Predictors of relapse and recurrence following cognitive behavioural therapy for anxiety-related disorders: a systematic review

Abstract

Cognitive behavioural therapy (CBT) is an effective psychological treatment for anxiety-related disorders (anxiety disorders, post-traumatic stress disorder, and obsessivecompulsive disorder). However, relapse of anxiety symptoms is common following completion of treatment. This study aimed to identify predictors of relapse of anxiety after CBT for adult (18+) patients to enable the identification of 'at-risk' patients who could potentially benefit from relapse prevention interventions. A systematic review and meta-analysis was conducted, including studies found in PsycINFO, PubMed, Scopus, and Web of Science, and through hand-searches of references lists and reverse citations. Nine studies met eligibility criteria (N=532 patients). On average, 23.8% of patients experienced relapse following completion of CBT. A total of 21 predictors were identified and grouped into seven categories: residual symptoms; personality disorders; medication; clinical features; stressful life-events; degree of improvement; and demographics. A meta-analysis of residual symptoms as a predictor of relapse yielded a moderate but non-significant pooled effect size (r=0.35; 95% CI -0.21, 0.74, p = .08). Further research with adequately powered samples and standardised operationalisations of relapse are required to identify robust predictors.

Exploring maintaining gains following therapy during the coronavirus pandemic with adults with an intellectual disability

“…Current research examining the maintenance of gains following therapy in neurotypical populations has recently been consolidated. Two systematic reviews have revealed that stressful life events predict an increased risk of relapse following cognitive behavioural therapy (CBT) for anxiety-related disorders (Lorimer et al, 2021) and depression (Wojnarowski et al, 2019). This is particularly pertinent as evidence preceding the pandemic indicated that anxiety disorders have recurrence rates of between 39% and 56% (Vervliet et al, 2013) and depression of between 50 and 80% (American Psychiatric Association, 2000).…”

“…An increase in the rates of relapse following psychotherapy would worsen the already high global disease burden of common mental health conditions such as anxiety and depression (Lorimer et al, 2021). Additionally, for adults with IDs, access to psychological services has been impeded due to the pandemic (Purrington and Beail, 2021), therefore relapse not only causes emotional difficulties for individuals but also produces wider detrimental impacts such as inefficient service provision and increased health-care costs (Lorimer et al, 2021;Wojnarowski et al, 2019). Therefore, a service evaluation was conducted to explore the experiences of adults with ID living through the Covid-19 pandemic after completing a course of psychological therapy.…”

The clinical characterization of the adult patient with an anxiety or related disorder aimed at personalization of management

“…First, it is consonant with a growing re-emergence of interest in the establishment of a personalized psychiatry, and with similar reviews in other important areas of psychiatry 6,260 . Second, it resonates with systematic work on identification of treatment outcomes, and may help identify variables for potential inclusion in complex predictive models, including machine learning approaches 261,262 . Third, the literature suggests a number of clinically feasible measures, including self-report scales, that can potentially be included in future observational or intervention research.…”

Is Continued Improvement After Automated Virtual Reality Exposure Therapy for Spider Phobia Explained by Subsequent in-vivo Exposure? A First Test of the Lowered Threshold Hypothesis

“…While these findings need to be replicated in independent samples, our results are consistent with the observed difference in long-term outcomes across the two trials on this particular VR intervention ( 17 , 18 ), and suggest that it is indeed beneficial to explicitly promote transition to in-vivo exposure after completing VR exposure, and that this can be accomplished with brief oral and written instructions. Even in the broader field of cognitive behavioral therapy (CBT), where numerous studies have examined predictors of relapse ( 44 , 45 ), there has been very relatively little research on the associations between long-term symptom trajectories and post-treatment adherence to the therapeutic strategies taught and practiced during active treatment. This lack of comparable research also makes it difficult to interpret whether the self-rated compliance of 61% found in the current study is high or not.…”