Occupational functioning, sickness absence and medication utilization before and after cognitive-behaviour therapy for generalized anxiety disorders.
BACKGROUND
Cognitive-behaviour therapy (CBT) is efficacious in reducing symptoms of generalized anxiety disorders (GAD). The question is whether it is also efficient, i.e., whether there are also enduring effects with respect to improving utilization of medication and psychotherapy, or occupational functioning and sick leave after the end of treatment.


METHODS
The study was based on 44 outpatients (age 18-65 years; HAM-A score ≥18; GAD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria as assessed by standardized interview) who were treated with 25 sessions of CBT (treatment by 12 state-licensed behaviour therapists in office-based practice; no psychotropic treatment for the duration of the therapy). The rate of medication treatment, occupational functioning and sick leave was assessed for 8 months before and after the end of treatment.


RESULTS
In the comparison of the pre-treatment and post-treatment periods, 46.5% versus 7.2% of patients used psychotropic medication for at least 4 weeks and had been 3.1 versus 1.1 days on sickness absence per month, respectively. About 70% of patients showed impairment in occupational role performance during the pre-treatment phase compared with 5% to 20%, depending on the dimension, in the follow-up period.


CONCLUSIONS
The data suggest that CBT is not only efficacious in terms of symptom reduction but also efficient in terms of reducing inappropriate medication intake and improving occupational functioning.
Research Group Psychosomatic Rehabilitation, Charité University Medicine, Berlin and Department of Behavioural Medicine, Rehabilitation Centre Seehof, Teltow/Berlin, Germany. michael.linden@charite.de
Michael
M
Linden
Doris
D
Zubrägel
Thomas
T
Bär
D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000188:drug therapy / Q000534:rehabilitation*; D015928:Cognitive Behavioral Therapy; D004363:Drug Utilization; D004651:Employment; D005858:Germany; D006801:Humans; D008875:Middle Aged; D011619:Psychotropic Drugs; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D011619:Psychotropic Drugs