The role of exposure in treatment of anxiety disorders: a meta-analysis

OBJECTIVE: This meta-analysis aimed to determine the overall effect that psychotherapy has on anxiety disorders and to determine what moderates that effect. Studies were grouped by type (efficacy or effectiveness) and grouped by analysis type (completer or intent-to-treat). METHOD: Medline was searched for articles published between 2011 and 2014 that related to the treatment of anxiety disorders. An initial search revealed 8056 articles. Of these, 99 articles met inclusion criteria and were included in the final analyses. RESULTS: Overall, manualised psychotherapy outperformed control conditions. In general, psychotherapy for anxiety disorders had a large effect. This effect appeared to be moderated by the use or lack of use of exposure techniques, with greater effects if exposure was used. This finding held particularly true for the treatment of post-traumatic stress disorder. CONCLUSION: Psychotherapies for anxiety disorders are both efficacious and effective. Exposure techniques enhance the effect of therapies. Future research work is required to determine what else moderates the effect of such therapies.