L’autogestion des troubles anxieux en première intention

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A clinical trial proves the effectiveness and cost-effectiveness of a cognitive behavioral therapy over the Internet in people with social anxiety.

A Swedish meta-analysis of Haug and his colleagues published in the journal Clinical Psychology Review in 2011 verifies the effectiveness of self-management in anxiety disorders. The results show that self-management is an important first step in support for people with anxiety disorders. It identifies the needs of patients and severity of anxiety symptoms.

The Study Rationale

Anxiety disorders are the most common mental disorders in the general population. 30% of the population is affected by this chronic disease. However, the majority of people who suffer do not seek and do not have recourse to care. This lack is mainly due to an insufficient number of trained therapists, the cost of the meetings and the embarrassment or shame associated with seeking help.

The self-management technique could enhance the availability and motivation of people with anxiety disorders to seek professional help to help. This technique relies on a manual containing information, explanations and exercises relevant to apply in everyday life and especially during stressful situations. This preventive technology allow effective regulation of anxiety symptoms. However, studies verifying its effectiveness showed mixed results. A meta-analysis was to identify predictors and moderators contributing to a better application of this technique.

The Question

Is a self-management technique proposed as first line really effective in the case of the management of anxiety disorders?

The Method

The Swedish meta-analysis of Haug and his colleagues identified 3510 publications on self-management of anxiety disorders. 56 randomized controlled trials met the criteria for inclusion and non-inclusion in the meta-analysis were included. Articles that dealt with adult individuals with anxiety disorders. The group benefiting from the technique of self-management was compared to a control group and / or another type of therapy. Control groups concerned is a group put on a waiting list receiving the self-management technique by the end of surgery or placebo group receiving an intervention without proven therapeutic property. Therapies used for comparison were either cognitive behavioral therapy (CBT) specialist in anxiety disorders or unspecified therapy in studies.

Anxiety symptoms were the specific primary endpoint. They included panic / agoraphobia disorders, social phobia, the condition of PTSD / acute stress, anxiety-depressive disorder, specific phobias, disorders of generalized anxiety, obsessive-compulsive disorders and disorders mixed anxiety. The secondary endpoints involved other signs such as depressive symptoms and quality of life.

The Non-Pharmacological Intervention (NPI) assessed

The self-management technology was designed to reduce the anxiety symptoms of participants. Based on studies, the technique was based on self-management manuals on computer software and / or on exchanges emails with a trained psychotherapist. The duration of the interventions ranged from 3 weeks to 12 weeks.

Main Results

The results show the effectiveness of self-management comparable to non-specialized therapies in anxiety disorders. The most effective self-management techniques are those based on computer software and exchanges of emails with psychotherapists. By cons, self-management is less effective as cognitive behavioral therapy specialist in anxiety disorders.

It effectively helps people with minor anxiety symptoms. For those whose symptoms are more severe, plugs and heavier loads must then be proposed.

The self-management technique is a useful response to first line or first line.

What it means for Patients

Anxiety is not a fatality. It can be treated. Unfortunately, too few people looking despite the existence of effective preventive and therapeutic solutions. A self-management handbook received from a health professional is already proving sufficiently effective for people suffering from anxiety disorders minors. For others, it encourages to engage a longer therapy.

What it means for Healthcare Professionals

This meta-analysis provides evidence of the effectiveness of self-management technique proposed as first-line treatment of anxiety disorders. Some health services offer to stage models of care for the treatment of these disorders. Non-drug interventions should prioritized according to the needs of patients with self-management as a first step.

What it means for Researchers

The meta-analysis shows promising results of a self-management technique on the secondary prevention of anxiety disorders. Future research is needed to assess the cost / efficiency of this technique and test its efficacy in other chronic diseases.

What it means for Policymakers

Anxiety disorders affect 30% of the general population. Technical self-management of anxiety disorders is as effective as non-specific psychotherapy. It could well be offered to patients at first. It would then be possible to progress to more complex levels of care when anxiety symptoms persist. It is essential to develop in the future by step care model to optimize the quality of care offered to people with anxiety disorders.

The Reference

Haug T, Nordgreen T, Ost LG, Havik OE (2011). Self-help treatment of anxiety disorders: a meta-analysis and meta-regression of effects and potential moderators. Clinical Psychology Review, 32, 425-445.

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To reference this Blog en Sante © article.

Ninot G (2015). Self-management of anxiety disorders in primary-care. Blog en Sante, A49.

© Copyright 2015 Gregory Ninot. All rights reserved.