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Cognitive Therapy, Analytic Psychotherapy and Anxiety Management Training for Generalised Anxiety Disorder

Published online by Cambridge University Press:  02 January 2018

Robert C. Durham ,
Tom Murphy ,
Thérèse Allan ,
Karen Richard ,
Linda R. Treliving  and
George W. Fenton
Robert C. Durham*
Affiliation:
Tayside Area Clinical Psychology Department, Royal Dundee Liff Hospital
Tom Murphy
Affiliation:
Psychotherapy Unit, 40 Colinton Road, Edinburgh
Thérèse Allan
Affiliation:
Department of Psychiatry, University of Dundee, Ninewells Hospital, Dundee
Karen Richard
Affiliation:
Royal Dundee Liff Hospital
Linda R. Treliving
Affiliation:
Royal Dundee Liff Hospital
George W. Fenton
Affiliation:
University of Dundee, Ninewells Hospital
*
Dr Durham, Tayside Area Clinical Psychology Department, Royal Dundee Liff Hospital, Dundee DD2 5NF
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Abstract

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 randomly 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 clinically 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 resources 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.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 165 , Issue 3 , September 1994 , pp. 315 - 323
Copyright
Copyright © Royal College of Psychiatrists, 1994 

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