Group transdiagnostic cognitive-behavior therapy for anxiety disorders: a pragmatic randomized clinical trial

• Published in: Psychological medicine 2022-10, Vol.52 (13), p.2460-2470
• Main Authors: Roberge, Pasquale, Provencher, Martin D., Gaboury, Isabelle, Gosselin, Patrick, Vasiliadis, Helen-Maria, Benoît, Annie, Carrier, Nathalie, Antony, Martin M., Chaillet, Nils, Houle, Janie, Hudon, Catherine, Norton, Peter J.
• Format: Article
• Language: English
• Subjects: Agoraphobia; Anxiety; Anxiety disorders; Behavior modification; Behavior therapy; Clinical research; Clinical trials; Cognition; Cognitive ability; Cognitive behavioral therapy; Cognitive-behavioral factors; Community health care; Community mental health services; Comorbidity; Disorders; Dissemination; Generalized anxiety disorder; Group therapy; Health care policy; Mental disorders; Mental health care; Mental health services; Original; Original Article; Panic attacks; Panic disorders; Patients; Population; Primary care; Psychiatrists; Psychotherapy; Regression analysis; Social anxiety; Therapists; Treatment outcomes
• ISSN: 0033-2917; 1469-8978
• DOI: 10.1017/S0033291720004316

Transdiagnostic group cognitive-behavioral therapy (tCBT) is a delivery model that could help overcome barriers to large-scale implementation of evidence-based psychotherapy for anxiety disorders. The aim of this study was to assess the effectiveness of combining group tCBT with treatment-as-usual (TAU), compared to TAU, for the treatment of anxiety disorders in community-based mental health care. In a multicenter single-blind, two-arm pragmatic superiority randomized trial, we recruited participants aged 18-65 who met DSM-5 criteria for principal diagnoses of generalized anxiety disorder, social anxiety disorder, panic disorder, or agoraphobia. Group tCBT consisted of 12 weekly 2 h sessions. There were no restrictions for TAU. The primary outcome measures were the Beck Anxiety Inventory (BAI) and clinician severity rating from the Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5) for the principal anxiety disorder at post-treatment, with intention-to-treat analysis. A total of 231 participants were randomized to either tCBT + TAU (117) or TAU (114), with outcome data available for, respectively, 95 and 106. Results of the mixed-effects regression models showed superior improvement at post-treatment for participants in tCBT + TAU, compared to TAU, for BAI [p < 0.001; unadjusted post-treatment mean (s.d.): 13.20 (9.13) v. 20.85 (10.96), Cohen's d = 0.76] and ADIS-5 [p < 0.001; 3.27 (2.19) v. 4.93 (2.00), Cohen's d = 0.79]. Our findings suggest that the addition of group tCBT into usual care can reduce symptom severity in patients with anxiety disorders, and support tCBT dissemination in routine community-based care.