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Psychological treatment of anxiety in primary care: a meta-analysis

Published online by Cambridge University Press:  12 April 2012

W. Seekles ,
P. Cuijpers ,
R. Kok ,
A. Beekman ,
H. van Marwijk  and
A. van Straten
W. Seekles*
Affiliation:
Department of Clinical Psychology, VU University, Amsterdam, The Netherlands EMGO Institute for Health Care and Research, VU University Medical Center, Amsterdam, The Netherlands
P. Cuijpers
Affiliation:
Department of Clinical Psychology, VU University, Amsterdam, The Netherlands EMGO Institute for Health Care and Research, VU University Medical Center, Amsterdam, The Netherlands
R. Kok
Affiliation:
Department of Clinical Psychology, VU University, Amsterdam, The Netherlands EMGO Institute for Health Care and Research, VU University Medical Center, Amsterdam, The Netherlands
A. Beekman
Affiliation:
EMGO Institute for Health Care and Research, VU University Medical Center, Amsterdam, The Netherlands Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
H. van Marwijk
Affiliation:
EMGO Institute for Health Care and Research, VU University Medical Center, Amsterdam, The Netherlands Department of General Practice, VU University Medical Center, Amsterdam, The Netherlands
A. van Straten
Affiliation:
Department of Clinical Psychology, VU University, Amsterdam, The Netherlands EMGO Institute for Health Care and Research, VU University Medical Center, Amsterdam, The Netherlands
*
*Address for correspondence: Dr W. Seekles, Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. (Email: [email protected])
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Abstract

Background

Guidelines and mental healthcare models suggest the use of psychological treatment for anxiety disorders in primary care but systematic estimates of the effect sizes in primary care settings are lacking. The aim of this study was to examine the effectiveness of psychological therapies in primary care for anxiety disorders.

Method

The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Medline, PsycINFO and Pubmed databases were searched in July 2010. Manuscripts describing psychological treatment for anxiety disorders/increased level of anxiety symptoms in primary care were included if the research design was a randomized controlled trial (RCT) and if the psychological treatment was compared with a control group.

Results

In total, 1343 abstracts were identified. Of these, 12 manuscripts described an RCT comparing psychological treatment for anxiety with a control group in primary care. The pooled standardized effect size (12 comparisons) for reduced symptoms of anxiety at post-intervention was d = 0.57 [95% confidence interval (CI) 0.29–0.84, p = 0.00, the number needed to treat (NNT) = 3.18]. Heterogeneity was significant among the studies (I2 = 58.55, Q = 26.54, p < 0.01). The quality of studies was not optimal and missing aspects are summarized.

Conclusions

We found a moderate effect size for the psychological treatment of anxiety disorders in primary care. Several aspects of the treatment are related to effect size. More studies are needed to evaluate the long-term effects given the chronicity and recurrent nature of anxiety.

Keywords

Anxietycognitive behaviour therapymeta-analysisprimary carepsychological treatment
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 2 , February 2013 , pp. 351 - 361
Copyright
Copyright © Cambridge University Press 2012

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