Question: In adults with anxiety, which group intervention is most effective in improving patient outcomes?


Plain language summary
Research suggests that group cognitive behavioural therapy and group psychotherapy can be helpful in reducing symptoms of anxiety. However, in order to determine the most effective group intervention, more trials comparing different group therapies are required.

Clinical and research implications
Evidence from three high-quality systematic reviews (70 studies, 3585 participants) showed that group CBT significantly improved social anxiety symptoms, and group psychotherapy significantly improved social anxiety, general anxiety and depression compared to a waiting list control in adults with social anxiety. Group CBT also significantly reduced anxiety compared to a waiting list or treatment as usual in adults with generalised anxiety disorder however, no statistically significant differences were found between group and individual CBT. 

These conclusions are likely to be reliable. However, as there were no studies comparing group CBT to a different form of group therapy (comparators were waiting list control, treatment as usual or individual therapy) the question about group versus group therapy cannot be answered.

Further research is needed into non-CBT models such as cognitive analytic or interpersonal therapy, and comparing CBT and non-CBT models in generalised anxiety disorder. Large trials comparing different active interventions in social anxiety disorder, with controlled long-term follow-up, clear reporting of the therapy components and measurement of economic outcomes are also needed.

These results are consistent with the NICE guidelines, in fact Mayo-Wilson et al. (2014) stated that the "NICE recommendations are consistent with the results of the study which suggests that increased access to treatment would reduce disability and improve quality of life for people with social anxiety disorder". NICE recommends offering individual CBT to people with social anxiety disorder, but not group CBT as it is less clinically and cost-effective. This is supported by the Mayo-Wilson results as they compared a range of treatments, not just group CBT, and concluded that individual CBT was the most effective.

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