Role of Cognitions in Treatment of Generalized Anxiety Disorder: A Randomized Trial

Aim of this study is to study the mediating role of cognitions following cognitive behaviour therapy (alone) as compared with pharmacotherapy therapy (alone) and cognitive behaviour therapy along pharmacotherapy (combination therapy) in generalized anxiety disorder (GAD). A sample of Ninety (90) patients fulfilled the criteria for GAD and agreed to participate in the study were randomly allocated to three groups. Intervention was randomly assigned, Group I received CBT alone, Group-II received Pharmacotherapy alone and Group-III received combination of both (CBT+ Pharmacotherapy) for consequently three months each. A cross sectional intervention research was conducted. The multi-group pre to post design was adopted. The Cognition Checklist (CCL), Automatic Thoughts Questionnaire, Dysfunctional Attitude Scale, Beck's Anxiety Inventory. One Way ANOVA was administered at pre treatment and Paired t test were employed for testing the hypotheses at post intervention. Independent t test and effect size (Cohen'd) were calculated to see the differences between the groups at post intervention Finally, to study the mediation role of cognitions, multiple regression followed by Sobel's test of mediation were calculated. Results: CBT+PT group was significantly more efficacious than PT group in the treatment of GAD. Largest effect size (.77) was found for the CBT and CBT+PT groups while comparing to PT group. CBT alone and CBT+PT in combination interventions were more effective than PT alone. An effect of interventions on anxiety symptoms was mediated only through ATQ-F during CBT alone and in combination of CBT+PT groups. Findings were concluded that CBT is an effective and cost effective treatment in the management of generalized anxiety disorder as compare to pharmacotherapy alone. Although CBT and Pharmacotherapy may be combined for the treatment of GAD but it may have no additional advantage over CBT. In addition to it automatic thoughts frequency was found to be an important predictor of acute anxiety relief at 12th week during the treatment which included the CBT.