Running Head: USE OF PSYCHOTHERAPY FOR TREATING ANXIETY DISORDERS

USE OF PSYCHOTHERAPY FOR TREATING ANXIETY DISORDERS

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PSYCOTHERAPY & ANXIETY DISORDERS 2

INTRODUCTION

After extensive research on how the psychological treatments effect, a resolution has

recently been passed by the American Psychological Association (APA), identifying that

psychotherapy has significant clinical impact. In order to identify whether anxiety disorders can

be treated by the psychological therapy, strong evidence is required which is available through

different studies and researches (Clark, Hanstock & Clark, 2016). Anxiety has been defined as an

unpleasant state of emotions with fear as its main characteristic and unwanted thoughts and

distressing physical symptoms. World Health Organization (WHO) conducted a survey on 25000

people from across 14 countries; it was identified that 8% of the respondents had an anxiety

disorder. The most common form of mental disorder found in UK is a mix of anxiety and

disorder. The survey by NHS identifies that one in three adults which makes roughly 37% of the

population between the ages of 16-74, who has the anxiety disorder, were accessing the

treatment for mental health in 2014 (NHS Digital, 2016). The most common form of disorders

diagnosed in children, adolescents and elderly are the anxiety disorders. Mostly, the anxiety

disorders are treated through psychological therapies that vary depending on the type and nature

of the disorder. This paper tends to focus on the available strong evidence that psychotherapy is

used for treating anxiety disorders.

ANXIETY DISORDERS & PSYCHOTHERAPY

There are several types of anxiety disorders (Clark, Hanstock & Clark, 2016; Kase &

Ledley, 2007), with varying characteristics including: panic disorder, obsessive compulsive

disorder (OCD), generalized anxiety disorder (GAD), specific phobias and post-traumatic stress

disorder (PTSD).
PSYCOTHERAPY & ANXIETY DISORDERS 3

In certain anxiety disorders, particular symptoms may arise like dizziness, shortness of breath,

trembling and rise in heart rate. There is no particular time in which these disorders may begin in

life, but mostly the anxiety disorders surface in either early adulthood or adolescence. Some

evidence is also available of anxiety disorders of having genetic tendency but in certain cases.

The anxiety disorders cannot be left unattended could lead to severe consequences in the long

run. If the disorder is not properly treated then, the individual could incur avoidance behavior

due to the fear of triggering an attack, which may result in conflicting with basic activities of the

daily life. Furthermore, people whose anxiety disorder remains untreated are more prone to

developing other psychological disorders like depression, and also have higher chances of

getting involved in alcohol and drug abuse.

Psychotherapies have been developed to ensure that a wide variety of mental and health

conditions can be treated. It also helps to spread awareness regarding the strengths of the

findings of the research in relation to a particular disorder. This information is useful not only for

the patients seeking treatment and the clinicians who deliver the treatment, but it is also helpful

for those who develop the policies with regards to the treatment. The disorder-specific

information is provided by several sources like scholarly articles (Nathan & Gorman, 2007;

Weisz & Kazdin, 2010), guidelines for clinical practice (for instance, National Institute for

Health and Care Excellence, http://www.nice.org.uk), and the practice reviews that have been

produced by professional organizations (for instance, Australian Psychological Society, 2010). A

significant example is the systematic review of the research literature produced by the Australian

Psychological Society (2010), on the usefulness of psychological interventions to address the

mental health problems like anxiety disorders, eating disorders, sleep disorders, personality

disorders and other disorders that become apparent in childhood.

To deal with anxiety, the best way is to become informed about the options for treatment

and then tailor them according to your needs. Through therapy, one becomes aware of what and

why they feel in a particular way, what triggers those feelings and how could they overcome it.

There are numerous types of therapies available but mostly three traditional methods are blended

together known as cognitive behavioral therapy, interpersonal therapy and psychodynamic

therapy. The cognitive/behavioral therapy focuses on identifying and changing the patterns of

thinking and behaviors by recognizing the worries and negative thinking styles. The first step is

to identify the negative thoughts; then the therapist teaches the patient to evaluate those thoughts

by weighing the pros and cons and determining how this would happen in real life. After

identification of the anxiety, the negative thoughts are replaced by positive ones. For instance,

David was fearful of taking subway as he thought he would pass out despite the convincing by

everyone. His therapist asked him to write down what errors were present in his thinking and

rationally interpret it. CBT requires practicing at home too as the habit is only broken through

practice. Through interpersonal therapy, the disturbed personal relationships of the patient are

focused upon that are causing negative feelings. Exposure therapy is helpful for patients who

learn to avoid the situation out of fear like leaving a friend's wedding due to the prospect of

speaking in public. Exposure therapy exposes the person repeatedly to the situation until one

feels that they have control over the situation and anxiety reduces. Either the therapist asks the

patient to imagine the situation, or may actually confront in real life.

National Institute of Mental Health has identified that anxiety disorders can be treated by

both cognitive therapy and behavioral therapy in a highly effective manner. PTSD is considered

to be caused by cognitive behavioral factors since the unconditioned stimulus is related to the

anxiety that was felt during the traumatic event. Due to PTSD, individuals may start avoiding the
PSYCOTHERAPY & ANXIETY DISORDERS 5

places, people and even the objects that may remind them of the trauma, leading to a complete

disconnection with the society. One of the main psychological treatments for PTSD is Cognitive

Behavioral Therapy (CBT). Through CBT, the behavior of the people is modified; the initial

thoughts associated with the situation are identified and then the patient is helped to overcome

through different tactics which also includes relaxation to deal in case of relapse. The cognitive

part influences the thinking pattern of the people so that their fears are no more supported, while

the behavioral part helps the people in changing their reaction to the situations that may provoke

anxiety.

In a study conducted by Taylor et al. (2001), 50 people involved in a road traffic

collision were studied over a 12-week course. Among these, 45 participants also completed a

follow-up of 3 months where they received 6 stages of CBT which included learning about CBT,

cognitive restructuring, relaxation and exposure tactics. The researchers identified that there was

a significant reduction in the symptoms of PTSD after the treatment. In another study conducted

on Latino women, Hinton, Hoffman, Rivera, Otto and Pollack (2011), identified that CBT is

highly effective in managing the treatment of PTSD. 12 participants were given muscle

relaxation therapy while the other 12 were given CBT which was adapted culturally. The

assessment was taken both before and after the treatment as well as at a 12-week follow up. The

women being treated through culturally adapted CBT showed more significant improvement in

the symptoms as compared to the rest. This research indicates that not only CBT has an element

of treating cross-culturally but it has more efficacy in treating PTSD. In yet another study that

was conducted by Felmingham and Bryant (2012), it was found that gender differences can also

play a significant role in determining the outcomes of different therapies as men displayed severe

symptoms of PTSD as compared to women in the long run.

The most common form of psychiatric disorder diagnosed in children and adolescents are

anxiety disorders (Stockman, 2012). Pediatric anxiety disorder is linked to functional difficulty

in children which then persists into their adulthood leading to functional impairment and other

psychiatric disorders (Beesdo-Baum & Knappe, 2012). CBT have been found to be useful in

dealing with panic disorder. In a clinical trial (Pincus, May, Whitton, Mattis & Barlow, 2010), 26

adolescents were randomly chosen between the ages of 14-17, diagnosed with panic disorder, to

receive the panic control treatment for adolescents (PCT-A) for a time period of 11 weeks. This

involved self-monitoring panic symptoms and the monitoring was reviewed every two weeks in

a meeting with the therapist. After the treatment, the group receiving PCT-A was identified to

have reduced the panic symptoms as compared to those who had control condition. It has also

been identified through clinical trials that CBT is highly useful for overcoming pediatric social

anxiety disorder (Spence, Donovan & Brechman-Toussaint, 2000; PIET, HOUGAARD,

HECKSHER & ROSENBERG, 2010). In a clinical trial, 50 youths between the ages of 7 to 14

were randomly assigned to a 12-week study of child-focused CBT, CBT along with involvement

of the parent, or to a waitlist condition. After the treatment period ended, it was identified that

the patients assigned to CBT groups (58% and 87.5%) had higher rates of remission as compared

to those in the control group (7%). After a follow up of 12 months, it was found that there was

more efficacy when CBT was combined to the parent involvement (81%) as compared to only

CBT (53%) (Spence, Donovan & Brechman-Toussaint, 2000).

GAD is a common disorder often linked to depression, physical illnesses and dependence

on alcohol. Women are twice as likely them men to be affected by GAD as there is a lifetime

prevalence of 7% in women while 4% in men (Bolognesi, Baldwin & Ruini, 2014). Since, there

is no specific cause of worry to appear in GAD, the exposure techniques have very limited
PSYCOTHERAPY & ANXIETY DISORDERS 7

influence. The first choice of treating GAD has been CBT. Borkovec and Ruscio (2001)

reviewed 13 controlled studies; it was found that the CBT approaches had significant efficacy as

compared to the only cognitive or only behavioral interventions. A novel treatment has emerged

in the recent era as there has been a development of 'well-being therapy'(WBT) (Fava, 1999;

Ruini & Fava, 2009). It has certain mutual elements with CBT like using diary, interacting of the

patient and the therapist and homework assignments, but the main focus is on the psychological

well-being of the patient. The therapist aims to improve 6 dimensions: autonomy, personal

growth, environmental mastery, purpose in life, positive relationship with others, and self-

acceptance. In a study (Ruini & Fava, 2009), 20 GAD patients were chosen and divided into two

random groups; the first group undertook 8 CBT sessions, while the second had 4 sessions of

CBT and 4 sessions of WBT, with a follow-up after a year. Significant improvement was noticed

in the sequential approach CBT/WBT in the symptoms of anxiety, not only at the end of the

treatment but also after the follow-up.

CONCLUSION

There have been several studies and researches that provide strong evidence that using

psychotherapy for treating anxiety disorder has high efficacy. Despite the gender difference or

age difference, the impact of using psychotherapy techniques is more in the patients suffering

from anxiety disorder. CBT is the most common form of psychotherapy which has higher rates

of success in treating the anxiety disorder. There are several other psychotherapy tactics too but

in the case of CBT, both the thinking and the behavior is modified which has a lasting impact on

the patient. By combining CBT with relaxation, exposure, parent involvement and other
PSYCOTHERAPY & ANXIETY DISORDERS 8

methods, the efficacy of the treatment can be enhanced depending on the situation and the

condition of the patient. In conclusion, it has become evident from all the data provided and the

above discussion that in order to treat anxiety disorder, the best and the most efficient tactic is

using psychotherapy. The paper has focused on providing evidence that assures the positive role

played by psychotherapy in the treatment of the anxiety disorder. Since the symptoms are usually

clear in the childhood or the early adolescent, relevant studies have also been included.
PSYCOTHERAPY & ANXIETY DISORDERS 9

REFERENCES

Australian Psychological Society. (2010). Evidence- based psychological interventions in the

treatment of mental disorders: A literature review [Ebook] (3rd ed.). Retrieved from

http://www.psychology.org.au/As- sets/Files/Evidence-Based-Psychological-Interven-

tions.pdf

Beesdo-Baum, K., & Knappe, S. (2012). Developmental Epidemiology of Anxiety Disorders.

Child And Adolescent Psychiatric Clinics Of North America, 21(3), 457-478. doi:

10.1016/j.chc.2012.05.001

Bolognesi, F., Baldwin, D., & Ruini, C. (2014). Psychological interventions in the treatment of

generalized anxiety disorder: a structured review. Journal Of Psychopathology, 20, 111-

126.

Borkovec, T., & Ruscio, A. (2001). Psychotherapy for generalized anxiety disorder. Journal Of

Clinical Psychiatry, 62(11), 37-42.

Clark, G., Hanstock, T., & Clark, L. (2016). Psychological Treatment of Co-occurring Anxiety

Disorders in Clinical Practice: A Vignette Study. Australian Psychologist, 52(6), 480-

490. doi: 10.1111/ap.12214

Fava, G. (1999). Well-Being Therapy: Conceptual and Technical Issues. Psychotherapy And

Psychosomatics, 68(4), 171-179. doi: 10.1159/000012329

Felmingham, K., & Bryant, R. (2012). Gender differences in the maintenance of response to
PSYCOTHERAPY & ANXIETY DISORDERS 10

cognitive behavior therapy for posttraumatic stress disorder. Journal Of Consulting And

Clinical Psychology, 80(2), 196-200. doi: 10.1037/a0027156

Hinton, D., Hofmann, S., Rivera, E., Otto, M., & Pollack, M. (2011). Culturally adapted CBT

(CA-CBT) for Latino women with treatment-resistant PTSD: A pilot study comparing

CA-CBT to applied muscle relaxation. Behaviour Research And Therapy, 49(4), 275-

280. doi: 10.1016/j.brat.2011.01.005

Kase, L., & Ledley, D. (2007). Anxiety disorders. Hoboken, N.J.: Wiley.

Nathan, P., & Gorman, J. (2007). A guide to treatments that work (3rd ed.). New York: Oxford

University Press.

NHS Digital. (2016). Survey shows one in three adults with common mental disorders report

using treatment services. Retrieved from https://digital.nhs.uk/news-and-events/news-

archive/2016-news-archive/survey-shows-one-in-three-adults-with-common-mental-

disorders-report-using-treatment-services

PIET, J., HOUGAARD, E., HECKSHER, M., & ROSENBERG, N. (2010). A randomized pilot

study of mindfulness-based cognitive therapy and group cognitive-behavioral therapy for

young adults with social phobia. Scandinavian Journal Of Psychology. doi:

10.1111/j.1467-9450.2009.00801.x

Pincus, D., May, J., Whitton, S., Mattis, S., & Barlow, D. (2010). Cognitive-behavioral treatment

of panic disorder in adolescence. J Clin Child Adolesc Psychol, 39(5), 638-49.

Ruini, C., & Fava, G. (2009). Well-being therapy for generalized anxiety disorder. Journal Of

Clinical Psychology, 65(5), 510-519. doi: 10.1002/jclp.20592

Spence, S., Donovan, C., & Brechman-Toussaint, M. (2000). The Treatment of Childhood Social

Phobia: The Effectiveness of a Social Skills Training-based, Cognitive-behavioural

Intervention, with and without Parental Involvement. Journal Of Child Psychology And

Psychiatry, 41(6), 713-726. doi: 10.1111/1469-7610.00659

Stockman, J. (2012). Lifetime Prevalence of Mental Disorders in U.S. Adolescents: Results from

the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A).

Yearbook Of Pediatrics, 2012, 385-387. doi: 10.1016/j.yped.2011.04.014

Taylor, S., Fedoroff, I., Koch, W., Thordarson, D., Fecteau, G., & Nicki, R. (2001).

Posttraumatic stress disorder arising after road traffic collisions: Patterns of response to

cognitive–behavior therapy. Journal Of Consulting And Clinical Psychology, 69(3), 541-

551. doi: 10.1037/0022-006x.69.3.541

Weisz, J., & Kazdin, A. (2010). Evidence-based psychotherapies for children and adolescents

(2nd ed.). New York: Guilford Press.