Response to anxiety treatment before, during, and after the COVID-19 pandemic

TL;DR

This study found that anxiety treatment outcomes remained consistent before, during, and after the pandemic, with no significant increase in anxiety during the acute pandemic phase.

Contribution

The study provides novel evidence that anxiety treatment effectiveness was not negatively impacted by the pandemic.

Findings

Anxiety levels rapidly decreased during treatment and continued to decline into the mild symptom range.

There were no substantive differences in treatment outcomes between groups before, during, and after the pandemic.

Anxiety did not increase during the acute pandemic phase for patients in treatment.

Abstract

The COVID-19 pandemic yielded a substantial increase in worldwide prevalence and severity of anxiety, but less is known about effects on anxiety treatment.

We evaluated effects of the COVID-19 pandemic on responses to Cognitive Behavioral Therapy for anxiety, in a clinically heterogeneous sample of patients.

A sample of 764 outpatients were separated into four groups: (1) Pre-pandemic (start date on or prior to 12/31/2019), (2) Pandemic-Onset (start date from 01/01/2020 to 03/31/2020), (3) During-Pandemic (start date from 04/01/2020 through 12/31/2020), and (4) Post-Pandemic (start date on or after 01/01/2021). We subsequently compared treatment trajectories and effects within and between these groups over 5621 total time points (mean of 7.38 measurements per patient).

Overall, patients presented with moderate levels of anxiety (M = 13.25, 95%CI: 12.87, 13.62), which rapidly decreased for 25 days (M = 9.46, 95%CI: 9.09, 9.83), and thereafter slowly declined into the mild symptom range over the remainder of the study period (M = 7.36, 95%CI: 6.81, 7.91), representing clinically as well as statistically significant change. A series of conditional multilevel regression models indicated that there were no substantive differences between groups, and no increase in anxiety during the acute pandemic phase.

Our results suggest that responses to treatment for anxiety were equivalent before, during, and after the COVID-19 pandemic. Among patients who were in treatment prior to the pandemic, we failed to detect an increase in anxiety during the pandemic’s acute phase (March 20th, 2020 through July 1st, 2020).

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