An effectiveness study of group therapy for anxiety disorders

Efficacy of an acceptance-based group behavioral therapy for generalized anxiety disorder

BACKGROUND

Generalized anxiety disorder (GAD) shows the weakest treatment response among anxiety disorders. This study aimed at examining whether an acceptance-based group behavioral therapy (ABBT) for patients in a Brazilian anxiety disorders program, combining mindfulness and exposure strategies, can improve clinical outcome when compared with a standard nondirective supportive group therapy (NDST).

METHODS

Ninety-two individuals diagnosed with GAD were randomized to receive 10 sessions of either ABBT or NDST. Assessments at pretreatment, midtreatment, posttreatment, and 3-month follow-up comprised the following outcome measures: Hamilton Anxiety Rating Scale (HAM-A), Penn State Worry Questionnaire (PSWQ), Depression Anxiety and Stress Scale (DASS), and the Clinical Global Impressions (CGI). The World Health Organization Quality of Life (WHOQOL) was administered at pretreatment and posttreatment.

RESULTS

The mixed-effects regression models for DASS-stress, Hamilton Anxiety Interview, and CGI showed a significant effect for Time and the Time × Treatment effect, but not for the Treatment main effect. Similarly, there was a significant Time × Treatment effect for the PSWQ, but not main effects of Time or Treatment. Altogether, these data indicate that symptoms decreased in both conditions across treatment and follow-up, and that the rate of change was more rapid for those participants in the ABBT condition. We found no differences between groups from pretreatment to posttreatment in DASS-anxiety or any secondary outcome measure, but for the physical health domain of WHOQOL, which was faster in ABBT.

CONCLUSIONS

Both groups showed good clinical outcomes, but in general, participants of the ABBT group improved faster than those in the NDST group.

What are the recovery and attrition outcomes for group CBT and individual CBT for generalised anxiety disorder in an IAPT service? An exploratory study

Group cognitive behavioural therapy (gCBT) is commonly used in Increasing Access to Psychological Therapies (IAPT) services. However, there is limited knowledge of the efficacy of gCBT as a delivery format for generalised anxiety disorder (GAD). To address gaps in literature, this study aims to explore the efficacy and attrition of individual and group CBT interventions, respectively, at Step 3 for GAD using data from a routine IAPT service over a 24-month period. Data were retrospectively derived from a routine serviceʼs IAPTus database, separating those eligible for comparison into group (n = 44) and individual (n = 55) CBT for GAD. Outcomes were differences in pre–post self-reported anxiety (GAD-7) and depression (PHQ-9) scores, clinical recovery and attrition for gCBT and individual CBT. Both gCBT and individual CBT yielded significant reductions in self-reported anxiety and depression scores over time. Results indicate that 53% of patients attending individual CBT achieved clinical recovery, with similar but less competitive rates of 41% in gCBT. Attrition rates were similar between gCBT (29.5%) and individual CBT (27.3%), respectively. Preliminary results suggest that both individual and gCBT are effective interventions for GAD patients in IAPT, offering symptom alleviation and comparable recovery and attrition rates post-intervention. This observational design offers credibility and insight into a pragmatic evaluative and explorative comparison. gCBT may offer an acceptable and potentially economical alternative.

Key learning aims

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Applying Group Cognitive Behavioral Therapy for Anxiety Disorders in Community Settings: Retention, Outcome, and Clinical Considerations

The efficacy, and to a lesser extent, effectiveness, of individual cognitive behavioral therapy (CBT) for anxiety disorders has been demonstrated, but whether manualized treatments work in a group format in community settings is less established. We investigated the predictors of retention and outcome in 26 groups (11 Generalized Anxiety Disorder, 11 Panic, 4 Social Phobia groups), conducted for more than 10 years in a semirural community mental health center by 19 therapists. Members of the Anxiety Disorders Treatment Team delivered manualized group CBT treatments. Analysis of standard symptom measures at pre- and posttreatment and archival data revealed significant pre–post decreases in anxiety, retention rates comparable to past findings on group retention, and several significant predictors of retention and outcome. Manualized group CBT for anxiety appears to be a viable treatment in community settings. Limitations of the study as well as related practice–research implications of the findings are discussed.

The acceptability and efficacy of a group cognitive behavioural therapy programme in a community mental health setting

This paper presents data on a patient evaluation of a group cognitive behavioural therapy programme in an applied setting and its efficacy for reducing generalised anxiety and or depression, and distress. Patients (n=14) participated in one of two 8-week group cognitive behavioural therapy programmes for generalised anxiety or depression, within a mental health service. Patients’ perceptions of the programme were collected via an evaluation questionnaire, and data on clinical outcomes were sourced from patients’ case notes. Most patients who were invited to participate in the programme (n=14 of 17), and their evaluations were generally favourable. Almost all participants (93%) indicated that the programme either met or exceeded their expectations. The clinical outcomes of the intervention were similar to those found in efficacy studies reported in the published literature (approximately half to threequarters of one standard deviation improvement in anxiety, depression, and distress scores).