2026 ECNP Congress

PS03-3031

Comparative effectiveness of cognitive behavioural therapy and selective serotonin reuptake inhibitors in moderate generalised anxiety disorder in primary care

Alina Bologan — Nicolae Testemitanu State University of Medicine and Pharmacy, Department of Mental Health- Medical Psychology and Psychotherapy, Ialoveni, Moldova

2026 ECNP Congress

Background

Generalised anxiety disorder is a common and often under-recognised condition in primary care, characterised by persistent worry, autonomic hyperarousal and impaired daily functioning [1]. Neurobiological models suggest dysregulation of stress-response systems and altered emotional processing. First-line treatments include cognitive behavioural therapy and pharmacological interventions with selective serotonin reuptake inhibitors; however, psychological interventions may demonstrate more sustained effects beyond treatment discontinuation [2]. Comparative effectiveness data in real-world primary care populations remain limited [3]. Recent evidence indicates that cognitive behavioural therapy provides both short-term symptom reduction and sustained long-term benefits, including through digital delivery formats, while pharmacological treatments remain effective but show variability in response and tolerability [4,5].

Aims

To compare the effectiveness of cognitive behavioural therapy and selective serotonin reuptake inhibitors in reducing symptom severity and improving functional outcomes in patients with moderate generalised anxiety disorder in primary care.

Methods

A controlled clinical study was conducted in a primary care setting. A total of 524 patients were screened for anxiety symptoms using the GAD-7. Only patients presenting with moderate anxiety severity based on established cut-off scores were eligible for inclusion, while those with mild or severe anxiety were excluded. A final sample of 66 patients meeting inclusion criteria was randomly allocated into two groups: cognitive behavioural therapy (n=33) and pharmacological treatment with selective serotonin reuptake inhibitors (n=33), including Sertraline or Escitalopram, based on clinical indication. Participants were consecutively recruited from primary care consultations. The intervention period was 12 weeks. All patients underwent comprehensive assessment using validated instruments, including the GAD-7, the Beck Anxiety Inventory, the Hamilton Anxiety Rating Scale and the Zung Self-Rating Anxiety Scale. Anxiety severity was assessed at baseline and endpoint. Functional impairment was evaluated using a standardised functional assessment approach. Statistical analysis included paired sample t-tests for within-group comparisons and independent sample t-tests for between-group differences. Statistical significance was set at p<0.05.

Results

Both interventions were associated with statistically significant reductions in anxiety severity. In the cognitive behavioural therapy group, mean GAD-7 scores decreased from 15.4±2.2 at baseline to 6.5±2.3 at week 12 (p<0.001). In the pharmacological group, scores decreased from 15.7±2.4 to 8.8±2.6 (p<0.001).Between-group comparison demonstrated a statistically significant greater reduction in the cognitive behavioural therapy group (mean difference 2.3 points, p=0.02). Functional outcomes improved in both groups, with superior improvement observed in the cognitive behavioural therapy group (p=0.03). Pharmacological treatment was associated with faster symptom reduction during the initial four weeks; however, 27.3% of patients reported adverse effects, including gastrointestinal discomfort and increased sweating.

Conclusions

Cognitive behavioural therapy and selective serotonin reuptake inhibitors are both effective treatments for moderate generalised anxiety disorder in primary care. Cognitive behavioural therapy may provide more sustained benefits and improved functional recovery, while pharmacological treatment offers earlier symptomatic relief but may be associated with tolerability limitations. These findings support the importance of individualised, patient-centred treatment strategies integrating psychological and neurobiological mechanisms.

References

  1. American Psychiatric Association, 2013. Diagnostic and statistical manual of mental disorders, fifth ed. American Psychiatric Association Publishing, Washington.
  2. Bandelow, B., Sagebiel, A., Belz, M., Görlich, Y., Michaelis, S., Wedekind, D., 2017. Enduring effects of psychological treatments for anxiety disorders: a meta-analysis. Psychother. Psychosom. 86 (6), 268–276.
  3. Cuijpers, P., Sijbrandij, M., Koole, S.L., Huibers, M.J.H., Berking, M., Andersson, G., 2014. Psychological treatment of generalised anxiety disorder: a meta-analysis. Clin. Psychol. Rev. 34 (2), 130–140.
  4. Carl, E., Witcraft, S.M., Kauffman, B.Y., Gillespie, E.M., Becker, E.S., Cuijpers, P., Powers, M.B., 2020. Psychological and pharmacological treatments for generalised anxiety disorder: a meta-analysis. Depress. Anxiety 37 (6), 524–534.
  5. Andersson, G., Titov, N., 2022. Advantages and limitations of internet-based interventions for common mental disorders. World Psychiatry 21 (1), 54–65.