In 56 effectiveness studies of CBT in anxiety disorders in naturalistic real-life settings, the (uncontrolled) effect sizes ranged
from 0.92 in generalized anxiety disorder to 2.59 in post-traumatic stress disorder. It is important to keep in mind that these uncontrolled pre-to post-treatment effect sizes cannot be readily compared with the controlled effect sizes. Nevertheless, these effect sizes seem to indicate that CBT Inhibitors,research,lifescience,medical also works in real-world settings in the treatment of anxiety disorders. Again, in that meta-analysis only 4 out of 56 included reports of intention-to-treat data, prohibiting a meaningful ITT-analysis. Newer therapies for anxiety disorders include mindfulness-based therapies. These therapies propose different approaches for dealing with anxiety-related cognition, including cognitive defusion Inhibitors,research,lifescience,medical (eg, distancing from the content of fear-based thinking) and mindfulness and acceptance, and are
more contextually based. They are sometime called the “third wave” of CBT. A recent meta-analysis found that mindfulness-based therapy in patients with anxiety disorders was associated with a large effect size (Hedges’ g) of 0.97 (95% CI: 0.72-1.22) for improving anxiety.18 Thus, mindfulness-based therapy is a promising newapproach in Inhibitors,research,lifescience,medical the treatment of anxiety disorders. Furthermore, pharmacological augmentation strategies designed to enhance the learning that occurs with CBT approaches for anxiety disorders may hold particular promise.
Inhibitors,research,lifescience,medical For example, recent studies demonstrated that glucocorticoids administered 1 hour prior to therapy sessions enhance extinction-based psychotherapy in anxiety disorders.19,20 Furthermore, d-cycloserine, a drug used in the treatment of tuberculosis, has been shown to enhance fear extinction in several preclinical studies21 but Inhibitors,research,lifescience,medical also in clinical trials in patients with different anxiety disorders:22 Thus, combining exposure therapy with pharmacological agents holds significant promise for improving the GSK2118436 efficacy of CBT. Conclusion Despite some weaknesses of the original studies, the quantitative literature review of randomized placebo-controlled trials and of trials in naturalistic and treatment settings provides strong support for both the efficacy and effectiveness of CBT as an acute intervention for adult anxiety disorders. At the same time, the results also suggest that there is still considerable room for further improvement of study and analysis methods. Thus, the exact magnitude of effect is currently difficult to estimate. Nevertheless, the meta-analyses confirm that CBT is by far the most consistently empirically supported psychotherapeutic option in the treatment of anxiety disorders. Thus, CBT can be recommended as a gold standard in the psychotherapeutic treatment of patients with anxiety disorders.
Picture the world in 2050.
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