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. Method. 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. Received 2 December 2011; Revised 6 March 2012; Accepted 8 March 2012; First published online 12 April 2012