The state of personalized treatment for anxiety disorders: A systematic review of treatment moderators

Clin Psychol Rev. 2015 Jun;38:39-54. doi: 10.1016/j.cpr.2015.02.004. Epub 2015 Mar 11.

Abstract

Introduction: The aim of this review was to synthesize findings for moderators of treatment outcome across adult anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder.

Methods: Twenty-four papers that compared two or more active treatments (at least one of which was a form of cognitive behavioral therapy [CBT]) were identified and organized into five treatment comparison categories (distinct psychotherapy combinations, CBT full package vs. single components, CBT vs. augmented CBT, CBT delivery methods, and CBT vs. pharmacotherapy). Sixty-three distinct baseline moderators were tested across seven categories (symptom severity, comorbid emotional disorders or emotional reactivity, cognitive maintenance factors, behavioral maintenance factors, personality traits and disorders, sociodemographic factors, and biological factors).

Results: Few consistent treatment moderators were identified. All studies testing quadratic effects found at least one significant non-linear moderator or predictor effect. In addition, the majority of studies had methodological problems and limitations, demonstrating the need for future methodological improvements.

Conclusion: Limited conclusions can be drawn about how to match anxiety disorder patients to treatment. A strong need to improve the methodological consistency and rigor of treatment moderator studies was identified. A series of recommendations for moderation analyses are proposed in order to strengthen future studies and facilitate replication efforts.

Keywords: Anxiety disorders; Cognitive-behavioral therapy; Moderators; Personalized medicine; Treatment moderation; Treatment outcome.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Anxiety Disorders / psychology
  • Anxiety Disorders / therapy*
  • Cognitive Behavioral Therapy / methods*
  • Humans
  • Precision Medicine
  • Stress Disorders, Post-Traumatic / psychology
  • Stress Disorders, Post-Traumatic / therapy*
  • Treatment Outcome