Disorders - Generalized Anxiety Disorder
Ginsburg, Golda S., Kendall, Philip C., Sakolsky, Dara, Compton, Scott N., Piacentini,
John, Albano, Anne Marie, Walkup, John T., Sherrill, Joel, Coffey, Kimberly A., Rynn, Moira A., Keeton, Courtney P., McCracken, James T., Bergman,
Lindsey, Iyengar,
Satish, Birmaher, Boris, March, John
Objective: To report on remission rates in anxious youth who participated in the Child/Adolescent Anxiety Multimodal Study (CAMS). The CAMS, a
multisite clinical trial, randomized 488 children and adolescents (ages 7–17 years; 79% Caucasian; 50% female) with separation, social, and/or
generalized anxiety disorder to a 12-week treatment of sertraline (SRT), cognitive behavioral therapy (CBT), their combination (COMB), or clinical
management with pill placebo (PBO). Method: The primary definition of remission was loss of all study-entry anxiety disorder diagnoses; additional
definitions of remission were used. All outcomes were rated by independent evaluators blind to treatment assignment. Predictors of remission were
also examined. Results: Remission rates after 12 weeks of treatment ranged from 46% to 68% for COMB, 34% to 46% for SRT, 20% to 46% for CBT, and 15%
to 27% for PBO. Rates of remission (i.e., achieving a nearly symptom-free state) were significantly lower than rates of response (i.e., achieving a
clinically meaningful improvement relative to baseline) for the entire sample. Youth who received COMB had significantly higher rates of remission
compared to all other treatment groups. Both monotherapies had higher remission rates compared to PBO, but rates were not different from each other.
Predictors of remission were younger age, nonminority status, lower baseline anxiety severity, absence of other internalizing disorders (e.g.,
anxiety, depression), and absence of social phobia. Conclusions: For the majority of children, some symptoms of anxiety persisted, even among those
showing improvement after 12 weeks of treatment, suggesting a need to augment or extend current treatments for some children. (PsycINFO Database
Record (c) 2012 APA, all rights reserved) (journal abstract)
Journal of Consulting & Clinical Psychology, 79(6) : 806-
813
- Year: 2011
- 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), Other Psychological Interventions
Heiervang, E, Wergeland, G. J., Fjermestad, K., Haugland, B. S. M., Ost, L.
G., Havik, O. E., Oeding, K., Bjanullstad, J.
F.
Introduction: Efficacy studies of CBT for childhood anxiety disorders have found significant effects for up to 70% of the patients, but less
is known about the effectiveness with youths in routine clinical care. We have therefore studied the effectiveness of the FRIENDS for Life program in
seven child and adolescent mental health outpatient clinics in Western Norway. Method: Subjects were randomized to group or individual treatment,
some with a preceding wait-list period with a mean duration equal to the treatment period of 10 weeks. A total of 183 referred youths aged 8-15 years
with separation anxiety, generalized anxiety or social anxiety disorder were included. There were few exclusion criteria. Pre-, post- and 1 year
follow-up assessments included the Anxiety Disorder Interview Schedule for children and parents, Spence Children's Anxiety Scale and the Short Mood
and Feelings Questionnaire. Results: Significant improvement was observed both for individual and group treatment with regard to diagnostic status,
anxiety symptoms and depressive symptoms, with little change after the wait-list period. Post-treatment around had recovered from their principal
diagnosis. There was a moderate effect size on anxiety and depressive symptoms. Preliminary data show continuing effects at 1 year follow-up, with no
significant effect of treatment format. Discussion: The study is one of the largest studies of CBT for anxiety in children carried out in regular
clinics with regular clinicians. The FRIENDS for Life CBT program seems to be an effective treatment when delivered in ordinary clinical settings,
with equal effects for individual and group formats. Conclusion: Manualised CBT is effective for childhood anxiety disorders in ordinary clinical
care both at short- and long-term (1 year) and may be recommended for clinical use.
European Child & Adolescent
Psychiatry, 20 : S45
- Year: 2011
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Herring, Matthew P., Jacob, Marni L., Suveg, Cynthia, O'Connor,
Patrick J.
Background: No randomized controlled trial has investigated
exercise training effects on signs and symptoms that characterize patients with Generalized Anxiety Disorder (GAD). Objectives: To quantify and
compare the effects of six weeks of resistance (RET) and aerobic exercise training (AET) on signs and symptoms associated with GAD. Methods: Thirty
sedentary women, aged 18-37 years, diagnosed by blinded clinicians with a primary DSM-IV diagnosis of GAD, who were not engaged in treatment other
than pharmacotherapy, were randomized to six weeks of RET, AET, or wait list (WL). RET involved two weekly sessions of lower-body weightlifting. AET
involved two weekly sessions of leg cycling matched with RET on body region, positive work, exercise time, and load progression. Outcomes included
concentration difficulty, trait anxiety, symptoms of depression, tension, low vigor, fatigue and confusion, irritability, muscle tension, and pain
location and intensity. Hedges’ d effect sizes and 95% confidence intervals were calculated at weeks two, four, and six for each exercise condition
compared to WL. Results: RET significantly reduced feelings of anxiety-tension and the frequency and intensity of irritability. RET also resulted in
six-week Hedges’ d effect sizes ≥0.36 for trait anxiety, concentration, symptoms of depression, fatigue and vigor, and pain intensity. AET
resulted in comparable improvements in trait anxiety, concentration, irritability, muscle tension, and symptoms of fatigue and vigor. Effects for 9
of 12 outcomes were non-significantly larger for RET compared to AET. Conclusions: Short-term RETand AET provoke comparable improvements in signs and
symptoms associated with GAD, particularly irritability, anxiety, low vigor and pain. Findings warrant further investigation. Clinical trial
registration: (ClinicalTrials.gov) Identifier: NCT00953654. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Mental Health & Physical Activity, 4(2) : 71-
77
- Year: 2011
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Physical activity, exercise
Herring, Matthew P., Jacob, Marni L., Suveg, Cynthia, Dishman, Rodney K., O'Connor,
Patrick J.
Background: Exercise training may be especially helpful for patients with generalized anxiety disorder (GAD). We conducted a randomized
controlled trial to quantify the effects of 6 weeks of resistance (RET) or aerobic exercise training (AET) on remission and worry symptoms among
sedentary patients with GAD. Methods: Thirty sedentary women aged 18–37 years, diagnosed by clinicians blinded to treatment allocation with a
primary DSM-IV diagnosis of GAD and not engaged in any treatment other than pharmacotherapy, were randomly allocated to RET, AET, or a wait list
(WL). RET involved 2 weekly sessions of lower-body weightlifting. AET involved 2 weekly sessions of leg cycling matched with RET for body region,
positive work, time actively engaged in exercise, and load progression. Remission was measured by the number needed to treat (NNT). Worry symptoms
were measured by the Penn State Worry Questionnaire. Results: There were no adverse events. Remission rates were 60%, 40%, and 30% for RET, AET, and
WL, respectively. The NNT was 3 (95% CI 2 to 56) for RET and 10 (95% CI –7 to 3) for AET. A significant condition-by-time interaction was found for
worry symptoms. A follow-up contrast showed significant reductions in worry symptoms for combined exercise conditions versus the WL. Conclusions:
Exercise training, including RET, is a feasible, low-risk treatment that can potentially reduce worry symptoms among GAD patients and may be an
effective adjuvant, short-term treatment or augmentation for GAD. Preliminary findings warrant further investigation. (PsycINFO Database Record (c)
2012 APA, all rights reserved) (journal abstract)
Psychotherapy & Psychosomatics, 81(1) : 21-28
- Year: 2011
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Physical activity, exercise
Davidson, J. R. T., Feltner, D. E., Dugar, A.
Background: Generalized anxiety disorder (GAD) is one of the most common psychiatric disorders in primary care, although it
is often underrecognized and undertreated. GAD is chronic, disabling, and associated with other health problems. Treatment response is often
unsatisfactory, but the clinical evidence base for new treatments has expanded substantially in the past decade and suggests a growing range of
options for reducing the burden of GAD. The objective of this article was to review current literature on GAD and its management to provide an
overview of the clinical importance of GAD in primary care and available treatments. Data Sources: Recent studies (ie, over the past decade) on the
epidemiology and treatment of GAD were identified by searching Medline using the term generalized anxiety disorder only and in combination with the
terms epidemiology and treatment and for each drug class (benzodiazepines, azapirones, antidepressants, antihistamines, alpha-2-delta ligands, and
antipsychotics) and for named drugs (buspirone, venlafaxine, duloxetine, fluoxetine, escitalopram, olanzapine, paroxetine, pregabalin, quetiapine,
and risperidone in addition to psychological therapies and cognitive-behavioral therapy. The literature search was conducted in August 2008 for the
period 1987-2009. Study Selection: Studies were included if judged to be relevant to a review of the epidemiology and management of GAD. Articles
were excluded if they were not written in English or were published more than 10 years before the literature search was conducted. A few older
studies were included for which more recent research evidence was not available. Recent national and international guidelines for the management of
GAD were also reviewed. Data Extraction/Synthesis: Most currently available interventions have similar overall efficacy, and treatment choices should
reflect the situation of individual patients. Important unmet needs exist for treatments (1) that work rapidly, with (2) broad spectrum benefits, (3)
that can improve rates of remission and well-being, (4) are devoid of risk for withdrawal symptoms, and (5) have few if any adverse interactions with
other drugs. Additional needs include (6) safer drugs for the elderly, (7) safe and effective drugs for children with GAD, (8) further evaluation of
psychotherapy, and (9) understanding the appropriate circumstances for, and optimal choices of, drug combination. Conclusion: While the development
of novel treatments evolves, current management approaches can focus on improving identification and defining optimal use of available therapies for
GAD. (copyright) 2010 Physicians Postgraduate Press, Inc.
Primary Care Companion to the Journal of Clinical
Psychiatry, 12(2) :
- Year: 2010
- Problem: Generalized Anxiety Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Southam-Gerow, M. A., Weisz, J. R., Chu, B. C., McLeod,
B. D., Gordis, E. B., Connor-Smith, J. K.
Objective: Most tests of cognitive behavioral
therapy (CBT) for youth anxiety disorders have shown beneficial effects, but these have been efficacy trials with recruited youths treated by
researcher-employed therapists. One previous (nonrandomized) trial in community clinics found that CBT did not outperform usual care (UC). The
present study used a more stringent effectiveness design to test CBT versus UC in youths referred to community clinics, with all treatment provided
by therapists employed in the clinics. Method: A randomized controlled trial methodology was used. Therapists were randomized to training and
supervision in the Coping Cat CBT program or UC. Forty-eight youths (56% girls, 8 to 15 years of age, 38% Caucasian, 33% Latino, 15% African-
American) diagnosed with DSM-IV anxiety disorders were randomized to CBT or UC. Results: At the end of treatment more than half the youths no longer
met criteria for their primary anxiety disorder, but the groups did not differ significantly on symptom (e.g., parent report, eta-square = 0.0001;
child report, eta-square = 0.09; both differences favoring UC) or diagnostic (CBT, 66.7% without primary diagnosis; UC, 73.7%; odds ratio 0.71)
outcomes. No differences were found with regard to outcomes of comorbid conditions, treatment duration, or costs. However, youths receiving CBT used
fewer additional services than UC youths ((chi)21 = 8.82, p = .006). Conclusions: CBT did not produce better clinical outcomes than usual community
clinic care. This initial test involved a relatively modest sample size; more research is needed to clarify whether there are conditions under which
CBT can produce better clinical outcomes than usual clinical care.
Journal of the American Academy of Child & Adolescent Psychiatry, 49(10) : 1043-
1052
- Year: 2010
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder), Specific
Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Wood, J. J., McLeod, B. D., Piacentini, J. C., Sigman, M.
Objective To compare the relative long-term benefit of family-focused cognitive behavioral therapy (FCBT) and
child-focused cognitive behavioral therapy (CCBT) for child anxiety disorders at a 1-year follow-up. Method Thirty-five children (6-13 years old)
randomly assigned to 12-16 sessions of family-focused CBT (FCBT) or child-focused CBT (CCBT) participated in a 1-year follow-up assessment.
Independent evaluators, parents, and children rated anxiety and parental intrusiveness. All were blind to treatment condition and study hypotheses.
Results Children assigned to FCBT had lower anxiety scores than children assigned to CCBT on follow-up diagnostician- and parent-report scores, but
not child-report scores. Exploratory analyses suggested the advantage of FCBT over CCBT may have been evident more for early adolescents than for
younger children and that reductions in parental intrusiveness may have mediated the treatment effect. Conclusion FCBT may yield a stronger treatment
effect than CCBT that lasts for at least 1 year, although the lack of consistency across informants necessitates a circumspect view of the findings.
The potential moderating and mediating effects considered in this study offer interesting avenues for further study.
Child Psychiatry & Human Development, 40(2) : 301-316
- Year: 2009
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Specific
Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Keeton, C. P., Kolos, A. C., Walkup, J.
T.
Pediatric generalized anxiety disorder (GAD) is characterized by
excessive and uncontrollable worry about a variety of events and is accompanied by physical symptoms such as headaches, tension, restlessness,
gastrointestinal distress, and heart palpitations. Symptoms impose marked distress and interfere with social, emotional, and educational functioning.
GAD occurs in over 10 of children and adolescents, has an average age of onset of 8.5 years, and is more often reported in girls. Common co-occurring
conditions include separation anxiety disorder and social phobia.Assessment involves a multi-informant, multi-method approach involving the child,
parents, and school teachers. A clinical interview should be conducted to assess for the three primary ways anxiety presents: behaviors, thoughts,
and somatic symptoms. Several semi-structured diagnostic interviews are available, and the Anxiety Disorders Interview Schedule is increasingly used.
Rating scales completed by the patient, caregivers, and teachers provide useful information for diagnosis and symptom monitoring. Several scales are
available to assess patients for the Diagnostic and Statistical Manual of Mental Disorders (4th Edition) GAD diagnosis; however, instruments
generally cannot distinguish children with GAD from children with similar anxiety disorders.Both cognitive-behavioral therapy (CBT) and selective
serotonin reuptake inhibitors (SSRIs) have demonstrated efficacy for the treatment of pediatric anxiety disorders including GAD. Evidence suggests
that the combination of CBT plus sertraline offers additional benefit compared with either treatment alone. With pharmacotherapy, systematic tracking
of treatment-emergent adverse events such as headaches, stomach aches, behavioral activation, worsening symptoms, and emerging suicidal thoughts is
important. Recommended starting doses are fluvoxamine 25mgday, fluoxetine 10mgday, and sertraline 25mgday, though lower starting doses are possible.
Dosing can be adjusted as often as weekly with the goal of achieving a high-quality response, while minimizing side effects. Long-term treatment with
medication has not been well studied; however, to achieve optimal long-term outcome extended use of medication may be required. It is recommended to
continue medication for approximately 1 year following remission in symptoms, and when discontinuing medication to choose a stress-free time of the
year. If symptoms return, medication re-initiation should be considered seriously. (copyright) 2009 Adis Data Information BV. All rights
reserved.
Pediatric Drugs, 11(3) : 171-183
- Year: 2009
- Problem: Generalized Anxiety Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Liber, J. M., VanWidenfelt, B. M., Utens, E.
M. W. J., Ferdinand, R. F., VanDerLeeden, A. J. M., Gastel, W. V., Treffers, P. D. A.
Background: The present study compares an individual versus a group format in the delivery of
manualised cognitive-behavioural therapy (FRIENDS) for children with anxiety disorders. Clinically referred children (aged 8 to 12) diagnosed with
Separation Anxiety Disorder (n = 52), Generalised Anxiety Disorder (n = 37), Social Phobia (n = 22) or Specific Phobia (n = 16) were randomly
assigned to individual (n = 65) or group (n = 62) treatment. Method: Analyses were conducted separately for the intent-to-treat sample and the sample
of children who completed treatment. Analyses included chi-square comparisons and regression analyses with treatment format as a predictor. Results:
Forty-eight percent of the children in the individual versus 41% in the group treatment were free of any anxiety disorder at post-treatment; 62%
versus 54% were free of their primary anxiety disorder. Regression analyses showed no significant difference in outcome between individual and group
treatment. Conclusions: Children improved in both conditions. Choice between treatments could be based on pragmatic considerations such as
therapeutic resources, referral rates, and the preference of the parents and the child. copyright 2008 The Authors.
Journal of Child Psychology & Psychiatry & Allied
Disciplines., 49(8) : 886-893
- Year: 2008
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder), Specific
Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Bernstein, G. A., Bernat, D. H., Victor, A. M., Layne,
A. E.
Objective: To follow 61 participants (7-
11 years old) from a study that compared three school-based interventions for anxious children: group cognitive-behavioral therapy (CBT) for
children, group CBT for children plus parent training, and no-treatment control to determine whether posttreatment benefits are sustained
longitudinally. Method: Parent, child, and clinician report measures of child anxiety were completed at 3, 6, and 12 months posttreatment.
Semistructured diagnostic interviews were administered at 6- and 12-month follow-ups. For initial analyses, the group CBT and group CBT plus parent
training conditions were collapsed into one group and compared to control. When significant results were found, each active treatment group was
compared to control. Results: Across several measures, the collapsed CBT group sustained significant improvement in anxiety severity and impairment
across a 12-month period compared to control. There were no significant differences between the three groups on remission of baseline anxiety
disorders or incidence of new anxiety disorders during the follow-up. Several parent-report measures at 3 and 6 months posttreatment suggested that
group CBT for children plus parent training provided additional benefit over the group CBT for children when each was compared to the control group.
Conclusions: School-based CBT appears effective in decreasing anxiety symptoms up to 12 months posttreatment for anxious children. copyright2008 by
the American Academy of Child and Adolescent Psychiatry.
Journal of the American Academy of Child & Adolescent
Psychiatry., 47(9) : 1039-1047
- Year: 2008
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions
Rezvan, S., Baghban, I., Bahrami, F., Abedi, M.
Objective: The aim of this
study was to compare the effectiveness of cognitive behavior therapy with the combination of cognitive behavior therapy and interpersonal therapy on
decreasing the excessiveness of pathological worry and increasing happiness of the individuals with generalized anxiety disorder. Method: The sample
consisted of 36 female undergraduate students who referred themselves to the Isfahan University Counseling Center and met the criteria for GAD. They
were randomly assigned into three groups; namely, two experimental groups and one control group. Before receiving the interventions all of the groups
completed Penn State Worry Questionnaire and Oxford Happiness Inventory. One of the experimental groups underwent cognitive behavior therapy and the
other one received the integration of cognitive behavior therapy and interpersonal therapy. The control group received no intervention. Result: The
statistical analyses indicated that the differences between the CBT and CBT + IPT groups on excessive worry and happiness in the post tests were not
significant. But significant mean differences were observed in the follow-ups regarding pathological worry and happiness between two groups.
Conclusion: It can be concluded that the integration of cognitive behavior therapy and interpersonal therapy can be applied as an effective
intervention for decreasing the rate of GADs’ relapses after cognitive behavior therapy. (PsycINFO Database Record (c) 2010 APA, all rights
reserved) (journal abstract)
Counselling Psychology Quarterly, 21(4) : 309-
321
- Year: 2008
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Interpersonal therapy (IPT)
Rynn, M. A., Riddle, M. A., Yeung, P. P., Kunz, N. R.
Objective: The authors evaluated the efficacy, safety, and tolerability of extended-release venlafaxine in the treatment of
pediatric generalized anxiety disorder. Method: Two randomized, double-blind, placebo-controlled trials were conducted at 59 sites in 2000 and 2001.
Participants 6 to 17 years of age who met DSM-IV criteria for generalized anxiety disorder received a flexible dosage of extended-release venlafaxine
(N=157) or placebo (N= 163) for 8 weeks. The primary outcome measure was the composite score for nine delineated items from the generalized anxiety
disorder section of a modified version of the Schedule for Affective Disorders and Schizophrenia for School-Age Children, and the primary efficacy
variable was the baseline-to-endpoint change in this composite score. Secondary outcome measures were overall score on the nine delineated items,
Pediatric Anxiety Rating Scale, Hamilton Anxiety Rating Scale, Screen for Child Anxiety Related Emotional Disorders, and the severity of illness and
improvement scores from the Clinical Global Impression scale (CGI). Results: The extended-release venlafaxine group showed statistically significant
improvements in the primary and secondary outcome measures in study 1 and significant improvements in some secondary outcome measures but not the
primary outcome measure in study 2. In a pooled analysis, the extended-release venlafaxine group showed a significantly greater mean decrease in the
primary outcome measure compared with the placebo group (-17.4 versus -12.7). The response rate as indicated by a CGI improvement score <3 was
significantly greater with extended-release venlafaxine than placebo (69% versus 48%). Common adverse events were asthenia, anorexia, pain, and
somnolence. Statistically significant changes in height, weight, blood pressure, pulse, and cholesterol levels were observed in the extended-release
venlafaxine group. Conclusions: Extended-release venlafaxine may be an effective, well-tolerated short-term treatment for pediatric generalized
anxiety disorder.
American Journal of
Psychiatry., 164(2) : 290-300
- Year: 2007
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Serotonin-norepinephrine reuptake inhibitors
(SNRIs)