Table 2.
Criteria included in definitions for treatment resistance anxiety disorders
| Treatment resistance definition criteria | n | % |
|---|---|---|
| Minimal number of failed treatments | ||
| Not part of definition | 9 | 14.5 |
| Included in definition | 53 | 85.5 |
| Unspecified or varying number | 7 | 11.3 |
| 1 failed treatment | 39 | 62.9 |
| 2 failed treatments | 3 | 4.8 |
| 3 or more failed treatments | 4 | 6.5 |
| Failed psychotherapy trials | ||
| Not part of definition | 44 | 71.0 |
| Included in definition | 18 | 29.0 |
| Any | 9 | 14.5 |
| At least one failed CBT trial | 7 | 11.3 |
| Varying number (stepped‐care or staging approach) | 2 | 3.2 |
| Failed pharmacological trials | ||
| Not part of definition | 4 | 6.5 |
| Included in definition | 58 | 93.5 |
| Unspecified number or type of failed pharmacological treatment | 27 | 43.5 |
| At least one failed SSRI/SNRI trial | 15 | 24.2 |
| At least one failed other pharmacotherapeutic trial | 14 | 22.6 |
| Varying number or types (stepped‐care or staging approach) | 2 | 3.2 |
| Other biological treatments | ||
| Not part of definition | 62 | 100 |
| Included in definition | 0 | 0 |
| Minimal length of treatment | ||
| Not part of definition | 28 | 45.2 |
| Included in definition | 34 | 54.8 |
| >4 weeks | 8 | 12.9 |
| >6 weeks | 3 | 4.8 |
| >8 weeks a | 15 | 24.2 |
| >11 weeks or 20 sessions of CBT | 1 | 1.6 |
| >12 weeks | 3 | 4.8 |
| >4 months | 2 | 3.2 |
| >6 months | 2 | 3.2 |
| Treatment response criterion | ||
| Not part of definition | 36 | 58.1 |
| Included in definition | 26 | 41.9 |
| Cut‐off values for effective/ failed treatment provided b | 26 | 41.9 |
| Minimal duration of anxiety disorder | ||
| Not part of definition | 60 | 96.8 |
| Included in definition | 2 | 3.2 |
| >1 year | 1 | 1.6 |
| >2 years | 1 | 1.6 |
| Severity of symptoms | ||
| Not part of definition | 33 | 53.2 |
| Included in definition | 29 | 46.8 |
| Aspecific criterion (e.g., “severe”) | 1 | 1.6 |
| Specific criterion (cut‐off values) provided c | 28 | 45.2 |
| Functional impairment | ||
| Not part of definition | 57 | 91.9 |
| Included in definition | 5 | 8.1 |
| Aspecific criterion (e.g., “marked impairments”) | 4 | 6.5 |
| Specific criteria (cut‐off values) provided d | 1 | 1.6 |
| Presence of comorbidity | ||
| Not part of definition | 61 | 98.4 |
| Included in definition | 1 | 1.6 |
| Comorbidity as exclusion criterion for TR‐AD | 1 | 1.6 |
Note: CBT: cognitive behavioral therapy; CGI‐I:Clinical Global Impression Improvement Scale; CGI‐S: Clinical Global Impression Severity Scale; HAM‐A: Hamilton Anxiety Rating Scale; LSAS: Leibowitz Social Anxiety Scale; PD(A): panic disorder (with or without agoraphobia); PDSS: Panic Disorder Severity Scale; SAD:social anxiety disorder; SDS: Sheehan Disability Scale; SSRI: selective serotonin reuptake inhibitor; SNRI: selective norepinephrine reuptake inhibitor.
including studies with minimal treatment duration of “2 months.”
the most often used criteria were: ∆HAM‐A < 50% or CGI‐I < 2.
the most often used criteria for severe symptomatology were HAM‐A < 16 or CGI‐S ≥ 4 (for all Anxiety Disorders), PDSS > 3 or any PDSS item > 1 (for PD(A)), LSAS > 60 (for SAD).
one study used SDS > 1 on each item as criterion for functional impairments.