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Anxiety DisordersA Review

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Abstract

Importance  Anxiety disorders have a lifetime prevalence of approximately 34% in the US, are often chronic, and significantly impair quality of life and functioning.

Observations  Anxiety disorders are characterized by symptoms that include worry, social and performance fears, unexpected and/or triggered panic attacks, anticipatory anxiety, and avoidance behaviors. Generalized anxiety disorder (6.2% lifetime prevalence), social anxiety disorder (13% lifetime prevalence), and panic disorder (5.2% lifetime prevalence) with or without agoraphobia are common anxiety disorders seen in primary care. Anxiety disorders are associated with physical symptoms, such as palpitations, shortness of breath, and dizziness. Brief screening measures applied in primary care, such as the Generalized Anxiety Disorder–7, can aid in diagnosis of anxiety disorders (sensitivity, 57.6% to 93.9%; specificity, 61% to 97%). Providing information about symptoms, diagnosis, and evidence-based treatments is a first step in helping patients with anxiety. First-line treatments include pharmacotherapy and psychotherapy. Selective serotonin reuptake inhibitors (SSRIs, eg, sertraline) and serotonin-norepinephrine reuptake inhibitors (SNRIs, eg, venlafaxine extended release) remain first-line pharmacotherapy for generalized anxiety disorder, social anxiety disorder, and panic disorder. Meta-analyses suggest that SSRIs and SNRIs are associated with small to medium effect sizes compared with placebo (eg, generalized anxiety disorder: standardized mean difference [SMD], −0.55 [95% CI, −0.64 to −0.46]; social anxiety disorder: SMD, −0.67 [95% CI, −0.76 to −0.58]; panic disorder: SMD, −0.30 [95% CI, −0.37 to −0.23]). Cognitive behavioral therapy is the psychotherapy with the most evidence of efficacy for anxiety disorders compared with psychological or pill placebo (eg, generalized anxiety disorder: Hedges g = 1.01 [large effect size] [95% CI, 0.44 to 1.57]; social anxiety disorder: Hedges g = 0.41 [small to medium effect] [95% CI, 0.25 to 0.57]; panic disorder: Hedges g = 0.39 [small to medium effect[ [95% CI, 0.12 to 0.65]), including in primary care. When selecting treatment, clinicians should consider patient preference, current and prior treatments, medical and psychiatric comorbid illnesses, age, sex, and reproductive planning, as well as cost and access to care.

Conclusions and Relevance  Anxiety disorders affect approximately 34% of adults during their lifetime in the US and are associated with significant distress and impairment. First-line treatments for anxiety disorders include cognitive behavioral therapy, SSRIs such as sertraline, and SNRIs such as venlafaxine extended release.

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Article Information

Corresponding Author: Naomi M. Simon, MD, MSc, Department of Psychiatry, New York University Grossman School of Medicine, 1 Park Ave, 8th Floor, New York, NY 10016 (naomi.simon@nyulangone.org).

Accepted for Publication: November 18, 2022.

Conflict of Interest Disclosures: Dr Szuhany reported receiving grants from the National Institutes of Health (K23MH122773), Brain & Behavior Research Foundation (Young Investigator Award), National Center for Advancing Translational Sciences (5KL2 TR001446-05), Department of Defense, and Patient-Centered Outcomes Research Institute outside the submitted work. Dr Simon reported receiving grants from the American Foundation for Suicide Prevention, Department of Defense, Patient-Centered Outcomes Research Institute, National Institutes of Health, and Cohen Veterans Network; personal fees from Bionomic Ltd, BehavR LLC, Vanda Pharmaceuticals, Praxis Therapeutics, Cerevel, Genomind, Engrail Therapeutics, and Wiley; royalty from Wolters Kluwer and APA Publishing; and spousal equity from G1 Therapeutics and Zentalis outside the submitted work.

Funding/Support: Dr Szuhany’s work was supported by the National Institute of Mental Health (K23MH122773) and by a National Alliance for Research on Schizophrenia & Depression Young Investigator Grant from the Brain & Behavior Research Foundation.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
Olfson  M , Blanco  C , Wall  MM , Liu  SM , Grant  BF .  Treatment of common mental disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III.   J Clin Psychiatry. 2019;80(3):18m12532. doi:10.4088/JCP.18m12532PubMedGoogle ScholarCrossref
2.
Kessler  RC , Petukhova  M , Sampson  NA , Zaslavsky  AM , Wittchen  HU .  Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States.   Int J Methods Psychiatr Res. 2012;21(3):169-184. doi:10.1002/mpr.1359PubMedGoogle ScholarCrossref
3.
Bandelow  B , Michaelis  S .  Epidemiology of anxiety disorders in the 21st century.   Dialogues Clin Neurosci. 2015;17(3):327-335. doi:10.31887/DCNS.2015.17.3/bbandelowPubMedGoogle ScholarCrossref
4.
Santabárbara  J , Lasheras  I , Lipnicki  DM ,  et al.  Prevalence of anxiety in the COVID-19 pandemic: an updated meta-analysis of community-based studies.   Prog Neuropsychopharmacol Biol Psychiatry. 2021;109:110207. doi:10.1016/j.pnpbp.2020.110207PubMedGoogle ScholarCrossref
5.
GBD 2016 Disease and Injury Incidence and Prevalence Collaborators.  Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.   Lancet. 2017;390(10100):1211-1259. doi:10.1016/S0140-6736(17)32154-2PubMedGoogle ScholarCrossref
6.
Harder  HG , Wagner  S , Rash  J .  Mental Illness in the Workplace: Psychological Disability Management. Routledge; 2016. doi:10.4324/9781315595009
7.
Kariuki-Nyuthe  C , Stein  DJ . Anxiety and related disorders and physical illness. In: Sartorius  N , Holt  RIG , Maj  M , eds.  Comorbidity of Mental and Physical Illness: A Selective Review. Karger; 2015:81-87.
8.
Vermani  M , Marcus  M , Katzman  MA .  Rates of detection of mood and anxiety disorders in primary care: a descriptive, cross-sectional study.   Prim Care Companion CNS Disord. 2011;13(2):PCC.10m01013. doi:10.4088/PCC.10m01013PubMedGoogle ScholarCrossref
9.
Kroenke  K , Spitzer  RL , Williams  JB , Monahan  PO , Löwe  B .  Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection.   Ann Intern Med. 2007;146(5):317-325. doi:10.7326/0003-4819-146-5-200703060-00004PubMedGoogle ScholarCrossref
10.
Olariu  E , Forero  CG , Castro-Rodriguez  JI ,  et al.  Detection of anxiety disorders in primary care: a meta-analysis of assisted and unassisted diagnoses.   Depress Anxiety. 2015;32(7):471-484. doi:10.1002/da.22360PubMedGoogle ScholarCrossref
11.
Cumming  G , Fidler  F , Kalinowski  P , Lai  J .  The statistical recommendations of the American Psychological Association publication manual: effect sizes, confidence intervals, and meta-analysis.   Aust J Psychol. 2012;64(3):138-146. doi:10.1111/j.1742-9536.2011.00037.xGoogle ScholarCrossref
12.
Bandelow  B , Michaelis  S , Wedekind  D .  Treatment of anxiety disorders.   Dialogues Clin Neurosci. 2017;19(2):93-107. doi:10.31887/DCNS.2017.19.2/bbandelowPubMedGoogle ScholarCrossref
13.
World Health Organization. ICD-11: International Classification of Diseases 11th Revision. Accessed October 20, 2022. https://icd.who.int/
14.
American Psychiatric Association.  Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013.
15.
Jameson  JP , Blank  MB .  Diagnosis and treatment of depression and anxiety in rural and nonrural primary care: national survey results.   Psychiatr Serv. 2010;61(6):624-627. doi:10.1176/ps.2010.61.6.624PubMedGoogle ScholarCrossref
16.
Katzman  MA , Bleau  P , Blier  P ,  et al; Canadian Anxiety Guidelines Initiative Group on behalf of the Anxiety Disorders Association of Canada/Association Canadienne des Troubles Anxieux and McGill University.  Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders.   BMC Psychiatry. 2014;14(Suppl 1)(suppl 1):S1. doi:10.1186/1471-244X-14-S1-S1PubMedGoogle ScholarCrossref
17.
Andrews  G , Bell  C , Boyce  P ,  et al.  Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder.   Aust N Z J Psychiatry. 2018;52(12):1109-1172. doi:10.1177/0004867418799453Google ScholarCrossref
18.
Baldwin  DS , Anderson  IM , Nutt  DJ ,  et al.  Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology.   J Psychopharmacol. 2014;28(5):403-439. doi:10.1177/0269881114525674PubMedGoogle ScholarCrossref
19.
Bandelow  B , Sher  L , Bunevicius  R ,  et al; WFSBP Task Force on Mental Disorders in Primary Care; WFSBP Task Force on Anxiety Disorders, OCD and PTSD.  Guidelines for the pharmacological treatment of anxiety disorders, obsessive-compulsive disorder and posttraumatic stress disorder in primary care.   Int J Psychiatry Clin Pract. 2012;16(2):77-84. doi:10.3109/13651501.2012.667114PubMedGoogle ScholarCrossref
20.
Stein  MB , Goin  MK , Pollack  MH ,  et al; Work Group on Panic Disorder.  Practice Guideline for the Treatment of Patients With Panic Disorder. American Psychiatric Association; 2010.
21.
Christensen  H , Batterham  PJ , Grant  JB , Griffiths  KM , Mackinnon  AJ .  A population study comparing screening performance of prototypes for depression and anxiety with standard scales.   BMC Med Res Methodol. 2011;11:154. doi:10.1186/1471-2288-11-154PubMedGoogle ScholarCrossref
22.
Mulvaney-Day  N , Marshall  T , Downey Piscopo  K ,  et al.  Screening for behavioral health conditions in primary care settings: a systematic review of the literature.   J Gen Intern Med. 2018;33(3):335-346. doi:10.1007/s11606-017-4181-0PubMedGoogle ScholarCrossref
23.
Plummer  F , Manea  L , Trepel  D , McMillan  D .  Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic meta-analysis.   Gen Hosp Psychiatry. 2016;39:24-31. doi:10.1016/j.genhosppsych.2015.11.005PubMedGoogle ScholarCrossref
24.
Spitzer  RL , Kroenke  K , Williams  JB , Löwe  B .  A brief measure for assessing generalized anxiety disorder: the GAD-7.   Arch Intern Med. 2006;166(10):1092-1097. doi:10.1001/archinte.166.10.1092PubMedGoogle ScholarCrossref
25.
Rytwinski  NK , Fresco  DM , Heimberg  RG ,  et al.  Screening for social anxiety disorder with the self-report version of the Liebowitz Social Anxiety Scale.   Depress Anxiety. 2009;26(1):34-38. doi:10.1002/da.20503PubMedGoogle ScholarCrossref
26.
von Glischinski  M , Willutzki  U , Stangier  U ,  et al.  Liebowitz Social Anxiety Scale (LSAS): optimal cut points for remission and response in a German sample.   Clin Psychol Psychother. 2018;25(3):465-473. doi:10.1002/cpp.2179PubMedGoogle ScholarCrossref
27.
Connor  KM , Davidson  JR , Churchill  LE , Sherwood  A , Foa  E , Weisler  RH .  Psychometric properties of the Social Phobia Inventory (SPIN): new self-rating scale.   Br J Psychiatry. 2000;176:379-386. doi:10.1192/bjp.176.4.379PubMedGoogle ScholarCrossref
28.
Connor  KM , Kobak  KA , Churchill  LE , Katzelnick  D , Davidson  JR .  Mini-SPIN: a brief screening assessment for generalized social anxiety disorder.   Depress Anxiety. 2001;14(2):137-140. doi:10.1002/da.1055PubMedGoogle ScholarCrossref
29.
Forsell  E , Kraepelien  M , Blom  K ,  et al.  Development of a very brief scale for detecting and measuring panic disorder using two items from the Panic Disorder Severity Scale-Self Report.   J Affect Disord. 2019;257:615-622. doi:10.1016/j.jad.2019.07.057PubMedGoogle ScholarCrossref
30.
Shear  MK , Rucci  P , Williams  J ,  et al.  Reliability and validity of the Panic Disorder Severity Scale: replication and extension.   J Psychiatr Res. 2001;35(5):293-296. doi:10.1016/S0022-3956(01)00028-0PubMedGoogle ScholarCrossref
31.
Kroenke  K , Spitzer  RL , Williams  JB .  The PHQ-9: validity of a brief depression severity measure.   J Gen Intern Med. 2001;16(9):606-613. doi:10.1046/j.1525-1497.2001.016009606.xPubMedGoogle ScholarCrossref
32.
Mitchell  AJ , Yadegarfar  M , Gill  J , Stubbs  B .  Case finding and screening clinical utility of the Patient Health Questionnaire (PHQ-9 and PHQ-2) for depression in primary care: a diagnostic meta-analysis of 40 studies.   BJPsych Open. 2016;2(2):127-138. doi:10.1192/bjpo.bp.115.001685PubMedGoogle ScholarCrossref
33.
Cano-Vindel  A , Muñoz-Navarro  R , Medrano  LA ,  et al; PsicAP Research Group.  A computerized version of the Patient Health Questionnaire-4 as an ultra-brief screening tool to detect emotional disorders in primary care.   J Affect Disord. 2018;234:247-255. doi:10.1016/j.jad.2018.01.030PubMedGoogle ScholarCrossref
34.
Campbell-Sills  L , Norman  SB , Craske  MG ,  et al.  Validation of a brief measure of anxiety-related severity and impairment: the Overall Anxiety Severity and Impairment Scale (OASIS).   J Affect Disord. 2009;112(1-3):92-101. doi:10.1016/j.jad.2008.03.014PubMedGoogle ScholarCrossref
35.
Allan  NP , Raines  AM , Capron  DW , Norr  AM , Zvolensky  MJ , Schmidt  NB .  Identification of anxiety sensitivity classes and clinical cut-scores in a sample of adult smokers: results from a factor mixture model.   J Anxiety Disord. 2014;28(7):696-703. doi:10.1016/j.janxdis.2014.07.006PubMedGoogle ScholarCrossref
36.
Gregory  KD , Chelmow  D , Nelson  HD ,  et al; Women’s Preventive Services Initiative.  Screening for anxiety in adolescent and adult women: a recommendation from the Women’s Preventive Services Initiative.   Ann Intern Med. 2020;173(1):48-56. doi:10.7326/M20-0580PubMedGoogle ScholarCrossref
37.
US Preventive Task Force. Screening for anxiety in adults. Accessed October 20, 2022. https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/anxiety-adults-screening
38.
Herr  NR , Williams  JW  Jr , Benjamin  S , McDuffie  J .  Does this patient have generalized anxiety or panic disorder? the Rational Clinical Examination systematic review.   JAMA. 2014;312(1):78-84. doi:10.1001/jama.2014.5950PubMedGoogle ScholarCrossref
39.
Hirschfeld  RM .  The comorbidity of major depression and anxiety disorders: recognition and management in primary care.   Prim Care Companion J Clin Psychiatry. 2001;3(6):244-254. doi:10.4088/PCC.v03n0609PubMedGoogle ScholarCrossref
40.
Kalin  NH .  The critical relationship between anxiety and depression.   Am J Psychiatry. 2020;177(5):365-367. doi:10.1176/appi.ajp.2020.20030305PubMedGoogle ScholarCrossref
41.
Grant  BF , Stinson  FS , Dawson  DA ,  et al.  Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.   Arch Gen Psychiatry. 2004;61(8):807-816. doi:10.1001/archpsyc.61.8.807PubMedGoogle ScholarCrossref
42.
National Collaborating Centre for Mental Health.  Generalised Anxiety Disorder in Adults: Management in Primary, Secondary and Community Care. British Psychological Society; 2011.
43.
National Collaborating Centre for Mental Health.  Social Anxiety Disorder: Recognition, Assessment and Treatment. British Psychological Society; 2013.
44.
Baldwin  D . Generalized anxiety disorder in adults: epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis. In: Stein MB, ed. UpToDate. Accessed September 8, 2022. https://www.uptodate.com/contents/generalized-anxiety-disorder-in-adults-epidemiology-pathogenesis-clinical-manifestations-course-assessment-and-diagnosis
45.
Roy-Byrne  PP . Panic disorder in adults: epidemiology, clinical manifestations, and diagnosis. In: Stein MB, ed. UpToDate. Accessed September 8, 2022. https://www.uptodate.com/contents/panic-disorder-in-adults-epidemiology-clinical-manifestations-and-diagnosis
46.
Bandelow  B , Lichte  T , Rudolf  S , Wiltink  J , Beutel  ME .  The diagnosis of and treatment recommendations for anxiety disorders.   Dtsch Arztebl Int. 2014;111(27-28):473-480. doi:10.3238/arztebl.2014.0473PubMedGoogle ScholarCrossref
47.
Bandelow  B , Reitt  M , Röver  C , Michaelis  S , Görlich  Y , Wedekind  D .  Efficacy of treatments for anxiety disorders: a meta-analysis.   Int Clin Psychopharmacol. 2015;30(4):183-192. doi:10.1097/YIC.0000000000000078PubMedGoogle ScholarCrossref
48.
McAllister-Williams  RH , Baldwin  DS , Cantwell  R ,  et al; endorsed by the British Association for Psychopharmacology.  British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017.   J Psychopharmacol. 2017;31(5):519-552. doi:10.1177/0269881117699361PubMedGoogle ScholarCrossref
49.
Gosmann  NP , Costa  MA , Jaeger  MB ,  et al.  Selective serotonin reuptake inhibitors, and serotonin and norepinephrine reuptake inhibitors for anxiety, obsessive-compulsive, and stress disorders: a 3-level network meta-analysis.   PLoS Med. 2021;18(6):e1003664. doi:10.1371/journal.pmed.1003664PubMedGoogle ScholarCrossref
50.
Chen  TR , Huang  HC , Hsu  JH , Ouyang  WC , Lin  KC .  Pharmacological and psychological interventions for generalized anxiety disorder in adults: a network meta-analysis.   J Psychiatr Res. 2019;118:73-83. doi:10.1016/j.jpsychires.2019.08.014PubMedGoogle ScholarCrossref
51.
Chawla  N , Anothaisintawee  T , Charoenrungrueangchai  K ,  et al.  Drug treatment for panic disorder with or without agoraphobia: systematic review and network meta-analysis of randomised controlled trials.   BMJ. 2022;376:e066084. doi:10.1136/bmj-2021-066084PubMedGoogle ScholarCrossref
52.
Williams  T , Hattingh  CJ , Kariuki  CM ,  et al.  Pharmacotherapy for social anxiety disorder (SAnD).   Cochrane Database Syst Rev. 2017;10(10):CD001206. doi:10.1002/14651858.CD001206.pub3PubMedGoogle ScholarCrossref
53.
Bonnet  U , Scherbaum  N .  How addictive are gabapentin and pregabalin? a systematic review.   Eur Neuropsychopharmacol. 2017;27(12):1185-1215. doi:10.1016/j.euroneuro.2017.08.430PubMedGoogle ScholarCrossref
54.
Depping  AM , Komossa  K , Kissling  W , Leucht  S .  Second-generation antipsychotics for anxiety disorders.   Cochrane Database Syst Rev. 2010;(12):CD008120. doi:10.1002/14651858.CD008120.pub2PubMedGoogle ScholarCrossref
55.
Craske  MG , Bystritsky  A . Generalized anxiety disorder in adults: management. In: Stein MB, ed. UpToDate. Accessed September 8, 2022. https://www.uptodate.com/contents/generalized-anxiety-disorder-in-adults-management
56.
Roy-Byrne  P , Craske  MG . Management of panic disorder with or without agoraphobia in adults. In: Stein MB, ed. UpToDate. Accessed September 8, 2022. https://www.uptodate.com/contents/management-of-panic-disorder-with-or-without-agoraphobia-in-adults
57.
Stein  MB . Pharmacotherapy for social anxiety disorder in adults. In: Roy-Byrne PP, ed. UpToDate. Accessed September 8, 2022. https://www.uptodate.com/contents/pharmacotherapy-for-social-anxiety-disorder-in-adults
58.
Jakubovski  E , Johnson  JA , Nasir  M , Müller-Vahl  K , Bloch  MH .  Systematic review and meta-analysis: dose-response curve of SSRIs and SNRIs in anxiety disorders.   Depress Anxiety. 2019;36(3):198-212. doi:10.1002/da.22854PubMedGoogle ScholarCrossref
59.
Batelaan  NM , Bosman  RC , Muntingh  A , Scholten  WD , Huijbregts  KM , van Balkom  AJLM .  Risk of relapse after antidepressant discontinuation in anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder: systematic review and meta-analysis of relapse prevention trials.   BMJ. 2017;358:j3927. doi:10.1136/bmj.j3927PubMedGoogle ScholarCrossref
60.
Agarwal  SD , Landon  BE .  Patterns in outpatient benzodiazepine prescribing in the United States.   JAMA Netw Open. 2019;2(1):e187399. doi:10.1001/jamanetworkopen.2018.7399PubMedGoogle ScholarCrossref
61.
Stimpfl  JN , Mills  JA , Strawn  JR .  Pharmacologic predictors of benzodiazepine response trajectory in anxiety disorders: a bayesian hierarchical modeling meta-analysis.   CNS Spectr. Published October 1, 2021. doi:10.1017/S1092852921000870PubMedGoogle ScholarCrossref
62.
Breilmann  J , Girlanda  F , Guaiana  G ,  et al.  Benzodiazepines versus placebo for panic disorder in adults.   Cochrane Database Syst Rev. 2019;3(3):CD010677. doi:10.1002/14651858.CD010677.pub2PubMedGoogle ScholarCrossref
63.
Gomez  AF , Barthel  AL , Hofmann  SG .  Comparing the efficacy of benzodiazepines and serotonergic anti-depressants for adults with generalized anxiety disorder: a meta-analytic review.   Expert Opin Pharmacother. 2018;19(8):883-894. doi:10.1080/14656566.2018.1472767PubMedGoogle ScholarCrossref
64.
Jones  CM , McAninch  JK .  Emergency department visits and overdose deaths from combined use of opioids and benzodiazepines.   Am J Prev Med. 2015;49(4):493-501. doi:10.1016/j.amepre.2015.03.040PubMedGoogle ScholarCrossref
65.
Powers  M , Becker  E , Gorman  J , Kissen  D , Smits  J . Clinical practice review for GAD. Anxiety and Depression Association of America. Accessed October 20, 2022. https://adaa.org/resources-professionals/practice-guidelines-gad
66.
Van Ameringen  M , Heimberg  RG , Schneier  F , Shannon  J , Stein  DJ . Clinical practice review for social anxiety disorder. Anxiety and Depression Association of America. Accessed October 20, 2022. https://adaa.org/resources-professionals/clinical-practice-review-social-anxiety
67.
Shinfuku  M , Kishimoto  T , Uchida  H , Suzuki  T , Mimura  M , Kikuchi  T .  Effectiveness and safety of long-term benzodiazepine use in anxiety disorders: a systematic review and meta-analysis.   Int Clin Psychopharmacol. 2019;34(5):211-221. doi:10.1097/YIC.0000000000000276PubMedGoogle ScholarCrossref
68.
Hirsch  M , Birnbaum  RJ . Tricyclic and tetracyclic drugs: pharmacology, administration, and side effects. In: Roy-Byrne PP, ed. UpToDate. Accessed September 8, 2022. https://www.uptodate.com/contents/tricyclic-and-tetracyclic-drugs-pharmacology-administration-and-side-effects
69.
Chessick  CA , Allen  MH , Thase  M ,  et al.  Azapirones for generalized anxiety disorder.   Cochrane Database Syst Rev. 2006;2006(3):CD006115. doi:10.1002/14651858.CD006115PubMedGoogle ScholarCrossref
70.
Guaiana  G , Barbui  C , Cipriani  A .  Hydroxyzine for generalised anxiety disorder.   Cochrane Database Syst Rev. 2010;(12):CD006815. doi:10.1002/14651858.CD006815.pub2PubMedGoogle ScholarCrossref
71.
LaLonde  CD , Van Lieshout  RJ .  Treating generalized anxiety disorder with second generation antipsychotics: a systematic review and meta-analysis.   J Clin Psychopharmacol. 2011;31(3):326-333. doi:10.1097/JCP.0b013e31821b2b3fPubMedGoogle ScholarCrossref
72.
Steenen  SA , van Wijk  AJ , van der Heijden  GJ , van Westrhenen  R , de Lange  J , de Jongh  A .  Propranolol for the treatment of anxiety disorders: systematic review and meta-analysis.   J Psychopharmacol. 2016;30(2):128-139. doi:10.1177/0269881115612236PubMedGoogle ScholarCrossref
73.
Carpenter  JK , Andrews  LA , Witcraft  SM , Powers  MB , Smits  JAJ , Hofmann  SG .  Cognitive behavioral therapy for anxiety and related disorders: a meta-analysis of randomized placebo-controlled trials.   Depress Anxiety. 2018;35(6):502-514. doi:10.1002/da.22728PubMedGoogle ScholarCrossref
74.
Zhang  A , Borhneimer  LA , Weaver  A ,  et al.  Cognitive behavioral therapy for primary care depression and anxiety: a secondary meta-analytic review using robust variance estimation in meta-regression.   J Behav Med. 2019;42(6):1117-1141. doi:10.1007/s10865-019-00046-zPubMedGoogle ScholarCrossref
75.
Andrews  G , Basu  A , Cuijpers  P ,  et al.  Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: an updated meta-analysis.   J Anxiety Disord. 2018;55:70-78. doi:10.1016/j.janxdis.2018.01.001PubMedGoogle ScholarCrossref
76.
Tolin  DF .  Can cognitive behavioral therapy for anxiety and depression be improved with pharmacotherapy? a meta-analysis.   Psychiatr Clin North Am. 2017;40(4):715-738. doi:10.1016/j.psc.2017.08.007PubMedGoogle ScholarCrossref
77.
Cuijpers  P , Sijbrandij  M , Koole  S , Huibers  M , Berking  M , Andersson  G .  Psychological treatment of generalized anxiety disorder: a meta-analysis.   Clin Psychol Rev. 2014;34(2):130-140. doi:10.1016/j.cpr.2014.01.002PubMedGoogle ScholarCrossref
78.
Haller  H , Breilmann  P , Schröter  M , Dobos  G , Cramer  H .  A systematic review and meta-analysis of acceptance- and mindfulness-based interventions for DSM-5 anxiety disorders.   Sci Rep. 2021;11(1):20385. doi:10.1038/s41598-021-99882-wPubMedGoogle ScholarCrossref
79.
Milrod  B , Leon  AC , Busch  F ,  et al.  A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder.   Am J Psychiatry. 2007;164(2):265-272. doi:10.1176/ajp.2007.164.2.265PubMedGoogle ScholarCrossref
80.
Milrod  B , Chambless  DL , Gallop  R ,  et al.  Psychotherapies for panic disorder: a tale of two sites.   J Clin Psychiatry. 2016;77(7):927-935. doi:10.4088/JCP.14m09507PubMedGoogle ScholarCrossref
81.
Ramos-Sanchez  CP , Schuch  FB , Seedat  S ,  et al.  The anxiolytic effects of exercise for people with anxiety and related disorders: an update of the available meta-analytic evidence.   Psychiatry Res. 2021;302:114046. doi:10.1016/j.psychres.2021.114046PubMedGoogle ScholarCrossref
82.
Cramer  H , Lauche  R , Anheyer  D ,  et al.  Yoga for anxiety: a systematic review and meta-analysis of randomized controlled trials.   Depress Anxiety. 2018;35(9):830-843. doi:10.1002/da.22762PubMedGoogle ScholarCrossref
83.
Hofmann  SG . Psychotherapy for social anxiety disorder in adults. In: Stein MB, ed. UpToDate. Accessed September 8, 2022. https://www.uptodate.com/contents/psychotherapy-for-social-anxiety-disorder-in-adults
84.
van Dis  EAM , van Veen  SC , Hagenaars  MA ,  et al.  Long-term outcomes of cognitive behavioral therapy for anxiety-related disorders: a systematic review and meta-analysis.   JAMA Psychiatry. 2020;77(3):265-273. doi:10.1001/jamapsychiatry.2019.3986PubMedGoogle ScholarCrossref
85.
Sakiris  N , Berle  D .  A systematic review and meta-analysis of the Unified Protocol as a transdiagnostic emotion regulation based intervention.   Clin Psychol Rev. 2019;72:101751. doi:10.1016/j.cpr.2019.101751PubMedGoogle ScholarCrossref
86.
Ost  LG .  Applied relaxation: description of a coping technique and review of controlled studies.   Behav Res Ther. 1987;25(5):397-409. doi:10.1016/0005-7967(87)90017-9PubMedGoogle ScholarCrossref
87.
Kashdan  TB , Rottenberg  J .  Psychological flexibility as a fundamental aspect of health.   Clin Psychol Rev. 2010;30(7):865-878. doi:10.1016/j.cpr.2010.03.001PubMedGoogle ScholarCrossref
88.
Sabourin  BC , Stewart  SH , Watt  MC , Krigolson  OE .  Running as interoceptive exposure for decreasing anxiety sensitivity: replication and extension.   Cogn Behav Ther. 2015;44(4):264-274. doi:10.1080/16506073.2015.1015163PubMedGoogle ScholarCrossref
89.
Wong  SY , Yip  BH , Mak  WW ,  et al.  Mindfulness-based cognitive therapy v group psychoeducation for people with generalised anxiety disorder: randomised controlled trial.   Br J Psychiatry. 2016;209(1):68-75. doi:10.1192/bjp.bp.115.166124PubMedGoogle ScholarCrossref
90.
Hoge  EA , Bui  E , Marques  L ,  et al.  Randomized controlled trial of mindfulness meditation for generalized anxiety disorder: effects on anxiety and stress reactivity.   J Clin Psychiatry. 2013;74(8):786-792. doi:10.4088/JCP.12m08083PubMedGoogle ScholarCrossref
91.
Hoge  EA , Bui  E , Mete  M , Dutton  MA , Baker  AW , Simon  NM .  Mindfulness-based stress reduction vs escitalopram for the treatment of adults with anxiety disorders: a randomized clinical trial.   JAMA Psychiatry. 2022. doi:10.1001/jamapsychiatry.2022.3679PubMedGoogle ScholarCrossref
92.
Coull  G , Morris  PG .  The clinical effectiveness of CBT-based guided self-help interventions for anxiety and depressive disorders: a systematic review.   Psychol Med. 2011;41(11):2239-2252. doi:10.1017/S0033291711000900PubMedGoogle ScholarCrossref
93.
Newman  MG , Szkodny  LE , Llera  SJ , Przeworski  A .  A review of technology-assisted self-help and minimal contact therapies for anxiety and depression: is human contact necessary for therapeutic efficacy?   Clin Psychol Rev. 2011;31(1):89-103. doi:10.1016/j.cpr.2010.09.008PubMedGoogle ScholarCrossref
94.
Lewis  C , Pearce  J , Bisson  JI .  Efficacy, cost-effectiveness and acceptability of self-help interventions for anxiety disorders: systematic review.   Br J Psychiatry. 2012;200(1):15-21. doi:10.1192/bjp.bp.110.084756PubMedGoogle ScholarCrossref
95.
Saramago  P , Gega  L , Marshall  D ,  et al.  Digital interventions for generalized anxiety disorder (GAD): systematic review and network meta-analysis.   Front Psychiatry. 2021;12:726222. doi:10.3389/fpsyt.2021.726222PubMedGoogle ScholarCrossref
96.
Carlo  AD , Hosseini Ghomi  R , Renn  BN , Areán  PA .  By the numbers: ratings and utilization of behavioral health mobile applications.   NPJ Digit Med. 2019;2:54. doi:10.1038/s41746-019-0129-6PubMedGoogle ScholarCrossref
97.
Bruce  SE , Yonkers  KA , Otto  MW ,  et al.  Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study.   Am J Psychiatry. 2005;162(6):1179-1187. doi:10.1176/appi.ajp.162.6.1179PubMedGoogle ScholarCrossref
98.
Loerinc  AG , Meuret  AE , Twohig  MP , Rosenfield  D , Bluett  EJ , Craske  MG .  Response rates for CBT for anxiety disorders: need for standardized criteria.   Clin Psychol Rev. 2015;42:72-82. doi:10.1016/j.cpr.2015.08.004PubMedGoogle ScholarCrossref
99.
Springer  KS , Levy  HC , Tolin  DF .  Remission in CBT for adult anxiety disorders: a meta-analysis.   Clin Psychol Rev. 2018;61:1-8. doi:10.1016/j.cpr.2018.03.002PubMedGoogle ScholarCrossref
100.
Levy  HC , O’Bryan  EM , Tolin  DF .  A meta-analysis of relapse rates in cognitive-behavioral therapy for anxiety disorders.   J Anxiety Disord. 2021;81:102407. doi:10.1016/j.janxdis.2021.102407PubMedGoogle ScholarCrossref
101.
Bighelli  I , Castellazzi  M , Cipriani  A ,  et al.  Antidepressants versus placebo for panic disorder in adults.   Cochrane Database Syst Rev. 2018;4(4):CD010676. doi:10.1002/14651858.CD010676.pub2PubMedGoogle ScholarCrossref
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Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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