Long-Term Outcomes of CBT for Anxiety-Related Disorders

introduction

Anxiety disorders, PTSD, and OCD are highly prevalent and associated with substantial personal and societal costs

Many patients favor psychotherapy over pharmacotherapy

CBT is generally associated with reduced symptoms in the short-term

We lack long-term data on CBT outcomes

Four meta-analyses have been conducted on long-term outcomes, and they indicate a medium effect size

Limitations:

Control groups not always included

Lack of data around relapse rate (31%-55% with remitted anxiety meet DSM-5 criteria within 4 years)

Aims:

Comprehensive meta-analysis to establish long-term outcomes of CBT and 2. Assess relapse rates

methods

• Literature Search!

  • Terms: anxiety terms and study terms

  • Inclusion criteria

    • Examination effects of CBT at least 1 month after treatment completion 

    • Comparison group

    • Adult patients (primarily) with diagnosis of anxiety or PTSD or OCD

      • Based on?

  • Exclusion criteria

    • Did not use CBT or used CBT and meds together

    • Inpatient population

results

• 69 published studies met criteria that represented 4118 patients

• Post-treatment findings

  • Panic disorder: small effect size

  • *GAD, SAD, specific phobia: medium effect size

  • PTSD and OCD: medium to large

• 1-6 months follow up data:

  • *GAD and PD: small effect size

  • SAD: medium effect size

  • Specific phobia: *PTSD and OCD: medium to large

• * = high heterogeneity 

• 6-12 month follow up data

  • *GAD. PD, and SAD: small to medium effect size

  • PTSD: medium

• 12+ months follow up data

  • GAD: small effect size

  • SAD: small effect size

  • *PTSD: large

  • PD: no significant findings

• Relapse rates: relatively low (0-14%)

discussion

• CBT was associated with moderate symptom reductions up to 12 months after treatment

• Long-term effects not significant for panic disorder

  • Why?

• Perhaps power was an issue (results indicate the absence of evidence rather than the evidence of absence)

• Evidence suggests treatment gains are stable for 12 months (“but do not improve further”)

• Minimal data on relapse