What type of study is this?

This is a RCT study (also classified as: Meta-Analysis, Systematic Review).

September 10, 2025Open Access

Cognitive Behavioral Therapy Versus Antidepressant Medication in Generalized Anxiety Disorder: A Prospective Schematic Meta-Analysis Approach

Key Points

CBT demonstrates a slight improvement in anxiety symptoms compared to antidepressants post-treatment.
The mean anxiety scores were 20.46 for CBT versus 22.75 for pharmacotherapy in the main analysis.
Eight randomized controlled trials with 259 participants were included in this prospective meta-analysis.
The study highlights the need for standardized outcome measures and investigation of predictors for treatment response.

Abstract

Background: Generalized Anxiety Disorder (GAD) is a common mental disorder, which is usually treated by cognitive behavioral therapy (CBT) or antidepressant medications (ADMs). Nevertheless, a significant number of patients do not respond well to monotherapy, resulting in complete remission. The present review focuses on the main comparison of CBT and ADM outcomes in GAD. Cases of combination therapy (CBT + ADM) were reviewed secondarily in those studies that reported it. Methods: The articles were identified through systematic searches of PubMed and Google Scholar that were carried out to determine randomized controlled trials published between 2011 and 2025. The inclusion criteria included studies that used adults with standardized measurement of GAD diagnosis and post-therapeutic outcomes of anxiety measures CBT, and/or ADM. Combination data were identified where available. The mean anxiety scores were pooled in a random-effects meta-analysis and risk of bias was evaluated according to the Cochrane method. Results: The number of included studies was eight randomized controlled trials with 259 participants. In the main analysis, CBT resulted in slightly improved post-treatment anxiety results (mean = 20.46, 95% CI: 5.9534.96) than pharmacotherapy alone (mean = 22.75, 95% CI: 4.6940.80). The lowest pooled score (mean = 17.72, 95% CI: 10.83 24.62) was observed in those studies that reported combination therapy. Nonetheless, because of great heterogeneity among the studies (I2 > 95%), the findings were viewed with caution. The overall direction of effect was supported by subgroup and sensitivity analyses. Discussion: CBT can be slightly more effective than antidepressant drugs in alleviating anxiety symptoms in GAD. Combination therapy also demonstrated good outcomes in a few studies, but this was not the key aspect of this analysis. Future studies are needed on standardizing outcome measures and examining individual predictors of treatment responsiveness in order to conduct personalized care.

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