Cognitive Behavioral Therapy (CBT) is an evidence-based treatment for Generalized Anxiety Disorder (GAD). It typically involves several key components:
CBT helps individuals identify and change maladaptive thought patterns and behaviors that maintain anxiety. It teaches coping skills to manage worry and physical symptoms of anxiety.
Treatment usually occurs over 12-20 sessions, with homework assignments between sessions to practice new skills. CBT has been shown to produce significant and lasting reductions in GAD symptoms.
Key Points
Rationale
While cognitive-behavioral therapy (CBT) has been shown to be an effective treatment for GAD (Carpenter et al., 2018), many individuals face barriers in accessing evidence-based care, including affordability, geographical isolation, and difficulty finding trained clinicians (Coles & Coleman, 2010; Goetter et al., 2020).
Remote treatments, particularly those delivered via videoconferencing (VCBT), may help overcome these barriers.
However, research on the efficacy of high-intensity remote treatments for GAD is limited, with existing studies having small sample sizes or focusing on specific populations (Bouchard & Renaud, 2001; Brenes et al., 2015).
Method
Procedure
The study used arandomized controlled designcomparing an immediate VCBT treatment group to a waitlist control group.
The VCBT group received 10 weekly 50-minute treatment sessions conducted via Zoom. Assessments were conducted at pre-treatment, mid-treatment, post-treatment, and 3-month follow-up.
Sample
78 adults (Mage = 36.92; SD = 12.92; 84.4% female) with a primary diagnosis of GAD were enrolled in the study. 39 participants were allocated to the VCBT group and 39 to the waitlist control group.
Measures
Statistical measures
Mixed-linear models with an unstructured covariance structure were used for the main analyses. Multiple imputation was used to handle missing data.
Effect sizesusing Cohen’s d were calculated for within-group and between-group differences.
Results
Hypothesis 1:VCBT would result in significant reductions in symptoms from pre-treatment to post-treatment and pre-treatment to 3-month follow-up with large within-group effect sizes.
This hypothesis was supported. On the primary outcome measure (GAD-7), significant reductions were observed from pre-treatment to post-treatment (d = 1.03, 95% CI: 0.55-1.50) and pre-treatment to 3-month follow-up (d = 1.50, 95% CI: 0.98-1.99).
Hypothesis 2:VCBT would have significantly better outcomes at post-treatment when compared to the control group with large between-group effect sizes.
This hypothesis was supported. Large between-group effect sizes were observed at post-treatment on the GAD-7 (d = 0.80; 95% CI: 0.33-1.26) and GAD-D (d = 0.82; 95% CI: 0.35-1.28). Medium to large between-group effect sizes were observed on other secondary measures.
Hypothesis 3:VCBT would be an acceptable treatment to individuals with GAD.
This hypothesis was supported. 96.43% of participants who completed post-treatment questionnaires reported being ‘satisfied’ or ‘extremely satisfied’ with the treatment. The mean score on the Client Satisfaction Questionnaire was 28.55 (SD = 3.60), indicating high satisfaction.
Additional findings:
Insight
This study provides strong evidence for the efficacy and acceptability of VCBT as a treatment for GAD.
The large effect sizes observed are comparable to those seen in meta-analyses of in-person CBT for GAD (Carpenter et al., 2018), suggesting that VCBT may be as effective as traditional face-to-face treatment.
The high satisfaction rates indicate that participants found the treatment acceptable despite the remote delivery format.
By using modern videoconferencing platforms and allowing participants to receive treatment from their preferred location, this study better reflects real-world applications of VCBT.
Interestingly, while large effects were observed on GAD symptom measures, smaller effects were seen for worry andintolerance of uncertainty.
This aligns with previous research showing that worry measures often demonstrate smaller treatment effects than broader GAD symptom measures (Dear et al., 2011).
Future research could explore whether additional focus on worry exposure or addressing intolerance of uncertainty could enhance outcomes further.
The study also highlights the potential for VCBT to increase access to evidence-based treatment for GAD.
By removing geographical barriers and potentially increasing the reach of trained therapists, VCBT could help address the significant treatment gap that exists for anxiety disorders.
Further research directions could include:
Strengths
The study had many methodological strengths including:
Limitations
These limitations suggest caution in generalizing the results to all individuals with GAD and highlight the need for further research comparing VCBT to active treatments and assessing long-term outcomes.
Implications
The results of this study have significant implications for the treatment of GAD:
Variables that may influence the results and should be considered in future research include patient characteristics (e.g., severity of GAD, comorbidities, technology comfort), therapist factors (e.g., experience with VCBT, adherence to treatment protocol), and technological aspects (e.g., internet connectivity, platform usability).
References
Primary reference
Trenoska Basile, V., Newton‐John, T., McDonald, S., & Wootton, B. M. (2023). Internet videoconferencing delivered cognitive behaviour therapy for generalized anxiety disorder: A randomized controlled trial.British Journal of Clinical Psychology.https://doi.org/10.1111/bjc.12482
Other references
Bouchard, S., & Renaud, P. (2001). CBT in videoconference for panic disorder and generalized anxiety disorder. In35th Annual Convention of the Association for Advancement of Behavioral Therapies, Philadelphia, Pennsylvania.
Brenes, G. A., Danhauer, S. C., Lyles, M. F., Hogan, P. E., & Miller, M. E. (2015). Telephone-delivered cognitive behavioral therapy and telephone-delivered nondirective supportive therapy for rural older adults with generalized anxiety disorder: a randomized clinical trial.JAMA psychiatry,72(10), 1012-1020.
Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers, M. B., Smits, J. A., & Hofmann, S. G. (2018). Cognitive behavioral therapy for anxiety and related disorders: A meta‐analysis of randomized placebo‐controlled trials.Depression and anxiety,35(6), 502-514.https://doi.org/10.1002/da.22728
Coles, M. E., & Coleman, S. L. (2010). Barriers to treatment seeking for anxiety disorders: initial data on the role of mental health literacy.Depression and anxiety,27(1), 63-71.https://doi.org/10.1002/da.20620
Dear, B. F., Titov, N., Sunderland, M., McMillan, D., Anderson, T., Lorian, C., & Robinson, E. (2011). Psychometric comparison of the generalized anxiety disorder scale-7 and the Penn State Worry Questionnaire for measuring response during treatment of generalised anxiety disorder.Cognitive behaviour therapy,40(3), 216-227.https://doi.org/10.1080/16506073.2011.582138
Goetter, E. M., Frumkin, M. R., Palitz, S. A., Swee, M. B., Baker, A. W., Bui, E., & Simon, N. M. (2020). Barriers to mental health treatment among individuals with social anxiety disorder and generalized anxiety disorder.Psychological services,17(1), 5.
Ruscio, A. M., Hallion, L. S., Lim, C. C., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., … & Scott, K. M. (2017). Cross-sectional comparison of the epidemiology of DSM-5 generalized anxiety disorder across the globe.JAMA psychiatry,74(5), 465-475.
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Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
