Any Treatment Intervention for Anxiety Associates With Symptom Improvement

A systematic review and meta-analysis found that anxiety disorders were unlikely to remit without treatment. These findings were published in the Journal of Anxiety Disorders.

Investigators at Macquarie University in Australia searched publication databases through June 2021 for randomized controlled trials of any treatment for anxiety disorders. The primary outcome was the magnitude of symptom improvement compared with controls.

A total of 173 studies published between 1983 and 2021 conducted in 28 countries were included in this analysis.

The average study sample size was 88 participants and the most common disorder being studied was social anxiety disorder (35.7%) followed by generalized anxiety disorder (18.8%), all anxiety disorder (13.6%), panic disorder without agoraphobia (12.3%), specific phobia (9.1%), panic disorder with agoraphobia (7.1%), and other (3.2%). The active interventions included individual psychotherapy (49.1%), online psychotherapy (26.0%), mixed (9.2%), bibliotherapy (5.2%), other (4.6%), group psychotherapy (4.0%), and biofeedback (1.7%). The control conditions were waitlist (94.2%) or no treatment (5.8%).

A significant effect of treatment on symptom improvement was observed overall (g, 0.17; 95% CI, 0.14-0.21; I², 52.56%; P <.001).

The magnitude of symptom change differed significantly in anxiety disorders (P =.01), in which the largest effects were observed for panic disorder (g, 0.23), generalized anxiety disorder (g, 0.22), and social anxiety disorder (g, 0.15). Greater effects were observed in studies which recruited participants on the basis of symptoms (g, 0.28) than studies which recruited specific disorders (g, 0.16) and studies which had a pre-registered protocol (g, 0.26) than studies without a protocol (g, 0.13).

Risk for bias was high in 41% of studies, there was some concern for bias in 46%, and 12.7% were associated with low bias risk.

The major limitation of this analysis was that participants who were seeking medical care for their symptoms of anxiety were recruited, indicating that these findings may not be generalizable for individuals with anxiety not seeking care.

“The results of this study provide theoretical insight into the natural remission process among anxiety disorders and suggest that different anxiety disorders remit to a greater or lesser extent than others. […] Our findings may better inform treatment providers and patients about the relative benefits and risks of watchful waiting vs immediate treatment,” stated the study authors.

Reference

Scott AJ, Bisby MA, Heriseanu AI, et al. Understanding the untreated course of anxiety disorders in treatment-seeking samples: A systematic review and meta-analysis. J Anxiety Disord. 2022;89:102590. doi:10.1016/j.janxdis.2022.102590