Determination of the effectiveness of unified group cognitive behaviour therapy for patients with heterogeneous anxiety disorders in Klang Valley, Malaysia

The prevalence rate of anxiety disorders both globally and in Malaysia has increased for the past decade. However, many patients with anxiety disorder remain under-treated or untreated. Based on the literature review, the problems were rooted in poor treatment delivery on this disorder (i.e., poor dissemination of treatments to the clinicians and limited availability of treatments for patients). Therefore, current study intended to provide solutions to this problem. There are two phases of study. Phase 1 involved the validation of measures used. While Phase 2 evaluate the effectiveness of Unified Group Cognitive Behaviour Therapy as an adjunct to pharmacological treatment (Treatment-As-Usual) (Group CBT+TAU) for patients with heterogeneous anxiety disorders in Klang Valley, Malaysia. Patients diagnosed with heterogeneous anxiety disorders (N=242) were randomly allocated to receive either Unified GCBT+TAU (n=81), or Group Relaxation Training (GRT)+TAU (n=81), or TAU alone (n=80). The Unified GCBT+TAU and GRT+TAU consisted of eight and seven sessions, respectively. The primary outcome measure was the Beck Anxiety Inventory-Malay. The secondary outcome measures consisted of other symptom measures of anxiety (PAS-Malay and FQ-Malay), catastrophic cognition measures (CCQ-Modified-Malaysia and ACQ-Malaysia), a quality of life measure (WHOQOL-BREF-Malay), and a symptom measure of depression (Beck Depression Inventory-Malay). All the measures were validated in terms of its construct and its criterion prior to be used in the study. The participants completed the questionnaire battery at pre-treatment (week 0), middle of the treatment (week 4), post-treatment (week 8), and follow-ups (1-month, 3-month, and 6 -month after the treatment) General linear model (i.e., repeated measures MANOVA and mixed ANOVA) and an intention-to-treat with last observation carried forward model was used for data analyses. Participants receiving Unified GCBT+TAU improved more significantly and at a faster rate than the GRT+TAU group and TAU group. The effect size (Cohen’sd) of the Unified GCBT+TAU group for the primary outcome measure was 1.61, ranging from 0.98 to 1.30 for the other secondary outcome measures. Meanwhile, the effect size of the GRT+TAU group for the primary outcome measure was 0.70, ranging from 0.12 to 0.54 for the other secondary outcome measures. Onthe other hand, the effect size of the TAU group for the primary outcome measure was 0.09, ranging from 0.02 to – 0.28 for the other secondary outcome measures. Furthermore, 70.1% and 36.7% of the participants receiving Unified GCBT+TAU and GRT+TAU, respectively, experienced either reliable or clinically significant change. Meanwhile, none of the participants in the TAU group experienced anyreliable or clinically significant change from pre-treatment to post-treatment.The findings suggest that Unified GCBT, when used in addition to TAU, is faster and more effective in reducing symptoms of anxiety disorders, decreasing catastrophic cognitions, increasing the quality of life, and reducing comorbid symptoms of depression among the patients with anxiety disorders in Klang Valley, Malaysia, when compared to GRT+TAU and TAU alone.

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