Cognitive Behavioral Therapy Versus Pharmacotherapy for Generalized Anxiety Disorder at University of Nigeria Teaching Hospital, Enugu

Generalized anxiety disorder (GAD) is highly prevalent and impairing, yet comparative evidence on the effectiveness of cognitive behavioral therapy (CBT) versus pharmacotherapy in Nigerian clinical settings remains limited. This randomized controlled trial compares the effectiveness of individual CBT with first-line pharmacotherapy (escitalopram) in the treatment of GAD among outpatients at the University of Nigeria Teaching Hospital (UNTH), Enugu, South East Nigeria. Ninety patients meeting DSM-5 criteria for GAD will be randomized into three arms: CBT alone, pharmacotherapy alone, and combined treatment. The Generalized Anxiety Disorder-7 (GAD-7), Penn State Worry Questionnaire (PSWQ), and Sheehan Disability Scale (SDS) will measure outcomes at baseline, week 8, and week 16. Treatment fidelity for CBT will be assessed through session recordings and supervisor ratings. Intention-to-treat analysis using linear mixed models will compare outcomes across arms. Global evidence supports both modalities, but Nigerian data are largely anecdotal. This study will provide the first such comparative trial from South East Nigeria, generating actionable evidence for GAD treatment guidelines in tertiary psychiatric care. Keywords: generalized anxiety disorder, CBT, pharmacotherapy, randomized controlled trial, UNTH Enugu