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    Journal Club: Psychological Treatment of Generalized Anxiety Disorder: A Meta-Analysis

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    Riley Jellal Ellen
    1. The meta-analysis examined 41 studies on psychological treatments for generalized anxiety disorder (GAD). 2. It found that psychological treatments were effective in treating GAD and reducing depressive symptoms, with cognitive behavioral therapy (CBT) showing the strongest effects. 3. However, more research is still needed to directly compare CBT to other treatments like applied relaxation, as well as to examine long-term and internet-based treatment effects.

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    Journal Club: Psychological Treatment of Generalized Anxiety Disorder: A Meta-Analysis

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    Riley Jellal Ellen
    25 views19 pages
    1. The meta-analysis examined 41 studies on psychological treatments for generalized anxiety disorder (GAD). 2. It found that psychological treatments were effective in treating GAD and reducing depressive symptoms, with cognitive behavioral therapy (CBT) showing the strongest effects. 3. However, more research is still needed to directly compare CBT to other treatments like applied relaxation, as well as to examine long-term and internet-based treatment effects.

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    Anxiety disorder Treatment

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    Final Journal Club

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    1. The meta-analysis examined 41 studies on psychological treatments for generalized anxiety disorder (GAD). 2. It found that psychological treatments were effective in treating GAD and reducing depressive symptoms, with cognitive behavioral therapy (CBT) showing the strongest effects. 3. However, more research is still needed to directly compare CBT to other treatments like applied relaxation, as well as to examine long-term and internet-based treatment effects.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    25 views19 pages

    Journal Club: Psychological Treatment of Generalized Anxiety Disorder: A Meta-Analysis

    Uploaded by

    Riley Jellal Ellen
    1. The meta-analysis examined 41 studies on psychological treatments for generalized anxiety disorder (GAD). 2. It found that psychological treatments were effective in treating GAD and reducing depressive symptoms, with cognitive behavioral therapy (CBT) showing the strongest effects. 3. However, more research is still needed to directly compare CBT to other treatments like applied relaxation, as well as to examine long-term and internet-based treatment effects.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 19

    Journal Club

    Psychological treatment of generalized anxiety


    disorder: A meta-analysis

    ERICA WILLSON
    NELLIE L AWLOR
    RILEY GRAHAM
    What is Generalized Anxiety
    Disorder?
    Generalized
    anxiety disorder
    or (GAD) is a
    highly
    prevalent,
    chronic, costly
    and disabling
    mental disorder.
    Background Research
    GAD was first introduced in the DSM in 1980

    Other types of therapies for GAD


    psychodynamic therapies non-directive supportive
    therapy (Stanley, Beck, & DeWitt Glassco, 1996)
    Spiritual therapy (Koszycki, Raab, Aldosary, &
    Bradwejn, 2010)
    Aim and Purpose
    1. Examine whether it could assess the overall effects of
    psychotherapies for GAD.
    2. Assess whether there are now enough studies to evaluate the long-
    term effects of GAD treatments.
    3. To examine whether enough studies are now available to compare
    the differential effects between types of therapy.
    4. Examine the quality of psychotherapy studies.
    5. Since recent trials tend to meet quality criteria more often, it also
    examined the association between publication year and the
    outcome.
    Significance of the article

    1. Large number of trials used in the meta analysis


    2. Results more accurate/generalizable
    Main Findings
    Comparisons
    Cognitive Behavioural Therapy (CBT) VS Applied Relaxation:
    Compared in 5 studies
    Effect size revealed comparable difference between the two
    Statistical power too small to justify further analysis

    CBT VS Pharmacotherapy:
    Compared in 4 studies
    Small, non-significant result favoured CBT
    Main Findings
    Long term Outcomes
    Psychotherapy VS Control:
    3 studies
    Follow up periods; 3-15 months
    Odds Ratio for a positive outcome = 1.53; Indicates Psychotherapy may produce
    better results than control
    Statistical power too small to continue analysis
    CBT VS Applied Relaxation:
    5 studies
    Follow up periods; 6-24 months
    No significant difference between the methods at 6 months and 24 months
    CBT showed significantly better results at 12 months
    Main Findings
    Internet Based Treatment VS Face-to-face treatment
    Small amount of studies on Internet-based treatment
    Despite this, the effect size revealed the treatments yield comparable results
    Findings consistent to previous literature (Andrews, Cuijpers, Craske, McEvoy, & Titov, 2010)

    Effects of different types of therapy and pharmacotherapy:


    Number of studies too small to determine significant differences

    Quality Criteria and Effect size


    Recent studies has better quality criteria, however there was no evidence that they had a
    higher or lower effect size than older studies
    May be due to older studies meeting quality criteria without reporting it
    May be due to limited amount of studies making it difficult to find significant association
    Main Findings
    Moderator analysis
    Found Psychological treatments that met all the criteria had a smaller effect size
    than those that didn't
    Psychotherapy was not found to be more effect for younger people than older, as
    was seen in a previous meta-analysis (Covin et al., 2008)
    Findings and Conclusions
    Psychological treatment of GAD may be as effective as medication
    A large effect size for the treatment of depressive symptoms was found
    Evidence suggest GAD often precedes depression (Schoevers, Deeg, van Tilburg, &
    Beekman, 2005)
    thus treatment for GAD may also reduce depressive symptoms
    Clinician ratings of effects were often higher than self-report
    The exact cause for this is unknown
    May be due to positive bias from the clinician or negative bias from the participant
    Finding consistent with other research (Cuijpers, Li, Hofmann, & Andersson, 2010).
    The amount of studies directly comparing CBT and Applied relaxation was too small
    Previous research has found the two methods had comparable effects (Siev & Chambless,
    2007).
    The number of studies was too limited in this analysis leading to unsubstantial results.
    Critiquing
    Time to look into whether the
    Meta-analysis was conducted
    in a validated way

    Are conclusions justified??


    Limitations
    1. CBT over-focus?
    - 28 x CBT, 3 x behavioural, 3x relaxation, 4 x other therapies
    2. Need more follow-ups!
    - 3/41 included follow-up measures
    3. Too general?
    - No dismantling of actual treatment types
    4. Predominantly waiting list groups
    - 31 involved WL groups
    5. Lack of studies (& therefore lack of evidence)
    - Can show effectively but not comparatively speaking
    Strengths
    1. Two independent raters (2= better than 1!)
    - Decisions may be questioned
    2. Criteria selectivity
    - Narrowed down to 41/100+
    3. Meta-analysis= bias avoidance
    - Not own studies, objective viewpoint maintained
    4. Identified LT effects as important
    5. Standardised diagnosis across studies
    - Validity check
    Strengths cont
    6. Acknowledgment & assessment of depression (common co-occurrence with GAD)

    7. Clinical Psychology R/V


    - Highly respected, will only use quality & peer-reviewed articles
    8. Primary & secondary sources used assessed with Risk of Bias tool (Cochrane)
    9. New forms of treatment included (not just traditional)
    - Internet CBT
    10. Subject pool
    - Drawn from community, clinical & specialised mental health care environments
    11. Consistency with past research findings
    Overall Does indicate effectiveness of receiving clinical treatment, particularly
    CBT= provides further support (no harm done!)
    Implications and future research

    Psychotherapy is an effective and clinically relevant form of treatment for


    GAD
    Lack of research about some topics
    Internet based treatments
    Applied relaxation
    Quality criteria and outcome

    Breakdown of components within the psychotherapies to reveal what is actually


    effective
    Implications and future research
    Included studies are believed to have some limitations such as
    1. Small number of studies using other than waiting list control groups,
    2. The lack of follow-up measurements
    3. The low quality of many of the included studies

    Future research should include well established trials in order to produce


    greater accuracy and less bias.
    References
    Andrews,G.,Cuijpers,P.,Craske,M.G.,McEvoy,P.,&Titov,N.(2010).ComputerTherapy
    fortheAnxietyandDepressiveDisordersIsEffective,AcceptableandPracticalHealthCare:A
    Meta-Analysis.PLoS ONE,5(10),e13196.doi:10.1371/journal.pone.0013196
    Covin,R.,Ouimet,A.J.,Seeds,P.M.,&Dozois,D.J.(2008).Ameta-analysisofCBTfor
    pathologicalworryamongclientswithGAD.Journal of Anxiety Disorders,22(1),108-116.
    doi:10.1016/j.janxdis.2007.01.002
    Cuijpers,P.,Li,J.,Hofmann,S.G.,&Andersson,G.(2010).Self-reportedversusclinician-
    ratedsymptomsofdepressionasoutcomemeasuresinpsychotherapyresearchondepression:
    Ameta-analysis.Clinical Psychology Review,30(6),768-778.doi:10.1016/j.cpr.2010.06.001
    Cuijpers,P., Sijbrandij,M., Koole,S., Huibers,M., Berking,M., & Andersson,G.
    (2014). Psychological treatment of generalized anxiety disorder: A meta-
    analysis.Clinical Psychology Review,34(2), 130-140.
    doi:10.1016/j.cpr.2014.01.002
    Schoevers,R.A.,Deeg,D.,VanTilburg,W.,&Beekman,A.(2005).DepressionandGeneralized
    AnxietyDisorder:Co-OccurrenceandLongitudinalPatternsinElderlyPatients.The American
    Journal of Geriatric Psychiatry,13(1),31-39.doi:10.1097/00019442-200501000-00006
    Siev,J.,&Chambless,D.L.(2007).Specificityoftreatmenteffects:Cognitivetherapyandrelaxationfor
    generalizedanxietyandpanicdisorders.Journal of Consulting and Clinical Psychology,75(4),513-
    522.doi:10.1037/0022-006x.75.4.513
    Stanley,M.A.,Beck,J.G.,&DeWittGlassco,J.(1996).Treatmentofgeneralisedanxietyinolderadults:
    Apreliminarycomparisonofcognitivebehavioralandsupportiveapproaches.BehaviorTherapy,
    27,565581
    Koszycki,D.,Raab,K.,Aldosary,F.,&Bradwejn,J.(2010).Amultifaithspirituallybasedintervention
    forgeneralizedanxietydisorder:Apilotrandomizedtrial.JournalofClinicalPsychology,66,430
    441.

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