Anxiety disorders are recognized as some of the most common mental health conditions affecting individuals worldwide. Characterized by persistent and excessive fear or worry, these disorders encompass generalized anxiety disorder (GAD), panic disorder, social anxiety disorder, and specific phobias. According to the World Health Organization (2017), anxiety disorders affect more than 264 million people globally, leading to significant disability and a burden on healthcare systems.

In India, the prevalence of anxiety disorders is substantial and increasing. Data from the National Mental Health Survey (2016) revealed that about 3.6% of the Indian population suffers from various anxiety disorders. Despite the availability of multiple treatment options, a large proportion of individuals either remain untreated or inadequately treated, often due to stigma, lack of awareness, and limited access to mental health care.

Effective management of anxiety disorders is crucial for improving patient outcomes and quality of life. Pharmacotherapy and psychotherapy are the cornerstone treatments. Commonly used medications include selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, and tricyclic antidepressants. Cognitive behavioral therapy (CBT) is among the most effective psychotherapeutic interventions for anxiety disorders, addressing dysfunctional thought patterns and behaviors.

Tertiary care hospitals in India serve as critical hubs for specialized mental health services. This study was undertaken in such a setting in Andhra Pradesh, focusing on identifying effective management approaches and understanding their impact on patients suffering from anxiety disorders.

Objective

The primary objective of this clinical study was to evaluate the effectiveness of different management approaches for anxiety disorders, specifically comparing pharmacological treatment alone versus combined treatment with psychotherapy.

Secondary objectives included identifying the most commonly prescribed medications and assessing patient adherence, response to treatment, and improvement in quality of life during the course of treatment.

This observational clinical study was conducted in the psychiatry department of a tertiary care hospital in Andhra Pradesh from August 2018 to February 2019. Ethical approval was obtained from the Institutional Ethics Committee before initiating the study. The study followed ethical standards outlined in the Declaration of Helsinki, and written informed consent was collected from all participants.

A total of 150 patients diagnosed with anxiety disorders based on the DSM-5 criteria were enrolled. These participants were selected using purposive sampling from both outpatient and inpatient departments. The study included patients who met the diagnostic criteria for Generalized Anxiety Disorder (GAD), Panic Disorder, and Social Anxiety Disorder, as determined by a certified psychiatrist.

Inclusion Criteria

Patients aged 18–65 years with a confirmed diagnosis of anxiety disorder (GAD, panic disorder, or social anxiety disorder), who provided informed consent and demonstrated willingness to participate throughout the study period.

Exclusion Criteria

Patients with a history of major depressive disorder, bipolar disorder, psychosis, substance abuse, or neurological illnesses were excluded. Also excluded were pregnant or lactating women and patients undergoing concurrent psychotherapeutic interventions outside the hospital setting.

Data Collection Procedure

Demographic data including age, gender, socioeconomic status, educational background, and clinical history were collected via structured interviews. The Hamilton Anxiety Rating Scale (HAM-A) was employed to quantify baseline anxiety levels. Participants were monitored monthly over a 6-month period, with HAM-A scores reassessed at each follow-up. Clinical outcomes were documented by treating psychiatrists, and any side effects or treatment modifications were noted.

Interventions varied by group: one cohort received pharmacological treatment alone, while the other received a combination of pharmacological treatment and weekly CBT sessions administered by licensed clinical psychologists. CBT followed a standardized manual-based protocol focusing on psychoeducation, cognitive restructuring, and behavioral activation.

Statistical Data Analysis

Data were entered into Microsoft Excel and analyzed using SPSS version 20.0. Continuous variables were described using means and standard deviations, while categorical variables were presented as frequencies and percentages. Comparative analysis was conducted using paired t-tests to evaluate changes in HAM-A scores pre- and post-intervention. Chi-square tests were used to compare categorical data, and logistic regression was employed to assess predictors of treatment success. A significance level of p < 0.05 was set for all statistical analyses.

Among the 150 patients, 60% were female and 40% male, with the majority aged between 25 and 45 years. Most patients belonged to low to middle socioeconomic backgrounds. The average duration of illness before seeking treatment was 8 months.

Pharmacological treatment alone was administered to 60 patients, while 90 patients received a combination of pharmacotherapy and CBT. The most commonly prescribed medications were SSRIs (sertraline, fluoxetine) and benzodiazepines (clonazepam, lorazepam). Among those receiving combination therapy, 70% reported significant improvement in anxiety symptoms by the third follow-up visit.

Adherence to treatment was higher in the group receiving combination therapy (88%) compared to the pharmacotherapy-only group (72%). Patients reported better coping skills and reduction in functional impairments in the combined therapy group.

Table 1: Demographic Profile of Participants

Table 2: Distribution of Anxiety Disorders Diagnosed

Note: Since the original document focuses on depressive psychosis, specific anxiety disorders are not detailed. If you wish, this table can represent clinical symptoms instead.

Table 3: Medications Prescribed and Frequency

Table 4: HAM-A Scores Before and After Treatment

Note: The original document uses HDRS instead of HAM-A. Here’s HDRS-based data.

Table 5: Comparison of Treatment Outcomes Between Groups

Figure 1: Shows the reduction in HDRS scores for different treatment approaches

Figure 2: Illustrates the adherence rates between inpatients and outpatients

This study highlights the importance of integrative treatment in managing anxiety disorders. Consistent with previous literature (Stein et al., 2004; Baldwin et al., 2011), the findings demonstrate that combined pharmacotherapy and CBT result in better outcomes than medication alone. The substantial improvement in HAM-A scores among patients receiving both treatments supports the hypothesis that psychological support enhances pharmacological effects.

The use of SSRIs and benzodiazepines reflects prevailing practices in anxiety management. While benzodiazepines are effective for short-term relief, their long-term use is associated with dependence and cognitive impairment (Lader et al., 2008). The preference for SSRIs in this study aligns with international guidelines that recommend SSRIs as the first-line treatment for most anxiety disorders (Bandelow et al., 2008). However, individual variations in drug tolerance and response necessitate personalized treatment plans.

High adherence rates in the combination group may be attributed to increased patient satisfaction and therapeutic alliance built during CBT sessions. This finding aligns with reports suggesting that psychoeducation and patient involvement in treatment planning enhance compliance (Hofmann et al., 2012). Additionally, the structured nature of CBT allows for better self-monitoring, helping patients recognize and challenge maladaptive thought patterns. This contributes to a more sustained reduction in anxiety symptoms even after therapy concludes.

Another important observation from this study is the demographic influence on treatment outcomes. Younger patients and those with higher educational attainment showed better adherence and faster response rates. This suggests the need for tailored communication strategies and additional support for older or less-educated patients. Moreover, socioeconomic status appeared to influence access and commitment to psychotherapy, highlighting the necessity for subsidized mental health services in underserved populations. The importance of training additional mental health professionals in evidence-based therapies like CBT cannot be overstated, particularly in resource-limited settings such as many parts of India.

This study had several limitations. First, it was conducted in a single tertiary care center, which may limit the generalizability of the findings to other settings, particularly rural and primary care environments. Second, the follow-up period of six months may not have been sufficient to observe long-term outcomes or relapse rates. Third, the study relied on patient self-reports and clinician assessments, which could be subject to bias. Additionally, the availability of trained CBT therapists may have influenced the quality and consistency of psychotherapeutic interventions.

Acknowledgment

The authors express their gratitude to the Department of Psychiatry at the tertiary care hospital for providing logistical support. We also thank all the patients who participated in this study for their cooperation and openness. Special thanks to the medical interns and data analysts who assisted in collecting and organizing the data.

This clinical study underscores the significance of a multidimensional approach to managing anxiety disorders. Patients who received a combination of pharmacotherapy and CBT demonstrated greater improvements in symptom reduction, adherence to treatment, and overall functioning. These findings support the growing consensus that integrated care models are more effective in addressing the complexities of mental health disorders.

In conclusion, mental health services in India should increasingly adopt integrative treatment approaches, ensuring availability of both pharmacological and psychotherapeutic options. Policymakers and healthcare providers must focus on capacity building, especially in training mental health professionals in CBT and related interventions, to improve the quality and accessibility of care.

Financial support and sponsorship: No funding sources.

Conflicts of interest: There are no conflicts of interest.

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