Disorders - Generalized Anxiety Disorder
Richards, D., Timulak, L., Rashleigh, C., McLoughlin, O., Colla, A., Joyce, C., Doherty, G., Sharry, J., Duffy, D., Anderson-Gibbons, M.
Background Cognitive behavioural therapy is
one of the main and preferred treatments for generalized anxiety disorder. Numerous barriers can hinder an individual from seeking or receiving
appropriate treatment; internet-delivered CBT interventions offer a relatively new means of increasing access to treatment. Methods A service-based
effectiveness randomised waiting list control trial examined the impact of an internet-delivered CBT intervention, Calming Anxiety, amongst Irish
university students (N = 137). Primary outcome was self-reported GAD and secondary outcomes included depression and work and social functioning.
Results Analyses returned inconclusive results. Both treatment and waiting list conditions displayed significant decreases in anxiety symptoms post-
treatment, but we did not observe a significant between-group effect (p = 0.076). Significant within-group differences from pre to post time points
were observed for depression (BDI-II) and work and social functioning (WASA), and between group differences were also significant for depression (d =
0.46) and functioning (d = 0.36). Both groups demonstrated cases of remission and recovery from anxiety, however differences in the number of cases
reaching clinically meaningful change between conditions were non-significant. Conclusions Several explanations regarding the results are presented,
examining issues related to active waiting lists, study limitations and treatment expectancies. Trial registration: Current Controlled Trials
ISRCTN16303842. Copyright © 2016 The Authors
Internet Interventions, 6 : 80-
88
- Year: 2016
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Technology, interventions delivered using technology (e.g. online, SMS)
Gale, C. K., Millichamp, J.
INTRODUCTION: Generalised anxiety disorder (GAD) in a child or adolescent is excessive worry and tension about everyday events
that the child or adolescent cannot control and that is expressed on most days for at least 6 months, to the extent that there is distress or
difficulty in performing day-to-day tasks. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical
question: What are the effects of pharmacological treatments for generalised anxiety disorder in children and adolescents? We searched: Medline,
Embase, The Cochrane Library, and other important databases up to August 2014 (Clinical Evidence reviews are updated periodically; please check our
website for the most up-to-date version of this review). RESULTS: At this update, searching of electronic databases retrieved 949 studies. After
deduplication and removal of conference abstracts, 417 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to
the exclusion of 310 studies and the further review of 107 full publications. Of the 107 full articles evaluated, one systematic review was added at
this update. We performed a GRADE evaluation for six PICO combinations. CONCLUSIONS: In this systematic overview, we categorised the efficacy for six
interventions based on information about the effectiveness and safety of antidepressants, antipsychotics, benzodiazepines, buspirone, hydroxyzine,
and pregabalin.
BMJ clinical evidence, (pagination) :
- Year: 2016
- Problem: Generalized Anxiety Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Antidepressants
(any), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions
Calear, A. L., Batterham, P. J., Poyser, C.
T., Mackinnon, A. J., Griffiths, K. M., Christensen, H.
Background: Anxiety is a common mental health problem in youth. The current study aimed to test the
effectiveness of an online self-directed anxiety prevention program in a school-based sample and to compare two methods of implementing an anxiety
program in schools. Methods: A three-arm cluster stratified randomised controlled trial was conducted with 30 Australian schools. Each school was
randomly assigned to receive: (1) externally-supported intervention, (2) teacher-supported intervention, or (3) wait-list control. All consenting
students (N = 1767) were invited to complete pre-intervention, post-intervention, 6- and 12-month follow-up questionnaires measuring generalised
anxiety, social anxiety, anxiety sensitivity, depressive symptoms and mental wellbeing. Intervention participants completed the e-couch Anxiety and
Worry program over 6 weeks. Results: At post-intervention, 6- and 12-month follow-up no significant differences were observed between the
intervention and control conditions for generalised anxiety (Cohen's d = -0.14 to 0.15), social anxiety (d = 0.04-0.23), anxiety sensitivity (d = -
0.07 to 0.07), depressive symptoms (d = -0.05 to 0.04) or mental wellbeing (d = -0.06 to -0.30). Limitations: The current study only included self-
report measures that may have been influenced by situational factors or biases. Conclusions: The e-couch Anxiety and Worry program did not have a
significant positive effect on participant mental health or wellbeing. The addition of a mental health education officer to support classroom
teachers in the delivery of the program also had no effect on intervention outcomes. Future prevention research should look to develop briefer and
more interactive interventions that are more engaging for youth. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Journal of Affective Disorders, 196 : 210-217
- Year: 2016
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Psychoeducation, Self-help, Physical activity, exercise, Relaxation
Calear, A.
L., Christensen, H., Brewer, J., Mackinnon, A., Griffiths, K. M.
The aim of this pilot study was to evaluate the acceptability and feasibility of delivering an online anxiety prevention
program in schools, and to assess the effectiveness of the intervention in reducing symptoms of anxiety. Three schools located in South Australia and
the Australian Capital Territory were recruited to participate in the trial, with classes randomly allocated to the intervention or wait-list control
condition. All participants (N = 225) were invited to complete a pre-intervention, post-intervention and 3-month follow-up questionnaire.
Participants in the intervention condition completed the online e-couch Anxiety and Worry program during one class period a week for six weeks. No
significant differences were found between the intervention and control conditions at post-intervention or 3-month follow-up for generalised anxiety
(Cohen's d = - 0.09-0.08), social anxiety (d = 0.09 & - 0.26), anxiety sensitivity (d = 0.19 & - 0.15), depressive symptoms (d = 0.01 & 0.08) or
mental wellbeing (d = 0.17 & 0.30). Online anxiety prevention programs are acceptable and can be feasibly delivered in schools. Although not
significant, the sizes of some of the effects obtained in this pilot trial are consistent with earlier studies, and warrant further investigation in
a larger trial. Copyright © 2016 The Authors
Internet Interventions, 6 : 1-5
- Year: 2016
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Psychoeducation, Self-help, Physical activity, exercise, Relaxation
Dobson, E. T., Strawn, J.
R.
BACKGROUND: Randomized controlled trials consistently support the efficacy of antidepressants in treating youth with generalized
anxiety disorder (GAD), although integrated examinations of efficacy, safety, and tolerability of psychotropic medications in GAD, specifically, are
rare. With this in mind, we sought to describe the efficacy, safety, and tolerability of psychopharmacologic interventions in pediatric patients with
GAD.\rMETHODS: Randomized, double-blind, placebo-controlled, prospective trials of psychopharmacologic interventions in youth with GAD were
identified through a PubMed/Medline (1966-2015) search. Both authors manually reviewed trials and, to evaluate comparative efficacy and tolerability
across medications, numbers needed to treat (NNT) [based on Pediatric Anxiety Rating Scale (PARS) remission criteria (PARS <=8)] and number needed to
harm (NNH) for selected treatment-emergent adverse events (TEAEs) were calculated. Finally, treatment-emergent suicidality and taper-emergent/post-
study adverse events are reported descriptively.\rRESULTS: Five trials that involved 1186 patients and evaluated four medications were reviewed and
efficacy data were extracted with regard to dimensional measures of anxiety. Selective serotonin reuptake inhibitors (SSRIs) and serotonin
norepinephrine reuptake inhibitors (SNRIs) demonstrated efficacy in the reduction of anxiety symptoms with NNTs ranging from 2.8 to 9.3. TEAEs varied
considerably between studies but tended to be mild and generally did not lead to discontinuation.\rCONCLUSIONS: Data from five trials of SSRI/SNRI in
youth with GAD, many of whom had co-occurring separation and social anxiety disorders, suggest superiority to placebo and favorable tolerability
profiles.
Paediatric Drugs, 18(1) : 45-
53
- Year: 2016
- Problem: Generalized Anxiety Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Serotonin-norepinephrine reuptake inhibitors
(SNRIs), Antidepressants
(any)
LaFreniere, L. S., Newman, M. G.
Background: The efficacy
of many cognitive behavioral component interventions has not been examined, with worry outcome monitoring among them. Methods: To address this issue,
51 participants with clinical levels of generalized anxiety disorder were randomly assigned to a treatment or control condition for 10 days. The
treatment condition consisted of a brief ecological momentary intervention termed the Worry Outcome Journal (WOJ). WOJ participants recorded worries
and tracked their outcomes, rating worry distress, interference, and expected outcome probabilities. Thought log (TL) control participants completed
a record of their everyday thoughts and rated associated distress. All participants made four entries on paper each day when randomly prompted by
text message. They then entered their paper contents online each night. After 30 days they reviewed their contents electronically and completed
follow-up measures. Results: Primary results revealed significant reductions in worry for WOJ users compared to TL users at postintervention. A
marginally significant difference was found at 20-day follow-up and treatment gains were maintained. Secondary analyses showed no harmful increases
in worry beliefs for WOJ users, as well as preliminary evidence for decreases in beliefs about the uncontrollability of thoughts in both groups.
Conclusion: The WOJ may be a viable therapist-independent treatment for reducing worry, even after only 10 days of use. (PsycINFO Database Record (c)
2017 APA, all rights reserved)
Depression and Anxiety, 33(9) : 829-
839
- Year: 2016
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Caldwell, K. L., Bergman, S., Collier, S., Triplett, N. T.
This feasibility study used a 3-arm randomized controlled trial design to determine optimal levels of instruction in Tai Chi
Chuan (TCC) in the target population of young adults age 18-40 who indicated that they had mild to severe symptoms of anxiety on the Generalized
Anxiety Disorder (GAD-7) screening measure. Seventy-five young adults (M age = 21.13, SD = 3.5) were randomized to one of three groups: (1) self-
study of education materials (placebo control), (2) self-study materials plus 10 weeks of TCC meeting 2 times per week for one hour for each class
period, or (3) self-study materials plus 10 weeks of RCC classes meeting 2 times per week plus an instructional DVD designed to encourage practice
outside of class. The overall retention rate was 80%, and no significant differences were found across the three groups in terms of retention rates.
A qualitative review of reasons for withdrawing from the study or being unable to attend classes found time management issues to be a frequently
reported concern. Intent-to-treat analyses found no differences in groups across time. When only retained subjects were included in analysis of pre-
intervention and post-intervention scores, no significant differences were found on State-Trait Anxiety Scale (STAI) scores or Pittsburgh Sleep
Quality Index (PSQI) scores for participants in the Control group. Tai chi participant scores on both the State and Trait scales of the STAI
decreased from pre- to immediate post-intervention as did PSQI scores. Tai chi chuan may be a promising intervention for anxiety and poor sleep
quality in young adults.
Psychosomatic Medicine, 77(3) : A139
- Year: 2015
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any), Self-help, Mind-body exercises (e.g. yoga, tai chi, qigong)
Dash, S.
R., Meeten, F., Jones, F., Davey, G. C. L.,
Background & objectives: Given the ubiquity of worrying as a consuming and distressing activity at both clinical and sub-clinical
levels, it is important to develop theory-driven procedures that address worrying and allow worriers to manage this activity. This paper describes
the development and testing of a psychoeducation procedure based on mood-as-input hypothesis, which is a transdiagnostic model that describes a
proximal mechanism for perseverative worrying. The study used nonclinical participants meeting IAPT criteria indicating GAD symptomatology. Methods:
In 4 sessions, participants in experimental groups received psychoeducation about the basic principles of the mood-as-input hypothesis and received
guidance on how to identify and change worry-relevant goal-directed decision rules and negative moods. Participants in the psychoeducation conditions
were compared with participants in a befriending control group. Results: Psychoeducation about the model significantly reduced PSWQ scores at
follow-up compared with the befriending control condition (a between-groups large effect size, Cohen's d = 1.05), and the homework tasks undertaken
by the psychoeducation groups raised mood and reduced worry immediately. At follow up 48.2% of participants in the psychoeducation groups were below
the recommended cut-off for identifying GAD symptomatology compared with 20% of participants in the control condition. Limitations: This study was
conducted on a small sample, high-worry student population, without a formal diagnosis. Conclusions: This brief, low-intensity procedure is
potentially adaptable to online or self-help procedures, and can be integrated into fuller cognitive therapy packages.
Journal of Behavior Therapy & Experimental Psychiatry, 46 : 126-
132
- Year: 2015
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Psychoeducation
Strawn, J. R., Prakash, A., Zhang, Q., Pangallo, B. A, Stroud, C. E., Cai, N., Findling, R. L.
Objective: To evaluate the efficacy, safety, and tolerability of
the selective serotonin norepinephrine inhibitor duloxetine in children and adolescents with generalized anxiety disorder (GAD). Method: Youth aged 7
through 17 years with a primary diagnosis of GAD were treated with flexibly dosed duloxetine (30-120 mg daily, n = 135) or placebo (n = 137) for 10
weeks, followed by open-label duloxetine (30-120mg daily) for 18 weeks. Efficacy measures included the Pediatric Anxiety Rating Scale (PARS),
Clinical Global Impression-Severity (CGI-Severity) scale, and Children's Global Assessment Scale (CGAS). Safety measures included the Columbia-
Suicide Severity Rating Scale (C-SSRS) as well as vital signs and electrocardiographic and laboratory monitoring. Results: On the primary efficacy
measure (PARS severity for GAD), mean improvement from baseline to 10 weeks was statistically significantly greater for duloxetine (-9.7) compared
with placebo (-7.1, p < .001, Cohen's d: 0.5). Symptomatic response (50% improvement on the PARS severity for GAD), remission (PARS severity for GAD
< 8), and functional remission (CGAS > 70) rates for the duloxetine group (59%, 50%, 37%, respectively) were statistically significantly greater than
for the placebo group (42%, 34%, 24%, respectively, p < .05) during acute treatment. Changes in systolic and diastolic blood pressure and
discontinuation because of adverse events did not statistically differ between the duloxetine and placebo groups, although gastrointestinal-related
adverse events, oropharyngeal pain, dizziness, cough, and palpitations were reported with a statistically significantly greater incidence for the
duloxetine group compared with the placebo group. Mean changes in pulse and weight for the duloxetine group (+ 6.5 beats/min, -0.1 kg, respectively)
were statistically different from the placebo group (+ 2.0 beats/min, + 1.1 kg, respectively, p < .01). Conclusion: In this study, duloxetine was
superior to placebo on the primary efficacy analysis of mean change from baseline to week 10 on the PARS severity for GAD score, and safety results
were consistent with the known safety profile of duloxetine in pediatric and adult patients. (PsycINFO Database Record (c) 2015 APA, all rights
reserved) (journal abstract).
Journal of the American
Academy of Child & Adolescent Psychiatry, 54(4) : 283-293
- Year: 2015
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Serotonin-norepinephrine reuptake inhibitors
(SNRIs)
Peris, T. S., Compton, S. N., Kendall, P. C., Birmaher, B., Sherrill, J., March, J., Gosch, E., Ginsburg,
G., Rynn, M., McCracken,
J.T., Keeton, C. P., Sakolsky, D., Suveg,
C., Aschenbrand, S., Almirall, D., Iyengar, S., Walkup, J. T., Albano, A. M., Piacentini, J.,
Objective: To evaluate changes in the trajectory of youth
anxiety following the introduction of specific cognitive-behavior therapy (CBT) components: relaxation training, cognitive restructuring, and
exposure tasks. Method: Four hundred eighty-eight youths ages 7-17 years (50% female; 74% < 12 years) were randomly assigned to receive either CBT,
sertraline (SRT), their combination (COMB), or pill placebo (PBO) as part of their participation in the Child/Adolescent Anxiety Multimodal Study
(CAMS). Youths in the CBT conditions were evaluated weekly by therapists using the Clinical Global Impression Scale-Severity (CGI-S; Guy, 1976) and
the Children's Global Assessment Scale (CGAS; Shaffer et al., 1983) and every 4 weeks by blind independent evaluators (IEs) using the Pediatric
Anxiety Ratings Scale (PARS; RUPP Anxiety Study Group, 2002). Youths in SRT and PBO were included as controls. Results: Longitudinal discontinuity
analyses indicated that the introduction of both cognitive restructuring (e.g., changing self-talk) and exposure tasks significantly accelerated the
rate of progress on measures of symptom severity and global functioning moving forward in treatment; the introduction of relaxation training had
limited impact. Counter to expectations, no strategy altered the rate of progress in the specific domain of anxiety that it was intended to target
(i.e., somatic symptoms, anxious self-talk, avoidance behavior). Conclusions: Findings support CBT theory and suggest that cognitive restructuring
and exposure tasks each make substantial contributions to improvement in youth anxiety. Implications for future research are discussed. (PsycINFO
Database Record (c) 2016 APA, all rights reserved) (journal abstract).
Journal of Consulting & Clinical Psychology, 83(2) : 239-
252
- Year: 2015
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Specific
Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Antidepressants
(any), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Piacentini,
J., Bennett, S., Compton, S. N., Kendall, P. C., Birmaher, B., Albano, A. M., March, J., Sherrill, J., Sakolsky, D., Ginsburg,
G., Rynn, M., Bergman, R. L., Gosch, E., Waslick, B., Iyengar, S., McCracken, J., Walkup, J.
Objective We report active treatment group differences on response and
remission rates and changes in anxiety severity at weeks 24 and 36 for the Child/Adolescent Anxiety Multimodal Study (CAMS). Method CAMS youth (N =
488; 74% (less-than or equal to)12 years of age) with DSM-IV separation, generalized, or social anxiety disorder were randomized to 12 weeks of
cognitive-behavioral therapy (CBT), sertraline (SRT), CBT+SRT (COMB), or medication management/pill placebo (PBO). Responders attended 6 monthly
booster sessions in their assigned treatment arm; youth in COMB and SRT continued on their medication throughout this period. Efficacy of COMB, SRT,
and CBT (n = 412) was assessed at 24 and 36 weeks postrandomization. Youth randomized to PBO (n = 76) were offered active CAMS treatment if
nonresponsive at week 12 or over follow-up and were not included here. Independent evaluators blind to study condition assessed anxiety severity,
functioning, and treatment response. Concomitant treatments were allowed but monitored over follow-up. Results The majority (>80%) of acute
responders maintained positive response at both weeks 24 and 36. Consistent with acute outcomes, COMB maintained advantage over CBT and SRT, which
did not differ, on dimensional outcomes; the 3 treatments did not differ on most categorical outcomes over follow-up. Compared to COMB and CBT, youth
in SRT obtained more concomitant psychosocial treatments, whereas those in SRT and CBT obtained more concomitant combined (medication plus
psychosocial) treatment. Conclusions COMB maintained advantage over CBT and SRT on some measures over follow-up, whereas the 2 monotherapies remained
indistinguishable. The observed convergence of COMB and monotherapy may be related to greater use of concomitant treatment during follow-up among
youth receiving the monotherapies, although other explanations are possible. Although outcomes were variable, most CAMS-treated youth experienced
sustained treatment benefit. Clinical trial registration information - Child and Adolescent Anxiety Disorders (CAMS); URL: http://clinicaltrials.
gov. Unique identifier: NCT00052078.
Journal of the American Academy of Child & Adolescent Psychiatry, 53(3) : 297-
310
- Year: 2014
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Wergeland,
G. J. H., Fjermestad, K. W., Marin, C. E., Haugland, BS-M., Bjaastad, J. F., Oeding, K., Bjelland, I., Silverman, W. K., Ost, L-G., Havik, O.
E., Heiervang, E. R.
Objective: Conducted a randomized controlled trial to
investigate the effectiveness of cognitive behavioral therapy (CBT), and compared the relative effectiveness of individual (ICBT) and group (GCBT)
treatment approaches for anxiety disorders in children and adolescents.; Methods: Referred youth (N = 182, M age = 11.5 years, range 8-15 years, 53%
girls) with separation anxiety, social phobia, or generalized anxiety disorder were randomly assigned to ICBT, GCBT or a waitlist control (WLC) in
community clinics. Pre-, post-, and one year follow-up assessments included youth and parent completed diagnostic interview and symptom measures.
After comparing CBT (ICBT and GCBT combined) to WLC, ICBT and GCBT were compared along diagnostic recovery rates, clinically significant improvement,
and symptom measures scores using traditional hypothesis tests, as well as statistical equivalence tests.; Results: Significantly more youth lost all
anxiety disorders after CBT compared to WLC. Full diagnostic recovery rate was 25.3% for ICBT and 20.5% in GCBT, which was not significantly
different. There was continued lack of significant differences between ICBT and GCBT at one year follow-up. However, equivalence between GCBT and
ICBT could only be demonstrated for clinical severity rating of the principal anxiety disorder and child reported anxiety symptoms post-treatment.;
Conclusion: Findings support the effectiveness of CBT compared to no intervention for youth with anxiety disorders, with no significant differences
between ICBT and GCBT. However, the relatively low recovery rates highlight the need for further improvement of CBT programs and their
transportability from university to community settings.; Copyright © 2014 Elsevier Ltd. All rights reserved.
Behaviour
Research & Therapy, 57 : 1-12
- Year: 2014
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other service delivery and improvement
interventions