Physician-Led CBT Skills Group Eases Anxiety and Depression in Primary Care

A primary care-based cognitive behavioural therapy (CBT) skills group led by physicians was associated with meaningful reductions in depression and anxiety symptoms, according to a longitudinal cohort study published in BMC Primary Care. The strongest and most consistent evidence emerged at three months after the eight-week program, while longer-term findings proved highly sensitive to how missing follow-up data were handled, leading the authors to label outcomes beyond three months exploratory rather than confirmatory.

The observational cohort study followed adult patients with mild to moderate anxiety and/or depression who completed the CBT Skills Group program, an eight-week course delivered in a primary care setting. Participants completed validated self-report questionnaires, the PHQ-8 for depressive symptoms and the GAD-7 for anxiety symptoms, at baseline, at program completion, and at three, six and twelve months after the intervention. Reporting followed the STROBE guidelines for observational studies.

Retention posed a substantial challenge. Of 206 invited participants, 67 formed the analytic cohort. Complete-case paired analyses included 57 and 55 participants at three months for the PHQ-8 and GAD-7 respectively, 43 and 45 at six months, and only 26 and 25 at twelve months. By the final follow-up, outcome availability had declined to roughly 40 percent of the analytic cohort, a level of attrition that shapes how the longer-term results can be interpreted.

Across the primary analyses, PHQ-8 and GAD-7 scores were significantly lower than baseline at all three follow-up points when the researchers applied complete-case analysis, last observation carried forward (LOCF), or multiple imputation by chained equations (MICE). These three approaches represent increasingly sophisticated statistical strategies for coping with participants whose follow-up questionnaires are missing, and their agreement initially suggested a durable symptom benefit.

The picture changed under a more conservative extreme-value approach, which makes pessimistic assumptions about the outcomes of participants lost to follow-up. Under that method, only the GAD-7 improvement at three months remained statistically significant. More strikingly, at twelve months both measures showed a statistically significant change in the opposite direction, an apparent deterioration, illustrating how dramatically conclusions about long-term benefit can flip depending on assumptions about missing data amid substantial attrition.

The authors concluded that group-based CBT skills training in primary care was associated with reductions in depression and anxiety symptoms, with the strongest evidence at three months. Because observed-data, LOCF and MICE analyses pointed toward continued benefit while outcome availability fell sharply, they advised that longer-term findings should be considered exploratory and confirmed in future studies with improved retention.

Beyond the symptom scores, the study collected qualitative responses at twelve months from 25 participants. Most of these respondents reported that they continued using the CBT skills they had learned. The researchers cautioned, however, that these responses reflect only participants who remained engaged with follow-up, so they cannot be generalised to everyone who started the program.

The CBT Skills Group model is designed to fit the realities of publicly funded primary care. Rather than relying on scarce one-on-one psychotherapy slots, it trains groups of patients in CBT techniques under physician leadership, a format the authors suggest may offer a scalable and accessible option for mental health support, pending confirmation of longer-term outcomes. As with any observational cohort without a randomised control group, the findings show associations between program participation and symptom change rather than definitive causal effects, and the modest analytic cohort limits precision. The study’s central contribution lies in its transparent handling of uncertainty: by comparing multiple missing-data methods side by side, it shows both the promise of group CBT in primary care and the caution required before claiming benefits that persist a full year after the course ends.

Subject of Research: Long-term outcomes of a physician-led cognitive behavioural therapy skills group for anxiety and depression in primary care

Article Title: Outcomes following a physician-led CBT skills group for anxiety and depression in primary care: a longitudinal cohort study

Article References: Pawluk, A., Ward, G., & Niyyati, S. (2026). Outcomes following a physician-led CBT skills group for anxiety and depression in primary care: a longitudinal cohort study. BMC Primary Care. https://doi.org/10.1186/s12875-026-03599-6

Image Credits: AI Generated

DOI: 10.1186/s12875-026-03599-6

Keywords: CBT, primary care, anxiety, depression, cohort study, PHQ-8, GAD-7, missing data, group therapy, mental health, Outcomes, following