Generalized anxiety: Most psychological and self-help interventions exerted greater effects than the waitlist group, but no psychological interventions had greater effects compared with the psychological placebo

Pharmacological and psychological interventions for generalized anxiety disorder in adults: A network meta-analysis. Ting-Ren Chen et al. Journal of Psychiatric Research, September 1 2019. https://doi.org/10.1016/j.jpsychires.2019.08.014

Abstract: Generalized anxiety disorder (GAD) is a significant and common mental illness with a lifetime prevalence of 3.7%. Regardless of the complexity of treatment decisions for GAD, few studies have conducted systematic comparisons of the efficacies of varying interventions. Thus, this study performed a valid network meta-analysis (NMA) of randomized controlled trials (RCTs) to synthesize direct and indirect evidence for alternative interventions for GAD. We searched four major bibliographic databases, the Cochrane Central Register of Controlled Trials, Embase, PsycINFO, and PubMed, for published RCTs of adult patients with a diagnosis of GAD and allowed for all comorbidities. A total of 91 articles (14,812 participants) were identified in the final NMA. The results showed that all pharmacological treatments except for serotonin modulators and second-generation antipsychotics had greater effects than placebo: norepinephrine–dopamine reuptake inhibitors (standardized mean difference (SMD) −1.84, 95% credible interval −3.05 to −0.62), noradrenergic and specific serotonergic antidepressants (−0.91, −1.62 to −0.20), melatonergic receptor agonists (−0.68, −1.15 to −0.21), selective serotonin reuptake inhibitors (SSRIs; −0.67, −0.90 to −0.43), azapirones (−0.58, −1.00 to −0.17), anticonvulsants (−0.56, −0.85 to −0.28), serotonin–norepinephrine reuptake inhibitors (SNRIs; −0.54, −0.79 to −0.30), and benzodiazepines (BZDs; −0.40, −0.65 to −0.15). Most psychological and self-help interventions exerted greater effects than the waitlist group. However, no psychological interventions had greater effects compared with the psychological placebo. Overall, most pharmacological interventions had larger effect sizes than psychological interventions, and most psychological interventions showed larger effect sizes than self-help interventions.


Check also An analysis of psychotherapy versus placebo studies. Leslie Prioleau, Martha Murdock and Nathan Brody. Behavioral and Brain Sciences, Volume 6 Issue 2, June 1983 , pp. 275-285. https://doi.org/10.1017/S0140525X00015867

Abstract: Smith, Glass, and Miller (1980) have reported a meta-analysis of over 500 studies comparing some form of psychological therapy with a control condition. They report that when averaged over all dependent measures of outcome, psychological therapy is. 85 standard deviations better than the control treatment. We examined the subset of studies included in the Smith et al. metaanalysis that contained a psychotherapy and a placebo treatment. The median of the mean effect sizes for these 32 studies was. 15. There was a nonsignificant inverse relationship between mean outcome and the following: sample size, duration of therapy, use of measures of outcome other than undisguised self-report, measurement of outcome at follow-up, and use of real patients rather than subjects solicited for the purposes of participation in a research study. A qualitative analysis of the studies in terms of the type of patient involved indicates that those using psychiatric outpatients had essentially zero effect sizes and that none using psychiatric inpaticnts provide convincing evidence for psychotherapeutic effectiveness. The onty studies clearly demonstrating significant effects of psychotherapy were the ones that did not use real patients. For the most part, these studies involved small samples of subjects and brief treatments, occasionally described in quasibeliavioristic language. It was concluded that for real patients there is no evidence that the benefits of psychotherapy are greater than those of placebo treatment.