Efficacy of group psychotherapy for panic disorder: Meta-analysis of randomized, controlled trials.

Abstract

Among psychological treatments for panic disorder (PD) with or without agoraphobia, group therapy is an established and cost-effective treatment. The typical review assessing the effects of psychological treatments for PD merges findings from both individual and group formats. What is absent from the literature is a meta-analysis that separately summarizes the efficacy of group treatments. The present meta-analysis addresses this gap by estimating the efficacy of group psychotherapy for PD in adults using randomized, controlled trials (RCTs). More specifically, studies that directly compared the effects of group psychotherapy with control groups or alternative treatments were included. We identified 15 RCTs that yielded 19 comparisons with 864 patients. In most studies, group therapy was based on a cognitive–behavioral approach. Outcomes assessing panic, agoraphobia, depression, and general anxiety symptoms were extracted and between-groups effect sizes (Hedges’ g) calculated using a random-effects model. Results showed large effects for group therapy reducing symptoms of panic and agoraphobia when compared with no-treatment control groups (k = 9; g = 1.08; 95% confidence interval [CI] [0.82, 1.34]; p < .001). However, no significant differences were found when group therapy was compared with alternative treatments (k = 6; g = 0.18; 95% CI [−0.14, 0.49]; p = .264). This review adds support for group psychotherapy (primarily cognitive–behavioral therapy, CBT) being one of several treatment options for PD. Results are discussed with respect to the positive effects of group therapy and the limits of group therapy when compared with alternative treatments such as individual therapy or pharmacotherapy.

The psychology of the COVID-19 pandemic: A group-level perspective.

“…Reports so far indicate an increase of anxiety and panic symptoms and anxiety disorders as an immediate consequence of the COVID-19 pandemic (Huang & Zhao, 2020; Rajkumar, 2020), raising the question of how effective treatments for patients suffering from panic and combined anxiety disorders can benefit from group treatments. The effects of CBGT were assessed in a recent meta-analysis comprising RCTs of group treatments for panic disorder (Schwartze et al, 2017). A large effect for CBGT was found on panic and agoraphobia symptoms when compared to no-treatment controls ( g = 1.08), and no differences were found when CBGT was compared to treatments ( g = 0.18) including individual therapy.…”

What are the recovery and attrition outcomes for group CBT and individual CBT for generalised anxiety disorder in an IAPT service? An exploratory study

“…However, literature to date has been inconsistent over the efficacy and acceptability of gCBT, with the quality of evidence cited in meta-analyses and the relevance of results obtained from RCTs being brought into question (Schwartze et al, 2017). This pragmatic exploration of gCBT outcomes aids our understanding of attrition and recovery in ecologically relevant settings, whilst extending and replicating findings from well-controlled comparative formats from other populations.…”

“…However, discrepancies in the age of participants between individual and group may have confounded reliable interpretation of outcomes, particularly given the likely increased distress and resistance to change that may be associated with longer chronicity in GAD. The lack of relevant studies of gCBT may create scepticism about its use as a first line of treatment (Schwartze et al, 2017). This is important considering that literature on GAD is under-developed in the anxiety field in general (Cuijpers et al, 2016).…”

“…Although between-studies comparisons should be interpreted with caution, it is one of the only controlled studies with adults that demonstrates group efficacy in GAD patients using the same protocol and patient factors. Indeed, in a recent review of 25 years of group therapy literature, Schwartze et al (2017) argue that the evidence base is too small to draw meaningful conclusions in support of gCBT, and Burlingame and Jensen (2017) comment that convincing evidence specific to GAD is lacking, as group data on GAD is missing from literature (Burlingame and Jensen, 2017). This warrants further exploration into the effectiveness of gCBT for GAD.…”

Group cognitive behavioural therapy with virtual reality exposure versus group cognitive behavioural therapy with in vivo exposure for social anxiety disorder and agoraphobia: a protocol for a randomised clinical trial

“…5 6 Several meta-analyses have found that patients with social anxiety disorder and agoraphobia respond well to CBT with exposure therapy, provided in individual as well as group format. [7][8][9][10] Exposure therapy aims to change expectations and emotional responses associated with feared stimuli, by exposing the patient to the stimuli and challenging the patients' expectancies of the likelihood and consequences of a feared outcome. 11 However, in clinical practice, in-vivo exposure stimuli can be difficult to access and control and patients or therapists sometimes reject the treatment, because they consider it too aversive or too logistically demanding.…”