Being in Therapy Prior to COVID-19 Pandemic Prevented Anxiety Uptick During Its Peak

March 13, 2024

The start of the COVID-19 pandemic led to unprecedented exposure to stressors driven by fears of a novel and deadly disease, intense uncertainty, and resulting isolation measures, which in turn resulted in increases in anxiety for many.

According to new research, however, individuals who were in therapy for anxiety prior to the start of the pandemic did not experience upticks in their symptoms throughout this exceptionally challenging time.

Study Highlights

  • Researchers compared levels of anxiety among psychotherapy outpatients based on whether they initiated therapy before, during, or after the onset of COVID-19 pandemic
  • Authors say findings suggest that cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) can provide tools to help individuals manage anxiety in the face of major world events and upheaval

The new research, published March 13 in PLOS One, suggests that cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) provide tools to help individuals with anxiety manage their symptoms in the face of these intense stressors, according to the study’s authors.

“Our research suggests that CBT and DBT can offer major benefits to protect individuals’ mental health amidst a major world catastrophe and period of upheaval,” said lead study author David H. Rosmarin, PhD, ABPP, a clinical psychologist at McLean Hospital, and associate professor of psychology in the Department of Psychiatry at Harvard Medical School.

“People who have been treated for anxiety know that fighting it is not helpful, and that there are tools to help accept the current realities of their situations,” he added. “In some ways, having a previous anxiety disorder before a crisis occurs can be a blessing.”

Person sitting in therapy session with hands clasped

For the study, researchers compared the treatment trajectories of 764 individuals who participated in outpatient therapy and divided them into four groups based on when they initiated treatment:

  • Pre-pandemic (start date on or prior to December 31, 2019)
  • Pandemic onset (from January 1, 2020 to March 31, 2020)
  • During pandemic (from April 1, 2020 through December 31, 2020)
  • Post-pandemic once vaccines became available (on or after January 1, 2021)

Anxiety was measured at intake and at each subsequent session using the GAD-7 questionnaire, which assesses for anxiety symptoms. Then, the researchers analyzed the trajectories of anxiety and compared the four groups. Therapy consisted of CBT and DBT.

Their findings revealed that overall, patients presented with moderate anxiety when they began treatment. Symptoms rapidly decreased within 25 days of starting therapy, and gradually declined to mild anxiety over the remainder of their sessions.

When comparing the four groups of patients, the researchers found no substantive differences between groups. This suggests that treatment effects were robust to environmental stressors related to the pandemic.

Moreover, among patients who were in treatment at the start of the pandemic, the researchers did not detect an increase in anxiety during the initial acute phase of COVID-19 (March 20, 2020 through July 1, 2020).

Limitations of the study include that the participant pool, while demographically and clinically diverse, consisted primarily of highly educated individuals geographically specific to the northeastern United States. The pandemic-onset group was also smaller than the others, which may be attributed to limited availability of in-person therapy around that time.

This study also did not look at other mental health measures, including depression and substance use. More research is needed to gain insights into how these findings may be impacted in other regions of the country, and conditions aside from anxiety disorders.

Existing studies have shown that the COVID-19 pandemic adversely impacted mental health, with measurable increases in anxiety from the pandemic’s onset in early 2020 through the first availability of vaccinations in early 2021. One report from the World Health Organization found global prevalence of anxiety and depression increased by 25% in the first year of the pandemic.

“There is a widespread misperception that anxiety is a risk factor for people crumbling and not being able to function,” said Rosmarin. “However, when people receive evidence-based psychotherapy and learn skills to cope, they can become more resilient than those who have never had anxiety at all.”

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