CBT treatment delivery formats for generalized anxiety disorder: a systematic review and network meta-analysis of randomized controlled trials.

Objectives: To assess the comparative efficacy and acceptability of different delivery formats of cognitive behavior therapy (CBT) in treating generalized anxiety disorder (GAD).

Methods: We searched MEDLINE, Embase, PsycINFO, and the Web of Science from database inception to September, 2023, to identify randomized clinical trials (RCTs) of CBT for patients with GAD. Pairwise and network meta-analyses were conducted using a random-effects model.

Results: Finally, 52 trials that randomized 4361 patients (mean age 43 years; 69.7% women) with generalized anxiety disorder met the inclusion criteria. The most studied treatment comparisons were individual and remote CBT versus waiting list. The quality of the evidence was typically of low or unclear risk of bias (39 out of 52 trials, 75%). The network meta-analysis including 30 studies showed that individual CBT was superior to remote CBT (SMD 0.96; 95% Cl 0.13-1.79), treatment as usual (SMD 1.12; 95% Cl 0.24-2.00) and waiting list (SMD 1.62; 95% Cl 1.03-2.22) in relieving anxiety symptoms of GAD. Group CBT (SMD 1.65; 95% Cl 0.47-2.84) was more efficacious than waiting list. Remote CBT was not superior to treatment as usual or waiting list. In terms of acceptability CBT delivery formats did not differ significantly from each other.

Conclusions: Our findings provide evidence for the consideration of group treatment formats as alternative to individual CBT in relieving anxiety symptoms in patients with GAD, but remote CBT may be less effective.