***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The number of published systematic review s of studies of healthcare interventions has increased rapidly and these are used extensively for clinical and policy decisions . Systematic review s are subject to a range of biases and increasingly include non-r and omised studies of interventions . It is important that users can distinguish high quality review s. Many instruments have been design ed to evaluate different aspects of review s , but there are few comprehensive critical appraisal instruments . AMSTAR was developed to evaluate systematic review s of r and omised trials . In this paper , we report on the updating of AMSTAR and its adaptation to enable more detailed assessment of systematic review s that include r and omised or non-r and omised studies of healthcare interventions , or both . With moves to base more decisions on real world observational evidence we believe that AMSTAR 2 will assist decision makers in the identification of high quality systematic review s , including those based on non-r and omised studies of healthcare interventions Abstract This r and omized controlled trial was design ed to determine if art therapy in conjunction with Cognitive Processing Therapy ( CPT ) was more effective for reducing symptoms of combat posttraumatic stress disorder ( PTSD ) than CPT alone . Veterans ( N = 11 ) were r and omized to receive either individual CPT , or individual CPT in conjunction with individual art therapy .  PTSD Checklist – Military Version and Beck Depression Inventory – II scores improved with treatment in both groups with no significant difference in improvement between the experimental and control groups . Art therapy in conjunction with CPT was found to improve trauma processing and veterans considered it to be an important part of their treatment as it provided healthy distancing , enhanced trauma recall , and increased access to emotions BACKGROUND  Generalized social phobia is common , persistent , and disabling and is often treated with selective serotonin reuptake inhibitor drugs or cognitive behavioral therapy . OBJECTIVE We compared fluoxetine ( FLU ) , comprehensive cognitive behavioral group therapy ( CCBT ) , placebo ( PBO ) , and the combinations of CCBT/FLU and CCBT/PBO . DESIGN R and omized , double-blind , placebo-controlled trial . SETTING Two academic outpatient psychiatric centers . PATIENTS Subjects meeting a primary diagnosis of generalized social phobia were recruited via advertisement . Seven hundred twenty-two were screened , and 295 were r and omized and available for inclusion in an intention-to-treat efficacy analysis ; 156 ( 52.9 % ) were male , 226 ( 76.3 % ) were white , and mean age was 37.1 years . INTERVENTIONS Treatment lasted for 14 weeks . Fluoxetine and PBO were administered at doses from 10 mg/d to 60 mg/d ( or equivalent ) . Group comprehensive cognitive behavioral therapy was administered weekly for 14 sessions . MAIN OUTCOME MEASURES An independent blinded evaluator assessed response with the Brief Social Phobia Scale and Clinical Global Impressions scales as primary outcomes . A videotaped behavioral assessment served as a secondary outcome , using the Subjective Units of Distress Scale . Adverse effects were measured by self-rating . Each treatment was compared by means of chi2 tests and piecewise linear mixed-effects models . RESULTS Clinical Global Impressions scales response rates in the intention-to-treat sample were 29 ( 50.9 % ) ( FLU ) , 31 ( 51.7 % ) ( CCBT ) , 32 ( 54.2 % ) ( CCBT/FLU ) , 30 ( 50.8 % ) ( CCBT/PBO ) , and 19 ( 31.7 % ) ( PBO ) , with all treatments being significantly better than PBO . On the Brief Social Phobia Scale , all active treatments were superior to PBO . In the linear mixed-effects models analysis , FLU was more effective than CCBT/FLU , CCBT/PBO , and PBO at week 4 ; CCBT was also more effective than CCBT/FLU and CCBT/PBO . By the final visit , all active treatments were superior to PBO but did not differ from each other . Site effects were found for the Subjective Units of Distress Scale assessment , with FLU and CCBT/FLU superior to PBO at Duke University Medical Center , Durham , NC . Treatments were well tolerated . CONCLUSIONS All active treatments were superior to PBO on primary outcomes . Combined treatment did not yield any further advantage . Notwithst and ing the benefits of treatment , many patients remained symptomatic after 14 weeks Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Abstract Objective . Anxiety disorders are frequently under-diagnosed conditions in primary care , although they can be managed effectively by general practitioners . Methods . This paper is a short and practical summary of the World Federation of Biological Psychiatry ( WFSBP ) guidelines for the pharmacological treatment of anxiety disorders , obsessive – compulsive disorder ( OCD ) and posttraumatic stress disorder ( PTSD ) for the treatment in primary care . The recommendations were developed by a task force of 30 international experts in the field and are based on r and omized controlled studies . Results . First-line pharmacological treatments for these disorders are  selective serotonin reuptake inhibitors  ( for all disorders ) ,  serotonin-norepinephrine reuptake inhibitors  ( for some ) and  pregabalin  ( for generalized anxiety disorder only ) . A combination of  medication and cognitive behavior/exposure therapy  was shown to be a clinical ly desired treatment strategy . Conclusions . This short version of an evidence -based guideline may improve treatment of anxiety disorders , OCD , and PTSD in primary care Abstract Studies on group treatment of posttraumatic stress disorder ( PTSD ) in asylum seekers and refugees are scarce . The aim of this study was to evaluate the effectiveness of three different trauma-focused day-treatment group programs for treatment of PTSD in male asylum seekers and refugees . Three treatment groups ( n = 56 ) and a waitlisted control group ( n = 16 ) of help-seeking Iranian and Afghani patients were assessed with a set of self-rated symptom checklists for PTSD , anxiety , depression , and psychoticism 1 week before and 2 weeks after treatment . There are no indications that the 2 days ’ group program with three nonverbal and two group psychotherapy sessions per week is less effective in reducing symptoms than the program with the same amount of sessions spread over 3 days per week . The trauma-focused day-treatment group seems a promising approach for treatment of PTSD among asylum seekers and refugees in industrialized setting Background : Guided Internet-based cognitive behavior therapy ( ICBT ) has been tested in many trials and found to be effective in the treatment of  anxiety and mood disorders .  Generalized anxiety disorder ( GAD ) has also been treated with ICBT , but there are no controlled trials on guided Internet-based psychodynamic treatment ( IPDT ) . Since there is preliminary support for psychodynamic treatment for GAD , we decided to test if a psychodynamically informed self-help treatment could be delivered via the Internet . The aim of the study was to investigate the efficacy of IPDT for GAD and to compare against ICBT and a waiting list control group . Method : A r and omized controlled superiority trial with individuals diagnosed with GAD comparing guided ICBT ( n = 27 ) and IPDT ( n = 27 ) against a no treatment waiting list control group ( n = 27 ) . The primary outcome measure was the Penn State Worry Question naire . Results : While there were no significant between-group differences immediately after treatment on the main outcome measure , both IPDT and ICBT result ed in improvements with moderate to large within-group effect sizes at 3 and 18 months follow-up on the primary measure in the completer analyses . The differences against the control group , although smaller , were still significant for both PDT and CBT when conforming to the criteria of clinical ly significant improvement . The active treatments did not differ significantly . There was a significant group by time interaction regarding GAD symptoms , but not immediately after treatment . Conclusions : IPDT and ICBT both led to modest symptom reduction in GAD , and more research is needed OBJECTIVE Various approaches to cognitive-behavioral therapy ( CBT ) have been shown to be effective for social anxiety disorder . For psychodynamic therapy , evidence for efficacy in this disorder is scant . The authors tested the efficacy of psychodynamic therapy and CBT in social anxiety disorder in a multicenter r and omized controlled trial . METHOD In an outpatient setting , 495 patients with social anxiety disorder were r and omly assigned to manual-guided CBT ( N=209 ) , manual-guided psychodynamic therapy ( N=207 ) , or a waiting list condition ( N=79 ) . Assessment s were made at baseline and at end of treatment . Primary outcome measures were rates of remission and response , based on the Liebowitz Social Anxiety Scale applied by raters blind to group assignment . Several secondary measures were assessed as well . RESULTS Remission rates in the CBT , psychodynamic therapy , and waiting list groups were 36 % , 26 % , and 9 % , respectively . Response rates were 60 % , 52 % , and 15 % , respectively . CBT and psychodynamic therapy were significantly superior to waiting list for both remission and response .  CBT was significantly superior to psychodynamic therapy for remission but not for response . Between-group effect sizes for remission and response were small . Secondary outcome measures showed significant differences in favor of CBT for measures of social phobia and interpersonal problems , but not for depression . CONCLUSIONS CBT and psychodynamic therapy were both efficacious in treating social anxiety disorder , but there were significant differences in favor of CBT . For CBT , the response rate was comparable to rates reported in Swedish and German studies in recent years . For psychodynamic therapy , the response rate was comparable to rates reported for pharmacotherapy and cognitive-behavioral group therapy CONTEXT Medication and cognitive behavioral treatment are the best-established treatments for social anxiety disorder , yet many individuals remain symptomatic after treatment . OBJECTIVE To determine whether combined medication and cognitive behavioral treatment is superior to either monotherapy or pill placebo . DESIGN R and omized , double-blind , placebo-controlled trial . SETTING Research clinics at Columbia University and Temple University . PARTICIPANTS One hundred twenty-eight individuals with a primary DSM-IV diagnosis of social anxiety disorder . INTERVENTIONS Cognitive behavioral group therapy ( CBGT ) , phenelzine sulfate , pill placebo , and combined CBGT plus phenelzine . MAIN OUTCOME MEASURES Liebowitz Social Anxiety Scale and Clinical Global Impression ( CGI ) scale scores at weeks 12 and 24 . RESULTS Linear mixed-effects models showed a specific order of effects , with steepest reductions in Liebowitz Social Anxiety Scale scores for the combined group , followed by the monotherapies , and the least reduction in the placebo group ( Williams test = 4.97 , P < .01 ) . The CGI response rates in the intention-to-treat sample at week 12 were 9 of 27 ( 33.3 % ) ( placebo ) , 16 of 34 ( 47.1 % ) ( CBGT ) , 19 of 35 ( 54.3 % ) ( phenelzine ) , and 23 of 32 ( 71.9 % ) ( combined treatment ) ( chi(2)(1 ) = 8.76 , P < .01 ) . Corresponding remission rates ( CGI = 1 ) were 2 of 27 ( 7.4 % ) , 3 of 34 ( 8.8 % ) , 8 of 35 ( 22.9 % ) , and 15 of 32 ( 46.9 % ) ( chi(2)(1 ) = 15.92 , P < .01 ) . At week 24 , response rates were 9 of 27 ( 33.3 % ) , 18 of 34 ( 52.9 % ) , 17 of 35 ( 48.6 % ) , and 25 of 32 ( 78.1 % ) ( chi(2)(1 ) = 12.02 , P = .001 ) . Remission rates were 4 of 27 ( 14.8 % ) , 8 of 34 ( 23.5 % ) , 9 of 35 ( 25.7 % ) , and 17 of 32 ( 53.1 % ) ( chi(2)(1 ) = 10.72 , P = .001 ) . CONCLUSION Combined phenelzine and CBGT treatment is superior to either treatment alone and to placebo on dimensional measures and on rates of response and remission BACKGROUND To investigate the short-term cost-effectiveness of cognitive-behavioral therapy ( CBT ) and psychodynamic therapy ( PDT ) compared to waiting list ( WL ) . METHODS The analysis was conducted alongside the SOPHO-NET multi-center efficacy trial . Patients were r and omly assigned to CBT ( n=209 ) , PDT ( n=207 ) , or WL ( n=79 ) . Re source use was assessed prior and during treatment to determine direct and absenteeism costs . Unadjusted incremental cost-effectiveness ratios ( ICERs ) were calculated based on remission and response rates . To visualize statistical uncertainty , cost-effectiveness acceptability curves ( CEACs ) were constructed based on adjusted net-benefit regression . Different values for the society׳s willingness to pay ( WTP ) were assumed . RESULTS Both intervent 
    Output:
    
There is some evidence of effectiveness of AT for pre-exam  anxiety  in undergraduate students .
AT is possibly effective in reducing pre-release anxiety  in prisoners .
The AT characteristics varied and narrative synthesis led to hypothesized working mechanisms of AT : induce relaxation ; gain access to unconscious traumatic memories , thereby creating possibilities to investigate cognitions ; and improve emotion regulation .
This emphasizes the need for high quality trials study ing the effectiveness of AT on anxiety