Furukawa 2005). Melinda Stanley, University of Texas, US The current review adds 12 more recently conducted studies, providing increased statistical power. Method: Patients with generalized anxiety disorder according to DSM-IV were randomly assigned to receive either CBT (N=29) or short-term psychodynamic psychotherapy (N=28). Treatments were carried out according to treatment manuals and included up to 30 weekly sessions. Findings from subgroup analyses were reported in the text where outcome data from at least two studies were available for each subgroup. 30, No. Psychiatr Ann 1995; 25:401403Google Scholar, 8. HHS Vulnerability Disclosure, Help ): Therapie psychischer Erkrankungen, 13. Subgroup analyses Durham 1987, Durham 1994a, Gath 1986, Jannoun 1982. In measures of trait anxiety, worry, and depression, however, CBT was found to be superior. Future randomized, controlled trials comparing the outcome of psychodynamic psychotherapy with results from other active forms of psychotherapy should be carried out with larger study groups. The applied method of short-term psychodynamic psychotherapy was based on Luborskys supportive-expressive therapy (12) , which has been specifically adapted to the treatment of generalized anxiety disorder by Crits-Christoph et al. A significant difference in clinical response was indicated between CBT (46% response) and ST (26% response), in favour of CBT (RR 0.75, 95%CI 0.56 to 1.01) and for anxiety symptoms, a significant difference in effect was shown in favour of CBT compared with ST (SMD 0.49, 95%CI 0.81 to 0.16). 9, 28 March 2015 | Psychotherapy and Psychosomatics, Vol. Since there is preliminary Thirteen studies reported on the mean duration of GAD, which ranged from 30 months (Durham 1994a, Woodward 1980) to 20 years or longer (Ost 2000, Stanley 1996, Wetherell 2003a), demonstrating the striking chronicity of the disorder. Zubraegel D, eCollection 2022. Leichsenring F, Leibing E: The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: a meta-analysis. One study with 36 participants contributed to the outcome of improvement in quality of life at posttreatment. Notably, however, no studies reported whether intregity of blind was tested. Each of the selected sessions was rated blindly by three to eight raters (including U.J., H.K., F. Leweke) with regard to the type of treatment that was applied. Secondary outcomes At posttreatment, six studies, with a total of 235 participants, contributed data to the anxiety symptoms outcome. Allocation: randomised at patient and therapist level method not reported, Selfreport: STAIT, SCL90, FQ, Bouman Depression Inventory (Dutch BDI), Allocation: randomly assigned to treatment condition and to available therapists, 1. In future research, large-scale multicenter studies should examine more subtle differences between treatments, including differences in the patients who benefit most from each form of therapy. Analyses of the completer group yielded no divergent results. et al. Whilst this might suggest that individual therapy is a more popular modality of treatment, reasons for attrition were underreported in many study articles, and therefore it is uncertain to what extent dropout may have occurred because of low acceptability of group therapy. In 23 studies, all participants had a primary diagnosis of GAD. Adverse effects of psychological therapies were notably underreported in studies. All the studies included in the review were described as randomised controlled trials, with randomisation at the patient (n=16) or patient and therapist level (n=9). Psychother Res 1996; 6:8194Google Scholar, 37. Total scores range from 046. The patients were recruited by referrals of psychotherapists and physicians in private practices and by advertisements and information about the study presented in mass media. 170, No. In contrast to short-term psychodynamic psychotherapy, a core element in the applied method of CBT is modification of worrying. 20, No. J Clin Psychiatry. Six studies (seven comparisons), with a total of 332 participants, reported attrition rates at posttreatment. 24, No. The protocol for this review is being rewritten and publication of the new review is scheduled for 2016/17. 1) Clinical response (Graphs 03 01 and 03 08) 2. Nondirective counselling, Clinician rated: Clinical Anxiety Scale (Snaith 1982), SAS, Panic and Problem ratings Self report: HADS, STAIT, St George's Anxiety Questionnaire, Allocation: randomised at patient level using randomisation code patients blind to medication, 1. 11, Chinese Medical Journal, Vol. Studies in which fewer than 80% of participants had a primary diagnosis of GAD were also included in the review if data limited to GAD participants were provided. Averill PM, Novy DM, In the reviews by Gould 1997 and Borkovec 2001, the investigators categorised control conditions into two groups of nondirective/attention placebo/pill placebo and waitlist/no treatment conditions only. Four studies used 8 or less psychological therapy sessions (Jannoun 1982, Lindsay 1987, Stanley 2003, Woodward 1980) and nine studies used more than 8 sessions (Akkerman 2001, Barlow 1992, Butler 1991, Dugas 2003, Gath 1986, Ladouceur 2000, Mohlman 2003a, Mohlman 2003b, Wetherell 2003a). A similar finding was indicated for the worry symptoms outcome, with a nonsignificant difference in effect between psychological therapies and TAU (SMD 0.62, 95%CI 1.50 to 0.27), and a significant difference in favour of psychological therapies when compared with WL, which was of greater magnitude (SMD 0.99, 95%CI 1.30 to 0.69). 4) Improvement in quality of life Diefenbach GJ. As CBT focuses explicitly on changing cognitive processes such as worrying or automatic thoughts, using the Penn State Worry Questionnaire as an outcome measure may tailor outcome measurement specifically to the effects of CBT. This strategy carries risks. Scogin F, The magnitude of treatment effect was similar for the two subgroups. The Diagnosis and Treatment of Generalized Anxiety Disorder 174, No. 1) type of control condition (treatment as usual vs waiting list) Hamilton M: The assessment of anxiety states by rating. As noted earlier, these cognitive aspects are typically addressed by CBT. Burnard P. A Randomised Controlled Trial Comparing an Adult Education Class Using Cognitive Behavioural Therapy ('Stress Control'), Anxiety Management Group Treatment and a Waiting List for Anxiety Disorders, Preliminary evaluation of a broadspectrum cognitivebehavioral group therapy for anxiety, Psychosocial treatment in latelife anxiety, 151st Annual Meeting of the American Psychiatric Association. Comparison 01: All psychological therapies versus treatment as usual/waiting list Anxiety Symptoms Questionnaire (ASQ): development and validation. Eleven studies used waiting list (WL) control as the control condition (Akkerman 2001, Barlow 1992, Butler 1991, Dugas 2003, Gath 1986, Jannoun 1982, Ladouceur 2000, Lindsay 1987, Mohlman 2003a, Mohlman 2003b, Wetherell 2003a). 81, No. 1, Applied and Preventive Psychology, Vol. 84, No. 2011 Aug;56(8):503-8. doi: 10.1177/070674371105600809. In five studies, therapists saw participants in small groups of 47 participants (Akkerman 2001, Dugas 2003, Stanley 1996, Wetherell 2003a, Woodward 1980), and in one study large groups of 2224 participants were used (White 1992). Declaration of competing interest The authors declare that they have no conflict of interest in this study. Please enable it to take advantage of the complete set of features! Continuous data means, SDs and number of participants for each active treatment group were pooled across treatment arms as a function of the number of participants in each arm (Law 2003) to be compared against the control group. Treliving LR, 2) Reduction in depression symptoms (Graph 01 04) Blinding Costa e Silva JA, Tylee A. Mohlman 2004 conducted a narrative review limited to elderly populations. Outcomes were classified as posttreatment, short term followup (up to 6 months posttreatment), medium term followup (712 months posttreatment) and long term (longer than 12 months). 28, No. This site needs JavaScript to work properly. The significance of anxiety symptoms in predicting psychosocial functioning across borderline personality traits. Psychol Med. Selection of studies Therefore, it is not known whether participants received the optimal intensity of therapy specified in treatment manuals, and to what extent low adherence may have impacted upon posttreatment outcomes. Where data become available in future updates of the review, further sensitivity analyses will be conducted, as follows: Within the primary care setting, the WHO collaborative study on Psychological Disorders in Primary Health Care study (Sartorius 1993) reported that GAD formed the second largest category of psychological disorders, with a prevalence of just under 7.9%. This problem is called assay sensitivity (10 , 11) . SF36 Health Survey: Manual and 1993 Interpretation Guide. Ladouceur R, Korff M, For secondary outcomes of reduction in worry and depression at posttreatment, a highly significant difference in effect was shown for individual and group therapy when compared with TAU/WL. Conclusions: Quality rating scores were used for descriptive purposes and to categorise studies into high and low quality, for sensitivity analyses. Rickels K, 34, No. Edited by Nathan PE, Gorman JM. CBT 2. 3, Psychoanalytic Psychotherapy, Vol. 209, No. This is a limitation of our study. Anxiety is a central concept of psychoanalytic and psychodynamic theory and therapy. As described in the Privacy Policy and Terms of Use, this website utilizes cookies, including for the purpose of offering an optimal online experience and services tailored to your preferences. 1) Clinical response (Graph 02 01 and 02 08) The two therapies were not significantly different overall, but CBT appeared superior to supportive-expressive therapy across a number of outcome measures in this trial. No studies contributed data on satisfaction with care/therapy. Edited by Barber JP, Crits-Christoph P. New York, Basic Books, 1995, pp 4383Google Scholar, 14. Further information is provided in the Characteristics of Excluded Studies Table (see . 2, 1 January 2010 | American Journal of Psychiatry, Vol. Psychodynamic Therapy of Anxiety Disorders - The Wiley ), Longterm treatment of anxiety disorders, Psychotherapy for generalized anxiety disorder. Four studies (five comparisons) used active ST (nondirective therapy) as a control condition against CBT (Bond 2002a, Bond 2002b, Borkovec 1987, Borkovec 1993, Stanley 1996). Studies used between two and five arms to conduct comparisons. However, nondirective therapy was regarded as an inactive control comparison in some studies, suggesting potential allegiance towards CBT by those research teams. To meet Diagnostic and Statistical Manual for Mental Disorders (DSMIV) criteria for GAD, anxiety and worry should be accompanied by autonomic hyperactivity (rapid heart rate, shortness of breath, dry mouth and dizziness), increased motor tension (fatigue, restlessness, trembling and muscle tension) and increased vigilance (impaired concentration and feeling tense) (APA 1994). The within-group effect sizes for improvements in anxiety were large (14) and of the same size as those previously reported for CBT (15) . Psychodynamic therapy Of these 14 studies, seven included mixed anxiety disorders, with the proportion of participants diagnosed with GAD comprising less than 80% of the sample (van Boeijen 2005, Svartberg 1998, Barrowclough 2001, Borkovec 1988, Barlow 1984, Kitchiner 2006, Norton 2005), and one recruited students with state anxiety (Hutchings 1980). 12, 12 January 2010 | Journal of the American Psychoanalytic Association, Vol. Federal government websites often end in .gov or .mil. For the primary dichotomous outcome of clinical response, which was not examined in the two previous reviews, findings from this review indicated conflicting direction of effect between studies comparing CT and BT, although the small number of studies for inclusion in this comparison limits meaningful interpretation.