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Efficacy of exposure versus cognitive therapy in anxiety disorders systematic review and meta-analysis.doc

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Efficacy of exposure versus cognitive therapy in anxiety disorders systematic review and meta-analysis

Efficacyofexposureversuscognitivetherapyin anxietydisorders:systematicreviewandmeta- analysis Ougrin OugrinBMCPsychiatry2011,11:200 /1471-244X/11/200(20December2011) OugrinBMCPsychiatry2011,11:200 /1471-244X/11/200 RESEARCH ARTICLE OpenAccess Efficacyofexposureversuscognitivetherapyin anxietydisorders:systematicreviewand meta-analysis DennisOugrin Abstract Background:ThereisgrowingevidenceoftheeffectivenessofCognitiveBehaviouralTherapy(CBT)forawide rangeofpsychologicaldisorders.Thereisacontinuedcontroversyaboutwhetherchallengingmaladaptive thoughtsratherthanuseofbehaviouralinterventionsaloneisassociatedwiththegreatestefficacy.Howeverlittle isknownabouttherelativeefficacyofvariouscomponentsofCBT.Thisreviewaimstocomparetherelative efficacyofCognitiveTherapy(CT)versusExposure(E)forarangeofanxietydisordersusingthemostclinically relevantoutcomemeasuresandestimatingthesummaryrelativeefficacybycombiningthestudiesinameta- analysis. Methods:PsychINFO,MEDLINEandEMBASEweresearchedfromthefirstavailableyeartoMay2010.All randomisedcontrolledstudiescomparingtheefficacyofexposurewithcognitivetherapywereincluded.Odds ratios(OR)orstandardisedmeans’differences(Hedges’g)forthemostclinicallyrelevantprimaryoutcomeswere calculated.Outcomesofthestudiesweregroupedaccordingtospecificdisordersandwerecombinedinmeta- analysesexploringshort-termandlong-termoutcomes. Results:20RandomisedControlledTrialswith(n=1,308)directlycomparingtheefficacyofCTandEinanxiety disorderswereincludedinthemeta-analysis.NostatisticallysignificantdifferenceintherelativeefficacyofCTand EwasrevealedinPostTraumaticStressDisorder(PTSD),inObsessiveCompulsiveDisorder(OCD)andinPanic Disorder(PD).TherewasastatisticallysignificantdifferencefavouringCTversusEinSocialPhobiabothinthe short-term(Z=3.72,p=0.0002)andthelong-term(Z=3.28,p=0.001)outcomes. Conclusions:Onthebasisofextantliterature,thereappearstobenoevidenceofdifferentialefficacybetween cognitivetherapyandexposureinPD,PTSDandOCDandstrongevidenceofsuperiorefficacyof