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Feasibility of large group cognitive behavioural therapy education classes for anxiety disorders

Joshua Palay, Jacquelyne Y Wong, Jason R Randall, Tanya Sala, James M Bolton, Patricia Furer, Shay-Lee Bolton, Debbie L Whitney, Vishal Thakur, Sagar V Parikh, Jitender Sareen


Rationale, aims and objectives: Cognitive behavioural therapy (CBT) is effective in treating anxiety disorders. In publically funded systems, CBT is not easily accessible due to long wait times. In order to provide quicker access, a large group CBT intervention was implemented in a tertiary care clinic. This study describes the design, feasibility and acceptability of such an intervention as part of stepped care for anxiety disorders.

Method: The intervention followed a 2-session curriculum, consisting of 90 minutes classes providing didactic instruction on key CBT topics and self-management strategies. Classes accommodated 30 patients and were led by staff psychiatrists formally trained in CBT. A retrospective analysis of patients referred to the clinic during the first year of class implementation was performed to determine class completion rate, patient satisfaction (using a usefulness Likert Scale and Session Rating Scale [SRS]) and symptom trajectory (using the GAD-7).

Results: The implementation of large group CBT classes reduced waiting times from approximately one year to approximately 3 months. One hundred and thirty-one patients were screened by the clinic, 88 of whom (67%) completed the intervention. Sixty-eight percent of patients rated the classes as useful; however, SRS findings indicated that only 46% of patients were satisfied. GAD-7 scores decreased by 1.57 (95% CI 0.2 to 2.95; SMD=0.24).

Conclusions: This analysis contributes preliminary evidence that large group CBT education classes may be an acceptable means to reduce waiting times for CBT for anxiety disorders. Further controlled research is required to elucidate the benefit and cost effectiveness of such classes.


Anxiety disorders, cognitive behavioural therapy, cost effectiveness, evaluation, health services research, patient expectations, patient satisfaction, person-centered healthcare, self-management, waiting times

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Olatunji, B.O., Cisler, J.M. & Deacon, B.J. (2010). Efficacy of cognitive behavioral therapy for anxiety disorders: A review of meta-analytic findings. Psychiatric Clinics of North America 33 (3) 557-577.

Hans, E. & Hiller, W. (2013). A meta-analysis of nonrandomized effectiveness studies on outpatient cognitive behavioral therapy for adult anxiety disorders. Clinical Psychology Review 33 (8) 954-964.

Hofmann, S.G., Asnaani, A., Vonk, I.J.J., Sawyer, A.T. & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research 36 (5) 427-440.

McHugh, R.K., Whitton, S.W., Peckham, A.D., Welge, J. A. & Otto, M.W. (2013). Patient preference for psychological vs pharmacologic treatment of psychiatric disorders: A meta-analytic review. Journal of Clinical Psychiatry 74 (6) 595-602.

Mitte, K. (2005). Meta-analysis of cognitive-behavioral treatments for generalized anxiety disorder: a comparison with pharmacotherapy. Psychological Bulletin 131 (5) 785-795.

Van Ingen, D.J., Freiheit, S.R. & Vye, C.S. (2009). From the lab to the clinic: Effectiveness of cognitive-behavioral treatments for anxiety disorders. Professional Psychology, Research and Practice 40 (1) 69-74.

Hoyt, M.F. & Talmon, M. (Eds.). (2014). Capturing the Moment: Single Session Therapy and Walk-in Services. Carmarthen, UK: Crown House Publishing.

Follette, W. & Cummings, N.A. (1967). Psychiatric Services and Medical Utilization in a Prepaid Health Plan Setting. Medical Care 5 (1) 25-35.

Haug, T., Nordgreen, T., Öst, L.G. & Havik, O.E. (2012). Self-help treatment of anxiety disorders: A meta-analysis and meta-regression of effects and potential moderators. Clinical Psychology Review 32 (5) 425-445.

Arnberg, F.K., Linton, S.J., Hultcrantz, M., Heintz, E. & Jonsson, U. (2014). Internet-delivered psychological treatments for mood and anxiety disorders: A systematic review of their efficacy, safety, and cost-effectiveness. PLoS One 9 (5).

Mayo-Wilson, E. & Montgomery, P. (2013). Media-delivered cognitive behavioural therapy and behavioural therapy (self-help) for anxiety disorders in adults. Cochrane Database of Systematic Reviews 9:CD005330.

Olthuis, J.V., Watt, M.C., Bailey, K., Hayden, J.A. & Stewart, S.H. (2016). Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults. Cochrane Database of Systematic Reviews (3):CD011565.

Parikh, S. V. (2015). Improving Access to Psychosocial Treatments-Integrating Patient, Provider, and Systems Approaches. Canadian Journal of Psychiatry 60 (6) 242-244.

Graff, L.A., Kaoukis, G., Vincent, N., Piotrowski, A. & Ediger, J. (2012). New models of care for psychology in Canada’s health services. Canadian Psychology 53 (3) 165-177.

Houghton, S. & Saxon, D. (2007). An evaluation of large group CBT psycho-education for anxiety disorders delivered in routine practice. Patient Education and Counseling 68 (1) 107-110.

Duncan, B.L., Miller, S.D., Sparks, J.A., Claud, D.A., Reynolds, L.R.D., Brown, J. & Johnson, L.D. (2003). The Session Rating Scale : Preliminary Psychometric Properties of a “Working ” Alliance Measure. Journal of Brief Therapy 3 (1) 3-12.

Spitzer, R.L., Kroenke, K., Williams, J.B.W. & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine 166 (10) 1092-1097.

Ruiz, M.A., Zamorano, E., García-Campayo, J., Pardo, A., Freire, O. & Rejas, J. (2011). Validity of the GAD-7 scale as an outcome measure of disability in patients with generalized anxiety disorders in primary care. Journal of Affective Disorders 128 (3) 277-286.

Löwe, B., Decker, O., Müller, S., Brähler, E., Schellberg, D., Herzog, W. & Herzberg, P.Y. (2008). Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Medical Care 46 (3) 266-274.

Wyrwich, K.W., Tierney, W.M. & Wolinsky, F.D. (1999). Further evidence supporting an SEM-based criterion for identifying meaningful intra-individual changes in health-related quality of life. Journal of Clinical Epidemiology 52 (9) 861-873.

Beard, C. & Björgvinsson, T. (2014). Beyond generalized anxiety disorder: Psychometric properties of the GAD-7 in a heterogeneous psychiatric sample. Journal of Anxiety Disorders 28 (6) 547-552.



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