Beyond the Constraints of an RCT: Naturalistic Treatment Outcomes for Anxiety-Related Disorders. Issue 3 (May 2020)

• Record Type: Journal Article
• Authors: Asnaani, Anu; Benhamou, Kathy; Kaczkurkin, Antonia N.; Turk-Karan, Elizabeth; Foa, Edna B.
• Is Part Of: Behavior therapy. Volume 51:Issue 3(2020)
• Page Start: 434
• Page End: 446
• Publication Date: 2020-05
• Subjects: naturalistic treatment outcome -- anxiety -- technology -- computerized assessment; Behavior therapy -- Periodicals; 616.8914205
• DOI: 10.1016/j.beth.2019.07.007
• Languages: English
• ISSNs: 0005-7894

Abstract

Abstract: Despite considerable data from randomized controlled trials supporting use of behavioral therapies for anxiety disorders and anxiety-related disorders, there is a relative scarcity of data demonstrating that such findings are generalizable to patients in nonresearch settings, and a lack of standardized repeated outcome measurement in such settings. Using one of the largest examinations of naturalistic outcomes of behavioral therapies in treatment-seeking patients ( N = 489), we examined the clinical characteristics and treatment outcomes of patients seeking treatment for anxiety and anxiety-related disorders in the past 3 years. Patients seeking treatment at a clinic specializing in cognitive-behavioral therapy (CBT) completed self-report questionnaires via an electronic data capture system and diagnostic interview at baseline, and were reassessed at mid- and posttreatment. Patients with anxiety and related disorders were assessed for changes in symptom severity and secondary outcomes (impairment/functioning, quality of life, and depression) over the course of therapy. Patients showed clinically significant and statistically reliable improvement in anxiety symptom severity scores over treatment ( p < .001), after controlling for number of sessions received. Patients also showed significant improvement in depression, quality of life, and functioning ( p values ≤ .001). We also found significant improvement in disorder-specific symptoms, including obsessive-compulsive disorder, posttraumatic stress disorder, generalized anxiety disorder, and social anxiety disorder ( p values ≤ .001). Importance of, and ways to facilitate, integration of more routine assessment of a broader range of symptoms via online assessment systems and methods to better determine the effectiveness of CBT in naturalistic clinics are discussed. Highlights: Exposure therapy in naturalistic setting yields clinically significant improvements Results support the implementation of exposure protocols for anxiety in community Study models integration of computerized assessment into routine clinical practice Concerns that "real-world" patients do not respond well to exposure are unwarranted