Abstract
BACKGROUND: The COVID-19 pandemic yielded a substantial increase in worldwide prevalence and severity of anxiety, but less is known about effects on anxiety treatment. OBJECTIVE: We evaluated effects of the COVID-19 pandemic on responses to Cognitive Behavioral Therapy for anxiety, in a clinically heterogeneous sample of patients. METHODS: A sample of 764 outpatients were separated into four groups: (1) Pre-pandemic (start date on or prior to 12/31/2019), (2) Pandemic-Onset (start date from 01/01/2020 to 03/31/2020), (3) During-Pandemic (start date from 04/01/2020 through 12/31/2020), and (4) Post-Pandemic (start date on or after 01/01/2021). We subsequently compared treatment trajectories and effects within and between these groups over 5621 total time points (mean of 7.38 measurements per patient). RESULTS: Overall, patients presented with moderate levels of anxiety (M = 13.25, 95%CI: 12.87, 13.62), which rapidly decreased for 25 days (M = 9.46, 95%CI: 9.09, 9.83), and thereafter slowly declined into the mild symptom range over the remainder of the study period (M = 7.36, 95%CI: 6.81, 7.91), representing clinically as well as statistically significant change. A series of conditional multilevel regression models indicated that there were no substantive differences between groups, and no increase in anxiety during the acute pandemic phase. CONCLUSIONS: Our results suggest that responses to treatment for anxiety were equivalent before, during, and after the COVID-19 pandemic. Among patients who were in treatment prior to the pandemic, we failed to detect an increase in anxiety during the pandemic's acute phase (March 20th, 2020 through July 1st, 2020).