(Third-wave) cognitive behavioral therapy for generalized anxiety disorder in adults: A systematic review and Bayesian network meta-analysis

Generalized anxiety disorder (GAD) imposes a substantial burden on the patient and society. To manage GAD, cognitive behavioral therapy (CBT) is a widely recognized psychotherapeutic approach. Moreover, the third-wave CBTs expand the treatment options and have the potential to positively impact patient outcomes and preferences. However, which CBT protocols or third-wave CBTs are the most effective and appropriate for use in primary care settings remains uncertain. This study explored the short-and long-term relative efficacy of various CBT protocols and third-wave CBTs in reducing GAD symptom severity via a Bayesian network meta-analysis. The meta-analysis comprised 56 studies involving 4388 participants. Combining the initial analysis and sensitivity analysis, the results indicated that among the CBT protocols, Dugas's CBT protocol—which incorporates self-monitoring, education on uncertainty intolerance, assessment of worry beliefs, improvement of problem orientation, and dealing with core fears—demonstrated superior short- and long-term efficacy in reducing GAD symptom severity. Within the third-wave CBTs, the short- and long-term efficacy of acceptance-based therapy for GAD treatment is also notable. The Bayesian meta-regression analysis results showed that whether the therapies or protocols were guided by a clinician significantly moderated the effect size compared with the control group. These findings provide valuable insights for future GAD therapists in selecting appropriate therapies and protocols and a reference for updating GAD treatment guidelines.