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Does cognitive-behavioural therapy influence the long-term outcome of generalized anxiety disorder? An 8–14 year follow-up of two clinical trials

Published online by Cambridge University Press:  09 April 2003

R. C. DURHAM ,
J. A. CHAMBERS ,
R. R. MACDONALD ,
K. G. POWER  and
K. MAJOR
R. C. DURHAM
Affiliation:
From the Department of Psychiatry, University of Dundee and Department of Clinical Psychology, Tayside NHS, Dundee; Department of Psychology, University of Stirling; and Department of Health Policy, Ayrshire and Arran NHS, Ayr
J. A. CHAMBERS
Affiliation:
From the Department of Psychiatry, University of Dundee and Department of Clinical Psychology, Tayside NHS, Dundee; Department of Psychology, University of Stirling; and Department of Health Policy, Ayrshire and Arran NHS, Ayr
R. R. MACDONALD
Affiliation:
From the Department of Psychiatry, University of Dundee and Department of Clinical Psychology, Tayside NHS, Dundee; Department of Psychology, University of Stirling; and Department of Health Policy, Ayrshire and Arran NHS, Ayr
K. G. POWER
Affiliation:
From the Department of Psychiatry, University of Dundee and Department of Clinical Psychology, Tayside NHS, Dundee; Department of Psychology, University of Stirling; and Department of Health Policy, Ayrshire and Arran NHS, Ayr
K. MAJOR
Affiliation:
From the Department of Psychiatry, University of Dundee and Department of Clinical Psychology, Tayside NHS, Dundee; Department of Psychology, University of Stirling; and Department of Health Policy, Ayrshire and Arran NHS, Ayr
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Abstract

Background. Generalized anxiety disorder is a common condition of excessive worry and tension which tends to run a chronic course associated with significant psychiatric and medical problems. Cognitive behaviour therapy (CBT) has been shown to be of clinical value in about 50% of cases with treatment gains maintained over follow-up periods ranging from 6 to 12 months. The potential value of CBT over the longer term has not been subject to rigorous investigation.

Method. Results are reported of 8–14 year follow-up of two randomized controlled trials of cognitive-behaviour therapy for generalized anxiety disorder employing structured interview with an assessor blind to initial treatment condition. Comparison groups included medication and placebo in one study based in primary care, and analytical psychotherapy in the other based in secondary care. Follow-up samples (30% and 55% of trial entrants) were broadly representative of the original cohorts.

Results. Overall, 50% of participants were markedly improved of whom 30–40% were recovered (i.e. free of symptoms). Outcome was significantly worse for the study based in secondary care in which the clinical presentation of participants was more complex and severe. For a minority (30–40%), mainly from the secondary care study, outcome was poor. Treatment with CBT was associated with significantly lower overall severity of symptomatology and less interim treatment, in comparison with non-CBT conditions, but there was no evidence that CBT influenced diagnostic status, probability of recovery or patient perceptions of overall improvement.

Conclusions. Both CBT and the complexity and severity of presenting problems appear to influence the long-term outcome of GAD.

Type
Research Article
Information
Psychological Medicine , Volume 33 , Issue 3 , April 2003 , pp. 499 - 509
Copyright
© 2003 Cambridge University Press

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