COGNITIVE THERAPY, ANALYTIC-PSYCHOTHERAPY AND ANXIETY MANAGEMENT-TRAINING FOR GENERALIZED ANXIETY DISORDER

Background. We test the hypotheses that (a) cognitive therapy is of co mparable efficacy to psychodynamic psychotherapy, (b) 8-10 sessions of therapy is as effective as 16-20 sessions, and (c) brief therapist tr aining is as effective as intensive training. Method. Of 178 out-patie nts referred to a clinical trial of psychological treatment for genera lised anxiety, 110 patients met DSM-III-R criteria for generalised anx iety disorder and were randomly assigned to three different forms of p sychotherapy. The main comparison was between cognitive therapy and an alytic psychotherapy, delivered by experienced therapists at weekly or fortnightiy intervals over six months. A third treatment, anxiety man agement training, was delivered at fortnightly intervals by registrars in psychiatry after a brief period of training. Eighty patients compl eted treatment and were assessed before treatment, after treatment, an d at six-month follow-up. Results. Cognitive therapy was significantly more effective than analytic psychotherapy, with about 50% of patient s considerably better at follow-up. Analytic psychotherapy gave signif icant improvement but to a lesser degree than cognitive therapy. There was no significant effect for level of contact. Patients receiving an xiety management training showed similar improvements to cognitive the rapy after treatment, with rather lower proportions showing clinically significant change. Conclusions. Cognitive therapy is likely to be mo re effective than psychodynamic psychotherapy with chronically anxious patients. Significant improvements in symptoms can be achieved by tra inee 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 resources required f or this approach is likely to pay off in terms of more sustained impro vement. There is no evidence that 16-20 sessions of treatment is more effective, on average, than 8-10 sessions.