Group cognitive-behavioral therapy for generalized anxiety disorder: treatment outcome and long-term follow-up. Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: evaluation in a randomized controlled trial. Guided Internet-Delivered Cognitive Behavior Therapy for Generalized Anxiety Disorder: A Randomized Controlled Trial A randomized controlled trial of guided internet-delivered cognitive behaviour therapy for older adults with generalized anxiety. The diagnosis and treatment of generalized anxiety disorder. Mindfulness-based cognitive therapy v. group psychoeducation for people with generalised anxiety disorder: randomised controlled trial. A component analysis of cognitive-behavioral therapy for generalized anxiety disorder and the role of interpersonal problems. Efficacy of a cognitive-behavioral treatment for generalized anxiety disorder: evaluation in a controlled clinical trial. A randomized clinical trial of cognitive-behavioral therapy and applied relaxation for adults with generalized anxiety disorder. Virtual reality in the treatment of generalized anxiety disorders. Transdiagnostic versus disorder-specific and clinician-guided versus self-guided internet-delivered treatment for generalized anxiety disorder and comorbid disorders: A randomized controlled trial. Cognitive behavior therapy for generalized anxiety disorder among older adults in primary care: a randomized clinical trial. Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. Protocol for a randomised controlled trial investigating the effectiveness of an online e-health application compared to attention placebo or sertraline in the treatment of generalised anxiety disorder A randomized controlled trial of cognitive-behavioral therapy for generalized anxiety disorder with integrated techniques from emotion-focused and interpersonal therapies. Internet cognitive behavioural therapy for mixed anxiety and depression: a randomized controlled trial and evidence of effectiveness in primary care. Internet-Based Psychodynamic versus Cognitive Behavioral Guided Self-Help for Generalized Anxiety Disorder: A Randomized Controlled Trial
A recently developed cognitive-behavioral treatment for  generalized anxiety disorder  ( GAD ) targets intolerance of uncertainty by the reevaluation of positive beliefs about worry , problem-solving training , and cognitive exposure . As previous studies have established the treatment 's efficacy when delivered individually , the present study tests the treatment in a group format as a way to enhance its cost-benefit ratio . A total of 52 GAD patients received 14 sessions of cognitive-behavioral therapy in small groups of 4 to 6 participants . A wait-list control design was used , and st and ardized clinician ratings and self-report question naires assessed GAD symptoms , intolerance of uncertainty , anxiety , depression , and social adjustment . Results show that the treatment group , relative to the wait-list group , had greater posttest improvement on all dependent variables and that treated participants made further gains over the 2-year follow-up phase of the study Generalized anxiety disorder ( GAD ) is a chronic anxiety disorder , associated with comorbidity and impairment in quality of life , for which improved psychosocial treatments are needed . GAD is also associated with reactivity to and avoidance of internal experiences . The current study examined the efficacy of an acceptance-based behavioral therapy aim ed at increasing acceptance of internal experiences and encouraging action in valued domains for GAD . Clients were r and omly assigned to immediate ( n = 15 ) or delayed ( n = 16 ) treatment .  Acceptance-based behavior therapy led to statistically significant reductions in clinician-rated and self-reported GAD symptoms that were maintained at 3- and 9-month follow-up assessment s ; significant reductions in depressive symptoms were also observed . At posttreatment assessment 78 % of treated participants no longer met criteria for GAD and 77 % achieved high end-state functioning ; these proportions stayed constant or increased over time . As predicted , treatment was associated with decreases in experiential avoidance and increases in mindfulness Generalized anxiety disorder ( GAD ) has been effectively treated with cognitive behavioural therapy ( CBT ) in face-to face setting s. Internet-delivered CBT could be a way to increase the accessibility and affordability of CBT for people suffering from GAD . The aim of this study was to evaluate the efficacy of guided Internet-delivered CBT for GAD in a controlled trial with a wait-list control group . A total of 89 participants were included following online screening and a structured psychiatric telephone interview . Participants were r and omized to either an 8-week treatment group ( n = 44 ) or a wait-list control group ( n = 45 ) . Treatment consisted of a self-help program based on CBT principles and applied relaxation along with therapist guidance . The main outcome measure was the Penn State Worry Question naire . Ratings of clinical improvement and symptoms were included as well as secondary outcome measures dealing with anxiety , depression , and quality of life . Among the treatment group participants , 13.6 % did not complete the posttreatment measures . The treatment group showed significant improvement compared with the control group on all outcome measures . Large effect sizes ( Cohen 's d>0.8 ) were found both within the treatment group and between the groups in favor of the treatment on all outcome measures except on a measure of quality of life . Results at 1- and 3-year follow-up indicated that treatment results improved or were maintained . The authors conclude that Internet-delivered CBT with therapist support can reduce symptoms and problems related to GAD This study aim ed to establish the efficacy of guided Internet-delivered cognitive-behaviour therapy ( ICBT ) for older adults with generalized anxiety disorder ( GAD ) or sub clinical GAD . Participants were r and omized to receive seven modules of ICBT ( n=24 ) or to a waiting list condition ( WLC ; n=22 ) . Faster improvements in symptoms of anxiety and depression were observed for participants in the ICBT condition relative to the WLC , with large between-group effect sizes on the Generalized anxiety disorder-7 ( d=.85 ) and the Patient health question naire ( d=1.17 ) obtained at post-treatment . Further reduction in generalized anxiety symptoms was reported over the one-month follow-up . Treatment effects were replicated when control participants subsequently underwent treatment . Higher ratings of treatment credibility , but not expectancy , prior to ICBT predicted improvements over time . The results support the efficacy of ICBT as treatment for older adults with GAD BACKGROUND Generalized anxiety disorder  ( GAD ) is a common and serious disease with a lifetime prevalence of 4.3 % to 5.9 % . It is underdiagnosed in primary care . METHODS Recommendations on the treatment of GAD are given on the basis of all available findings from pertinent r and omized trials , retrieved by a selective search of the literature . RESULTS Among psychotherapeutic techniques , various kinds of cognitive behavioral therapy ( CBT ) have been found useful in controlled trials . The drugs of first choice include selective serotonin reuptake inhibitors ( SSRIs ) , serotonin-norepinephine reuptake inhibitors ( SNRIs ) , and the calcium-channel modulator pregabalin . Tricyclic antidepressants are also effective but have more adverse effects than SSRIs . Although benzodiazepines are effective anxiolytic agents for short-term use , they should not be given over the long term because of the danger of addiction . Buspirone , an azapirone , was found to be effective in a small number of trials , but the findings across trials are inconsistent . The response rate of GAD to CBT in published studies lies between 47 % and 75 % , while its response rate to drug treatment lies between 44 % and 81 % . CONCLUSION The treatment of GAD with CBT and drugs is evidence -based and has a good chance of improving the manifestations of the disorder BACKGROUND Research suggests that an 8-week mindfulness-based cognitive therapy ( MBCT ) course may be effective for generalised anxiety disorder ( GAD ) . AIMS To compare changes in anxiety levels among participants with GAD r and omly assigned to MBCT , cognitive-behavioural therapy-based psychoeducation and usual care . METHOD In total , 182 participants with GAD were recruited ( trial registration number : CUHK_CCT00267 ) and assigned to the three groups and followed for 5 months after baseline assessment with the two intervention groups followed for an additional 6 months . Primary outcomes were anxiety and worry levels . RESULTS Linear mixed models demonstrated significant group × time interaction ( F(4,148 ) = 5.10 , P = 0.001 ) effects for decreased anxiety for both the intervention groups relative to usual care . Significant group × time interaction effects were observed for worry and depressive symptoms and mental health-related quality of life for the psychoeducation group only . CONCLUSIONS These results suggest that both of the interventions appear to be superior to usual care for the reduction of anxiety symptoms Clients with generalized anxiety disorder ( GAD ) received either ( a ) applied relaxation and self-control desensitization , ( b ) cognitive therapy , or ( c ) a combination of these methods . Treatment result ed in significant improvement in anxiety and depression that was maintained for 2 years . The large majority no longer met diagnostic criteria ; a minority sought further treatment during follow-up . No differences in outcome were found between conditions ; review of the GAD therapy literature suggested that this may have been due to strong effects generated by each component condition . Finally , interpersonal difficulties remaining at posttherapy , measured by the Inventory of Interpersonal Problems Circumplex Scales ( L. E. Alden , J. S. Wiggins , & A. L. Pincus , 1990 ) in a subset of clients , were negatively associated with posttherapy and follow-up improvement , suggesting the possible utility of adding interpersonal treatment to cognitive-behavioral therapy to increase therapeutic effectiveness Recent advances in the underst and ing of worry have led to the development of treatments for generalized anxiety disorder ( GAD ) . The present study tested a GAD treatment that targeted intolerance of uncertainty , erroneous beliefs about worry , poor problem orientation , and cognitive avoidance . Twenty-six primary GAD patients were r and omly allocated to a treatment condition ( n = 14 ) or a delayed treatment control condition ( n = 12 ) . Self-report , clinician , and significant other ratings assessed GAD and associated symptoms . The results show that the treatment led to statistically and clinical ly significant change at posttest and that gains were maintained at 6- and 12-month follow-ups . Furthermore , 20 of 26 participants ( 77 % ) no longer met GAD diagnostic criteria following treatment . With regard to the treatment 's underlying model , the results show that intolerance of uncertainty significantly decreased over treatment and that gains were maintained at both follow-ups . Although nonspecific factors were not significant predictors of treatment outcome , their role in the treatment of GAD requires further investigation This r and omized clinical trial compared cognitive-behavioral therapy ( CBT ) , applied relaxation ( AR ) , and wait-list control ( WL ) in a sample of 65 adults with a primary diagnosis of generalized anxiety disorder ( GAD ) . The CBT condition was based on the intolerance of uncertainty model of GAD , whereas the AR condition was based on general theories of anxiety . Both manualized treatments were administered over 12 weekly 1-hour sessions . St and ardized clinician ratings and self-report question naires were used to assess GAD and related symptoms at pretest , posttest , and at 6- , 12- , and 24-month follow-ups . At posttest , CBT was clearly superior to WL , AR was marginally superior to WL , and CBT was marginally superior to AR . Over follow-up , CBT and AR were equivalent , but only CBT led to continued improvement . Thus , direct comparisons of CBT and AR indicated that the treatments were comparable ; however , comparisons of each treatment with another point of reference ( either waiting list or no change over follow-up ) provided greater support for the efficacy of CBT than AR Generalized anxiety disorder ( GAD ) is a common anxiety disorder characterized by 6 months of " excessive anxiety and worry " about a variety of events and situations . Anxiety and worry are often accompanied by additional symptoms like restlessness , being easily fatigued , difficulty concentrating , irritability , muscle tension and disturbed sleep . GAD is usually treated with medications and /or psychotherapy . In particular , the two most promising treatments seem to be cognitive therapy and applied relaxation . In this study we integrated these approaches through the use of a biofeedback enhanced virtual reality ( VR ) system used both for relaxation and controlled exposure . Moreover , this experience is strengthened by the use of a mobile phone that allows patients to perform the virtual experience even in an outpatient setting . This paper describe the results of a controlled trial ( NCT00602212 ) involving 20 GAD patients r and omly assigned to the following groups :  ( 1 ) the VR and Mobile group ( VRMB ) including biofeedback ; ( 2 ) the VR and Mobile group ( VRM ) without biofeedback ; ( 3 ) the waiting list ( WL ) group . The clinical data underlined that ( a ) VR can be used also in the treatment of GAD ; ( b ) in a VR treatment , patients take advantage of a mobile device that delivers in an outpatient setting guided experiences , similar to the one experienced in VR Generalized anxiety disorder ( GAD ) can be treated effectively with either disorder-specific cognitive behavior therapy ( DS-CBT ) or transdiagnostic CBT ( TD-CBT ) . The relative benefits of DS-CBT and TD-CBT for GAD and the relative benefits of delivering treatment in clinician guided ( CG-CBT ) and self-guided ( SG-CBT ) formats have not been examined . Participants with GAD ( n=338 ) were r and omly allocated to receive an internet-delivered TD-CBT or DS-CBT intervention delivered in either CG-CBT or SG-CBT formats . Large reductions in symptoms of GAD ( Cohen 's d ≥ 1.48 ; avg . reduction ≥ 50 % ) and comorbid major depressive disorder ( Cohen 's d ≥ 1.64 ; avg . reduction ≥ 45 % ) , social anxiety disorder ( Cohen 's d ≥ 0.80 ; avg . reduction ≥ 29 % ) and panic disorder ( Cohen 's d ≥ 0.55 ; avg . reduction ≥ 33 % ) were found across the conditions . No substantive differences were observed between DS-CBT and TD-CBT or CG-CBT and SG-CBT , highlighting the public health potential of carefully developed TD-CBT and SG-CBT CONTEXT Cognitive behavior therapy ( CBT ) can be effective for  late-life generalized anxiety disorder ( GAD )  , but only pilot studies have been conducted in primary care , where older adults most often seek treatment . OBJECTIVE To examine effects of CBT relative to enhanced usual care ( EUC ) in older adults with GAD in primary care . DESIGN , SETTING , AND PARTICIPANTS R and omized clinical trial recruiting 134 older adults ( mean age , 66.9 years ) from March 2004 to August 2006 in 2 primary care setting s. Treatment was provided for 3 months ; assessment s were conducted at baseline , posttreatment ( 3 months ) , and over 12 months of follow-up , with assessment s at 6 , 9 , 12 , and 15 months . INTERVENTION Cognitive behavior therapy ( n = 70 ) conducted in the primary care clinics . Treatment included education and awareness , motivational interviewing , relaxation training , cognitive therapy , exposure , problem-solving skills training , and behavioral sleep management . Patients assigned to receive EUC ( n = 64 ) received biweekly telephone calls to ensure patient safety and provide minimal support . MAIN OUTCOME MEASURES Primary outcomes included worry severity ( Penn State Worry Question naire ) and GAD severity ( GAD Severity Scale ) . Secondary outcomes included anxiety ratings ( Hamilton Anxiety Rating Scale , Beck Anxiety Inventory ) , coexistent depressive symptoms ( Beck Depression Inventory II ) , and physical/mental health quality of life ( 12-Item Short Form Health Survey ) . RESULTS Cognitive behavior therapy compared with EUC significantly improved worry severity ( 45.6 [ 95 % confidence interval { CI } , 43.4 - 47.8 ] vs 54.4 [ 95 % CI , 51.4 - 57.3 ] , respectively ; P < .001 ) , depressive symptoms ( 10.2 [ 95 % CI , 8.5 - 11.9 ] vs 12.8 [ 95 % CI , 10.5 - 15.1 ] , P = .02 ) , and general mental health ( 49.6 [ 95 % CI , 47.4 - 51.8 ] vs 45.3 [ 95 % CI , 42.6 - 47.9 ] , P = .008 ) . There was no difference in GAD severity in patients receiving CBT vs those receiving EUC ( 8.6 [ 95 % CI , 7.7 - 9.5 ] vs 9.9 [ 95 % CI , 8.7 - 11.1 ] , P = .19 ) . In intention-to-treat analyses , response rates defined according to worry severity were higher following CBT compared with EUC at 3 months ( 40.0 % [ 28/70 ] vs 21.9 % [ 14/64 ] , P = .02 ) . CONCLUSIONS Compared with EUC , CBT result ed in greater improvement in worry severity , depressive symptoms , and general mental health for older patients with GAD in primary care . However , a measure of GAD severity did not indicate greater improvement with CBT . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00308724 Nondirective ( ND ) , applied relaxation ( AR ) , and cognitive behavioral ( CBT ) therapies for generalized anxiety disorder ( GAD ) were compared . The latter 2 conditions were generally equivalent in outcome but superior to ND at post assessment . The 3 conditions did not differ on several process measures , and ND created the greatest depth of emotional processing . Follow-up results indicated losses in gains in ND , maintained gains in the other 2 conditions , especially CBT , and highest endstate functioning for CBT . AR and CBT thus contain active ingredients in the treatment of GAD ; support exists for further development of imagery exposure methods or cognitive therapy because of their likely role in promoting maintenance of change with this disorder . Expectancy for improvement was also associated with outcome , suggesting the need for further research on this construct for underst and ing the nature of GAD and its amelioration Background Generalised anxiety disorder ( GAD ) is a high prevalence , chronic psychiatric disorder which commonly presents early in the lifespan . Internet e-health applications have been found to be successful in reducing symptoms of anxiety and stress for post traumatic stress disorder ( PTSD ) , panic disorder , social phobia and depression . However , to date , there is little evidence for the effectiveness of e-health applications in adult GAD . There are no studies which have directly compared e-health applications with recognised evidence -based medication . This study aims to determine the effectiveness of a  web-based program for treating GAD relative to sertraline and attention placebo . Methods / Design 120 community-dwelling participants , aged 18 - 30 years with a clinical diagnosis of GAD will be recruited from the Australian Electoral Roll . They will be r and omly allocated to one of three conditions : ( i ) an online treatment program for GAD , E-couch ( ii ) pharmacological treatment with a selective serotonin re-uptake inhibitor ( SSRI ) , sertraline ( a fixed-flexible dose of 25 - 100 mg/day ) or ( iii ) an attention control placebo , HealthWatch . The treatment program will be completed over a 10 week period with a 12 month follow-up . Discussion As of February 2010 , there were no registered trials evaluating the effectiveness of an e-health application for GAD for young adults . Similarly to date , this will be the first trial to compare an e-health intervention with a pharmacological treatment . Trial Registration Current Controlled Trials IS RCT OBJECTIVE Recent models suggest that generalized anxiety disorder ( GAD ) symptoms may be maintained by emotional processing avoidance and interpersonal problems . METHOD This is the first r and omized controlled trial to test directly whether cognitive-behavioral therapy ( CBT ) could be augmented with the addition of a module targeting interpersonal problems and emotional processing . Eighty-three primarily White participants ( mean age = 37 ) with a principle diagnosis of GAD were recruited from the community . Participants were assigned r and omly to CBT plus supportive listening ( n = 40 ) or to CBT plus interpersonal and emotional processing therapy ( n = 43 ) within a study using an additive design . Doctoral-level psychologists with full-time private practice s treated participants in an outpatient clinic . Using blind assessors , participants were assessed at pretreatment , posttreatment , 6-month , 1-year , and 2-year follow-up with a composite of self-report and assessor-rated GAD symptom measures ( the Penn State Worry Question naire ; T. J. Meyer , M. L. Miller , R. L. Metzger , & T. D. Borkovec , 1990 ; Hamilton Anxiety Rating Scale ; M. Hamilton , 1959 ; assessor severity rating ; State-Trait Anxiety Inventory-Trait Version ; C. D. Spielberger , R. L. Gorsuch , R. Lushene , P. R. Vagg , & G. A. Jacobs , 1983 ) as well as with indices of clinical ly significant change . RESULTS Mixed models analysis of all r and omized participants showed very large within-treatment effect sizes for both treatments ( CI = [ -.40 , -.28 ] , d = 1.86 ) with no significant differences at post ( CI = [ -.09 , .07 ] , d = .07 ) or 2-year follow-up ( CI = [ -.01 , .01 ] ) , d = .12 ) . There was also no statistical difference between compared treatments on clinical ly significant change based on chi-square analysis . CONCLUSIONS Interpersonal and emotional processing techniques may not augment CBT for all GAD participants . Trial Registry name : Clinical Trials.gov , Identifier : NCT00951652 BACKGROUND Major depressive disorder ( MDD ) and generalized anxiety disorder ( GAD ) have the highest co-morbidity rates within the internalizing disorders cluster , yet no Internet-based cognitive behavioural therapy ( iCBT ) programme exists for their combined treatment . METHOD We design ed a six-lesson therapist-assisted iCBT programme for mixed anxiety and depression . Study 1 was a r and omized controlled trial ( RCT ) comparing the iCBT programme ( n = 46 ) versus wait-list control ( WLC ; n = 53 ) for patients diagnosed by structured clinical interview with MDD , GAD or co-morbid GAD/MDD . Primary outcome measures were the Patient Health Question naire nine-item scale ( depression ) , Generalized Anxiety Disorder seven-item scale ( generalized anxiety ) , Kessler 10-item Psychological Distress scale ( distress ) and 12-item World Health Organization Disability Assessment Schedule II ( disability ) . The iCBT group was followed up at 3 months post-treatment . In study 2 , we investigated the adherence to , and efficacy of the same programme in a primary care setting , where patients ( n = 136 ) completed the programme under the supervision of primary care clinicians . RESULTS The RCT showed that the iCBT programme was more effective than WLC , with large within- and between-groups effect sizes found ( > 0.8 ) . Adherence was also high ( 89 % ) , and gains were maintained at 3-month follow-up . In study 2 in primary care , adherence to the iCBT programme was low ( 41 % ) , yet effect sizes were large ( > 0.8 ) . Of the non-completers , 30 % experienced benefit . CONCLUSIONS Together , the results show that iCBT is effective and adherence is high in research setting s , but there is a problem of adherence when translated into the ' real world ' . Future efforts need to be placed on developing improved adherence to iCBT in primary care setting Background : Guided Internet-based cognitive behavior therapy ( ICBT ) has been tested in many trials and found to be effective in the treatment of  anxiety and mood disorders .  Generalized anxiety disorder ( GAD ) has also been treated with ICBT , but there are no controlled trials on guided Internet-based psychodynamic treatment ( IPDT ) . Since there is preliminary support for psychodynamic treatment for GAD , we decided to test if a psychodynamically informed self-help treatment could be delivered via the Internet . The aim of the study was to investigate the efficacy of IPDT for GAD and to compare against ICBT and a waiting list control group . Method : A r and omized controlled superiority trial with individuals diagnosed with GAD comparing guided ICBT ( n = 27 ) and IPDT ( n = 27 ) against a no treatment waiting list control group ( n = 27 ) . The primary outcome measure was the Penn State Worry Question naire . Results : While there were no significant between-group differences immediately after treatment on the main outcome measure , both IPDT and ICBT result ed in improvements with moderate to large within-group effect sizes at 3 and 18 months follow-up on the primary measure in the completer analyses . The differences against the control group , although smaller , were still significant for both PDT and CBT when conforming to the criteria of clinical ly significant improvement . The active treatments did not differ significantly . There was a significant group by time interaction regarding GAD symptoms , but not immediately after treatment . Conclusions : IPDT and ICBT both led to modest symptom reduction in GAD , and more research is needed
Psychological therapy based on CBT principles is effective in reducing anxiety symptoms for short-term treatment of GAD .
The body of evidence comparing CBT with other psychological therapies is small and heterogeneous , which precludes drawing conclusions about which psychological therapy is more effective .
BACKGROUND Generalised anxiety disorder ( GAD ) is a highly prevalent condition , characterised by excessive worry or anxiety about everyday events and problems .
The effectiveness and effectiveness of psychological therapies as a group has not yet been evaluated in the treatment of GAD .
OBJECTIVES To examine the efficacy and acceptability of psychological therapies , categorised as cognitive behavioural therapy ( CBT ) , psychodynamic therapy and supportive therapy , compared with treatment as usual/waiting list ( TAU/WL ) and compared with one another , for patients with GAD .