A meta-analysis of CBT for pathological worry among clients with GAD

https://doi.org/10.1016/j.janxdis.2007.01.002Get rights and content

Abstract

Previous meta-analyses assessing the effectiveness of Cognitive Behavioural Therapy (CBT) for Generalized Anxiety Disorder (GAD) used general measures of anxiety to assess symptom severity and improvement (e.g., Hamilton Anxiety Ratings Scale or a composite measure of anxiety). While informative, these studies do not provide sufficient evidence as to whether CBT significantly reduces the cardinal symptom of GAD: pathological worry. The current meta-analysis employed stringent inclusion criteria to evaluate relevant outcome studies, including the use of the Penn State Worry Questionnaire as the main outcome variable. Results showed a large overall effect size (ES) that was moderated by age and modality of treatment. Specifically, the largest gains were found for younger adults and for individual treatment. Analyses also revealed overall maintenance of gains at 6- and 12-month follow-up. Clinical implications of different treatment packages are discussed, as well as potential explanations for the differential effectiveness of CBT.

Section snippets

A meta-analysis on CBT for pathological worry among GAD clients

Generalized Anxiety Disorder (GAD) is characterized by uncontrollable and excessive worry, a necessary feature for its diagnosis. Although other cognitive and/or physical symptoms, such as muscle tension and poor concentration, must be present for diagnosis, the fundamental component is pathological worry across multiple domains of life (e.g., work, health, relationships; American Psychiatric Association [APA], 2000). While everyone worries to some degree, pathological worry is distinguished

Method

A PSYCHINFO literature search (up to 2006) was conducted using a variety of keywords designed to find articles on the outcome literature for CBT with GAD. Also, studies listed in the reference lists of previously published meta-analytic articles were used to identify additional relevant publications. Unpublished manuscripts were not used in this manuscript because the quality of data used in any meta-analysis is extremely important, and therefore only peer-reviewed research was utilized. There

Between-groups analysis

As previously outlined, a control group was defined as any comparison group that provided a nonspecific treatment (e.g., supportive therapy) or individuals on a wait-list and currently not receiving any treatment. Unbiased effect sizes can be seen in Table 2 for each of the studies used in the between-groups analysis. When CBT was compared to a control group, the average ES was found to be quite large (−1.15). Tests of significance were performed using Fischer's Z-test, and yielded a

Discussion

Findings from the current meta-analysis show that CBT for GAD can be a highly effective treatment for reducing pathological worry. However, CBT's effectiveness appears to be moderated by the age of GAD patients being treated. Younger adults responded much more favourably to CBT at post-treatment relative to older adults. Nevertheless, when compared to control groups, the mean ES of CBT for geriatric patients was still impressive, both at post-treatment and follow-up. In fact, mean PSWQ scores

Acknowledgements

David J.A. Dozois was funded by the Ontario Mental Health Foundation (OMHF), Allison J. Ouimet was supported by a Fonds Québécois de la Recherche sur la Société et la Culture (FQRSC) fellowship, and Pamela M. Seeds was supported by the Social Sciences and Humanities Research Council (SSHRC) scholarship.

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