Comparative Efficacy of Brief Psychoanalytic Psychotherapy and Cognitive Behavioral Therapy for Generalized Anxiety Disorder: A Randomized Controlled Trial

Abstract

Background: Cognitive behavioral therapy (CBT) is the most established psychological treatment for generalized anxiety disorder (GAD), yet many patients do not achieve full remission. Brief psychoanalytic psychotherapy represents a theoretically distinct alternative, but direct controlled comparisons remain limited. This study examined the short-term efficacy of brief psychoanalytic psychotherapy and CBT relative to a waitlist control in adults with GAD. Methods: In a three-arm randomized controlled trial, 60 adults with DSM-5-diagnosed GAD were allocated to brief psychoanalytic psychotherapy (12 weekly sessions), CBT (12 weekly sessions), or a waitlist control. Assessments were conducted at pre-treatment and post-treatment. The primary outcome was anxiety severity measured by the Beck Anxiety Inventory (BAI). Secondary outcomes included depressive symptoms (BDI-II), quality of life (WHOQOL-BREF), functional impairment (WHODAS 2.0), and therapeutic alliance (Working Alliance Inventory). Data were analyzed using mixed-design ANOVAs and effect size estimates. Results: Both active treatments produced significantly greater reductions in anxiety than the waitlist control, with large effect sizes. Mean BAI scores decreased by 14.5 points in the psychoanalytic group and 16.3 points in the CBT group, compared to minimal change in the waitlist condition. Similar patterns were observed for depressive symptoms, quality of life, and functional impairment, with both therapies outperforming waitlist controls on all secondary outcomes. No statistically significant differences were found between CBT and brief psychoanalytic psychotherapy on any outcome measure. Therapeutic alliance ratings were high and comparable across the two active treatments. Conclusions: Brief psychoanalytic psychotherapy and CBT were both effective short-term treatments for GAD and superior to no treatment, with no significant differences between the two modalities at post-treatment. These findings suggest that time-limited psychoanalytic psychotherapy may represent a promising short-term therapeutic option to CBT for GAD, expanding treatment options for patients and clinicians. © 2026 by the authors.