The Food and Drug Administration (13) has made it clear: In order to implement an equivalence or non-inferiority trial, the magnitude of [medication] effect must be stable and well-established in the literature, with consistent results seen from one trial to the next ( 12 , p. 32). 1, 12 July 2010 | Clinical Case Studies, Vol. Psychological therapies used in UK primary care practice remain predominantly Rogerian, psychodynamic and integrative in theoretical framework (Stiles 2006). Four studies used more than eight sessions to conduct CBT and ST (Borkovec 1987, Borkovec 1993, Linden 2002, Wetherell 2003b). Based on six studies (332 participants), using best/worst case scenario analysis, the review provides inconclusive evidence that patients assigned to CBT were more likely to achieve clinical response than those assigned to supportive therapy (ST). 30, No. Leichsenring, Salzer, and Leibing Reply, Novel approaches to treatment of generalized anxiety disorder, Prior Treatment and Its Effect on Outcome, Evidence-Based Psychodynamic Psychotherapy, Psychodynamic Psychotherapy Outcome for Generalized Anxiety Disorder. Consideration of publication bias Measures used to assess depression symptoms comprised the HAMD (one study), BDI (nine studies) and depression subscale of GHQ28 (one study). London, Hogarth Press, 1955, pp 157168Google Scholar, 25. For studies comparing different psychological therapy categories, it was planned to examine the process of psychological therapy, using validated measures of the therapist/client relationship, such as the Relationship Inventory (BarrettLennard 1986). As noted earlier, these cognitive aspects are typically addressed by CBT. 27, No. Five studies contributed data to Comparison 04 (Arntz 2003, Barlow 1992, Durham 1987, Durham 1994a, Ost 2000). However, in future updates of the review, additional head to head comparisons are planned for CBT versus CT, CBT versus BT, CBT/CT versus BT and CBT/BT versus CT. (11) reported significant improvements for patients with generalized anxiety disorder after treatment. Gorenstein EE, PMC Arch Gen Psychiatry 2005; 62:593602Google Scholar, 3. In 23 studies, all participants had a primary diagnosis of GAD. Enter your email address below and we will send you the reset instructions, If the address matches an existing account you will receive an email with instructions to reset your password, Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. After providing their informed consent, the patients were randomly allocated to the two treatment groups. Agegroup = Child, CCDANCTRReferences Thompson SG, Group cognitivebehavioral therapy for generalized anxiety disorder: treatment outcome and longterm followup, Cognitive therapy vs behaviour therapy in the treatment of chronic general anxiety, On predicting improvement and relapse in generalized anxiety disorder following psychotherapy. 34, No. More studies should be carried out to establish whether psychodynamic and supportive therapies are effective for GAD, and whether CBT is more helpful than other psychological therapy approaches in treating GAD. Eighteen studies (72%) employed assessors who were blind to treatment allocation (Akkerman 2001,Barlow 1992, Blowers 1987, Bond 2002a, Borkovec 1987, Borkovec 1993, Dugas 2003. 2014 Jul 1;(7):CD004687. 5. 2010 Jan;167(1):103-4; author reply 104-5. doi: 10.1176/appi.ajp.2009.09091264. Primary outcome The psychological intervention was limited to bibliotherapy ('Stresspac'), and the facetoface intervention ('Advice Only') did not include a psychological component. For this study, the treatment manual by Crits-Christoph et al. Measures used to assess improvement in social functioning comprised the social functioning subscale of the SF36 (two studies) and the extraversion subscale of the Eysenck Personality Inventory. The current review adds 12 more recently conducted studies, providing increased statistical power. The aim of this study was to compare short-term psychodynamic psychotherapy and CBT with regard to treatment outcome in generalized anxiety disorder. For the primary outcome of clinical response and anxiety symptoms at posttreatment, a highly significant difference in effect was shown for both individual and group therapy when compared with TAU/WL, and the effect was of similar magnitude for each modality. sharing sensitive information, make sure youre on a federal Clipboard, Search History, and several other advanced features are temporarily unavailable. Thorp SR, Gamsu CV, 30th May 4th June, The effects of common and specific factors in shortterm anxietyprovoking psychotherapy: a pilot processoutcome study. 2019 Dec 18;32(6):e100144. Six studies (seven comparisons), with a total of 332 participants, reported attrition rates at posttreatment. Furukawa TA, Clinical response rates were increased in both the CT group (54%) and the ST group (41%). b) Satisfaction with care/therapy Integrative therapy (short-term psychodynamic psychotherapy The site is secure. 170, No. Control comparators Only one study (Linden 2002) reported using a power calculation to identify the required sample size prior to recruitment. In contrast, this review stratified control comparators, and investigated this as a potential source of heterogeneity. doi: 10.1136/gpsych-2019-100144. CBT+placebo 3. The primary outcome was reduction in anxiety, which was measured in the following two ways: Washington, DC, FDA, May 2001Google Scholar, 14. Using the BDI to measure depression symptoms at posttreatment, with a total of 64 participants, a highly significant difference in mean scores was indicated between the high/low contact CT groups and the high/low contact AP groups, in favour of CT (WMD 8.37, 95%CI 12.55 to 4.20). In one further study, dropouts (n=3) were replaced (Blowers 1987). The magnitude of effect for reduction of worry was similar for the two groups, but adults showed a higher magnitude of effect for reduction in depression than the elderly. Denney DR, Dr. Falk Leichsenring and his colleagues report the results of a methodologically rigorous randomized, controlled trial of supportive-expressive psychodynamic psychotherapy and cognitive-behavioral therapy (CBT) for generalized anxiety disorder in this issue of the Journal(1) . For the primary outcome of clinical response and anxiety symptoms, a significant difference in effect was shown for8 or less sessions and more than 8 sessions when compared with TAU/WL, and the magnitude of effect was similar for both levels of contact. Salzer S, Pincus AL, Hoyer J, Kreische R, Leichsenring F, Leibing E: Interpersonal subtypes within generalized anxiety disorder. Leichsenring F, Rabung S, Leibing E: The efficacy of short-term psychodynamic psychotherapy in specific psychiatric disorders: a meta-analysis. In contrast to the CBT practitioners, for example, the therapists applying short-term psychodynamic psychotherapy were not specifically trained in their treatment model. The review provides a moderate body of evidence on psychological therapies underpinned by CBT principles. Prior treatment and its effect on outcome. Davidson JR, Objective: While several studies have shown that cognitive-behavioral therapy (CBT) is an efficacious treatment for generalized anxiety disorder, few studies have addressed the 166, No. What do these reflections imply about the efficacy of psychodynamic psychotherapy for generalized anxiety disorder? Statistical heterogeneity was no longer indicated, and a fixed effects model was used. Three studies, with a total of 69 participants, contributed to the outcome of improvement in social functioning at posttreatment. 3) number of psychological therapy sessions (up to and including 8 sessions vs more than 8 sessions) An additional quality assessment was performed using the Cochrane Collaboration Depression and Anxiety Group Quality Rating Scale (QRS) (Moncrieff 2001). Brief therapy models have been devised by Malan 1963, Balint 1972 and Mann 1973. For attrition rates, a nonsignificant difference in effect was found for eight sessions or less and more than 8 sessions of CBT compared with ST, and the magnitude of attrition was similar for each subgroup. Before Leibing E, Winkelbach C, Leichsenring F: Die Generalisierte Angststrung: Darstellung eines kognitiv-behavioralen Behandlungsmanuals [Generalized anxiety disorder: a cognitive-behavioral treatment manual]. Does experimental research support psychoanalysis? The fixed effects model was used for all outcomes unless otherwise stated in the text. Generalized anxiety disorder (GAD) has also been treated with ICBT, but there are no controlled trials on guided Internet-based psychodynamic treatment (IPDT). The control comparison included treatment as usual (TAU) (also called standard care, usual care or no treatment) and waiting list (WL). The difference in response rates between the two groups remained nonsignificant (RR 0.79, 95%CI 0.59 to 1.06). Methodological quality was assessed according to the criteria set out in the Cochrane Handbook (Clarke 2002), based on evidence of a strong relationship between allocation concealment and potential for bias in the results (Schulz 1995). Costeffectiveness outcomes (days of work absence/ability to return to work, number of appointments with primary care physician, number of referrals to secondary services, use of additional treatments, hospitalisation for mental or physical health problems). These subtypes do not differ in levels of symptom severity or comorbid diagnoses, but they exhibit differences in the improvement of interpersonal problems (unpublished data). Tarrier N. A randomized trial of the effectiveness of cognitivebheavioral therapy and supportive counseling for anxiety symptoms in older adults, Treatment of nonphobic anxiety disorders: a comparison of nondirective, cognitive and copying desensitization therapy. Psychotherapy for generalized anxiety disorder. In one study the CBT arm was manualised, but the BT arm was described as standardised and the analytic arm was nonmanualised (Durham 1994a). No studies reported on costeffectiveness outcomes. J Clin Psychol 2008; 64:119126Google Scholar, 21. 2011 Aug;56(8):503-8. doi: 10.1177/070674371105600809. 1) Clinical response (Graph 01 01) Treatment acceptability, measured in the following ways: 28, No. Comparison 3 Cognitive behavioural therapy vs Supportive therapy, Outcome 4 Reduction in depression symptoms at posttreatment. Scrutiny of reference lists of all included and excluded studies resulted in the identification of three additional trials for possible inclusion in the review. Comparison 4 Cognitive therapy vs Behavioural therapy, Outcome 4 Reduction in depression symptoms at posttreatment. In psychodynamic psychotherapy, worrying can be conceptualized as a mechanism of defense that protects the subject from fantasies or feelings that are even more threatening than the contents of his or her worries (36) . 56, No. It was planned not to use trials with skewed data, in which the standard deviation, when multiplied by 2, was higher than the mean (Altman 1996). 5, Psychology and Psychotherapy: Theory, Research and Practice, Vol. This review supports these conclusions, and provides increased statistical power to demonstrate a consistent effect in favour of CBT for reduction in depression symptoms at posttreatment, compared with TAU/WL, psychodynamic therapy and nondirective therapy. Clinicianrated: GAD section of SCID Selfreport: PSWQ, BAI, BDI, QOL Inventory, SF36, CSQ, Expectancy Rating Scale. No data were provided for adverse effects. Epub 2016 Jan 11. The measure used to assess improvement in quality of life comprised the SF36. However, despite an exhaustive search of the literature, no trials examining the effectiveness of other psychological therapy models against no treatment control conditions were identified, and very few comparative studies between psychological therapy models were located. c) 8 sessions or less vs >8 sessions There was a lack of available evidence for the longerterm effectiveness of CBT in treating GAD. The mean attrition rate from included studies between baseline and posttreatment assessment was 15.6%. The authors acknowledged that some of the findings of their review were influenced by limitations of statistical power for some comparisons. The specificity of pathological worry in generalized anxiety disorder has been questioned by several authors (37) . Edited by Nathan PE, Gorman JM. Within a positive therapeutic alliance, it is recommended that therapists encourage new behaviors, including approaching feared situations, which is consistent with Freuds recommendations (24) for the treatment of phobia. All interviews were carried out by an experienced and trained masters-degree-level clinical psychologist (C.W.). 2) Reduction in anxiety symptoms (Graphs 04 02, 04 09 and 04 10) In the general population, the lifetime prevalence of GAD is 5.1%, with a 12month prevalence measured at 3.1% (Kessler 1994). Blinding of participants was not achievable in studies where psychological therapy was compared against treatment as usual/waiting list, and was probably not achievable in comparative studies of psychological therapy approaches, given that clients attending for CBT are encouraged to access appropriate reading material on CBT methods. 2022 Jul 28;13:832167. doi: 10.3389/fpsyt.2022.832167. 17, No. Other potential sources of bias Internet-based psychodynamic versus cognitive behavioral Heterogeneity was nonsignificant in both subgroups. 2. Lipscomb P, and Leichsenring F, Salzer S, Beutel ME, Herpertz S, Hiller W, Hoyer J, Huesing J, Joraschky P, Nolting B, Poehlmann K, Ritter V, Stangier U, Strauss B, Stuhldreher N, Tefikow S, Teismann T, Willutzki U, Wiltink J, Leibing E. Am J Psychiatry. 4) age (adult vs elderly population) Further information is provided in the Characteristics of Excluded Studies Table (see . Fennell M, Based on thirteen studies, psychological therapies, all using a CBT approach, were more effective than TAU/WL in achieving clinical response at post-treatment (RR 0.63, 95%CI 0.55 to 0.73), and also in reducing anxiety, worry and depression symptoms. Crits-Christoph P, Wolf-Palacio D, Ficher M, Rudick D: Brief supportive-expressive psychodynamic therapy for generalized anxiety disorder, in Dynamic Therapies for Psychiatric Disorders (Axis I). Durham RC, In that study, however, the two treatments were not equally carefully implemented. However, psychological therapies comprising couples therapy and family therapy were excluded, because these therapies work with patterns and dynamics of relating within and between systems, rather than focusing on the individual. Male and female adults, aged between 1875 years, treated in a primary, secondary or community setting, were eligible for inclusion. Control comparators In two studies (Borkovec 1987, Borkovec 1993), a process measure of relaxationinduced anxiety was completed after each session by participants receiving a psychological therapy that included applied relaxation. 64, No. This achievement made it possible to conduct much of the psychodynamic psychotherapy outcome research that has been performed thus far (17 19) , including promising studies of generalized anxiety disorder (17 , 20) . Hamilton M: The assessment of anxiety states by rating. 2001;62 Suppl 11:37-42; discussion 43-5. Chambless DL, Gillis MM: Cognitive therapy of anxiety disorders. As shown in several studies and meta-analyses (4 7) , cognitive behavior therapy (CBT) is an efficacious and specific treatment for generalized anxiety disorder, according to the definition of efficacy by Chambless and Hollon (8) . Brambilla P, Six studies compared CBT against supportive therapy (nondirective therapy and attentionplacebo conditions). McGonagle KA, 4, 12 July 2010 | Clinical Case Studies, Vol. One study currently in progress is evaluating an interpersonal and emotional processing therapy approach as an additional component to CBT in treating GAD (Borkovec 2003), and it is hoped to include the findings in a future update of this review. Secondary outcomes Five studies offered booster sessions once initial therapy had been completed. Heterogeneity was no longer indicated, and several other advanced features are temporarily.! Psychology and psychotherapy: Theory, Research and practice, Vol adults, aged between years... Size prior to recruitment excluded studies resulted in the identification of three additional trials for possible in... Scholar, 25 disorder has been questioned by several authors ( 37 ) specifically in... And CBT with regard to treatment outcome in generalized anxiety disorder Supportive therapy ( nondirective therapy and attentionplacebo )! 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