Psychological treatment of anxiety in primary care: a meta-analysis.
BACKGROUND
Guidelines and mental healthcare models suggest the use of psychological treatment for anxiety disorders in primary care but systematic estimates of the effect sizes in primary care settings are lacking. The aim of this study was to examine the effectiveness of psychological therapies in primary care for anxiety disorders.


METHODS
The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Medline, PsycINFO and Pubmed databases were searched in July 2010. Manuscripts describing psychological treatment for anxiety disorders/increased level of anxiety symptoms in primary care were included if the research design was a randomized controlled trial (RCT) and if the psychological treatment was compared with a control group.


RESULTS
In total, 1343 abstracts were identified. Of these, 12 manuscripts described an RCT comparing psychological treatment for anxiety with a control group in primary care. The pooled standardized effect size (12 comparisons) for reduced symptoms of anxiety at post-intervention was d = 0.57 [95% confidence interval (CI) 0.29-0.84, p = 0.00, the number needed to treat (NNT) = 3.18]. Heterogeneity was significant among the studies (I 2 = 58.55, Q = 26.54, p < 0.01). The quality of studies was not optimal and missing aspects are summarized.


CONCLUSIONS
We found a moderate effect size for the psychological treatment of anxiety disorders in primary care. Several aspects of the treatment are related to effect size. More studies are needed to evaluate the long-term effects given the chronicity and recurrent nature of anxiety.
Department of Clinical Psychology, VU University, Amsterdam, The Netherlands. wm.seekles@psy.vu.nl
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Seekles
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Cuijpers
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Kok
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Beekman
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van Marwijk
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van Straten
D001007:Anxiety / Q000628:therapy; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003627:Data Interpretation, Statistical; D016206:Databases, Bibliographic; D019468:Disease Management; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data