title: Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. Quality of life and psychiatric morbidity in panic disorder and generalized anxiety disorder. Predicting outcome after treatment for generalised anxiety disorder. Distressed high utilizers of medical care. DSM-III-R diagnoses and treatment needs. Cognitive-behavior therapy for late-life generalized anxiety disorder in primary care: preliminary findings. Cognitive therapy versus applied relaxation as treatment of generalized anxiety disorder. Recovery rates in generalized anxiety disorder following psychological therapy: an analysis of clinically significant change in the STAI-T across outcome studies since 1990. Comparison of behavior therapy and cognitive behavior therapy in the treatment of generalized anxiety disorder. Generalised anxiety: a controlled treatment study. Does cognitive-behavioural therapy influence the long-term outcome of generalized anxiety disorder? An 8-14 year follow-up of two clinical trials. Phenomenology and course of generalised anxiety disorder. Effectiveness of cognitive-behavioural, person-centred and psychodynamic therapies as practised in UK National Health Service settings. Standard and enhanced cognitive-behavior therapy for late-life generalized anxiety disorder: two pilot investigations. Cognitive therapy, analytic psychotherapy and anxiety management training for generalised anxiety disorder. A randomized trial of the effectiveness of cognitive-behavioral therapy and supportive counseling for anxiety symptoms in older adults. Treatment of generalised anxiety disorder with a short course of psychological therapy, combined with buspirone or placebo. Group cognitive-behavioral therapy for generalized anxiety disorder: treatment outcome and long-term follow-up. Treatment of anxiety disorders in primary care practice: a randomised controlled trial. Efficacy of a cognitive-behavioral treatment for generalized anxiety disorder: evaluation in a controlled clinical trial. Cognitive therapy vs behaviour therapy in the treatment of chronic general anxiety. Applied relaxation vs. cognitive therapy in the treatment of generalized anxiety disorder. Anxiety management and applied relaxation in reducing general anxiety. The effects of common and specific factors in short-term anxiety-provoking psychotherapy: a pilot process-outcome study. Cognitive restructuring treatment: a controlled trail with anxious patients. On predicting improvement and relapse in generalized anxiety disorder following psychotherapy. Predicting response to anxiety management in patients with generalised anxiety disorders.
abstract: Nondirective ( ND ) , applied relaxation ( AR ) , and cognitive behavioral ( CBT ) therapies for generalized anxiety disorder ( GAD ) were compared . The latter 2 conditions were generally equivalent in outcome but superior to ND at post assessment . The 3 conditions did not differ on several process measures , and ND created the greatest depth of emotional processing . Follow-up results indicated losses in gains in ND , maintained gains in the other 2 conditions , especially CBT , and highest endstate functioning for CBT . AR and CBT thus contain active ingredients in the treatment of GAD ; support exists for further development of imagery exposure methods or cognitive therapy because of their likely role in promoting maintenance of change with this disorder . Expectancy for improvement was also associated with outcome , suggesting the need for further research on this construct for underst and ing the nature of GAD and its amelioration OBJECTIVE This report examines the impact of panic disorder and /or generalized anxiety disorder on quality of life and the implication s of these findings on nosological categories . METHOD A total of 357 subjects with a current episode of panic disorder and /or generalized anxiety disorder were diagnosed according to DSM-III-R criteria , using structured clinical interviews , as part of a prospect i ve , naturalistic , longitudinal , multicenter study of a clinical population with anxiety disorders . RESULTS There was a high degree of coexistence of anxiety disorders and major depressive disorder . Subjects with generalized anxiety disorder almost universally had other disorders , were the most likely to have at least one other anxiety disorder or major depressive disorder at intake , had the earliest age at onset , and had the worst emotional health rating . Subjects with panic disorder without agoraphobia had the most likelihood of a history of alcohol abuse . Nine percent of the subjects had a history of suicide attempts or gestures . CONCLUSIONS The subjects showed significant impairment in quality of life . The highly frequent coexistence of other anxiety disorders with generalized anxiety disorder and the overall lack of differences on many quality of life measures raise questions of nosology , particularly for generalized anxiety disorder A previous paper , Butler and Anastasiades ( Behaviour Research and Therapy 26 , 531 - 534 , 1988 ) presented evidence for three reliable predictors of response to Anxiety Management in patients with generalised anxiety disorder . It was argued there that these reflected severity of anxiety , demoralisation and depression . A second study ( Butler , Fennell , Robson & Gelder , Journal of Consulting and Clinical Psychology , 59 , 167 - 175 , 1991 ) has compared two treatments for GAD : Behaviour Therapy and Cognitive Behaviour Therapy . Data from this study is used here to answer two questions : ( i ) do the same three variables predict outcome in the second study ? The answer to this question is ' no ' ; and ( ii ) which variables contribute to prediction of outcome when these two treatments are compared ? Information presented here suggests that this depends partly on the nature of the treatment given . Outcome after behaviour therapy is predicted by initial levels of anxiety only , but the gains made are also relatively modest . Outcome after  cognitive behaviour therapy  is predicted by the degree to which ambiguous ( external ) information is interpreted as threatening . Thus a cognitive variable contributes reliably to the prediction of outcome after a cognitive treatment , but does not predict in the same way to outcome after a behavioural treatment Among a sample of 767 high utilizers of health care , 51 % were identified as distressed by an elevated score on the SCL anxiety and depression scales , the SCL somatization scale , or by their primary -care physician . These distressed high utilizers were found to have a high prevalence of chronic medical problems and significant limitation of activities caused by illness . In the prior year , they made an average of 15 medical visits and 15 telephone calls to the clinic . The Diagnostic Interview Schedule was completed on 119 distressed high utilizers r and omly assigned to an intervention group in a controlled trial of psychiatric consultation . The following DSM-III-R disorders were most common : major depression 23.5 % , dysthymic disorder 16.8 % , generalized anxiety disorder 21.8 % , and somatization disorder 20.2 % . Two thirds had a lifetime history of major depression . The examination result ed in an improved diagnostic assessment for 40 % of intervention patients and a revised treatment plan for 67 % OBJECTIVE The authors present data from a pilot research program initiated to develop , refine , and test the outcomes of CBT-GAD/PC , a version of cognitive-behavior therapy ( CBT ) that targets the needs of older adults with generalized anxiety disorder ( GAD ) in primary care ( PC ) . METHODS The study involved a small , r and omized clinical trial comparing the impact of CBT-GAD/PC to usual care ( UC ) in a sample of 12 older medical patients with GAD . RESULTS Outcome data suggested significant improvements in worry and depression after CBT-GAD/PC , relative to UC . CONCLUSION Authors discuss results in terms of the " real-world " applicability of this treatment for late-life GAD , and present implication s for future research Cognitive therapy ( CT ) and applied relaxation ( AR ) as treatments of generalized anxiety disorder ( GAD ) were compared in a sample of 45 patients of a community mental health center , r and omly allocated to condition . Patients were assessed before and after a 12-session treatment , and at one and six months follow-ups . There was a 20 % drop out from CT and 15 % from AR ( NS ) , with some drop outs being considerably improved . Both completers and intention-to-treat analyses revealed that both treatments were effective ( ESs of composite and specific measures ranging from 0.53 to 1.14 ) . At one-month follow-up AR tended to do better than CT , with CT catching up with AR at six months . Recovery rates and proportions of patients showing reliable change were comparable to other studies on AR and CT , with 55 % of CT and 53.3 % of AR patients recovered on the STAI-trait at six-month follow-up . These results confirm that both CT and AR are effective treatments for GAD , and also that there is still room for improvement BACKGROUND There have been six r and omized controlled trials of psychological therapy with generalized anxiety disorder ( GAD ) using DSM-III-R and DSM-IV . All have used the Trait version of the Spielberger State-Trait Anxiety Inventory ( STAI-T ) as one of several outcome measures . Each study , however , employed different methods of calculating the clinical significance of outcomes making it difficult to reach a balanced appraisal of the efficacy of psychological treatment . METHODS Raw data on STAI-T scores at pre- , post- and follow-up were obtained for each of the six studies ( total N = 404 ) . Jacobson methodology for defining clinical ly significant change ( criterion c , reliable change index = 8 , cut-off point = 46 ) was used to allocate each patient to one of four outcomes : worse , unchanged , improved and recovered . The proportion of patients in each category was calculated for treatment conditions in each study and also for aggregate data across types of treatment . RESULTS A recovery rate of 40 % was found for the sample as a whole with 12 of the 20 treatment conditions obtaining very modest recovery rates of 30 % or less . Two treatment approaches -- individual cognitive behavioural therapy and applied relaxation -- do relatively well with overall recovery rates at 6-month follow-up of 50 - 60 % . CONCLUSIONS Jacobson methodology , in distinguishing between improvement and recovery on a st and ardized measure of general vulnerability to anxiety , provides a stringent but clinical ly more meaningful evaluation of the efficacy of psychological therapies with GAD than has been available hitherto . Systematic focus on either excessive worry or physiological arousal gives worthwhile results In a controlled clinical trial , 57 Ss meeting DSM-III-R criteria for generalized anxiety disorder , and fulfilling an additional severity criterion , were r and omly allocated to  cognitive behavior therapy ( CBT ) , behavior therapy ( BT ) , or a waiting-list control group . Individual treatment lasted 4 - 12 sessions ; independent assessment s were made before treatment , after treatment , and 6 months later , and additional follow-up data were collected after an interval of approximately 18 months . Results show a clear advantage for CBT over BT . A consistent pattern of change favoring CBT was evident in measures of anxiety , depression , and cognition . Ss were lost from the BT group , but there was no attrition from the CBT group . Treatment integrity was double-checked in Engl and and in Holl and , and special efforts were made to reduce error variance . Possible explanations for the superiority of CBT are discussed Abstract The effects of anxiety management training were evaluated by allocating 66 generally anxious clients to either a wait list condition , non-directive counselling , or a combination of relaxation and brief cognitive therapy . Anxiety management was significantly more effective than the wait list condition on a number of relevant measures at post-treatment , but there were relatively few differencs between anxiety management and non-directive counselling , either at post-treatment or at 6 months follow-up . Those differences which were found could plausibly be explained in terms of the dem and characteristics of training in relaxation or cognitive therapy . It was concluded that anxiety management is clearly better than a non-treatment control condition , but that its superiority to plausible alternatives which lack the specific components thought to be responsible for improvement has yet to be demonstrated 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 r and omized 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 sample s ( 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 BACKGROUND The diagnostic category of generalised anxiety disorder ( GAD ) was originally intended to describe residual anxiety states . Over the years clinical criteria have been refined in an attempt to describe a unique diagnostic entity . Given these changes , little is known about the clinical course of this newly defined disorder . This study investigates the longitudinal course , including remission and relapse rates , for patients with DSM-III-R defined GAD . METHOD Analysis of the 164 patients with GAD participating in the Harvard Anxiety Research Program . Patients were assessed with a structured clinical interview at intake and re-examined at six month intervals for two years and then annually for one to two years .  Psychiatric Status Ratings were assigned at each interview point . Kaplan-Meier curves were constructed to assess likelihood of remission . RESULTS Comorbidity was high , with panic disorder and social phobia as the most frequently found comorbid disorders . The likelihood of remission was 0.15 after one year and 0.25 after two years . The probability of becoming asymptomatic from all psychiatric symptoms was only 0.08 . CONCLUSIONS This prospect i ve study confirms the chronicity associated with GAD and extends this finding to define the one and two year remission rates for the disorder . Likelihood of remission for GAD and any other comorbid condition after one year was half the annual remission rate for GAD alone BACKGROUND Psychotherapy 's equivalence paradox is that treatments have equivalently positive outcomes despite non-equivalent theories and techniques . We compared the outcomes of contrasting approaches practised in routine care . METHOD Patients ( n = 1309 ) who received cognitive-behavioural therapy ( CBT ) , person-centred therapy ( PCT ) and psychodynamic therapy ( PDT ) at one of 58 National Health Service ( NHS ) primary and secondary care sites in the UK during a 3-year period completed the Clinical Outcomes in Routine Evaluation- Outcome Measure ( CORE-OM ) at the beginning and end of their treatment . Therapists indicated which treatment approaches were used on an End of Therapy form . We compared outcomes of six groups : three treated with CBT , PCT or PDT only , and three treated with one of these plus one additional approach ( e.g. integrative , supportive , art ) , design ated CBT+1 , PCT+1 or PDT+1 respectively . RESULTS All six groups averaged marked improvement ( pre-post effect size = 1.36 ) . Treatment approach and degree of purity ( ' only ' vs. ' + 1 ' ) each accounted for statistically significant but comparatively tiny proportions of the variance in CORE-OM scores ( respectively 1 % and 0.5 % as much as pre-post change ) . Distributions of change scores were largely overlapping . CONCLUSIONS Results for these three treatment approaches as practised routinely across a range of NHS setting s were generally consistent with previous findings that theoretically different approaches tend to have equivalent outcomes . Caution is warranted because of limited treatment specification , non-r and om assignment , lack of a control group , missing data and other issues OBJECTIVE Although cognitive-behavior therapy ( CBT ) is an efficacious treatment for generalized anxiety disorder ( GAD ) in younger adults , little is known about its efficacy in older patients . Investigations to date have tested group-format or otherwise nonst and ard versions of CBT . The studies described here are , to our knowledge , the first to test the efficacy of individual-format CBT administered in a mental health clinic for treatment of late-life GAD  . METHODS Study 1 tested a st and ard version , and Study 2 tested an enhanced version ( ECBT ) that included learning and memory aids design ed to make the therapy more effective with elderly patients ( e.g. , homework reminder and troubleshooting calls , weekly review of all concepts and techniques ) . RESULTS Study 1 CBT participants showed significant improvement on GAD severity ratings . Study 2 ECBT participants showed significant improvement on two self-report measures , rates of posttreatment GAD , and GAD severity ratings .  ECBT result ed in improvement on more measures and yielded larger effect sizes than st and ard CBT , when each was compared against a wait-list control group . CONCLUSION Results of these pilot studies suggest that st and ard individual-format CBT may not be optimally effective for treating late-life GAD ; thus , ECBT should be tested further in r and omized trials BACKGROUND We test the hypotheses that ( a ) cognitive therapy is of comparable efficacy to psychodynamic psychotherapy , ( b ) 8 - 10 sessions of therapy is as effective as 16 - 20 sessions , and ( c ) brief therapist training is as effective as intensive training . METHOD Of 178 out- patients referred to a clinical trial of psychological treatment for generalised anxiety , 110 patients met DSM-III-R criteria for generalised anxiety disorder and were r and omly assigned to three different forms of psychotherapy . The main comparison was between cognitive therapy and analytic psychotherapy , delivered by experienced therapists at weekly or fortnightly intervals over six months . A third treatment , anxiety management training , was delivered at fortnightly intervals by registrars in psychiatry after a brief period of training . Eighty patients completed treatment and were assessed before treatment , after treatment , and at six-month follow-up . RESULTS Cognitive therapy was significantly more effective than analytic psychotherapy , with about 50 % of patients considerably better at follow-up . Analytic psychotherapy gave significant improvement but to a lesser degree than cognitive therapy . There was no significant effect for level of contact .  Patients receiving anxiety management training showed similar improvements to cognitive therapy after treatment , with rather lower proportions showing clinical ly significant change . CONCLUSIONS Cognitive therapy is likely to be more effective than psychodynamic psychotherapy with chronically anxious patients . Significant improvements in symptoms can be achieved by trainee psychiatrists after only brief instruction in behaviourally based anxiety management . However , the superiority of cognitive therapy at follow-up suggests that the greater investment of re sources required for this approach is likely to pay off in terms of more sustained improvement . There is no evidence that 16 - 20 sessions of treatment is more effective , on average , than 8 - 10 sessions The authors used a r and omized trial to compare cognitive-behavioral therapy ( CBT ) and supportive counseling ( SC ) in the treatment of  anxiety symptoms in older adults who met Diagnostic and Statistical Manual of Mental Disorders ( 4th ed . : American Psychiatric Association , 1994 ) criteria for anxiety disorders . Both conditions had a 6-week baseline no-treatment phase . Treatment was delivered primarily in patients ' own homes and in an individual format . Outcomes were assessed at posttreatment and at 3- , 6- , and 12-month follow-ups . There was no spontaneous improvement during the baseline phase . Both groups showed improvement on anxiety measures following treatment , with a better outcome for the CBT group on self-rating of anxiety and depression . Over the follow-up period , the CBT group maintained improvement and had significantly greater improvement than the SC group on anxiety and 1 depression measure . Treatment response for anxiety was also superior for the CBT group , although there was no difference between groups in endstate functioning BACKGROUND Very few studies have examined the combination of drug and psychological treatment in generalised anxiety disorder ( GAD ) . Theoretically , buspirone should be a useful drug to combine with a learning-based therapy . METHODS Sixty patients with GAD were r and omly assigned to treatment with buspirone or placebo , combined with anxiety management training or non-directive therapy for a period of 8 weeks . RESULTS Forty-four patients with a mean Hamilton Anxiety Scale score of 28 completed treatment . There were no significant differences between treatment groups . All groups showed significant improvement after 8 weeks compared to baseline . There were no baseline differences between those who completed the trial and those who did not but patients given buspirone were more likely to drop out . CONCLUSIONS A short course of psychological therapy , whether or not accompanied by active medication , was an effective treatment for patients diagnosed as having quite severe symptoms of GAD . CLINICAL IMPLICATION S AND LIMITATIONS : Dropouts led to a sample size which may have been too small to detect group differences . Cognitive therapy may have been more effective A recently developed cognitive-behavioral treatment for  generalized anxiety disorder  ( GAD ) targets intolerance of uncertainty by the reevaluation of positive beliefs about worry , problem-solving training , and cognitive exposure . As previous studies have established the treatment 's efficacy when delivered individually , the present study tests the treatment in a group format as a way to enhance its cost-benefit ratio . A total of 52 GAD patients received 14 sessions of cognitive-behavioral therapy in small groups of 4 to 6 participants . A wait-list control design was used , and st and ardized clinician ratings and self-report question naires assessed GAD symptoms , intolerance of uncertainty , anxiety , depression , and social adjustment . Results show that the treatment group , relative to the wait-list group , had greater posttest improvement on all dependent variables and that treated participants made further gains over the 2-year follow-up phase of the study BACKGROUND Anxiety disorders are prevalent in primary care . Psychological treatment is effective but time-consuming , and there are waiting lists for secondary care . Interest has therefore grown in developing guidelines for treatment that would be feasible in primary care . AIM To compare the effectiveness and feasibility of guided self-help , the Anxiety Disorder Guidelines of the Netherl and s College of General Practitioners and cognitive behavioural therapy ( CBT ) . DESIGN OF STUDY R and omised controlled study lasting 12 weeks with follow-up at 3 and 9 months for primary care patients with panic disorder and /or generalised anxiety disorder . SETTING The first two forms of treatment were carried out by 46 GPs who were r and omly assigned to one or the other form .  CBT was carried out by cognitive behaviour therapists in a psychiatric outpatient clinic . METHOD Participants ( n = 154 ) were r and omly assigned to one of the three forms of treatment . The main outcome measure used was the state subscale of the Spielberger Anxiety Inventory . RESULTS All three forms of treatment gave significant improvement between pre-test and post-test , and this improvement remained stable between post-test and the follow-ups . The results obtained with the three treatment forms did not differ significantly over time . The feasibility of the Anxiety Disorder Guidelines was low compared with that of guided self-help . CONCLUSION Our results indicate that primary care patients with prevalent anxiety disorders for whom the GP does not find referral necessary can be adequately treated by the GP . Psychiatric outpatient clinic referral does not give superior results . Guided self-help is easier for the GP to carry out than a less highly-structured treatment like that laid down in the Anxiety Disorder Guidelines Recent advances in the underst and ing of worry have led to the development of treatments for generalized anxiety disorder ( GAD ) . The present study tested a GAD treatment that targeted intolerance of uncertainty , erroneous beliefs about worry , poor problem orientation , and cognitive avoidance . Twenty-six primary GAD patients were r and omly allocated to a treatment condition ( n = 14 ) or a delayed treatment control condition ( n = 12 ) . Self-report , clinician , and significant other ratings assessed GAD and associated symptoms . The results show that the treatment led to statistically and clinical ly significant change at posttest and that gains were maintained at 6- and 12-month follow-ups . Furthermore , 20 of 26 participants ( 77 % ) no longer met GAD diagnostic criteria following treatment . With regard to the treatment 's underlying model , the results show that intolerance of uncertainty significantly decreased over treatment and that gains were maintained at both follow-ups . Although nonspecific factors were not significant predictors of treatment outcome , their role in the treatment of GAD requires further investigation Abstract Psychiatric out patients with a diagnosis of chronic anxiety of at least one year 's duration were r and omly assigned to either behaviour therapy or Beck 's cognitive therapy , and to one of two experienced therapists . Both treatment conditions followed the therapeutic processes described in Beck 's treatment manual for anxiety states , but the behaviour therapy condition excluded any attempt to modify automatic thoughts , thinking errors , or underlying assumptions . However , it did include the use of positive self-statements . Treatment consisted of a maximum of 16 1-hour sessions . Several outcome measures were administered before treatment , during treatment , at discharge , and at 6 month follow-up . At the end of treatment there was no difference between the cognitive and behavioural treatments in the amount of improvement observed . By the 6 month follow-up , however , there was a trend , which was significant on a number of outcome measures , for the cognitive therapy patients to maintain or improve upon their progress and for the behaviour therapy patients to revert toward their pre-treatment scores The present study investigated the efficacy of a coping-technique , applied relaxation ( AR ) and cognitive therapy ( CT ) , in the treatment of generalized anxiety disorder . Thirty-six out patients fulfilling the DSM-III-R criteria for generalized anxiety were assessed with independent assessor ratings and self-report scales before and after treatment and at a 1 yr follow-up . The patients were r and omized and treated individually for 12 weekly sessions . The results showed that both treatments yielded large improvements , which were maintained , or furthered at follow-up . There was no difference between AR and CT on any measure . The drop-out rate was 12 % for AR and 5 % for CT . The proportions of clinical ly significantly improved patients were 53 and 62 % at post-treatment and 67 and 56 % at follow-up for AR and CT , respectively . Besides affecting generalized anxiety the treatments also yielded marked and lasting changes on ratings of worry , cognitive and somatic anxiety and depression . The conclusion that can be drawn is that both AR and CT have potential as treatments for generalized anxiety disorder but they have to be developed further in order to increase the efficacy to the level usually seen in panic disorder , 80 - 85 % clinical ly improved Abstract Sixty-three generally anxious subjects were assigned to anxiety management training , applied relaxation training , relaxation-only , placebo and untreated control conditions . After 6 weeks of treatment , anxiety management training led to reductions on a variety of self-report measures of state and trait anxiety and decreases in maladaptive cognitions during a laboratory stress procedure . On several measures , subjects in anxiety management training differed from relaxation-only and placebo subjects as well as untreated controls . However , treatment effects did not extend to performance and physiological measures of anxiety .  Applied relaxation training , which in contrast to anxiety management training lacks structured rehearsal involving the recognition and reduction of tension cues during the treatment sessions , result ed in less consistent decreases in measures of general anxiety This study attempted to identify the necessary and sufficient change factors in  short-term anxiety-provoking psychotherapy  ( STAPP ) . Twenty patients were r and omly assigned to either STAPP or a form of nondirective therapy  almost devoid of psychodynamic elements but with common factors of psychotherapy intact . Both treatments were 20 sessions long , were manualized , and therapists in both conditions were experienced clinicians receiving manual-guided supervision . Most patients had a diagnosis of anxiety . Results showed that patients in both treatments improved greatly symptomatically and that no further gains were made after termination . Treatments were equally effective . The therapeutic alliance was a strong predictor of symptom improvement . The findings underscore the importance of common factors pertaining to the therapeutic relationship , and they may open to question , to some degree , the therapeutic effectiveness of psychodynamic technique factors in STAPP . The way in which specific and common factors can be brought together under the umbrella of the concept of affect attunement is discussed Abstract Cognitive restructuring , modified systematic desensitization and a combined treatment ( cognitive behaviour modification ) were compared with a no-treatment control group , using a simple r and omized design . Twenty seven general anxiety out- patients selected from the hospital waiting list were used as subjects . Assessment s were made at the beginning and end of treatment , and at follow-up 1 month later . The assessment s included two subjective anxiety measures , the Zung self-rating anxiety scale and fear thermometer scores , a behavioural anxiety measure , a measure of cognitive anxiety as estimated by a diary recording of thinking time , fear survey schedule scores and I/E scores .  Cognitive behaviour modification was found to be a superior form of treatment , relative to the no-treatment control and the other active treatment groups as assessed by FSS intensity score . The cognitive behaviour modification group showed greater improvement than the cognitive restructuring group on the diary anxiety scores . The results also demonstrated a relationship between outcome and initial severity of condition . The higher the subjects ' initial scores on neurotic symptoms and subjective anxiety level , the greater the degree of positive change after treatment . Moreover , subjects with high levels of internal control prior to treatment responded most to therapy This paper concerns an investigation of outcome predictors in a clinical trial of psychological therapies for generalized anxiety disorder . A variety of information of potential predictive value was obtained at three stages of patient contact : the initial referral , a screening interview and early sessions of therapy . Three measures of the clinical significance of change over a 12-month follow-up period were used to construct a composite measure which categorized outcome in terms of sustained improvement , relapse and no consistent change . Logistic regression was used to examine the validity of predictors identified in previous research and the relative importance of data obtained from the three different stages . Seventy-one per cent of patients were correctly classified as improved or not from initial data with a significant increase in accuracy with information from the screening interview ( 77 per cent ) and early sessions ( 82 per cent ) . Patients who relapsed or not were predicted with considerable accuracy from initial data ( 90 per cent ) and there was no significant increase in predictive power with additional information . The most powerful and robust predictors were : type of treatment received , marital status , marital tension and complexity of clinical presentation in terms of axis 1 co-morbidity . A conceptual framework for prediction is outlined Abstract This paper describes the analysis of predictive factors in a group of generally anxious patients treated with anxiety management .  Evidence for three reliable predictors is presented . It is argued these reflect anxiety , demoralisation and depression . The same three variables contributed to prediction of outcome after treatment and 6 months later , and their pre-treatment values classified 80 % of the patients correctly into good or poor responders . Lower initial levels of anxiety and demoralisation together with higher depression rated by the assessor predicted a better outcome . Predictions were more accurate for patients with a mild degree of depression than for those who were not depressed
target: Psychological therapy based on CBT principles is effective in reducing anxiety symptoms for short-term treatment of GAD .
  The body of evidence comparing CBT with other psychological therapies is small and heterogeneous , which precludes drawing conclusions about which psychological therapy is more effective .
background: BACKGROUND Generalised anxiety disorder ( GAD ) is a highly prevalent condition , characterised by excessive worry or anxiety about everyday events and problems .
  The effectiveness and effectiveness of psychological therapies as a group has not yet been evaluated in the treatment of GAD .
  OBJECTIVES To examine the efficacy and acceptability of psychological therapies , categorised as cognitive behavioural therapy ( CBT ) , psychodynamic therapy and supportive therapy , compared with treatment as usual/waiting list ( TAU/WL ) and compared with one another , for patients with GAD .