The Effectiveness of Cognitive Behavior Therapy in Treatment of Anxiety - Assignment Example

Cognitive Behavioral Therapy for Anxiety Cognitive Behavioral Therapy or CBT is a form of psychotherapy that mainly influences dysfunctional and problematic cognitions, emotions and behaviors through a goal- oriented systematic approach. CBT is known to be effective in many psychological conditions like mood disorders, anxiety-related disorders, eating disorders, substance abuse, personality disorders and also various psychotic disorders. The first form of CBT was behavior therapy which was a combination of Pavlovian and Behavioristic ideas and methods. This form was successful in reducing fears. As early as late 70s introduction of cognitive ideas was seen. This fusion therapy then came to be known as CBT (Rachman, 2008). CBT can be of two types: Cognitive- oriented therapies and Behavior- oriented therapies. In cognitive- oriented therapies, the main objective of the treatment is to identify thoughts, beliefs, assumptions and behaviors that are related to debilitating, dysfunctional, inaccurate and unhelpful negative emotions and monitor them. The result expected out of such forms of therapy is to replace or transcend these emotions with more realistic and useful emotions. It is important to know that emotional dysfunction is maintained by metacognitive beliefs, inflexible self-focused attention, and perseverative thinking. CBT should be delivered only by those who are trained suitably. The therapists should adhere to empirically grounded treatment protocols (NICE guidelines, 2007). CBT and anxiety disorders CBT is very useful in the treatment of various anxiety disorders. It is now considered the first line therapy in any anxiety disorder. Infact, it is the most effective treatment for phobic disorders. CBT is a symptom oriented therapy approach combining psychoeducation and specific treatment intervention. The basic concept is in vivo exposure where in the person is gradually exposed to the actual, feared stimulus. Normally when a person is exposed to a fearful stimulus, a fear response is evoked and then maintained due to classical conditioning. In CBT, repeated exposure is provided and this conditioning is unlearned. This process of unlearning is known as extinction and habituation. When anxiety is not associated with severe co-morbid conditions like personality disorders, the therapy can be time limited. It can be done in 12 to 15 settings. Fear of spiders, a type of phobia or phobia to any such insects can be treated with in vivo exposure in one session itself (Ost, 1989). The optimal range of duration for anxiety therapy is usually 7 to 14 hours. Most people would require weekly sessions of 1-2 hours for about 4 months. Briefer CBT should be atleast 7 hours and should be supplemented with proper information and tasks (NICE guidelines, 2007). The nature of process should be determined on a case-to- case basis. The two components of CBT are: behavior therapy and cognitive therapy. Behavior therapy Behavioral therapy focuses on how a persons behavior contributes to the symptoms and difficulties. It deals with behavior modification (Kaplan, et al, 1998). There are various behavioral modification techniques used in the treatment of anxiety disorders. These include teaching self- monitoring skills, teaching relaxation skills, exposure techniques to extinguish the fears associated with certain situations like heights and public places and teaching more appropriate responses to situations. Cognitive therapy Cognition means thought process. It reflects what we think, believe and perceive. Cognition therapy focuses on perception of thoughts (Kaplan, et al, 1998). This is because distorted and unrealistic thoughts result in misinterpretations which lead to symptomatology in anxiety. Sessions in CBT are: 1. Psychoeducation: This is the first part of CBT treatment. During this session, the psychiatrist will explain to the patient about normal reactions of the body and also symptoms related to anxiety. The therapist will focus on real life experiences related to anxiety and phobia. Various forms of treatment including exposure therapy will be discussed in this session. Identification of early signs of relapse of anxiety symptoms and self- help options that help cope with these situations is done during this phase. 2. Panic monitoring. This is also known as self- monitoring. This is done by maintaining a symptom diary by the patient. The diary will consist of details of occurrence of symptoms, consequences of changed behavior and anxious cognitions. Thus symptoms are monitored. The frequency and nature of panic attacks can be assessed by this diary. The relationship of anxiety symptoms to various internal stimuli like images and emotion, and to external stimuli like behavior, substance and situation can be studied. Outcome can be measured by short, self -complete questionnaires such as panic subscale of agorophobic motility. 3. Relaxation: This is an anxiety management technique wherein breathing exercises are used for relaxation and control of symptoms. The exercises control physiologic activity. The most commonly used breathing technique is abdominal breathing. Progressive muscle reaction is also a useful technique for relaxation. The patient is advised to practice these exercises daily. 4. Cognitive restructuring: The purpose of the techniques used in cognitive restructuring is to identify and counter fear of bodily sensations. It involves overestimation of the probability catastrophic thinking and negative consequence. Patients are taught to think of alternative possible outcomes once they experience bodily cues. Most important is to identify the likely origin of the feared sensations and any misinformation about the meaning of the sensations. 5. Exposure therapy: Here the patient is exposed to fear cues really. The cues may be interoceptive or environmental. In panic attacks, the cues are interoceptive while in agarophobia, the cues are either interoceptive or environmental. Prior to starting exposure therapy, the psychiatrist evaluates the patient and identifies a hierarchy of fear-evoking situations. In each of these situations, the degree of anxiety is elicited and is graded on a 0- 10 scale. The patient is then exposed to the fearful situations. Initially, situations at the low end of the hierarchy are exposed to. The exposure is done on a regular basis until the fear is attenuated. Once this is done, situation at the next level of anxiety is targeted. Sometimes psychiatrist may use a technique called flooding for exposure. In flooding, the person is exposed to fearful situations suddenly and not proceeding in a graduated manner. Some of the examples of exposures to anxiety cues are having patients run in place, spin in a desk chair, and breathe through a straw. While interoceptive exposures are conducted in the psychiatrists room or at home in naturalistic situations, environmental exposures are conducted in actual situations. Obsessive compulsive disorder can be treated with exposure with response prevention. Most of the times, social phobia responses well to exposure coupled with some form of cognitive restructuring such as Heimbergs group therapy. Advantages of CBT The most important advantage of CBT is that it is brief and time oriented (Cooper, 2008). Also, it can be used both in individual cases and in group settings. Many techniques of CBT are adapted for self- help applications. CBT is a highly structured therapy. Hence it can be provided in a number of different formats such as computer interface, self- help books and training material. Limitations of CBT Many researchers question the foundations on which CBT rests. They feel that the foundations are not secure enough to be reliable. Also, there is lot much to be learned about the impact of CBT on the long term course of the disease. Thus CBT cannot be the only primary treatment for anxiety disorder. Thirdly, there is uncertainty about the effectiveness of CBT. This therapy works well in university based trials with subjects recruited from various advertisements, but real- life effectiveness is not much known. Conclusion CBT is the first line therapy for those with anxiety disorders. CBT involves various stages starting with psychotherapy and ending with exposure therapy. How effective is CBT is not fully known. Most of the evidence is from clinical trials rather than real- time experience. References Cooper, M. (2008). Essential Research Findings in Counselling and Psychotherapy: The Facts are Friendly. London: SAGE Publications. Kaplan, M.D, Harold, I. and Sadock, M.D, Benjamin, J. (1998). Synopsis of Psychiatry, Eighth Edition Baltimore: Williams & Wilkins. Holmes, J. (2002). Education and Debate. BMJ, 324, 288-294. NICE Guidelines. (2007). Anxiety. Retrieved on Dec 18, 2008 from http://www.nice.org.uk/Guidance/CG22/NiceGuidance/pdf/English NHS. (2008). Cognitive Behavioral Therapy. Retrieved on Dec 18, 2008 from http://www.ncbi.nlm.nih.gov/pubmed/10937426?dopt=Abstract Ost, L G (1989). One-session treatment for specific phobias. Behaviour Research and Therapy, 27 (1): 1–7. Rachman, S. (2008). Psychological Treatment of Anxiety: The Evolution of Behavior Therapy and Cognitive-Behavior Therapy. Annu Rev Clin Retrieved 15 Dec, 2008 from Psychol.http://www.ncbi.nlm.nih.gov/pubmed/19086834?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum Read More