Changes in affect, physical activity, physical health, and sleep in cognitive behavioral therapy for anxiety: A pilot study

Anxiety disorders are associated with poorer physical activity and sleep. While associated with significant reductions in anxiety, it is not clear whether CBT for anxiety also improves physical health, sleep and physical activity. We evaluated changes in psychological and physical health outcomes using technology-based assessments in a naturalistic sample of adult patients receiving CBT for anxiety disorders (N=40). Participants were provided with a wearable device (Fitbit) and ecological momentary assessments (EMA) throughout the duration of their CBT, or up to 20 weeks. We observed significant improvements in anxiety, depression, social isolation, and self-efficacy in emotion management. Self-reported sleep disorder symptoms, global physical health, or physical functioning and objectively measured sleep efficiency or physical activity (steps) did not significantly change. Steeper reductions in EMA-assessed anxiety were associated with steeper improvements in depression, social isolation, self-efficacy in emotion management, and physical function. These findings highlight the utility of EMA assessments during CBT in a naturalistic clinic. Whereas CBT for anxiety-related disorders is associated with significant improvements in affect, it may not be associated with improvements in sleep or physical activity. CBT for anxiety may require augmentation for patients who have goals of improving sleep, physical health, or physical activity.