By Lauren DeSouza- Master of Public Health, Simon Fraser Public Research University – Canada
https://cshmke.com/our-team/

Staff Research and Content Writer

© Copyright – SUD RECOVERY CENTERS – A Division of Genesis Behavioral Services, Inc., Milwaukee, Wisconsin – May 2024 – All rights reserved.

Generalized Anxiety Disorder (GAD) is one of the most common mental health disorders affecting US adults. Nearly 40 million US adults have been diagnosed with GAD in their lifetimes, and in 2023, an estimated 6 million reported currently having GAD.

Quick facts about Generalized Anxiety Disorder:

• GAD is treatable, yet less than half (43%) of those with GAD receive treatment
• GAD is more common among women than men
• GAD often co-occurs with depression

A new study aimed to determine which psychotherapies are most beneficial for patients with GAD. The researchers’ goal was to recommend one or more psychotherapies as the first-line treatment for GAD. The research team also assessed which forms of psychotherapy were preferred by GAD patients.

What is psychotherapy?

Healthcare providers typically treat Generalized Anxiety Disorder (GAD) using psychotherapy, medication, or a combination of both. Psychotherapy, also called talk therapy, encompasses a variety of treatment techniques that aim to help a person identify and change unhealthy emotions, thoughts, and behaviors. Psychotherapy for GAD can help patients unlearn negative thought patterns of worry or rumination and develop healthier thinking patterns.

Medications such as antidepressants or anti-anxiety medications can also be used to treat GAD.

Numerous studies on psychotherapy for GAD have been conducted in recent years. Still, few large-scale studies have been done to amalgamate and compare the results of all these studies (and thus all psychotherapies) against one another. Consequently, we need to determine which therapies are most effective for patients with GAD.

What did this study do?

This study used a systematic review and network meta-analysis approach to analyze a large group of studies on psychotherapy for Generalized Anxiety Disorder. The researchers specifically looked for randomized control trials that compared one form of psychotherapy against each other, conducted on patients for whom GAD was their primary diagnosis. This approach allowed them to rank treatment options, accounting for comparisons done within individual trials and between different trials.

The researchers were interested in two primary outcomes:

1. Generalized Anxiety Disorder symptoms at the end of the study (a continuous outcome that indicates treatment effectiveness)
2. All-cause discontinuation of treatment (a dichotomous outcome that indicates treatment acceptability by patients)

As a secondary outcome, they also analyzed the severity of anxiety symptoms at 3-12 months following the completion of treatment.

What were the results?

Sixty-five studies comprising 5048 patients were included in the final meta-analysis. The studies included the following psychotherapies: behavior therapy, cognitive behavioral therapy (CBT), cognitive restructuring, psychoeducation, psychodynamic therapy, relaxation therapy, supportive psychotherapy, and third-wave CBTs. Treatments were either compared against one another or to a control condition (treatment as usual and waiting list).

The network meta-analysis found the most promising results for three treatments:

1. Cognitive behavioral therapy
2. Third-wave CBT
3. Relaxation therapy

Cognitive behavioral therapy is one of the most commonly used treatments for anxiety disorders. It involves identifying negative thoughts and behaviors and working to restructure them, enabling patients to disrupt the spiral of anxiety.

Third-wave CBT expands on traditional CBT to emphasize acceptance and mindfulness. Standard third-wave CBT practices include Mindfulness-Based Interventions (MBI), Dialectical Behaviour Therapy (DBT), Metacognition Therapy (MCT), and Acceptance and Commitment Therapy (ACT). Finally, relaxation therapy helps to reduce tension and stress in the body through practices such as Progressive Muscle Relaxation.

All three of these therapies performed better than treatment as usual when used to treat patients in the acute phase of GAD. All of these treatments were equally effective. They were also similarly accepted by patients. However, studies examining relaxation therapy were of low certainty and judged as having a higher degree of bias.

What are the implications of this study?

From the results of this systematic review and meta-analysis, the researchers recommend that Cognitive Behavioral Therapy and Third-Wave CBT be considered for future guidelines to treat Generalized Anxiety Disorder (GAD). Cognitive behavior therapy is equally or more effective than treatment as usual when delivered in the individual, group, or guided self-help delivery format. This finding is consistent with previous studies on CBT. However, this study adds credibility to the use of third-wave CBTs as an equally efficacious and acceptable treatment for GAD.

Due to the risk of bias in their included studies, the researchers stress that caution is needed when recommending relaxation techniques as stand-alone interventions. Relaxation techniques may be best valued when considered embedded in CBT protocols.

Key points

• Cognitive Behavioural Therapy, Third-Wave CBT, and Relaxation Therapy are all efficacious for treating Generalized Anxiety Disorder and are equally acceptable to patients.
• Studies on relaxation therapy may be impacted by bias, and relaxation therapy should thus be used with caution.
• Future guidelines for GAD should include CBT and Third-Wave CBT as first-line treatments.

References:

Papola, D., Miguel, C., Mazzaglia, M., et al. (2024). Psychotherapies for generalized anxiety disorder in adults: A systematic review and network meta-analysis of randomized clinical trials. JAMA Psychiatry, 81(3), 250–259. https://doi.org/10.1001/jamapsychiatry.2023.3971

Anxiety and Depression Association of America. (n.d.). Facts & statistics. Retrieved July 27, 2024, from https://adaa.org/understanding-anxiety/facts-statistics#Treatment%20Options

Merwin, R., O’Rourke, S., Ives, L., Harstad, S., & Brooks, J. (2019). Third-wave cognitive-behavioral therapies for the treatment of anxiety among children and adolescents. In S. N. Compton, M. A. Villabø, & H. Kristensen (Eds.), Pediatric Anxiety Disorders (pp. 335-357). Academic Press.