The utilization pattern of Cognitive Behavior Therapy for anxiety disorders in adults: A naturalistic study from a Medical College Hospital

Background: Cognitive Behavior Therapy (CBT) for anxiety disorders is proved to be equally efficacious to medications in research settings. Is CBT effective in naturalistic settings? Studies in naturalistic setting are recently surfacing world over. Indian studies in this area are almost non-existent. Material and methods: Eighty adult patients satisfying criteria for an anxiety disorders as per Diagnostic and Statistical Manual of Mental disorders, 5th edition (DSM-5) were evaluated using appropriate rating scale and treated with medication only, CBT only or a combination. Socio-demographic variables between CBT (n=33) and no CBT (n=47) were compared. Various utilization parameters were evaluated. Results analyzed using statistical tests. Results: Education, economic status, closeness to hospital, younger age and male gender was associated with taking up psychotherapy. Panic disorder was 4 times prevalent than all other anxiety disorders. There was 59% primary dropout/refusal, 37% premature termination of CBT. Both refusal of 59% and premature termination of 14% of total sample add up to 73%. This indicated intent to treat number was 4. In this panic disorder dominant sample mean number of CBT sessions were 3.2 Conclusion: Treatment refusal and dropout from CBT is a significant problem among patients with anxiety in the general hospital psychiatry setup. At its darkest light, in this study intent to treat number is roughly 4. Still the silver line is that there are patients who utilize CBT and improve in this setup.