The state of personalized treatment for anxiety disorders: A systematic review of treatment moderators

Introduction: The aim of this review was to synthesize findings for moderators of treatment outcome across adult anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder. Methods: Twenty-four papers that compared two or more active treatments (at least one of which was a form of cognitive behavioral therapy [CBT]) were identified and organized into five treatment comparison categories (distinct psychotherapy combinations, CBT full package vs. single components, CBT vs. augmented CBT, CBT delivery methods, and CBT vs. pharmacotherapy). Sixty-three distinct baseline moderators were tested across seven categories (symptom severity, comorbid emotional disorders or emotional-reactivity, cognitive maintenance factors, behavioral maintenance factors, personality traits and disorders, sociodemographic factors, and biological factors). Results: Few consistent treatment moderators were identified. All studies testing quadratic effects found at least one significant non-linear moderator or predictor effect. In addition, the majority of studies had methodological problems and limitations, demonstrating the need for future methodological improvements. Conclusion: Limited conclusions can be drawn about how to match anxiety disorder patients to treatment. A strong need to improve the methodological consistency and rigor of treatment moderator studies was identified. A series of recommendations for moderation analyses are proposed in order to strengthen future studies and facilitate replication efforts. (C) 2015 Elsevier Ltd. All rights reserved.