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Anxiety: Psychosocial treatment

Psychotherapy

For anxiety, cognitive-behavioural therapy (CBT) is the psychotherapy with the best evidence base and therefore is the first-line psychotherapy.

Depending on an individual's response to CBT, the severity and complexity of any comorbidity, and possible personality problems, other types of psychotherapy may be indicated.

Patient choice is an important factor in the success of any therapy for anxiety. Those who choose CBT generally do better than those who are assigned to it without choice.

When CBT is instituted, an adequate treatment trial should be administered, with appropriate monitoring and long-term follow-up.

Minimal exposure-based CBT can be effective.

Implementing CBT

CBT is effective in individual and group formats. It is as effective as drug therapy. There is no evidence that routinely combining medication and CBT is more effective than either treatment alone.

In CBT, the patient's progress is monitored session by session. If insufficient progress is made, therapy can be modified to fit the specific patient's needs rather than switching to another psychotherapy.

The amount of time and frequency of CBT sessions are important: 

  • CBT should involve two sessions a week of 60 or 90 minutes.
  • 12–20 sessions, depending on the disorder, are usually sufficient to produce therapeutic effect.
  • Follow-up sessions every month are useful in maintaining gains. These can occur in self-help community-based groups.

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Frequently asked questions