EFFECTIVENESS OF AND DROPOUT FROM CBT FOR ADULT DEPRESSION
EFFECTIVENESS OF AND DROPOUT FROM CBT FOR ADULT ANXIETY
8
Supplemental Material to Appear on the Journal’s Website
Web Table 1
Descriptive Statistics of Included Effectiveness Studies on CBT
for Adult Anxiety Disorders (Completer Analyses)
Study
Treatment
N
Sessions
Age
%Female
%Axis I
%Axis II
%Med
%Dropout
FU
Variable
d
OCD
Aigner et al. (2004)
ERP
Grp
88
10.00
35.42
a
50.32
ab
0.00
−
60.23
12.00
−
Y-BOCS
1.27
Belloch et al. (2010)
CT
Ind
48
18.00
33.45
50.01
39.59
10.45
74.67
18.57
12
OBSI-R,Y-BOCS
2.11
Bouvard et al. (2002)
CT, ERP
Grp
19
24.00
c
37.05
60.00
−
−
90.00
5.00
6
OBQ,Y-BOCS
0.78
Challacombe & Salkovskis (2011)
Int CBT
Ind
6
48.00
c
34.33
100.00
50.00
−
50.00
−
3
OCI,Y-BOCS
2.56
Fenger et al. (2007)
ERP
Grp
24
16.00
28.50
79.17
20.83
4.17
41.67
−
−
Y-BOCS
0.74
Franklin et al. (2000)
Int ERP
Ind
100
30.00
c
34.20
47.00
−
17.00
a
61.00
9.09
−
Y-BOCS
2.92
Friedman et al. (2003)
ERP
Ind
57
40.00
c
39.40
a
67.61
a
−
−
65.68
a
8.06
−
Y-BOCS
0.95
Grabe et al. (1999)
ERP
Grp
10
45.00
38.80
90.00
100.00
−
100.00
0.00
−
Y-BOCS
1.41
Håland et al. (2010)
ERP
Grp
50
20.00
c
35.90
74.00
64.00
−
52.00
7.41
3, 12
Y-BOCS
1.74
Himle et al. (2001)
ERP
Grp
113
8.06
37.00
61.95
−
−
60.18
−
3, 49
Y-BOCS
1.03
Houghton et al. (2010)
ERP/CT
Ind
28
13.00
36.80
a
48.65
a
86.49
a
−
−
24.32
−
Y-BOCS
1.42
Mancini et al. (2006)
ERP
Ind
37
25.00
31.70
a
44.07
a
51.00
a
49.00
a
13.51
11.90
12-18
Y-BOCS
2.87
Meier et al. (2006)
ERP
Grp
45
16.67
c
34.80
77.78
−
−
35.56
7.55
−
Y-BOCS
0.89
Münchau et al. (1996)
CBT
Grp
45
10.00
41.00
66.67
−
−
33.33
18.18
−
HOCI-S,Y-BOCS
0.18
Niedermeier et al. (2007)
ERP/CBT
Ind
58
41.40
b
37.00
b
52.20
b
−bd
49.28
b
72.46
b
3.45
≥6e
Y-BOCS
1.68
Norberg et al. (2008)
Int ERP
Grp
95
22.42
29.20
54.50
−
−
−
−
−
Y-BOCS-SR
1.53
Norberg et al. (2008)
ERP
Ind
93
15.00−25.00
34.09
55.50
−
−
−
−
−
Y-BOCS-SR
1.02
Rothbaum & Shahar (2000)
ERP
Ind
23
24.00
c
32.83
56.52
−
−
47.83
17.86
1.3
Y-BOCS
3.00
Stengler-Wenzke & Angermeyer (2002)
ERP
Grp
20
12.00−16.00
−
50.00
−
−
60.00
−
−
Y-BOCS
1.81
Storch et al. (2008)
ERP/Int ERP
Ind
56
28.00
c
31.80
a
46.77
a
−
−
79.03
a
9.68
3
OCI-R,Y-BOCS
1.71
Tolin et al. (2004)
ERP
Ind
15
15.00
39.35
a
50.00
a
75.00
a
30.00
a
−
21.05
1, 3, 6
Y-BOCS
1.16
van Noppen et al. (1998)
ERP
Grp
73
10.00
−
70.00
a
−
−
79.45
18.89
25
Y-BOCS-SR
0.88
Warren & Thomas (2001)
ERP
Ind
19
21.87
c
30.10
36.84
26.32
5.26
68.42
26.92
−
Y-BOCS-SR
2.05
Panic Disorder
Deacon & Abramowitz (2006)
Int CBT
Ind
10
12.00
c
38.40
80.00
30.00
0.00
70.00
0.00
1
PAS, PDSS
1.85
Ellis & Lehman (1994)
EXP
Grp
21
12.00
37.80
76.00
−
−
−
−
29
ACQ, BSQ, FQ-AG, MI
0.83
Evans et al. (1991)
Int CBT
Grp
74
12.00
c
38.60
86.49
0.00
−
60.00
b
−
10.78
FQ-AG
0.90
Friedman et al. (2006)
EXP
Ind
40
16.20
39.70
80.00
75.00
−
72.50
−
−
ACQ, BSQ, FQ-AG, MI
0.36
García-Palacios et al. (2002)
CT
Grp
25
14.00
31.18
88.00
−
−
−
0.00
−
FQ-AG
0.84
Hahlweg et al. (2001)
Int EXP
Ind
416
36.20
35.60
67.00
−
−
65.00
25.34
12
ACQ, BSQ, MI
1.37
Hunt & Andrews (1998)
Int CBT
Grp
84
20.00
c
32.40
b
54.80
b
−
−
−
12.06
b
20b
SCL-90-R-PHOB
0.89
Keijsers et al. (1994)
EXP
Ind
60
16.79
35.50
73.33
−
−
20.00
13.04
−
ACQ, MI, NHL
0.57
Lange (2009)
CBT
Ind
35
–
34.00
b
66.00
b
30.00bd
−
24.82
−
ACQ, BSQ, MI
1.01
Martín et al. (2009)
PCT
Grp
123
12.00
36.91
82.11
−
−
89.42
14.97
−
ACQ, BSQ, FQ-AG
0.76
Martinsen et al. (1998)
EXP/CT
Grp
71
22.00
c
34.50
a
67.47
a
−
≥ 9.64
a
> 50.00
a
14.46
3, 12
ACQ, ACS, BSQ, MI, PARS
1.39
Øiesvold & Aarøe (2003)
CBT
Grp
15
14.00
34.10
66.67
−
−
50.00
0.00
6
MIA
0.32
Page (1994)
Int CBT
Grp
10
26.67
c
35.30
80.00
−
−
−
−
−
SCL-90-R-PHOB
1.19
Rosenberg & Hougaard (2005)
EXPf
Grp
53
14.00
33.10
73.58
86.80
−
58.49
8.33
18-24
SCL-90-R-PHOB
0.43
Shear et al. (1991)
EXP
Ind
23
17.00
33.00
a
69.57
0.00
0.00
0.00
11.54
−
SCL-90-R-PHOB
1.17
Starcevic et al. (2004)
EXPf
CF
24
≥24.00
31.75
72.55
b
−
−
0.00
0.00
−
ACQ, PAS, PDSS, SCL-90-R-PHOB
1.41
van der Heiden et al. (2010)
Int CBT
Ind
6
31.00−36.00
38.00
a
62.50
a
50.00
a
−
75.00
a
25.00
1.5
ACQ, BSQ, MI, SCL-90-PHOB
0.84
Wade et al. (1998)
PCT
CF
81
15.00
32.28
70.90
a
33.70
−
≥ 60.00
26.36
12
FQ-AG
0.84
Warren et al. (2008)
PCT
Ind
77
13.90
35.20
70.13
−
−
−
23.00
17
ACQ, BSQ, FQ-AG, MI
1.37
PTSD
Botero García (2005)
PE
Grp
42
32.00
c
−
0.00
0.00
0.00
0.00
40.00
−
PDS
1.65
Echeburúa et al. (1996)
CBT
Ind
62
12.00
37.00
100.00
0.00
0.00
−
0.00
1, 3, 6, 12
EGS-TEPT
2.82
Feske (2001)
PE
Ind
5
18.00
c
43.20
100.00
80.00
−
90.00
a
50.00
−
IES, PDS
3.38
Levitt et al. (2007)
STAR/MPE
Ind
38
19.00
45.00
a
68.00
a
−
−
−
18.64
−
MPSS-SR
1.74
Rauch et al. (2009)
PE
Ind
10
22.58
c
39.00
20.00
80.00
−
70.00
−
−
PDS
1.98
Resick & Schnicke (1992)
CPT
Grp
19
12.00
30.60
b
100.00
63.16
−
−
9.52
3, 6
IES, SCL-90-R-PTSD, PSS-SR
1.03
Schulz et al. (2006)
CPT
Ind
53
34.60
c
45.80
86.79
−
−
−
−
−
PSS-I
2.51
van Minnen & Foa (2006)
PE
Grp
73
10.00
35.10
a
68.48
a
16.30
a
−
−
20.65
1
PSS-SR
1.37
Social Phobia
Aderka et al. (2011)
CBT
Grp
127
18.00
29.70
a
47.40
a
71.00
a
−
37.00
a
29.83
3e
LSAS-SR
0.87
Ashbaugh et al. (2007)
CBT
Grp
107
12.00
36.31
53.27
49.53
−
−
−
−
SIAS, SPS
0.93
Camart et al. (2006)
CBT
Grp
60
12.00
34.80
56.67
40.00
−
−
−
−
LSAS-SR
1.26
Chen et al. (2007)
CBT
Grp
50
15.30
30.40
a
50.88
a
59.65ad
50.00
12.28
3, 12
(B)FNE,FQ-SP, LSAS, SCL-90-R-IS, SIAS, SPS
0.75
Gaston et al. (2006)
CBT
Grp
33
16.67
c
31.10
a
37.00
a
−
≥ 33.33
≥ 22.20
a
7.10
3
BFNE, SIAS, SPS
0.96
Heinrichs et al. (2009)
CT, EXP, SST
Ind
82
34.00
a
32.40
a
56.00
a
72.67ad
−
19.08
12
SCL-90-R-IS, SIAS, SPS
1.19
Hofmann (2000)
EXP
Grp
23
8.00
34.11
47.40
−
−
−
−
−
SPAI-SP
0.83
Leveni et al. (2002)
Int CBT
Grp/Ind
11
36.00
c
32.50
54.55
18.18
9.09
0.00
0.00
6
LSAS
0.58
Lincoln et al. (2003)
Int EXP
Ind
175
35.00
34.50
43.00
a
44.00
a
−
68.00
a
8.29
−
SCL-90-R-IS, SIAS, SPS
0.83
Marom et al. (2009)
CBT
Grp
163
30.00
c
35.25
a
51.60
a
56.16
a
−
6.39
a
25.57
12
LSAS-SR
1.41
McEvoy (2007)
CBT
Grp
125
14.00
c
32.50
a
39.00
a
74.00
a
−
48.00
a
18.30
−
SIAS, SPS
0.86
Mörtberg et al. (2005)
CBT
Grp
25
27.33
c
35.00
51.85
a
−
−
85.00
7.41
3, 6, 12
LSAS-SR
0.67
Rosser et al. (2004)
CBT
Grp
133
26.67
c
34.30
a
52.70
a
−
−
36.84
10.14
−
FNE, SIAS, SPS
0.80
Ruipérez et al. (2002)
CBT
Grp
28
12.00
28.00
60.70
−
32.14
−
−
−
FNE, SADS, SPAI-SP
1.00
van Velzen et al. (1997)
EXP
Ind
61
10.00−14.00
34.50
45.90
29.51
50.82
11.48
34.41
3
FNE, FQ-SP, SCI, LWASQ-B
0.99
Note. Dash indicates data is not available. ACS = Agoraphobic
Cognitions Scale; ACQ = Agoraphobic Cognitions Questionnaire; Axis
I/II = axis I/II comorbidity; BFNE = Brief Fear of Negative
Evaluation Scale; BSQ = Body Sensations Questionnaire; C(B)T =
cognitive (behavioral) therapy; CF = combined format (individual
and/or group); CPT = cognitive processing therapy; Dropout = number
of patients who have had at least one treatment session and
terminated treatment before post assessment, divided by the number
of patients having had at least one treatment session; EGS-TEPT =
Escala de Gravidad de Síntomas del Trastorno de Estrés
Postraumático [Scale of Severity of Posttraumatic Stress Disorder
Symptoms]; ERP = exposure and ritual prevention; EXP = exposure in
vivo; FNE = Fear of Negative Evaluation Scale; FQ-AG/SP = Fear
Questionnaire-Agoraphobia/Social Phobia; FU = follow-up; Grp =
group; HOCI-S = Hamburg Obsession/Compulsion Inventory- Short Form;
IES = Impact of Event Scale; Ind = individual; Int = intensive
(>2 standard sessions/week); LSAS(-SR) = Liebowitz Social
Anxiety Scale(-Self-Report); LWASQ-B = Lehrer-Woolfolk Anxiety
Symptom Questionnaire-Behavior; Med = psychotropic medication;
MI(A) = Mobility Inventory(-Alone); MPSS-SR = Modified PTSD Symptom
Scale-Self Report; NHL = Nijmegen Hyperventilation List; OBQ =
Obsessive Beliefs Questionnaire; OBSI-R = Obsessive Beliefs Spanish
Inventory-Revised; OCI(-R) = Obsessive–Compulsive
Inventory(-Revised); PARS = Phobic Avoidance Rating Scale; PAS =
Panic and Agoraphobia Scale; PCT = panic control treatment; PDS =
Posttraumatic Diagnostic Scale; PDSS = Panic Disorder Severity
Scale; PE = prolonged exposure; PSS-I/SR = PTSD Symptom
Scale-Interview/Self Report; SADS = Social Avoidance and Distress
Scale; SCI = Social Cognitions Inventory; SCL-90(-R)-IS/PHOB/PTSD =
Symptom Checklist-90(-Revised)-Interpersonal Sensitivity/Phobic
anxiety/Post-traumatic stress disorder; SIAS = Social Interaction
Anxiety Scale; SPAI-SP = Social Phobia and Anxiety Inventory-Social
Phobia; SPS = Social Phobia Scale; STAR/MPE = skills training in
affective and interpersonal regulation/modified prolonged exposure;
SST = social skills training; Y-BOCS(-SR) = Yale-Brown Obsessive
Compulsive Scale(-Self Report).a based on intention-to-treat
sample; b based on total sample; c sessions were converted into
standard 45- and 90-minute individual and group CBT sessions,
respectively; d not differentiated between axis I/II; e incomplete
data; f self-administered.
Web Table 2
Descriptive Statistics of Included Effectiveness Studies on CBT
for Adult Anxiety Disorders (ITT Analyses)
Study
Treatment
N
Sessions
Age
%Female
%Axis I
%Axis II
%Med
%Dropout
FU
Variable
d
OCD
Cordioli et al. (2002)
ERP
Grp
32
12.00
39.50
68.75
72.00
−
56.20
6.25
3
Y-BOCS
2.13
Franklin et al. (2000)
Int ERP
Ind
110
30.00
a
34.20
47.27
−
17.00
60.00
9.09
−
Y-BOCS
2.39
Grabe et al. (1999)
ERP
Grp
10
45.00
38.80
90.00
100.00
−
100.00
0.00
−
Y-BOCS
1.41
Håland et al. (2010)
ERP
Grp
54
20.00
a
35.90
b
74.00
b
64.00
b
−
52.00
b
7.41
3, 12
Y-BOCS
1.48
Kearns et al. (2010)
ERP
Grp
24
10.00
43.00
58.33
−
−
70.83
12.50
−
Y-BOCS-SR
1.23
Oldfield et al. (2011)
Int CBT
Ind
22
12.00−18.00
33.50
64.00
−
−
−
−
3
OCI
1.30
Rosqvist et al. (2001)
ERP
Ind
11
48.00
a
40.00
45.45
18.18
0.00
−
27.27
n.s.
Y-BOCS
0.91
Tolin et al. (2004)
ERP
Ind
19
15.00
39.35
50.00
75.00
30.00
−
21.05
1, 3, 6
Y-BOCS
0.93
Wilhelm et al. (2005)
CT
Ind
15
14.00
33.50
33.33
−
−
33.33
6.67
−
OBQ, PI, Y-BOCS-SR
0.83
Panic Disorder
Deacon & Abramowitz (2006)
Int CBT
Ind
10
12.00
a
38.40
80.00
30.00
0.00
70.00
0.00
1
PAS, PDSS
1.85
García-Palacios et al. (2002)
CT
Grp
25
14.00
31.18
88.00
−
−
−
0.00
−
FQ-AG
0.84
Joormann et al. (2005)
CBT
Ind
109
25.49
39.30
61.47
43.12
0.00
−
−
−
ACQ, MI
0.57
Øiesvold & Aarøe (2003)
CBT
Grp
15
14.00
34.10
66.67
−
−
50.00
0.00
6
MIA
0.32
Starcevic et al. (2004)
EXPc
CF
≥24
24.00
31.75
72.55
d
−
−
0.00
0.00
−
ACQ, PAS, PDSS, SCL-90-R-PHOB
1.41
van der Heiden et al. (2010)
Int CBT
Ind
8
31.00−36.00
b
38.00
62.50
50.00
−
75.00
25.00
1.5
ACQ, BSQ, MI, SCL-90-PHOB
0.46
PTSD
Echeburúa et al. (1996)
CBT
Ind
62
12.00
37.00
100.00
0.00
0.00
−
0.00
1, 3, 6, 12
EGS-TEPT
2.82
Gillespie et al. (2002)
CT
Ind
91
13.79
36.00
70.33
53.85
−
39.56
−
−
PDS
2.45
Levitt et al. (2007)
STAR/MPE
Ind
59
19.00
b
45.00
68.00
−
−
−
18.64
−
MPSS-SR
1.11
van Minnen & Foa (2006)
PE
Grp
92
10.00
35.10
68.48
16.30
−
−
20.65
1
PSS-SR
1.09
Social Phobia
Aderka et al. (2011)
CBT
Grp
192
18.00
29.70
47.40
71.00
−
37.00
29.83
3e
LSAS-SR
0.55
Chen et al. (2007)
CBT
Grp
57
14.00
30.40
50.88
59.65f
57.89
12.28
−
(B)FNE, FQ-SP, LSAS, SCL-90-R-IS, SIAS, SPS
0.63
Gaston et al. (2006)
CBT
Grp
54
16.67
a
31.10
37.00
−
≥ 33.33
≥ 22.20
7.10
3
BFNE, SIAS, SPS
0.72
Heinrichs et al. (2009)
CT, EXP, SST
Ind
131
34.00
32.40
56.00
72.67f
−
19.08
−
SCL-90-R-IS, SIAS, SPS
0.64
Joormann et al. (2005)
CBT
Ind
70
26.68
41.90
54.29
58.58
0.00
−
−
−
FNE
0.79
Leveni et al. (2002)
Int CBT
Grp/Ind
11
36.00
a
32.50
54.55
18.18
9.09
0.00
0.00
6
LSAS
0.58
Lincoln et al. (2003)
Int EXP
Ind
217
35.00
33.70
43.00
44.00
−
68.00
8.29
−
SCL-90-R-IS, SIAS, SPS
0.59
Marom et al. (2009)
CBT
Grp
219
30.00
a
35.25
51.60
56.16
−
6.39
25.57
12
LSAS-SR
0.97
McEvoy (2007)
CBT
Grp
153
14.00
a
32.50
39.00
74.00
−
48.00
18.30
−
SIAS, SPS
0.73
Note. Dash indicates data is not available. ACQ = Agoraphobic
Cognitions Questionnaire; Axis I/II = axis I/II comorbidity; BFNE =
Brief Fear of Negative Evaluation Scale; BSQ = Body Sensations
Questionnaire; C(B)T = cognitive (behavioral) therapy; CF =
combined format (individual and/or group); Dropout = number of
patients who have had at least one treatment session and terminated
treatment before post assessment, divided by the number of patients
having had at least one treatment session; EGS-TEPT = Escala de
Gravidad de Síntomas del Trastorno de Estrés Postraumático [Scale
of Severity of Posttraumatic Stress Disorder Symptoms]; ERP =
exposure and ritual prevention; EXP = exposure in vivo; F = female;
FNE = Fear of Negative Evaluation Scale; FU = follow-up; FQ-AG/SP =
Fear Questionnaire-Agoraphobia/Social Phobia; Grp = group; Ind =
individual; Int = intensive (>2 standard sessions/week);
LSAS(-SR) = Liebowitz Social Anxiety Scale(-Self-Report); Med =
psychotropic medication; MI(A) = Mobility Inventory(-Alone);
MPSS-SR = Modified PTSD Symptom Scale-Self Report; OBQ = Obsessive
Beliefs Questionnaire; OCI = Obsessive-Compulsive Inventory; PAS =
Panic and Agoraphobia Scale; PDS = Posttraumatic Diagnostic Scale;
PDSS = Panic Disorder Severity Scale; PE = prolonged exposure; PI =
Padua Inventory; PSS-SR = PTSD Symptom Scale-Self Report;
SCL-90(-R)-IS/PHOB = Symptom Checklist-90(-Revised)-Interpersonal
Sensitivity/Phobic anxiety; SIAS = Social Interaction Anxiety
Scale; SPS = Social Phobia Scale; STAR/MPE = skills training in
affective and interpersonal regulation/modified prolonged exposure;
SST = social skills training; Y-BOCS(-SR) = Yale-Brown Obsessive
Compulsive Scale(-Self Report).a sessions were converted into
standard 45- and 90-minute individual and group CBT sessions,
respectively; b based on completers; c self-administered; d based
on total sample; e incomplete data available; f not differentiated
between axis I/II.
Web Figure 1. Flow diagram of the inclusion process.
Study N
Aigner et al. (2004) 881.27[0.92;1.62]
Belloch et al. (2010) 482.11[0.80;3.42]
Bouvard et al. (2002) 190.78[0.09;1.46]
Challacombe & Salkovskis (2011) 62.56[0.72;4.40]
Fenger et al. (2007) 240.74[0.14;1.35]
Franklin et al. (2000) 1002.92[2.43;3.42]
Friedman et al. (2003) 570.95[0.55;1.36]
Grabe et al. (1999) 101.41[0.34;2.49]
Håland et al. (2010) 501.74[1.22;2.26]
Himle et al. (2001) 1131.03[0.74;1.32]
Houghton et al. (2010) 271.42[0.76;2.07]
Mancini et al. (2006) 372.87[2.07;3.67]
Meier et al. (2006) 450.89[0.44;1.34]
Münchau et al. (1996) 450.18[-0.23;0.60]
Niedermeier et al. (2007) 521.68[0.52;2.85]
Norberg et al. (2008)−Grp 901.53[1.16;1.89]
Norberg et al. (2008)−Ind 301.02[0.45;1.58]
Rothbaum & Shahar (2000) 233.00[1.96;4.05]
Stengler-Wenzke & Angermeyer (2002) 201.81[0.97;2.65]
Storch et al. (2008) 561.71[1.17;2.26]
Tolin et al. (2004) 151.16[0.33;1.98]
van Noppen et al. (1998) 730.88[0.52;1.23]
Warren & Thomas (2001) 192.05[1.14;2.96]
TOTAL 1,0471.46[1.17;1.75]
Heterogeneity:
c
2
(22) = 130.46; p < .001; I
2
= 83.14%
Test for overall effect: z = 9.93, p < .001
d (95% CI) Standardized mean gain (95% CI)
-0.500.000.501.001.502.002.503.003.50
Web Figure 2. Forest plot of 23 completer effect sizes of CBT
for adult OCD at posttreatment, using the random effects method.
Outcome is disorder-specific symptom severity.
Study N
Deacon & Abramowitz (2006) 101.85[0.65;3.04]
Ellis & Lehman (1994) 170.83[0.10;1.56]
Evans et al. (1991) 740.90[0.54;1.25]
Friedman et al. (2006) 400.36[-0.09;0.80]
García-Palacios et al. (2002) 250.84[0.23;1.44]
Hahlweg et al. (2001) 3771.37[1.20;1.54]
Hunt & Andrews (1998) 670.89[0.50;1.28]
Keijsers et al. (1994) 570.57[0.19;0.95]
Lange (2009) 351.01[0.48;1.53]
Martín et al. (2009) 1230.76[0.49;1.03]
Martinsen et al. (1998) 711.39[0.98;1.79]
Øiesvold & Aarøe (2003) 150.32[-0.41;1.04]
Page (1994) 101.19[0.17;2.21]
Rosenberg & Hougaard (2005) 530.43[0.04;0.82]
Shear et al. (1991) 151.17[0.34;2.00]
Starcevic et al. (2004) 241.41[0.72;2.10]
van der Heiden et al. (2010) 60.84[-0.39;2.07]
Wade et al. (1998) 810.84[0.51;1.18]
Warren et al. (2008) 631.37[0.95;1.79]
TOTAL 1,1630.94[0.76;1.11]
Heterogeneity:
c
2
(18) = 57.02; p < .001; I
2
= 68.43%
Test for overall effect: z = 9.77, p < .001
d (95% CI) Standardized mean gain (95% CI)
-0.500.000.501.001.502.002.503.003.50
Web Figure 3. Forest plot of 19 completer effect sizes of CBT
for adult panic disorder at posttreatment, using the random effects
method. Outcome is disorder-specific symptom severity.
Study N
Botero García (2005) 421.65[1.09;2.20]
Echeburúa et al. (1996) 622.82[2.21;3.42]
Feske (2001) 53.38[0.95;5.82]
Levitt et al. (2007) 381.74[1.14;2.33]
Rauch et al. (2009) 101.98[0.75;3.21]
Resick & Schnicke (1992) 191.03[0.31;1.75]
Schulz et al. (2006) 532.51[1.90;3.12]
van Minnen & Foa (2006) 731.37[0.98;1.77]
TOTAL 3021.91[1.43;2.38]
Heterogeneity:
c
2
(7) = 26.92; p < .001; I
2
= 74.00%
Test for overall effect: z = 7.90, p < .001
d (95% CI) Standardized mean gain (95% CI)
-0.500.000.501.001.502.002.503.003.50
Web Figure 4. Forest plot of 8 completer effect sizes of CBT for
adult PTSD at posttreatment, using the random effects method.
Outcome is disorder-specific symptom severity.
Study N
Aderka et al. (2011) 1270.87[0.60;1.14]
Ashbaugh et al. (2007) 1070.93[0.63;1.22]
Camart et al. (2006) 601.26[0.84;1.69]
Chen et al. (2007) 430.75[0.65;0.86]
Gaston et al. (2006) 330.96[0.43;1.50]
Heinrichs et al. (2009) 701.19[0.80;1.57]
Hofmann (2000) 200.83[0.16;1.50]
Leveni et al. (2002) 110.58[-0.29;1.46]
Lincoln et al. (2003) 1100.83[0.73;0.93]
Marom et al. (2009) 1631.41[1.04;1.77]
McEvoy (2007) 1230.86[0.59;1.14]
Mörtberg et al. (2005) 250.67[0.08;1.25]
Rosser et al. (2004) 1330.80[0.54;1.06]
Ruipérez et al. (2002) 281.00[0.01;1.99]
van Velzen et al. (1997) 610.99[0.59;1.38]
TOTAL 1,1130.90[0.80;0.99]
Heterogeneity:
c
2
(14) = 20.73; p =.11; I
2
= 32.45%
Test for overall effect: z = 18.94, p < .001
d (95% CI) Standardized mean gain (95% CI)
-0.500.000.501.001.502.002.503.003.50
Web Figure 5. Forest plot of 15 completer effect sizes of CBT
for social phobia at posttreatment, using the random effects
method. Outcome is disorder-specific symptom severity.
Study N
Cordioli et al. (2002) 322.13[1.41;2.85]
Franklin et al. (2000) 1102.39[1.98;2.81]
Grabe et al. (1999) 101.41[0.34;2.49]
Håland et al. (2010) 541.48[1.01;1.94]
Kearns et al. (2010) 241.23[0.57;1.90]
Oldfield et al. (2011) 221.30[0.60;2.01]
Rosqvist et al. (2001) 110.91[-0.01;1.83]
Tolin et al. (2004) 190.93[0.23;1.63]
Wilhelm et al. (2005) 150.83[0.05;1.60]
TOTAL 2971.45[1.03;1.86]
Heterogeneity:
c
2
(8) = 28.09; p < .001; I
2
= 71.52%
Test for overall effect: z = 6.80, p < .001
d (95% CI) Standardized mean gain (95% CI)
-0.500.000.501.001.502.002.503.003.50
Web Figure 6. Forest plot of 9 ITT effect sizes of CBT for adult
OCD at posttreatment, using the random effects method. Outcome is
disorder-specific symptom severity.
Study N
Deacon & Abramowitz (2006) 101.85[0.65;3.04]
García-Palacios et al. (2002) 250.84[0.23;1.44]
Joormann et al. (2005) 1090.57[0.29;0.85]
Øiesvold & Aarøe (2003) 150.32[-0.41;1.04]
Starcevic et al. (2004) 241.41[0.72;2.10]
van der Heiden et al. (2010) 80.46[-0.54;1.47]
TOTAL 1910.79[0.51;1.07]
Heterogeneity:
c
2
(5) = 9.88; p = .08; I
2
= 49.39%
Test for overall effect: z = 5.52, p < .001
d (95% CI) Standardized mean gain (95% CI)
-0.500.000.501.001.502.002.503.003.50
Web Figure 7. Forest plot of 6 ITT effect sizes of CBT for adult
panic disorder at posttreatment, using the random effects method.
Outcome is disorder-specific symptom severity.
Study N
Aderka et al. (2011) 1920.55[0.34;0.75]
Chen et al. (2007) 500.63[0.52;0.75]
Gaston et al. (2006) 540.72[0.32;1.12]
Heinrichs et al. (2009) 1170.64[0.37;0.91]
Joormann et al. (2005) 700.79[0.43;1.14]
Leveni et al. (2002) 110.58[-0.29;1.46]
Lincoln et al. (2003) 1490.59[0.52;0.66]
Marom et al. (2009) 2190.97[0.76;1.18]
McEvoy (2007) 1530.73[0.49;0.96]
TOTAL 1,0140.67[0.58;0.76]
Heterogeneity:
c
2
(8) = 13.52; p = .10; I
2
= 40.85%
Test for overall effect: z = 15.08, p < .001
d (95% CI) Standardized mean gain (95% CI)
-0.500.000.501.001.502.002.503.003.50
Web Figure 8. Forest plot of 9 ITT effect sizes of CBT for adult
social phobia at posttreatment, using the random effects method.
Outcome is disorder-specific symptom severity.
Web Appendix A
PsycINFO: Exact Search Strings
#
Search string
1
((clinic$ adj2 setting) OR CMHC OR community mental health
center? OR dissemination OR effectiveness OR generalizability OR
generalization OR (mental health adj3 field) OR naturalistic OR
nonrandomized OR non-randomized OR outpatient clinic OR private
practice OR (routine adj2 practice) OR (service adj2 setting) OR
transportability OR uncontrolled).ti, ab.
AND
2
(Cognitive Behavior Therapy OR "Acceptance and Commitment
Therapy" OR Cognitive Therapy OR Rational Emotive Behavior Therapy
OR Behavior Therapy OR Exposure Therapy OR Implosive Therapy OR
Reciprocal Inhibition Therapy OR Systematic Desensitization
Therapy).sh.
AND
(
3
(Generalized Anxiety Disorder OR Panic Disorder OR Agoraphobia
OR Phobias OR Acrophobia OR Agoraphobia OR Claustrophobia OR
Ophidiophobia OR Social Phobia OR Obsessive Compulsive Disorder OR
Posttraumatic Stress Disorder OR Acute Stress Disorder).sh.
4
1 AND 2 AND 3
Note. All searches were conducted to January Week 3, 2012.
PSYNDEXplus: Exact Search Strings
#
Search string
1
((clinic$ adj2 setting) OR CMHC OR community mental health
center? OR dissemination OR effectiveness OR generalizability OR
generalization OR (mental health adj3 field) OR naturalistic OR
nonrandomized OR non-randomized OR outpatient clinic OR private
practice OR (routine adj2 practice) OR (service adj2 setting) OR
transportability OR uncontrolled OR naturalistisch$2 OR Ambulanz OR
ambulant$2 OR Routine*).ti, ab.
AND
2
(Cognitive Behavior Therapy OR "Acceptance and Commitment
Therapy" OR Cognitive Therapy OR Rational Emotive Behavior Therapy
OR Behavior Therapy OR Exposure Therapy OR Implosive Therapy OR
Reciprocal Inhibition Therapy OR Systematic Desensitization
Therapy).sh.
AND
(
3
(Generalized Anxiety Disorder OR Panic Disorder OR Agoraphobia
OR Phobias OR Acrophobia OR Agoraphobia OR Claustrophobia OR
Ophidiophobia OR Social Phobia OR Obsessive Compulsive Disorder OR
Posttraumatic Stress Disorder OR Acute Stress Disorder).sh.
4
1 AND 2 AND 3
Note. All searches were conducted to December 2011.
Ovid MEDLINE search: Exact Search Strings
#
Search string
1
((clinic$ adj2 setting) OR CMHC OR community mental health
center? OR dissemination OR effectiveness OR generalizability OR
generalization OR (mental health adj3 field) OR naturalistic OR
nonrandomized OR non-randomized OR outpatient clinic OR private
practice OR (routine adj2 practice) OR (service adj2 setting) OR
transportability OR uncontrolled).ti, ab.
AND
2
(Behavior Therapy OR Implosive Therapy OR Cognitive Therapy OR
Psychotherapy, Rational-Emotive).sh.
AND
(
3
(Anxiety Disorders OR Agoraphobia OR Obsessive-Compulsive
Disorder OR Panic Disorder OR Phobic Disorders OR Stress Disorders,
Traumatic).sh.
4
1 AND 2 AND 3
Note. All searches were conducted to January Week 2, 2012. For
searching MEDLINE, alterations were necessary to the subject
heading searching used in PsycINFO and PSYNDEXplus, as subject
headings are different from medical subject headings [MeSH] used in
MEDLINE.
Web Appendix B
Coding of Clinical Representativeness
Referrals
1
Patients were referred through usual clinical routes (referred
by general practitioner, self-referral).
0
At least some of the patients under study were actively
recruited (from the community or from patient samples).
Therapists
1
Practicing licensed therapists and therapists in training.
0
Research therapists who provide therapy for research
purposes.
Structure
1
No treatment manual or flexible use of treatment manual and
structure (e.g., therapy open-ended). Code 1 if use of treatment
manual is not mentioned.
0
Strict adherence to treatment manual.
Monitoring
1
If any, the only adherence monitoring is routine supervision of
the therapists and/or outlines containing to be covered in session
(no formal adherence checks).
0
Extensive (more than monthly) supervision of the therapists
and/or adherence checks.
Therapist pretherapy training
1
Therapists received no specific training for the purposes of the
study. Code 1 if pretherapy training is not mentioned.
0
Therapists received pretherapy training for the purposes of the
study.
Patients
1
If patients meet criteria for disorder under study, there are no
exclusion criteria besides acute suicidality, acute psychosis,
organic brain disease, substance dependence, or disorders
potentially interfering with treatment engagement.
0
Exclusion criteria beyond those above, including comorbidity and
medication.
Allowance of medication
1
Medication is allowed. Code 1 if no specific mention in
exclusion criteria.
0
Patients are forced to stop medication or are excluded from the
study due to medication. Code 1 if medication is discontinued for
therapeutic reasons (e.g., benzodiazepines in the case of exposure
therapy).
Web Appendix C
Coding of Methodological Quality
Low dropout rate
1
Dropout rate was low (< 30%).
0
Dropout rate was ≥ 30%.
Use of ITT analysis
1
An intention-to-treat analysis was performed (or a
completers-only analysis with no dropouts), regardless of whether
or not results are fully reported. Code 1 if sufficient information
was provided to re-analyze data according to
intention-to-treat.
0
Study reports no intention-to-treat analysis.
Formal diagnostic investigation
1
Formal diagnostic procedures (diagnostic interview, checklist)
according to the Diagnostic and Statistical Manual of Mental
Disorders (DSM) or Research Diagnostic Criteria (RDC). Code 0 if
structured interview/checklist is not specified.
0
Diagnosis based on clinical judgment or a cut-off score of a
self-report depression-specific outcome measure.
Minimum within study sample size of 30
1
Thirty or more patients provided data at posttreatment.
0
Fewer than 30 patients provided data at posttreatment.
Minimum follow-up length of 6 months
1
Time period from posttreatment to follow-up is six months or
more.
0
No follow-up or time period from posttreatment to follow-up is
shorter than 6 months.
Records identified through database searching
PsycINFO (n = 876)
MEDLINE (n = 576)
PSYNDEXplus (n = 126)
Additional records identified through other sources�(n = 26)
Records after duplicates removed�(n = 1,358)
M
Records screened�(n = 1,358)
Records excluded�(n = 1,226)
Full-text articles assessed for eligibility�(n = 132)
Full-text articles excluded�No CBT (n = 1)
No face-to-face therapy (n = 1)
Add-on therapy (n = 1)
< 6 sessions (n = 2)
No primary anxiety disorder (n = 5)
No outpatients (n = 5)
RCTs (n = 2)
No disorder-specific outcome (n = 23)
Data not available (n = 5)
Duplicate studies (n = 10)
Attempts to locate study failed (n = 2)
Pilot studies (n = 3)
Outlier studies (n = 1)
Studies included in quantitative synthesis (meta-analysis)�(n =
71)