Having Therapy for Anxiety Before the Pandemic Prevented Uptick in Symptoms After

David H. Rosmarin, PhD, ABPP

Credit: Mass General Brigham, McLean Hospital

People who received therapy for anxiety before the COVID-19 pandemic had similar anxiety symptoms before, throughout, and after the pandemic, a new study found.¹ Therefore, these individuals did not experience an uptick in anxiety symptoms as many people did worldwide.

“We were surprised,” said investigator Steven Pirutinsky, PhD, assistant professor at the Graduate School of Social Work at Touro University, in a press release.² “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.”

The pandemic brought a lot of stress—from fearing the virus, uncertainty, frequent isolation, and job security, among many other things.¹ Studies saw increases in anxiety from the start of the pandemic in early 2020 to the arrival of the vaccinations in early 2021. World Health Organization reported the prevalence of anxiety and depression increased by 25 percent in the first year of the pandemic.³

However, as the study found, therapy—including cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT)—can manage and prevent further stress.¹

Led by David H. Rosmarin, PhD, ABPP, a clinical psychologist at McLean Hospital and associate professor of psychology at Harvard Medical School, the team conducted a study of 764 outpatients who participated in outpatient therapy. Investigators sought to assess the effects of the COVID-19 pandemic on responses to CBT and DBT for anxiety.

The team broke them into 4 groups based on when they started therapy: pre-pandemic (on or before December 31, 2019; n = 221), pandemic onset (January 1, 2020 – March 31, 2020; n = 42), during-pandemic (April 1, 2020 – December 31, 2020; n = 104), and post-pandemic (on or after January 1, 2021; n = 384). Anxiety was measured with the GAD-7 questionnaire. Rosmarin and colleagues compared treatment trajectories and effects between the groups over 5621 total time points with a mean of 7.38 measurements per patient.

During the study, patients with therapy had moderate levels of anxiety (M = 13.25; 95% confidence interval [CI], 12.87 – 13.62) which rapidly decreased for 25 days (M = 9.46; 95% CI, 9.09 – 9.83), and slowly decreased into the mild symptom range the rest of the study (M = 7.36; 95% CI, 6.81 – 7.91). The data revealed a clinically and statistically significant change in symptoms. Furthermore, multilevel regression models showed there were no significant differences between therapy start times, and no increase in anxiety during the acute pandemic phase (March 20, 2020 – July 1, 2020).

“There is a widespread misperception that anxiety is a risk factor for people crumbling and not being able to function,” Rosmarin said in the press release.² “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.”

Investigators pointed out several limitations—most of the participants were well-educated and often located in the northeastern United States, the pandemic-onset group was smaller than the other groups which could be because of limited in-person therapy at the time, and the study did not examine other mental health measures, such as depression or substance use.

“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,” Rosmarin said. “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…In some ways, having a previous anxiety disorder before a crisis occurs can be a blessing.”

^References

1. ^{Rosmarin, DH and Pirutinsky, S. Response to Anxiety Treatment Before, During, And After The COVID-19 Pandemic. PLoS ONE 2024; 19(3):e0296949. https://doi.org/10.1371/journal.pone.0296949}
2. ^{Being In Therapy Prior To COVID-19 Pandemic Prevented Anxiety Uptick During Its Peak. EurekAlert! March 13, 2024. https://www.eurekalert.org/news-releases/1037007?. Accessed March 13, 2024.}
3. ^{Wake-Up Call to All Countries to Step Up Mental Health Services and Support. World Health Organization. March 2, 2022. https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide. Accessed March 13, 2024.}