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)