A multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: an empirical examination of the status of empirically supported therapies.
The authors report a meta-analysis of high-quality studies published from 1990-1998 on the efficacy of manualized psychotherapies for depression, panic disorder, and generalized anxiety disorder (GAD) that bear on the clinical utility and external validity of empirically supported therapies. The results suggest that a substantial proportion of patients with panic improve and remain improved; that treatments for depression and GAD produce impressive short-term effects: that most patients in treatment for depression and GAD do not improve and remain improved at clinically meaningful follow-up intervals: and that screening procedures used in many studies raise questions about generalizability, particularly in light of a systematic relation across studies between exclusion rates and outcome. The data suggest the importance of reporting, in both clinical trials and meta-analyses, a range of outcome indices that provide a more comprehensive, multidimensional portrait of treatment effects and their generalizability. These include exclusion rates, percent improved, percent recovered, percent who remained improved or recovered at follow-up, percent seeking additional treatment at follow-up, and data on both completer and intent-to-treat samples.
Westen
D
D
Center for Anxiety and Related Disorders and Department of Psychology, Boston University, Massachusetts 02215, USA. dwesten@bu.edu
Morrison
K
K
D001008:Anxiety Disorders / Q000628:therapy*; D003866:Depressive Disorder / Q000628:therapy*; D005500:Follow-Up Studies; D005793:Generalization, Psychological; D006801:Humans; D016584:Panic Disorder / Q000628:therapy*; D011613:Psychotherapy / Q000379:methods* / Q000592:standards*; D012106:Research; D016896:Treatment Outcome