Bibliotherapy for generalised anxiety disorder : a controlled trial comparison and exploration of factors related to outcome

The pilot study served to develop and initially evaluate a cognitive behavioural bibliotherapy programme for use in treating Generalised Anxiety Disorder. Administered during 16 one hour appointments with a Psychologist, the programme was associated with significant improvements in anxiety, depression and problem severity. The finalized programme comprised two components - information about anxiety and cognitive behavioural anxiety management guidance. In the main study 46 patients with a primary diagnosis of Generalised Anxiety Disorder were randomly allocated to one of two treatment conditions - receipt of the full programme or only the information component - or a waiting list control condition. Psychologist administration of the programme took 10 minutes. Patients in receipt of the full programme experienced significantly greater gains than those in the waiting list condition in self assessed anxiety, depression, quality of life, and stress. There were no other between condition differences, but a trend in pre to post changes favouring the full programme. The presence of other co-morbid anxiety or depression conditions did not affect outcome. Clinical improvements in both treatment conditions were associated with improvements in anxiety related health attitudes including self-efficacy. Additionally, clinical improvements in patients in the full programme condition were associated with improvements in coping skills and compliance with the programme. The potential inter-relationship between clinical, attitudinal and coping skills change, and programme compliance were discussed.