Outcome of a Cognitive-Behavioral Therapy Intervention in Generalized Anxiety Disorder - Essay Example

?Outcome Studies of A Cognitive-Behavioral Therapy Intervention in Generalized Anxiety Disorder Everybody experiences anxiety in everyday life, and the level of anxiety and manifestations vary from one person to another. While mild level of anxiety may positively affect the person in terms of motivation and increased learning process, in severe case however, it may be detrimental to one’s health. When anxiety becomes persistent, excessive, and out of control, where the person already experiences unrealistic worrying about everyday things, it is more likely associated with generalized anxiety disorder (GAD). According to Anxiety Disorders Association of America (2011a), GAD affects 6.8 million adults, or 3.1% of the U.S. population, in any given year and women are twice as likely to be affected. Learning how to deal with anxiety requires management of the mind to handle things in proper order, and this is the emphasis of Cognitive-Behavioral Therapy (CBT). CBT treatment had been popularly used by many healthcare professionals, psychotherapists, and counselors in managing GAD and its efficiency had been proven in many clinical-based studies conducted by reliable researchers. To begin with, anxiety, according to the National Institute of Mental Health or NIMH (2011), is a normal reaction to stress. It helps the person cope with the different situations in life but once it becomes an excessive, irrational dread of everyday situations, it has become a disabling disorder (NIMH, 2011). Among the five major types of anxiety disorders [Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), Panic Disorder, Post-Traumatic Stress Disorder (PTSD), and Social Phobia (or Social Anxiety Disorder)], GAD is the most common. GAD is a pattern of frequent, constant worry and anxiety over many different activities and events (Berger & Zieve, 2010). The main symptom, according to Berger and Zieve (2010), is the almost constant presence of worry or tension that lasts at least six months, disrupting daily activities even when there is little or no cause. Worries seem to float from one problem to another, such as family or relationship problems, work issues, money, health, and other problems. Other symptoms are difficulty concentrating, fatigue, irritability, problems falling or staying asleep, and sleep that is often restless and unsatisfying, and restlessness or feeling keyed up or "on the edge," often becoming startled very easily. Physical manifestations are muscle tension, shakiness, and headache (Berger & Zieve, 2010). Risk factors for GAD include gender, family history, genetic factor, substance abuse, medical conditions, socioeconomic and ethnic factors, depression, cultural factors, and stressful events in susceptible people (Scholten, 2011). Moreover, treating anxiety disorders is an individualized approach but several standard approaches have proved effective. Treatment modalities include therapy [e.g. cognitive-behavioral therapy (CBT), acceptance and commitment therapy (ACT), dialectical behavioral therapy (DBT), interpersonal therapy (IPT), eye movement desensitization and reprocessing (EMDR)], medication [e.g. selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), benzodiazepines, and tricyclic antidepressants] and complementary and alternative treatment (e.g. kava, acupuncture, and yoga) (Anxiety Disorders Association of America, 2011b). For the treatment of GAD, cognitive-behavioral therapy is claimed by many psychotherapists, counselors, and healthcare professionals as the most effective therapy. According to Bingaman (2007, p. 11), this is the clear treatment of choice with anxiety disorder because it meets the criteria that empirically supports the treatment for GAD. CBT is very useful in treating anxiety disorders because the cognitive part helps people change the thinking patterns that support their fears, and the behavioral part helps people change the way they react to anxiety-provoking situations (National Institute of Mental Disorders, 2009). CBT is a form of psychotherapy that emphasizes the important role of thinking in how we feel and what we do (Pucci, 2010). CBT can help a person to make sense of overwhelming problems by breaking them down into smaller parts on how it affects the thought, emotions, feelings, the body (physical), and the actions of the individual. Arnold R. Pucci, the president of National Association of Cognitive-Behavioral Therapists (NACBT), discussed the ten characteristics of CBT: (1) that CBT is based on the cognitive model of emotional response--the idea that our thoughts cause our feelings and behaviors, not external things, like people, situations, and events. Thus, we can change the way we think to feel or act better with situations remaining unchanged; (2) Unlike other therapies that require long-term sessions, CBT is briefer because of its highly instructive nature and time-limited because an end of the therapy is readily agreed upon by the therapist and client from the very start of the treatment; (3) CBT does not solely focuses on the good, trusting relationship between client and therapist but a great deal is given on embarking rational self-counseling skills to the client; (4) There is a collaborative effort between the therapist and client where the therapist help the client identify and achieve his goals. The therapist listens, teaches, and encourages, while the client expresses his concerns, learns, and implements that learning; (5) CBT is based on aspects of stoic philosophy that teach the benefits of feeling, at worst, calm when confronted with undesirable situations so that we can make use of our intelligence, knowledge, energy, and resources to resolve the problem; (6) CBT uses the Socratic Method by asking many questions to the client and encouraging the client to ask questions, as well. This is in order to have a clear understanding of the client’s concerns; (7) CBT is structured because there is an agenda in every session and it is directive because therapist show the client how to think and behave to achieve the goals; (8) CBT is based on educational model through helping the clients unlearn their unwanted reactions and learn a new way of reacting; (9) CBT theory and techniques rely on the Inductive Method by looking at our thoughts as hypotheses or guesses that can be questioned and tested, thus allowing us to change our way of thinking to fit with the situation; and (10) Homework is a central feature of CBT to encourage the client to continuously practice what has been learned during the session. In connection to the efficacy of CBT in treating GAD, various researchers showed evidences to support this claim. In the study of Hunot, Churchill, Teixiera, and Silva de Lima (2007) on psychological therapies for GAD, a randomized and quasi-randomized controlled trials were conducted in non-inpatient settings, involving adults aged 18-75 years with a primary diagnosis of GAD, assigned to a psychological therapy condition compared with TAU/WL (treatment as usual/waiting list) or another psychological therapy. Hunot et al., (2007) determined that patients assigned to CBT were more likely to achieve clinical response in terms of absolute efficacy in anxiety, worry, and depression at post-treatment than those assigned to TAU/WL, though there was insufficient data to determine the long-term absolute efficacy of this therapy. The efficacy of CBT compared with psychodynamic and/or supportive therapies were limited to a single but relatively large study which found that patients who received CBT were more likely to show a clinical response and reduced anxiety and depression symptoms than those who received psychodynamic or supportive therapy at post-treatment and 6-month follow-up. Hunot et al., however, found was mixed results between CT (cognitive therapy) and BT (behavioral therapy); CT was more likely to result in clinical response and was more efficacious in reducing depression symptoms than BT, but there was no significant difference in anxiety symptoms. Thus, concluded that psychological therapy based on CBT principles is effective in reducing anxiety symptoms for short-term treatment of GAD compared with other psychological therapies in this single and heterogeneous body of evidence. Consequently, an article in the Journal of Consulting and Clinical Psychology also supported the superiority of CBT among other psychotherapy treatments in the management of anxiety disorders. This article is a meta-analysis of fifty-six effectiveness studies of CBT for adult anxiety disorders in clinical practice conducted by Stewart and Chambless (2009) of the University of Pennsylvania. All pretest and posttest effect sizes for disorder-specific symptom measures were large, suggesting that CBT for adult anxiety disorders is effective in clinically representative conditions. Six studies included a control group, and between-groups comparisons yielded large effect sizes for disorder-specific symptoms in favor of CBT. Benchmarking indicated that results from effectiveness studies were in the range of those obtained in selected efficacy trials. To test whether studies which are more representative of clinical settings have smaller effect sizes, the authors coded studies for 9 criteria for clinical representativeness. Results indicate an inverse relationship between clinical representativeness and outcome, but the magnitude of the relationship is quite small. Thus, though CBT has been criticized by some, arguing that no empirical and quantitative analysis can properly examine the fundamentally qualitative process of psychotherapy, it is still the most often type of therapy being chosen by practicing clinical psychologists and research psychologists. Moreover, a much earlier study of the effects of CBT in the management of GAD utilizing a controlled clinical trial, known as the Berlin CBT-GAD study, conducted by Linden, Zubraegel, Baer, Franke, and Schlattmann (2005) favored its efficacy. This study included seventy-two outpatients fulfilling GAD criteria according to DSM-IV. From this group, 36 patients (CBT-A) were randomly assigned to 25 sessions of CBT and the other 36 formed a contact control group (CCG). After the contact control period (CC period), these patients were also treated with CBT (CBT-B), allowing not only a parallel group comparison but also an A-B comparison. Therapists were licensed full-time psychologists who worked routinely in outpatient care and had a professional training in CBT. Treatment was done in accordance with a manual, and treatment conformity was controlled by several methods. Results showed that there were highly significant reductions of anxiety symptoms from the participants utilizing the Hamilton Anxiety Observer Rating Scale, self-rating Spielberger State-Trait Anxiety Inventory, and the Clinical Global Impression Rating. The clinical improvement remained stable over a follow-up period of 8 months. Hence, the researchers/authors affirmed that CBT is an effective method of treatment for GAD. Differences between control and treatment group are comparable to or larger than those reported in studies on antidepressant drugs. In conclusion, outcome studies demonstrating effectiveness of CBT intervention gave a great deal of significance to the popularity of this therapy. There are a large number of well constructed experiments that have shown evidences for it to be highly useful in treating anxiety disorders, including GAD. With the hallmark of CBT having an intense focus on thought processes and belief systems, short-termed treatment duration, and with overall goals of helping people identify problematic beliefs and thought patterns, which are often irrational or unrealistic, replacing them with a more rational and realistic views, it is not surprising to see how CBT topped the therapy treatment options for GAD. Nevertheless, these favorable results of outcome studies to CBT should not hinder psychotherapists, researchers, and healthcare and other professionals to keep searching for more solutions and betterment of the therapy, upholding patient/clients’ fast recovery, wellness, and safety. References Anxiety Disorders Association of America (2011a). Generalized anxiety disorder (GAD). Retrieved 06 April 2011 from . Anxiety Disorders Association of America (2011b). Treatment. Retrieved 08 April 2011 from . Berger, F.K. & Zieve, D. (2010). Generalized anxiety disorder. National Center for Biotechnology Information, U.S. National Library of Medicine, PubMed Health. Retrieved 06 April 2011 from . Bingaman, K.A. (2007). Treating the new anxiety (p. 11). United States of America: Roman & Littlefield Publishers, Inc. Hunot, V., Churchill, R., Teixeira, V., & Silva de Lima, M. (2007). Psychological therapies for generalized anxiety disorder. Cochrane Database of Systematic Reviews, Issue 1. Art. No.: CD001848. DOI: 10.1002/14651858.CD001848.pub4. Retrieved 05 April 2011 from . Linden, M., Zubraegel, D., Baer, T., Franke, U., & Schlattmann, P. (2005). Efficacy of cognitive behavior therapy in generalized anxiety disorders. Results of a controlled clinical trial (Berlin CBT-GAD Study). National Center for Biotechnology Information, U.S. National Library of Medicine, PubMed. 74(1):36-42. Retrieved 08 April 2011 from . National Institute of Mental Disorders (NIMH) (2009). Treatment of anxiety disorders. Retrieved 07 April 2011 from . National Institute of Mental Health (NIMH) (2011). Anxiety disorders. Retrieved 07 April 2011 from . Pucci, A.R. (2010). Cognitive behavioral therapy. National Association of Cognitive-Behavioral Therapists (NACBT). Retrieved 05 April 2011 from . Scholten, A. (2011). Risk factors for generalized anxiety disorder (GAD). The Doctors of USC. California: EBSCO Publishing. Retrieved 07 April 2011 from . Stewart, R.E. & Chambless, D.L. (2009). Cognitive-behavioral therapy for adult anxiety disorders in clinical practice: A meta-analysis of effectiveness studies. Journal of Consulting and Clinical Psychology, 77(3): 595-606. Read More