Being in therapy prior to COVID-19 pandemic prevented anxiety uptick during its peak

• 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

Belmont, Mass. – (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.

The new research suggests that cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT) provided tools to help individuals with anxiety to manage their symptoms in the face of these intense stressors, according to the study’s authors. The study, led by psychologists at McLean Hospital, a member of Mass General Brigham, and Touro University, published March 13^th in PLOS One.

“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,” says lead study author David H. Rosmarin, PhD, ABPP, a clinical psychologist at McLean Hospital, and associate professor of psychology 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.”             

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 12/31/2019), pandemic-onset (from 01/01/2020 to 03/31/2020), during-pandemic (from 04/01/2020 through 12/31/2020), and post-pandemic once vaccines became available (on or after 01/01/2021).

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, which 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, suggesting 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).

“We were surprised. We thought that during the height of the pandemic and before vaccines were available, patients would show increased anxiety and that therapy would be less effective but that was not the case,” says study co-author Steven Pirutinsky, PhD, assistant professor at Graduate School of Social Work at Touro University.

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 fist availability of vaccinations in early 2021. One report from the World Health Organization found global prevalence of anxiety and depression increased by 25 percent 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,” says 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.”

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. The 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.

Authorship: Authors of the study were David H. Rosmarin, PhD, of McLean Hospital and Harvard Medical School, and Steven Pirutinsky of Touro University in New York.
Disclosures: The authors have declared no competing interests.
Funding: This research was supported by the McLean Hospital Fund, grant no. 041537.
Paper cited:  Rosmarin, DH et al. “Response to Anxiety Treatment Before, During, and After the COVID-19 Pandemic.” PLOS One DOI: 10.1371/journal.pone.0296949

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