Nonbiological or psychological treatments
|
Mayo-Wilson, 2013 (25) |
Media-delivered behavioral and cognitive behavioral therapies |
Up to 2013 |
101 RCTs |
Adults with anxiety disorders |
8,403 |
67% |
CBT and behavioral therapy, media-delivered alone or as adjuncts to another treatment |
PTSD and acute stress disorder |
Change in symptoms of anxiety: continuous symptom measures, response and recovery |
Cochrane |
Self-help may be useful for people who cannot use other services. However, face-to-face CBT is probably clinically superior. |
Jayakody, 2014 (22) |
Exercise vs. other treatments |
Up to 2011 |
8 RCTs |
Adults with anxiety disorders |
563 |
NR |
Different forms of exercise (alone or in combination with other treatments) |
Depressive disorders |
Changes in symptoms of anxiety, improvement in mental state or quality of life, relapse, and compliance with exercise treatment |
Cochrane |
Exercise seems to be effective as an adjunctive treatment, but it is less effective than antidepressant treatment. |
Arnberg, 2014 (26) |
Internet-delivered psychological treatment |
Up to 2013 |
40 RCTs |
Participants with anxiety or mood disorders |
2,622 |
NR |
Theory-based psychological interventions, as delivered via the internet |
Primary physical illness |
Change in symptoms of anxiety, adverse events, and cost per effect and per quality-adjusted life-years |
Cochrane |
Internet-based CBT is a viable treatment option. Methodological questions remain before broad implementation can be supported. |
Abbass, 2014 (27) |
Efficacy of short-term psychodynamic psychotherapies |
Up to 2014 |
33 RCTs |
Adults with common mental disorders |
2,173 |
NR |
Individual short-term psychodynamic psychotherapies or approaches (40 weeks on average, 45- to 60-minute sessions) |
Psychotic disorders |
Improvement in general symptoms as measured by psychiatric instruments or criteria and somatic symptoms |
Cochrane |
Short-term psychodynamic psychotherapies show modest to large gains. Larger studies of higher quality and with specific diagnoses are warranted. |
Norton, 2015 (23) |
Mindfulness and acceptance-based treatment |
Up to 2014 |
9 RCTs |
Adults with social anxiety |
330 |
NR |
Mindfulness and acceptance-based treatment |
No statistical analyses, irrelevant interventions, not peer reviewed studies |
Changes in cognitive, behavioral, and physiological symptoms |
Cochrane |
The benefit of mindfulness and acceptance-based treatment can be considered a viable alternative. CBT remains best practice for first-line treatment of social anxiety. |
Olthuis, 2015 (28) |
Therapist-supported internet cognitive behavioral therapy |
Up to 2015 |
38 RCTs |
Adults with a primary anxiety disorder |
3,214 |
67.7% |
Therapist-supported CBT delivered via internet (web pages or e-mail) |
Other comorbidity and anxiety symptoms that did not meet diagnosis criteria |
Clinical improvement determined by interview and reduction in symptoms of anxiety by scores |
Cochrane |
Therapist-supported internet-based CBT appears to be an efficacious treatment for anxiety in adults. |
Newby, 2015 (29) |
Clinician-guided internet/computerized or face-to-face treatments |
Up to 2014 |
50 RCTs |
Adults with a primary anxiety or depressive disorder |
1,865 |
NR |
Manualized psychological treatments (at least 2 sessions) |
Insufficient data, under age 18, case studies, and case series |
Improvement in symptoms of anxiety, as measured by instruments and quality of life scores |
Cochrane |
Transdiagnostic psychological treatments are efficacious, but higher quality research studies are needed. |
Wu, 2015 (30) |
Morita therapy |
Up to 2014 |
7 RCTs |
Adults with anxiety disorders |
449 |
55.5% |
Morita therapy by the carers (at least two of the four phases) |
Secondary anxiety symptoms of a different disorder, comorbid disorders |
Clinical response, dropouts and measure of total acceptability. |
Cochrane |
The evidence base on Morita therapy was limited. All included studies were conducted in China, curbing the applicability of conclusions to Western countries. |
Piccirillo, 2016 (24) |
Safety behaviors in social anxiety |
Up to 2015 |
39 RCTs |
Adults with social anxiety |
NR |
NR |
Exposure to safety behaviors as attempts to prevent or avoid feared outcomes (threatening or catastrophic) during CBT |
No data on safety behaviors, children and adolescent, not in English, case studies, not social anxiety |
Change in measures of safety behaviors, e.g., Social Behaviors Questionnaire (SBQ) and Subtle Avoidance Frequency Evaluation (SAFE) |
NR |
Limited evidence suggests that reductions in the use of safety behaviors are related to better CBT outcomes, and reductions in social anxiety predict reduced safety-behavior use over the course of treatment. |
Stubbs, 2017 (31) |
Exercise in people with anxiety and/or stress-related disorders |
Up to 2015 |
6 RCTs |
Adults with a primary anxiety or stress disorders |
262 |
NR |
Exercise vs. a nonactive group (usual-care, wait-list, placebo or social activities) |
Yoga, tai chi or qigong; and comparison with active treatments (pharmacotherapy or psychotherapy). |
Mean change in anxiety symptoms in the exercise vs. control group according to a validated outcome measure |
Cochrane |
Data suggest that exercise is an effective intervention in improving anxiety symptoms in people with anxiety and stress-related disorders |
Cramer, 2018 (32) |
Effectiveness of yoga |
Up to 2016 |
6 RCTs |
Adults with anxiety disorders |
319 |
NR |
Multicomponent yoga, posture-based yoga, and breathing/meditation-based yoga |
Obsolete diagnoses |
Improvement in severity of anxiety and remission |
Cochrane |
Yoga is effective and safe for individuals with elevated anxiety. There was inconclusive evidence for effects of yoga in anxiety disorders. |
Biological or pharmacological treatments
|
Li, 2014 (33) |
Repetitive transcranial magnetic stimulation |
Up to 2014 |
2 RCTs |
Adults with panic disorder |
40 |
60% |
Repetitive transcranial magnetic stimulation of high or low frequency (alone or in combination with other interventions) |
Single-pulse intervention, or treatment period of less than one week |
Effectiveness measured by symptom severity, and acceptability: dropouts and adverse effects |
Cochrane |
There is insufficient evidence to draw any conclusions about efficacy. Further RCTs are needed. |
Patterson, 2016 (34) |
Augmentation strategies in treatment-resistant anxiety |
1990-2015 |
6 RCTs |
Treatment-resistant adults with anxiety disorders |
557 |
NR |
Pharmacotherapy or CBT augmentation of a first-line SSRI (with a placebo control) |
Concomitant medication trials or not SSRIs as first-line treatment |
Clinical Global Impression, changes in symptom severity, disability and functional impairment |
Cochrane |
Augmentation does not appear to be beneficial in treatment-resistant anxiety disorders |
Williams, 2017 (35) |
Pharmacotherapy for social anxiety disorder |
Up to 2015 |
66 RCTs |
Adults diagnosed with social anxiety |
11,597 |
NR |
Any medication administered to treat social anxiety versus an active or nonactive placebo |
Trials that included only a subset of participants that met the review inclusion criteria in the analysis |
Treatment efficacy measured as clinical global impressions and relapse rate, and treatment tolerability |
Cochrane |
The quality of evidence of efficacy for SSRIs is low to moderate. The tolerability was lower than placebo. |
Sugarman, 2017 (36) |
Antidepressants in obsessive-compulsive disorders |
1994-2008 |
56 RCTs |
DSM-IV-based anxiety disorders |
15,167 |
NR |
Second generation antidepressant for anxiety-related psychiatric diagnoses |
Not second generation antidepressant |
Changes in pre-post scores on symptom inventories |
NR |
Overall score changes were smaller for OCD compared to other anxiety disorders for both antidepressants and placebo. |
Yee, 2018 (37) |
Vortioxetine |
Up to 2017 |
7 RCTs |
Patients in treatment for anxiety disorders |
2,391 |
NR |
Vortioxetine for treating anxiety disorders |
Not human studies and not English language |
Change from baseline at the final week of study on the Hamilton Anxiety Scale |
NR |
The evidence supports the use of vortioxetine for anxiety disorders. However, further long-term placebo-control observational studies or a postmarket survey would strengthen the existing evidence. |
Multimodal combined treatment comparisons
|
Bandelow, 2015 (15) |
Efficacy of all treatments for anxiety disorders |
1980-2013 |
234 RCTs |
Adults with DSM-based GAD, panic disorder or social anxiety |
37,333 |
NR |
Effective drugs, psychological therapies and combined treatments, as shown in RCTs |
Missing information, sample size of less than 10, children and adolescents |
Evaluation of pre-post effect sizes for treatments |
SIGN |
The average pre-post effect sizes of medications were more effective than psychotherapies. Psychotherapy effects did not differ from pill placebos. |
Ho, 2016 (38) |
Stepped care prevention and treatment compared with care-as-usual |
Up to 2015 |
10 RCTs |
Participants with depressive and/or anxiety disorders |
488 |
63.5% |
Stepped care treatment or prevention (versus care-as-usual or wait-list) |
Studies with no “stepping-up” criteria |
Changes in pre-post scores on symptom inventories |
Cochrane |
Stepped-care model appeared to be better than care-as-usual in treating anxiety disorders. |
Bandelow, 2018 (14) |
Enduring effects of treatments for anxiety disorders |
1980-2016 |
93 RCTs |
Adults with DSM-based GAD, panic disorder or social anxiety |
NR |
NR |
Effective drugs, psychological therapies and combined treatments (RCTs with up to 24 months follow-up) |
Missing information, sample size of less than 10, children and adolescents |
Evaluation of effect sizes in different follow-up moments |
SIGN |
Not only psychotherapy but also medications and, to a lesser extent, placebo conditions have enduring effects. Long-lasting treatment effects observed in the follow-up period may be superimposed. |