A Comparison of Emotion-Focused Therapy and Cognitive-Behavioral Therapy in the Treatment of Generalized Anxiety Disorder: Results of a Feasibility Randomized Controlled Trial

Generalized anxiety disorder (GAD) is a chronic mental health difficulty typically present in primary care settings. Cognitive-behavioral therapy (CBT) is the psychological intervention with the best evidence for its efficacy for GAD. The development of other psychological interventions can increase client choice. This feasibility trial examined an initial assessment of the efficacy of EFT in comparison to CBT in the treatment of GAD in the context of an Irish public health service. The trial provided information on recruitment, therapist training/adherence, and client retention relevant for a potential noninferiority trial. A randomized controlled trial compared the efficacy of EFT versus CBT for GAD. Both therapies were offered in a 16-20 sessions format. Therapists (n = 8) were trained in both conditions and offered both therapies. Clients were randomly assigned to the two therapies EFT (n = 29) and CBT (n = 29). Outcomes were assessed using several measures, with the Generalized Anxiety Disorder-7 (GAD-7) being the primary outcome. Clients were assessed at baseline, week 16, end of therapy, and at 6-month follow-up. Therapists were able to learn the two models after a short training and showed moderate levels of adherence. Although not statistically significant, the drop out from treatment was 10% for EFT and 27% for CBT. The two therapies showed large pre-post change and similar outcomes across all measures, with these benefits retained at 6-month follow-up. Results suggest that EFT is a potentially promising treatment for GAD. Further investigation is indicated to establish its potential to expand the available psychological therapies for GAD. Clinical Impact Statement Question: This feasibility study was assessing the tentative relative efficacy of emotion-focused therapy (EFT) for generalized anxiety in comparison to an established cognitive-behavioral treatment. Findings: The study showed EFT as a promising treatment for GAD when compared to the established cognitive-behavioral treatment, worthwhile of further exploration. Meaning: The adaptation of EFT for generalized anxiety can broaden the range of treatment choices available for this condition. Next Steps: The trial offered a number of learnings in terms of planning a larger definitive trial comparing EFT to the established treatment.