A randomized clinical trial of cognitive-behavioral therapy and applied relaxation for adults with generalized anxiety disorder. Internet-Based Psychodynamic versus Cognitive Behavioral Guided Self-Help for Generalized Anxiety Disorder: A Randomized Controlled Trial Guided Internet-Delivered Cognitive Behavior Therapy for Generalized Anxiety Disorder: A Randomized Controlled Trial Internet-delivered acceptance-based behaviour therapy for generalized anxiety disorder: A randomized controlled trial. Virtual reality in the treatment of generalized anxiety disorders. Treatment of generalized anxiety disorder in older adults. Mindfulness-based cognitive therapy v. group psychoeducation for people with generalised anxiety disorder: randomised controlled trial. Recovery rates in generalized anxiety disorder following psychological therapy: an analysis of clinically significant change in the STAI-T across outcome studies since 1990. Group cognitive-behavioral therapy for generalized anxiety disorder: treatment outcome and long-term follow-up. Cognitive-behavior therapy for late-life generalized anxiety disorder in primary care: preliminary findings. A randomized controlled trial of 'MUMentum Pregnancy': Internet-delivered cognitive behavioral therapy program for antenatal anxiety and depression. Mindfulness-based cognitive therapy for generalized anxiety disorder. Well-Being Therapy of Generalized Anxiety Disorder A randomized controlled trial of guided internet-delivered cognitive behaviour therapy for older adults with generalized anxiety. Treatment of generalised anxiety disorder with a short course of psychological therapy, combined with buspirone or placebo. Cognitive behavior therapy for generalized anxiety disorder among older adults in primary care: a randomized clinical trial. Generalized anxiety disorder and health care use. Standard and enhanced cognitive-behavior therapy for late-life generalized anxiety disorder: two pilot investigations. Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. Does cognitive-behavioural therapy influence the long-term outcome of generalized anxiety disorder? An 8-14 year follow-up of two clinical trials. Feasibility of Exercise Training for the Short-Term Treatment of Generalized Anxiety Disorder: A Randomized Controlled Trial Transdiagnostic, affect-focused, psychodynamic, guided self-help for depression and anxiety through the internet: study protocol for a randomised controlled trial Tailored online cognitive behavioural therapy with or without therapist support calls to target psychological distress in adults receiving haemodialysis: A feasibility randomised controlled trial. Internet cognitive behavioural therapy for mixed anxiety and depression: a randomized controlled trial and evidence of effectiveness in primary care. A randomized controlled trial of cognitive-behavioral therapy for generalized anxiety disorder with integrated techniques from emotion-focused and interpersonal therapies. Predicting outcome after treatment for generalised anxiety disorder.
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 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 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 Generalized anxiety disorder ( GAD ) is a disabling condition which can be treated with cognitive behaviour therapy ( CBT ) . The present study tested the effects of therapist-guided internet-delivered acceptance-based behaviour therapy on symptoms of GAD and quality of life . An audio CD with acceptance and mindfulness exercises and a separate workbook were also included in the treatment . Participants diagnosed with GAD ( N = 103 ) were r and omly allocated to immediate therapist-guided internet-delivered acceptance-based behaviour therapy or to a waiting-list control condition . A six month follow-up was also included . Results using hierarchical linear modelling showed moderate to large effects on symptoms of GAD ( Cohen 's d = 0.70 to 0.98 ) , moderate effects on depressive symptoms ( Cohen 's d = 0.51 to 0.56 ) , and no effect on quality of life . Follow-up data showed maintained effects . While there was a 20 % dropout rate , sensitivity analyses showed that dropouts did not differ in their degree of change during treatment . To conclude , our study suggests that internet-delivered acceptance-based behaviour therapy can be effective in reducing the symptoms of GAD 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 Older adults with generalized anxiety disorder ( GAD ; N = 75 ; M age = 67.1 years ) were r and omly assigned to cognitive-behavioral therapy ( CBT ) , a discussion group ( DG ) organized around worry-provoking topics , or a waiting period . Participants in both active conditions improved relative to the waiting list . Although CBT participants improved on more measures than DG participants , the authors found only I significant difference immediately after treatment and no differences at 6-month follow-up . Effect sizes were smaller than in younger sample s , but CBT showed large effects and DG showed medium-sized effects Overall , results indicate that brief treatment of late-life GAD  is beneficial , but they provide only limited support for the superiority of CBT to a credible comparison intervention 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 BACKGROUND There have been six r and omized controlled trials of psychological therapy with generalized anxiety disorder ( GAD ) using DSM-III-R and DSM-IV . All have used the Trait version of the Spielberger State-Trait Anxiety Inventory ( STAI-T ) as one of several outcome measures . Each study , however , employed different methods of calculating the clinical significance of outcomes making it difficult to reach a balanced appraisal of the efficacy of psychological treatment . METHODS Raw data on STAI-T scores at pre- , post- and follow-up were obtained for each of the six studies ( total N = 404 ) . Jacobson methodology for defining clinical ly significant change ( criterion c , reliable change index = 8 , cut-off point = 46 ) was used to allocate each patient to one of four outcomes : worse , unchanged , improved and recovered . The proportion of patients in each category was calculated for treatment conditions in each study and also for aggregate data across types of treatment . RESULTS A recovery rate of 40 % was found for the sample as a whole with 12 of the 20 treatment conditions obtaining very modest recovery rates of 30 % or less . Two treatment approaches -- individual cognitive behavioural therapy and applied relaxation -- do relatively well with overall recovery rates at 6-month follow-up of 50 - 60 % . CONCLUSIONS Jacobson methodology , in distinguishing between improvement and recovery on a st and ardized measure of general vulnerability to anxiety , provides a stringent but clinical ly more meaningful evaluation of the efficacy of psychological therapies with GAD than has been available hitherto . Systematic focus on either excessive worry or physiological arousal gives worthwhile results 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 OBJECTIVE The authors present data from a pilot research program initiated to develop , refine , and test the outcomes of CBT-GAD/PC , a version of cognitive-behavior therapy ( CBT ) that targets the needs of older adults with generalized anxiety disorder ( GAD ) in primary care ( PC ) . METHODS The study involved a small , r and omized clinical trial comparing the impact of CBT-GAD/PC to usual care ( UC ) in a sample of 12 older medical patients with GAD . RESULTS Outcome data suggested significant improvements in worry and depression after CBT-GAD/PC , relative to UC . CONCLUSION Authors discuss results in terms of the " real-world " applicability of this treatment for late-life GAD , and present implication s for future research BACKGROUND Anxiety and depression are common during pregnancy and associated with adverse outcomes for the mother and infant if left untreated . Despite the need to improve treatment accessibility and uptake in this population , no studies have investigated internet-delivered cognitive behavioural therapy ( iCBT ) for antenatal anxiety and depression . In a r and omised controlled trial , we examined the efficacy and acceptability of a brief , unguided iCBT intervention - the MUMentum Pregnancy program - in pregnant women with anxiety and /or depression . METHODS Participants meeting clinical threshold on vali date d self-report measures of generalised anxiety and /or depression were recruited online and r and omised to iCBT  ( n = 43 ) or a treatment as usual ( TAU ) control  ( n = 44 ) . Outcomes were assessed at baseline , post-treatment and four-week follow-up ; and included anxiety , depression , psychological distress , antenatal bonding , quality of life , and treatment acceptability . RESULTS Of the 36 women who started iCBT , 26 completed all three lessons of treatment ( 76 % adherence rate ) . iCBT produced moderate to large effect size reductions for anxiety on the GAD-7 ( Hedges ' g = 0.76 ) and psychological distress on the Kessler-10 ( g = 0.88 ) that were superior to TAU . Only small nonsignificant differences were found for depression outcomes ( g = < 0.35 ) . Participants reported that iCBT was an acceptable treatment for antenatal anxiety and /or depression . LIMITATIONS Lack of an active control condition and long-term postpartum follow-up . CONCLUSIONS This is the first study to evaluate brief unguided iCBT for antenatal anxiety and depression . While our findings are promising , particularly for anxiety reduction , additional RCTs are required to establish treatment efficacy UNLABELLED While cognitive behavior therapy has been found to be effective in the treatment of generalized anxiety disorder ( GAD ) , a significant percentage of patients struggle with residual symptoms . There is some conceptual basis for suggesting that cultivation of mindfulness may be helpful for people with GAD . Mindfulness-based cognitive therapy ( MBCT ) is a group treatment derived from mindfulness-based stress reduction ( MBSR ) developed by Jon Kabat-Zinn and colleagues . MBSR uses training in mindfulness meditation as the core of the program . MBCT incorporates cognitive strategies and has been found effective in reducing relapse in patients with major depression ( Teasdale , J. D. , Segal , Z. V. , Williams , J. M. G. , Ridgeway , V. , Soulsby , J. , & Lau , M. ( 2000 ) . Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy . Journal of Consulting and Clinical Psychology , 6 , 615 - 623 ) . METHOD Eligible subjects recruited to a major academic medical center participated in the group MBCT  course and completed measures of anxiety , worry , depressive symptoms , mood states and mindful awareness in everyday life at baseline and end of treatment . RESULTS Eleven subjects ( six female and five male ) with a mean age of 49 ( range=36 - 72 ) met criteria and completed the study . There were significant reductions in anxiety and depressive symptoms from baseline to end of treatment . CONCLUSION MBCT may be an acceptable and potentially effective treatment for reducing anxiety and mood symptoms and increasing awareness of everyday experiences in patients with GAD . Future directions include development of a r and omized clinical trial of MBCT for GAD Background : There is increasing awareness that the goal of treatment in generalized anxiety disorder ( GAD ) should not simply be a response , but restoration of normal function . The aim of this study was to apply a novel psychotherapeutic approach for increasing the level of remission in GAD . Methods : Twenty patients with DSM-IV GAD devoid of comorbid conditions were r and omly assigned to 8 sessions of cognitive behavioral therapy ( CBT ) or the sequential administration of 4 sessions of CBT followed by other 4 sessions of well-being therapy ( WBT ) . Assessment methods included the Anxiety and Depression Scales of Paykel ’s Clinical Interview for Depression , Ryff ’s Psychological Well-being Scales and Kellner ’s Symptom Question naire . A one-year follow-up was undertaken . Results : Significant advantages of the CBT-WBT sequential combination over CBT only were observed with both observer and self-rated methods after treatment . Such gains were maintained at follow-up . Conclusions : These preliminary results suggest the feasibility and clinical advantages of adding WBT to the treatment of GAD . They lend support to a sequential use of treatment components for achieving a more sustained recovery 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 Very few studies have examined the combination of drug and psychological treatment in generalised anxiety disorder ( GAD ) . Theoretically , buspirone should be a useful drug to combine with a learning-based therapy . METHODS Sixty patients with GAD were r and omly assigned to treatment with buspirone or placebo , combined with anxiety management training or non-directive therapy for a period of 8 weeks . RESULTS Forty-four patients with a mean Hamilton Anxiety Scale score of 28 completed treatment . There were no significant differences between treatment groups . All groups showed significant improvement after 8 weeks compared to baseline . There were no baseline differences between those who completed the trial and those who did not but patients given buspirone were more likely to drop out . CONCLUSIONS A short course of psychological therapy , whether or not accompanied by active medication , was an effective treatment for patients diagnosed as having quite severe symptoms of GAD . CLINICAL IMPLICATION S AND LIMITATIONS : Dropouts led to a sample size which may have been too small to detect group differences . Cognitive therapy may have been more effective 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 OBJECTIVE To examine self-reported health care use and health care-seeking behaviour of patients meeting DSM-IV 's diagnostic criteria for generalized anxiety disorder ( GAD ) . DESIGN Survey of out patients recruited at three different times of the day  using question naires on worry and anxiety ( a six-item screening question naire based on DSM-IV criteria for GAD ) , on perceived health problems , and on health care use and health care-seeking behaviour . The assessment package also included well vali date d assessment instruments for insomnia and depression symptoms .  All patients seeking health care were invited to participate . Participants completed the survey as they waited in the reception area . SETTING Four r and omly selected community-based medical clinics of Quebec city 's metropolitan area . PARTICIPANTS A final sample of 1110 patients among 1878 out patients invited to participate included 219 ( 19.7 % ) who tested positive for GAD . MAIN OUTCOME MEASURES Self-reported worry and anxiety ( based on DSM-IV criteria for GAD ) , self-perceived health problems , health care use and health care-seeking behaviour , insomnia , and symptoms of depression . RESULTS Participants who tested positive on a screening test for GAD reported more annual medical visits ( 5.3 versus 3.4 ) than other patients . Those who reported at least five annual medical visits were nearly four times more likely to have positive results for GAD . Women were 1.6 times more likely to have positive results than men were . Patients who tested positive reported insomnia-type sleep disturbances , depressive symptoms , fatigue , and gastric problems significantly more often than others . Forty-two percent had consulted a family physician in the past year with a complaint of anxiety . Eighty percent of patients who tested positive reported they believed they had an anxiety problem , and this belief predicted positive test results ( odds ratio = 20.3 ) . Yet most reported not having sought other types of medical or psychological care specifically for anxiety in the past year . CONCLUSION Some patients in this sample with symptoms of GAD mainly seek primary care for their symptoms . Questions about excessive worrying and anxiety , as part of routine examination , can increase recognition of GAD OBJECTIVE Although cognitive-behavior therapy ( CBT ) is an efficacious treatment for generalized anxiety disorder ( GAD ) in younger adults , little is known about its efficacy in older patients . Investigations to date have tested group-format or otherwise nonst and ard versions of CBT . The studies described here are , to our knowledge , the first to test the efficacy of individual-format CBT administered in a mental health clinic for treatment of late-life GAD  . METHODS Study 1 tested a st and ard version , and Study 2 tested an enhanced version ( ECBT ) that included learning and memory aids design ed to make the therapy more effective with elderly patients ( e.g. , homework reminder and troubleshooting calls , weekly review of all concepts and techniques ) . RESULTS Study 1 CBT participants showed significant improvement on GAD severity ratings . Study 2 ECBT participants showed significant improvement on two self-report measures , rates of posttreatment GAD , and GAD severity ratings .  ECBT result ed in improvement on more measures and yielded larger effect sizes than st and ard CBT , when each was compared against a wait-list control group . CONCLUSION Results of these pilot studies suggest that st and ard individual-format CBT may not be optimally effective for treating late-life GAD ; thus , ECBT should be tested further in r and omized trials 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 Generalized anxiety disorder is a common condition of excessive worry and tension which tends to run a chronic course associated with significant psychiatric and medical problems . Cognitive behaviour therapy ( CBT ) has been shown to be of clinical value in about 50 % of cases with treatment gains maintained over follow-up periods ranging from 6 to 12 months . The potential value of CBT over the longer term has not been subject to rigorous investigation . METHOD Results are reported of 8 - 14 year follow-up of two r and omized controlled trials of cognitive-behaviour therapy for generalized anxiety disorder employing structured interview with an assessor blind to initial treatment condition . Comparison groups included medication and placebo in one study based in primary care , and analytical psychotherapy in the other based in secondary care . Follow-up sample s ( 30 % and 55 % of trial entrants ) were broadly representative of the original cohorts . RESULTS Overall , 50 % of participants were markedly improved of whom 30 - 40 % were recovered ( i.e. free of symptoms ) . Outcome was significantly worse for the study based in secondary care in which the clinical presentation of participants was more complex and severe . For a minority ( 30 - 40 % ) , mainly from the secondary care study , outcome was poor . Treatment with CBT was associated with significantly lower overall severity of symptomatology and less interim treatment , in comparison with non-CBT conditions , but there was no evidence that CBT influenced diagnostic status , probability of recovery or patient perceptions of overall improvement . CONCLUSIONS Both CBT and the complexity and severity of presenting problems appear to influence the long-term outcome of GAD Background : Exercise training may be especially helpful for patients with generalized anxiety disorder ( GAD ) . We conducted a r and omized controlled trial to quantify the effects of 6 weeks of resistance ( RET ) or aerobic exercise training ( AET ) on remission and worry symptoms among sedentary patients with GAD . Methods : Thirty sedentary women aged 18–37 years , diagnosed by clinicians blinded to treatment allocation with a primary DSM-IV diagnosis of GAD and not engaged in any treatment other than pharmacotherapy , were r and omly allocated to RET , AET , or a wait list ( WL ) . RET involved 2 weekly sessions of lower-body weightlifting . AET involved 2 weekly sessions of leg cycling matched with RET for body region , positive work , time actively engaged in exercise , and load progression . Remission was measured by the number needed to treat ( NNT ) . Worry symptoms were measured by the Penn State Worry Question naire . Results : There were no adverse events . Remission rates were 60 % , 40 % , and 30 % for RET , AET , and WL , respectively . The NNT was 3 ( 95 % CI 2 to 56 ) for RET and 10 ( 95 % CI –7 to 3 ) for AET . A significant condition-by-time interaction was found for worry symptoms . A follow-up contrast showed significant reductions in worry symptoms for combined exercise conditions versus the WL . Conclusions : Exercise training , including RET , is a feasible , low-risk treatment that can potentially reduce worry symptoms among GAD patients and may be an effective adjuvant , short-term treatment or augmentation for GAD . Preliminary findings warrant further investigation Introduction Cognitive behaviour therapy delivered in the format of guided self-help via the internet has been found to be effective for a range of conditions , including depression and anxiety disorders . Recent results indicate that guided self-help via the internet is a promising treatment format also for psychodynamic therapy . However , to date and to our knowledge , no study has evaluated internet-delivered psychodynamic therapy as a transdiagnostic treatment . The affect-phobia model of psychopathology by McCullough et al provides a psychodynamic conceptualisation of a range of psychiatric disorders . The aim of this study will be to test the effects of a transdiagnostic guided self-help treatment based on the affect-phobia model in a sample of clients with depression and anxiety . Methods and analysis This study will be a r and omised controlled trial with a total sample size of 100 participants . The treatment group receives a 10-week , psychodynamic , guided self-help treatment based on the transdiagnostic affect-phobia model of psychopathology . The treatment consists of eight text-based treatment modules and includes therapist contact in a secure online environment .  Participants in the control group receive similar online therapist support without any treatment modules . Outcome measures are the 9-item Patient Health Question naire Depression Scale and the 7-item Generalised Anxiety Disorder Scale ( GAD-7 ) . Process measures that concerns emotional processing and mindfulness are included . All outcome and process measures will be administered weekly via the internet and at 6-month follow-up . Discussion This trial will add to the body of knowledge on internet-delivered psychological treatments in general and to psychodynamic treatments in particular . We also hope to provide new insights in the effectiveness and working mechanisms of psychodynamic therapy based on the affect-phobia model BACKGROUND Psychological distress is prevalent in haemodialysis ( HD ) patients yet access to psychotherapy remains limited . This study assessed the feasibility and acceptability of online cognitive-behavioural therapy ( CBT ) tailored for HD patients , with or without therapist support , for managing psychological distress . METHODS This feasibility r and omised controlled trial recruited patients from a UK HD centre . Following psychological distress screens , patients with mild-moderate psychological distress ( Patient Health Question naire PHQ-9 ; score : 5 - 19 and /or Generalised Anxiety Disorder ; GAD-7 score : 5 - 14 ) who met remaining inclusion criteria were approached for consent . Consenters were individually r and omised ( 1:1 ) to online-CBT or online-CBT plus three therapist support calls . Outcomes included recruitment , retention , and adherence rates . Exploratory change analyses were performed for : psychological distress , quality of life ( QoL ) , illness perceptions , and costs . The statistician was blinded to allocation . RESULTS 182 ( 44 % ) out of 410 patients approached completed psychological distress screens . 26 % found screening unacceptable ; a further 30 % found it unfeasible . Psychological distress was detected in 101 ( 55 % ) patients , 60 of these met remaining inclusion criteria . The primary reason for in eligibility was poor computer literacy ( N=17 , 53 % ) . Twenty-five patients were r and omised to the supported ( N=18 ) or unsupported arm ( N=7 ) ; 92 % were retained at follow-up . No differences in psychological distress or cost-effectiveness were observed . No trial adverse events occurred . CONCLUSION Online CBT appears feasible but only for computer literate patients who identify with the label psychological distress . A definitive trial using the current methods for psychological distress screening and online care delivery is unfeasible . Clinical Trials.gov Identifier : NCT02352870 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 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 A previous paper , Butler and Anastasiades ( Behaviour Research and Therapy 26 , 531 - 534 , 1988 ) presented evidence for three reliable predictors of response to Anxiety Management in patients with generalised anxiety disorder . It was argued there that these reflected severity of anxiety , demoralisation and depression . A second study ( Butler , Fennell , Robson & Gelder , Journal of Consulting and Clinical Psychology , 59 , 167 - 175 , 1991 ) has compared two treatments for GAD : Behaviour Therapy and Cognitive Behaviour Therapy . Data from this study is used here to answer two questions : ( i ) do the same three variables predict outcome in the second study ? The answer to this question is ' no ' ; and ( ii ) which variables contribute to prediction of outcome when these two treatments are compared ? Information presented here suggests that this depends partly on the nature of the treatment given . Outcome after behaviour therapy is predicted by initial levels of anxiety only , but the gains made are also relatively modest . Outcome after  cognitive behaviour therapy  is predicted by the degree to which ambiguous ( external ) information is interpreted as threatening . Thus a cognitive variable contributes reliably to the prediction of outcome after a cognitive treatment , but does not predict in the same way to outcome after a behavioural treatment
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 .