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Is cognitive–behavioural therapy more effective than relaxation therapy in the treatment of anxiety disorders? A meta-analysis

Published online by Cambridge University Press:  17 October 2017

Jesus Montero-Marin ,
Javier Garcia-Campayo ,
Alba López-Montoyo ,
Edurne Zabaleta-del-Olmo  and
Pim Cuijpers
Jesus Montero-Marin*
Affiliation:
Faculty of Health and Sport Sciences, University of Zaragoza, Huesca, Spain Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
Javier Garcia-Campayo
Affiliation:
Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain Miguel Servet University Hospital, University of Zaragoza, Zaragoza, Spain
Alba López-Montoyo
Affiliation:
Departamento de Psicología Básica, Clínica y Psicobiología, Universidad Jaume I, Castellón, Spain
Edurne Zabaleta-del-Olmo
Affiliation:
Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain
Pim Cuijpers
Affiliation:
Department of Psychology, VU University, Amsterdam, The Netherlands
*
Author for correspondence: J. Montero-Marin, E-mail: jmontero@unizar.es
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Abstract

Background

It is not clear whether relaxation therapies are more or less effective than cognitive and behavioural therapies in the treatment of anxiety. The aims of the present study were to examine the effects of relaxation techniques compared to cognitive and behavioural therapies in reducing anxiety symptoms, and whether they have comparable efficacy across disorders.

Method

We conducted a meta-analysis of 50 studies (2801 patients) comparing relaxation training with cognitive and behavioural treatments of anxiety.

Results

The overall effect size (ES) across all anxiety outcomes, with only one combined ES in each study, was g = −0.27 [95% confidence interval (CI) = −0.41 to −0.13], favouring cognitive and behavioural therapies (number needed to treat = 6.61). However, no significant difference between relaxation and cognitive and behavioural therapies was found for generalized anxiety disorder, panic disorder, social anxiety disorder and specific phobias (considering social anxiety and specific phobias separately). Heterogeneity was moderate (I2 = 52; 95% CI = 33–65). The ES was significantly associated with age (p < 0.001), hours of cognitive and/or behavioural therapy (p = 0.015), quality of intervention (p = 0.007), relaxation treatment format (p < 0.001) and type of disorder (p = 0.008), explaining an 82% of variance.

Conclusions

Relaxation seems to be less effective than cognitive and behavioural therapies in the treatment of post-traumatic stress disorder, and obsessive–compulsive disorder and it might also be less effective at 1-year follow-up for panic, but there is no evidence that it is less effective for other anxiety disorders.

Keywords

Anxiety disorderscognitive–behavioural therapyrelaxation therapymeta-analysis
Type
Review Article
Information
Psychological Medicine , Volume 48 , Issue 9 , July 2018 , pp. 1427 - 1436
Copyright
Copyright © Cambridge University Press 2017 

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