Disorders - Generalized Anxiety Disorder
Bernstein, G. A., Bernat, D. H., Victor, A. M., Layne, A. E.
Objective: To follow 61 participants (7-11 years old) from a study that compared three school-based interventions for anxious children: group cognitive-behavioral therapy (CBT) for children, group CBT for children plus parent training, and no-treatment control to determine whether posttreatment benefits are sustained longitudinally. Method: Parent, child, and clinician report measures of child anxiety were completed at 3, 6, and 12 months posttreatment. Semistructured diagnostic interviews were administered at 6- and 12-month follow-ups. For initial analyses, the group CBT and group CBT plus parent training conditions were collapsed into one group and compared to control. When significant results were found, each active treatment group was compared to control. Results: Across several measures, the collapsed CBT group sustained significant improvement in anxiety severity and impairment across a 12-month period compared to control. There were no significant differences between the three groups on remission of baseline anxiety disorders or incidence of new anxiety disorders during the follow-up. Several parent-report measures at 3 and 6 months posttreatment suggested that group CBT for children plus parent training provided additional benefit over the group CBT for children when each was compared to the control group. Conclusions: School-based CBT appears effective in decreasing anxiety symptoms up to 12 months posttreatment for anxious children. copyright2008 by the American Academy of Child and Adolescent Psychiatry.
Journal of the American Academy of Child & Adolescent Psychiatry., 47(9) : 1039-1047
- Year: 2008
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other Psychological Interventions
Rezvan, S., Baghban, I., Bahrami, F., Abedi, M.
Objective: The aim of this study was to compare the effectiveness of cognitive behavior therapy with the combination of cognitive behavior therapy and interpersonal therapy on decreasing the excessiveness of pathological worry and increasing happiness of the individuals with generalized anxiety disorder. Method: The sample consisted of 36 female undergraduate students who referred themselves to the Isfahan University Counseling Center and met the criteria for GAD. They were randomly assigned into three groups; namely, two experimental groups and one control group. Before receiving the interventions all of the groups completed Penn State Worry Questionnaire and Oxford Happiness Inventory. One of the experimental groups underwent cognitive behavior therapy and the other one received the integration of cognitive behavior therapy and interpersonal therapy. The control group received no intervention. Result: The statistical analyses indicated that the differences between the CBT and CBT + IPT groups on excessive worry and happiness in the post tests were not significant. But significant mean differences were observed in the follow-ups regarding pathological worry and happiness between two groups. Conclusion: It can be concluded that the integration of cognitive behavior therapy and interpersonal therapy can be applied as an effective intervention for decreasing the rate of GADs’ relapses after cognitive behavior therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)
Counselling Psychology Quarterly, 21(4) : 309-321
- Year: 2008
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Interpersonal therapy (IPT)
Rynn, M. A., Riddle, M. A., Yeung, P. P., Kunz, N. R.
Objective: The authors evaluated the efficacy, safety, and tolerability of extended-release venlafaxine in the treatment of pediatric generalized anxiety disorder. Method: Two randomized, double-blind, placebo-controlled trials were conducted at 59 sites in 2000 and 2001. Participants 6 to 17 years of age who met DSM-IV criteria for generalized anxiety disorder received a flexible dosage of extended-release venlafaxine (N=157) or placebo (N= 163) for 8 weeks. The primary outcome measure was the composite score for nine delineated items from the generalized anxiety disorder section of a modified version of the Schedule for Affective Disorders and Schizophrenia for School-Age Children, and the primary efficacy variable was the baseline-to-endpoint change in this composite score. Secondary outcome measures were overall score on the nine delineated items, Pediatric Anxiety Rating Scale, Hamilton Anxiety Rating Scale, Screen for Child Anxiety Related Emotional Disorders, and the severity of illness and improvement scores from the Clinical Global Impression scale (CGI). Results: The extended-release venlafaxine group showed statistically significant improvements in the primary and secondary outcome measures in study 1 and significant improvements in some secondary outcome measures but not the primary outcome measure in study 2. In a pooled analysis, the extended-release venlafaxine group showed a significantly greater mean decrease in the primary outcome measure compared with the placebo group (-17.4 versus -12.7). The response rate as indicated by a CGI improvement score <3 was significantly greater with extended-release venlafaxine than placebo (69% versus 48%). Common adverse events were asthenia, anorexia, pain, and somnolence. Statistically significant changes in height, weight, blood pressure, pulse, and cholesterol levels were observed in the extended-release venlafaxine group. Conclusions: Extended-release venlafaxine may be an effective, well-tolerated short-term treatment for pediatric generalized anxiety disorder.
American Journal of Psychiatry., 164(2) : 290-300
- Year: 2007
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Bakhshani, N. M., Lashkaripour, K., Sadjadi, S. A.
Recent studies have suggested that Cognitive Behavior Therapy (CBT) is an effective treatment for anxiety disorders. Yet, many questions remain regarding the overall effectiveness of CBT. This controlled clinical trial was done to evaluate the efficacy of short term CBT treatment in Iranian outpatients with GAD. The study was performed in Baharan psychiatric center of Zahedan University of medical sciences (Zahedan-Iran). Twenty-one GAD patients were included in the study. From this group, 7 patients were randomly assigned to 8 sessions of CBT, seven patients were treated with antidepressant and Benzodiazepine drugs and the other 7 participants assigned to control group (Placebo). CBT was done in accordance with a manual. All patients completed at pre and post treatment the BAI, HARS and DAS. The results showed that both short term CBT and pharmacotherapy significantly produced symptoms reduction (BAI and HARS scores) in GAD patients comparing with placebo. Significant reduction of DAS scores only was observed in CBT group. Overall, short term CBT is an effective method of treatment for Iranian outpatients with GAD. Further research in this area will need to focus on comparing CBT with other psychological treatments.
Journal of Medical Sciences., 7(7) : 1076-1081
- Year: 2007
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Tricyclic antidepressants, Anxiolytics including benzodiazepines, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Hidalgo, R. B., Tupler, L. A., Davidson, J. R. T.
Generalized anxiety disorder (GAD) is a prevalent and impairing disorder, associated with extensive psychiatric and medical comorbidity and usually characterized by a chronic course. Different drugs have been investigated in GAD; among them are the following: 1) SSRIS: paroxetine, sertraline, fluvoxamine and escitalopram; 2) SNRI1S: venlafaxine; 3) benzodiazepines (BZS): alprazolam, diazepam and lorazepam; 4) azapirones (AZAS): buspirone; 5) antihistamines (AHS): hydroxyzine; 6) pregabalin (PGB); and 7) complementary/alternative medicine (CAM): kava-kava and homeopathic preparation. We conducted an effect size (ES) analysis of 21 double-blind placebo-controlled trials of medications treating DSM-III-R, DSM-IV or ICD-10 GAD using HAM-A change in score from baseline or endpoint score as the main efficacy measure. Literature search was performed using MEDLINE and PsycINFO databases including articles published between 1987 and 2003 and personal communications with investigators and sponsors. comparing all drugs versus placebo, the Es was 0.39. Mean Ess, excluding children, were PGB: 0.50, AH: 0.45, SNRI: 0.42, BZ: 0.38, SSRI: 0.36, AZA: 0.17 and CAM: -0.31. comparing ES for adults versus children/adolescents (excluding CAM) and conventional drugs versus CAM (excluding children/adolescents) we found significantly higher ES for children/adolescents and for conventional drugs (p < 0.001 and p < 0.01, respectively). No significant differences were found when comparing date of publication, location of site (i.e. US versus other), fixed versus flexible dosing, number of study arms, or number of outcome measures used. Medications varied in the magnitude of their Es, ranging from moderate to poor. AdolesCents and Children showed a muCh greater ES Compared with adultS. SubjeCts taking CAM had worse outComes than plaCebo. copyright 2007 British Association for Psychopharmacology.
Journal of Psychopharmacology., 21(8) : 864-872
- Year: 2007
- Problem: Generalized Anxiety Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
In-Albon, T., Schneider, S.
Background: The present study compared the efficacy of psychotherapy for childhood anxiety disorders (excluding trials solely treating post-traumatic stress disorder or obsessive-compulsive disorder). Methods: The meta-analysis included studies that met the basic CONSORT (consolidated standards of reporting trials) criteria. Several outcome variables (e.g. effect sizes, percentage of recovery) were analyzed using completer and intent-to-treat analyses during post-treatment and follow-up assessment. Twenty-four studies published by March 2005 were included in this meta-analysis. Results: In all the included studies, the active treatment condition was cognitive-behavioral. The overall mean effect of treatment was 0.86. No differences in outcome were found between individual and group treatments or child- and family-focused treatments. Follow-up data demonstrated that treatment gains were maintained up to several years after treatment. Conclusions: These findings provide evidence that anxiety disorders in children can be treated efficaciously. The gathered data support the clinical utility of cognitive-behavioral therapy in this regard. Randomized controlled trial studies investigating treatments other than cognitive-behavioral therapy are missing. Copyright copyright 2007 S. Karger AG.
Psychotherapy & Psychosomatics., 76(1) : 15-24
- Year: 2007
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Panic Disorder, Social phobia (social anxiety disorder)
, Specific Phobia
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
Bernstein, G. A., Layne, A. E., Egan, E. A., Tennison, D. M.
Objective: To compare the effectiveness of three school-based interventions for anxious children: group cognitive-behavioral therapy (CBT) for children, group CBT for children plus parent training group, and no-treatment control. Method: Students (7-11 years old) in three elementary schools (N = 453) were screened using the Multidimensional Anxiety Scale for Children and teacher nomination. Subsequently, 101 identified children and their parents completed the Anxiety Disorders Interview Schedule for DSM-IV, Child Version. Children with features or DSM-IV diagnoses of separation anxiety disorder, generalized anxiety disorder, and/or social phobia (n = 61) were randomized by school to one of three conditions. Active treatments were nine weekly sessions of either group CBT or group CBT plus concurrent parent training. Results: Clinician-report, child-report, and parent-report measures of child anxiety demonstrated significant benefits of CBT treatments over the no-treatment control group. Effect size was 0.58 for change in composite clinician severity rating, the primary outcome measure, favoring collapsed CBT conditions compared with control. In addition, several instruments showed significantly greater improvement in child anxiety for group CBT plus parent training over group CBT alone. Conclusions: Both active CBT treatments were more effective than the no-treatment control condition in decreasing child anxiety symptoms and associated impairment. When parent training was combined with child group CBT, there were some additional benefits for the children. copyright2005 by the American Academy of Child and Adolescent Psychiatry.
Journal of the American Academy of Child & Adolescent Psychiatry, 44(11) : 1118-1127
- Year: 2005
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder)
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other Psychological Interventions
Kunz, N, Khan, A, Lamm, L. W, Nicolacopoulos, E, Jenkins, L.
Objective: Venlafaxine extended release (XR), a selective serotonin and norepinephrine reuptake inhibitor, is an effective treatment for adults with depression or generalised anxiety disorder (GAD), but no data are available on the safety and efficacy of venlafaxine XR in paediatric patients with GAD. This abstract presents the combined results of 2 identical 8-week, multicentre, double-blind, placebo-controlled, flexible-dose studies, which evaluated the efficacy, safety, and tolerability of venlafaxine XR as a treatment for GAD in children (6-11 years old) and adolescents (12-17 years old). Methods: A total of 320 paediatric patients (175 children, 145 adolescents) were randomly assigned to receive venlafaxine XR (n=157) or placebo (n=163). The study medication was dosed by weight. The primary efficacy variable was the Columbia KIDDIE-SADS GAD total score for 9 delineated items (range of possible scores 9-55, with higher scores indicating greater anxiety and/or impairment) and the primary endpoint was the final on-therapy evaluation. Secondary efficacy variables were the C-KIDDIE-SADS GAD (complete) total score and the individual Severity (5 delineated items) and Impairment (4 delineated items) component scores of the primary efficacy variable, the Paediatric Anxiety Rating Scale (PARS) total score, the Hamilton Rating Scale for Anxiety (HAM-A) total score, the SCARED Parent and Child Forms total score, and the Clinical Global Impressions (CGI) Severity and Improvement scores. Results: Children and adolescents in the venlafaxine XR group had an adjusted mean (±SE) decrease of 17.4(±0.80) points on the primary efficacy variable, as compared to a 12.7(±0.84) point decrease for patients in the placebo group (p<0.001). On the secondary measures, similar results were obtained. On the CGI Improvement scale, 106 of 154 patients in the venlafaxine XR group (69%) responded to treatment, as indicated by a score <3, as compared with 77 of 159 patients in the placebo group (48%, p= 0.004). Eight (8) of 157 patients in the venlafaxine XR group (5%) discontinued from the study because of adverse events, as compared with 9 of 163 placebo patients (5%). The most common treatment-related adverse events (=5% and incidence twice placebo) were asthenia, anorexia, pain and somnolence. Conclusion: Venlafaxine XR is an effective and well-tolerated treatment for children and adolescents with GAD.
European Neuropsychopharmacology, 12(Suppl 3) :
- Year: 2002
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Kunz ,N, Khan, A, Nicolacopoulos, E, Jenkins, L, Yeung P. P.
(Abstracts of the 23rd Congress of the Collegium Internationale Neuro-Psychopharmacologicum, June 23-27 2002, Montreal, Canada
International Journal of Neuropsychopharmacology, 5(Suppl 1) :
- Year: 2002
- Problem: Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Serotonin-norepinephrine reuptake inhibitors (SNRIs)
The Research Unit on Pediatric Psychopharmacology Anxiety Study Group,
Drugs that selectively inhibit serotonin reuptake are effective treatments for adults with mood and anxiety disorders, but limited data are available on the safety and efficacy of serotonin-reuptake inhibitors in children with anxiety disorders. 128 children (aged 6-17 yrs) who met the criteria for social phobia, separation anxiety disorder, or generalized anxiety disorder, and who had received psychological treatment for 3 wks without improvement were studied. The children were randomly assigned to receive fluvoxamine or placebo for 8 wks and were evaluated with rating scales designed to assess the degree of anxiety and impairment. Children in the fluvoxamine group had a mean decrease of 9.7 points in symptoms of anxiety on the Pediatric Anxiety Rating Scale, as compared with a decrease of 3.1 points among children in the placebo group. On the Clinical Global Impressions-Improvement scale, 48 of 63 children in the fluvoxamine group had a response to the treatment, as compared with 19 of 65 children in the placebo group. It is concluded that fluvoxamine is an effective treatment for children and adolescents with social phobia, separation anxiety disorder, or generalized anxiety disorder. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
New England Journal of Medicine, 344(17) : 1279-1285
- Year: 2001
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs)