CBT and Psychoanalytical Approach in Treatment of Generalized Anxiety Disorder - Article Example

CBT and Psychoanalytical Approach in Treatment of Generalized Anxiety Disorder By Student’s Name Code+ course name Instructor’s Name University Name City, State Date Cognitive Behavior Therapy and Psychoanalytical Approach in Treatment of Generalized Anxiety Disorder Introduction Generalized Anxiety Disorder (GAD) is a psychological condition characterised by excess or exaggerated anxiety. Individual suffering from this condition often exhibit symptoms such as; excess pessimism, nervousness, constant expectation of disastrous outcomes and excess worry over common events in life (National Institutes of Health, 2007). This condition is also characterised by severe difficulties when it comes to preventing and controlling distressing thoughts. Hence, it negatively impacts on the daily lives and coping mechanisms of affected persons (Leichsenring et al 2009; White, 2013). GAD victims often find it very challenging to concentrate. This directly impacts on their social lives. Much of the lives of the GAD victims is affected by fear and nightmares. GAD condition also affects the ability of the patients to experience peaceful sleep and at times fail to sleep. Due to the increased mental activities, the patients often feel exhausted most of the time with prolonged headaches, muscle pain, peristalsis disorders and excessive trembling. Consequently, GAD patients are likely to regularly exhibit symptoms such as sweating, nausea and hot flashes. It has been established that the condition gradually develops from childhood to middle age (Behar et al., 2009). Over time, different approaches have been used in the treatment and management of GAD. Key among them include; Cognitive Behaviour Therapy (CBT) (Beck 1960) and the Psycho-analytical approach (Freud 1936). There exists significant debate on the efficacy of these approaches in the treatment of GAD. This paper seeks to critically examine the use of CBT and the psychoanalytical approach in the treatment of GAD. It will critically analyse the advantages and limitations of using CBT and the psychoanalytical approach in the treatment of GAD. Elements of self-analysis will also be included into this essay. . Use of CBT in the treatment of GAD Cognitive Behavior Therapy (CBT) can be described as a collaborative approach to therapy that focuses on examining and re-directing thoughts and behavior in order to achieve the expected behavioural outcomes (Otte 2011). Often times, this approach to therapy is used to deal with mental health issues (Dugas & Robichaud 2012). With cognitive behavior therapy (CBT), people have the opportunity to look at different personal perspectives, which help in the understanding of personal thoughts as well as emotions and behavior. The approach recognizes that links exist among emotions, behavior, thoughts and physical symptoms. According to Dugas and Robichaud (2012), the CBT approach for the treatment of GAD has four primary features. The features include; intolerance of uncertainties, negative problem orientation, cognitive avoidance and positive believes concerning worries. Using this model, a psychologist has to consider the fact that it comprises of biological, psychological as well as environmental models (National Institutes of Health, 2007). A major assumption used when adopting the model is that cognitive factors play a primary role in etiology. The human brain tends to process information from the immediate environment, and this can be useful in the treatment of GAD. The CBT approach intends to eliminate the maladaptive behaviors and replace them with the adaptive behaviors through alteration of the antecedents, consequences, and behaviors through learning. Through CBT approach, psychiatrists can change a patient’s maladaptive cognitive syndromes, self-ill statements and lack of belief. To establish the efficacy of the approach in the treatment of GAD results from studies revealed that 51 percent of the patients treated using this approach prove to be responsive (Otte, 2011). Other studies have shown that the effectiveness of the model in the treatment of GAD is 92 percent. Advantages According to Behar et al. (2009), CBT has been cited as one of the most recommended treatment approaches for GAD. The use of the CBT approach has proven to incur less expense thus making it the most preferred (Behar et al., 2009). For instance, a single session for mild cases can only last for a few hours. The patient is expected to attend between ten to twenty sessions for the approach to bear fruits. Another advantage of the model that makes it preferable is the fact that the model is natural, unlike other medication approaches that require the use of drugs. As a result, patient has zero chances of experiencing drug based on effects that at times require further medical attention. Due the ability of the approach to be practiced in a face-to-face scenario, the approach has proven to be applicable in many fields. A new form of CBT therapy known as the computerized interactive CBT has been on the rise making it possible for the psychotherapy to be offered to more than one individual (Behar et al., 2009). To many GAD patients who find it hard to adhere to regular meetings with therapists, the CBT approach stands out as the most convenient and efficient remedy (Dugas and Robichaud, 2012). In addition, the CBT approach has been the most recommended as it entails the collaboration of both the psychiatrist and the patient in achieving the specified set of goals. Both parties develop the goals to overcome the GAD condition and work together to overcome the condition. Goals set by the patient and the psychiatric are often achievable, time limited and specific. Through the therapeutic process, the patient is free to use his or her mind to identify feelings, thoughts, and behaviors, which are responsible for confining them to anxiety (National Institutes of Health, 2007). Psychiatrists can then use the critical approaches to enlighten the patients on the available strategies and options to overcome these daily situations. It has been argued that the CBT approach puts more emphasis on long-term outcome geared towards making the patient get better as opposed to short-term outcome meant to make the feel better at the moment. The CBT approach is also structured thus making it easy to monitor and direct the accomplishments made by the patient. Disadvantages According to Rapgay et al. (2011)certain concerns have been raised about the use of CBT in the treatment of GAD. In some instance CBT may be unsuitable method of treatment for some patients suffering from GAD. For instance, CBT has proven to be inefficient for GAD patients with other mental complications. GAD Patients with learning disorders and diffuculties have also proven to be resistant to change when the CBT approach is adopted. This is mainly due to the fact that, GAD is primarily a training approach, which makes it complicated to use in situations where the patient has other challenges of grasping the content (Rapgay et al. 2011). Moreover, the egocentrism associated with the CBT approach only means that GAD patients are concerned about making their situations better. The second and third parties associated with the patients are not included in the picture. Critics have argued that the narrowness of the approach in treating the patient overlooks the wider family issues (Otte 2011). In some cases, family issues can prove to be beneficial in psychiatric intervention thus overlooking the issues may only provide short term solutions for the patient with GAD. The CBT approach does not trigger the patients to view issues from a different perspective. As a result, psychiatric are often advised to consider incorporation psychodynamic counseling. CBT is only efficient in handling a single mental health issue such as GAD as well focusing on specific issues (Otte 2011). Another limitation of CBT includes the fact that it does not explore underlying issues. As compared to the psychoanalysis approach that explores the underlying issues associated with GAD, the use of CBT may not reveal underlying factors (Otte 2011). A critical look at the advantages and limitations associated with the use of CBT in the treatment of GAD, it is evident that the advantages outweight the limitations of the approach. CBT provides a more realiable and long-term approach of addressing issues associated with GAD. Additionally, this approach is cost-effective and does not involve the streinous use of resources. However, despite of these benefits, it may be important for psychiatrist to exercise their discretion to determine the context in which CBT may be applied for treating GAD patients. Using CBT in the treatment of GAD patients with additional mental disorders can prove to be detrimental. Use of psychoanalytic approach in the treatment of GAD The psychoanalytic approach is another option that psychologists employ when dealing with mental health issues such as GAD. Sigmund Freud developed the psychoanalysis approach based on a concept known as Oedipus complex. Psychologists adopting this model believe that unconscious thoughts can be enhanced through motivation, which also help the patients develop insights. It implies that the primary goal of psychoanalysis is to get rid of the repressed emotions that affect the psychological orientation of an individual. According to Simpson and Schneier (2010), the psychoanalytical approach is more often used in the psychology of the conflicting events that arise due to human nature. These conflicting events of the mind and human nature can be dialed into both conscious and unconscious. Therefore, this state of human nature within the society can also fit into a human being as a biological being or human as a social animal. These conflicts develop the state of humankind as described by Freud who insists that people’s behaviours is motivated by the way that they drive themselves to get comfort and get rid of any trauma or pain (Shedler, 2010). Hence, the psychoanalytical approach puts emphasis on psychodynamic terms that make use of worry as a means of getting away with any critical issue that may be somehow troublesome to some extent. This is used as a defense tool in most circumstances. Freud’s signal theory of anxiety can be well used to support such an approach. In his work, he emphasized that destruction or such a defense mechanism can equally be properly designed to get away from thinking of a critical, confusing or somehow painful event. Any traumatizing feeling may overpower an individual if at all a good type of defense mechanism is not properly employed (Strongman, 1995). Advantages Shedler (2010) argues that there is extensive evidence that demonstrates the advantages of psychoanalytical approach in the treatment of GAD. He argues that whichever form of defense tool can be effectively implemented to keep any worry out of the scene so that it does not become a burden. This is the best treatment for a feeling perceived to be a threat since a patient needs to feel safe and not be traumatized in any way. Getting rid of developments meant to keep off feelings gives sufficient room for anxiety minimization. Similarly, Simpson & Schneier (2010) note that the psychoanalytic approach offers an in-depth perspective of the of the GAD challenges which can be beneficial in identifying the causes of the psychiatric condition ( Simpson & Schneier, 2010). The approach also puts much emphasis on the mental development and focuses on critical issues of sexuality. Behaviors that most people are unaware of are well explained in this approach. The CBT approach has been identified as an option that overlooks the social issues of the patient. Moreover, another advantage of this approach as compared to CBT is that it addresses social issues such as family issues, which might contribute condition. It has also been highlighted as an option for enhancing self-psychology, which aids in the development of proper defense mechanism. Limitations The psychoanalytical approach in the treatment of GAD looks far much from the defense mechanism to other basic factors of anxiety (Shedler, 2010). In the implementation of main theories of anxiety, most psychiatrists emphasize the relationship between human and psychological growth (Simpson and Schneier, 2010). For instance, isolation and helplessness feeling can arise making a child very anxious due to lack of both internal and external confidence by a suggestion made by some theorists who claim that there are relationships that can prohibit psychological growth in such children. This can apply to caretakers that dominate a child’s life by making it more protective as well as dominated to some extent. Sullivan came up with another psychoanalytical theory of anxiety that supports the issue of a caregiver as a factor contributing conflicts in anxiety between the child and caregiver. Fairbairn also emphasized an issue on conflicts that arise because of anxiety produced by both child’s feelings and that of the caregiver. He supports this by the fear of being dominated and identity extinction. On the other hand, Klein recaptured anxiety by connecting it to the fear that an infant can have in the process and fail to be able to confront the caregiver. In all these, the relationship between self and others are reflected later on in life regarding anxiety generation (Shedler, 2010). Therefore, it appears that it is not clear if at all, the psychoanalytical approach can be effectively employed in the modern treatment of GAD. This has led to a lot of modern criticism made towards this approach. It is evident that the CBT approach and the psychoanalytic approach both have advantages and limitations, therefore it is good practice for psychiatrists to find a way to combine the two approaches to come up with the most efficient way of handling GAD patients. For instance, the CBT approach puts much emphasis on the personal life and overlooks the social life. On the other hand, psychoanalytic approach puts much emphasis on social life. It implies that the two approaches can be incorporated to form a single approach that can effectively manage the GAD condition in patients. Conclusion General anxiety disorder is an example of the diagnosed mental disorder which gradually develops from a tender age of ten up to the middle age. The effects of this mental disorder make a patient exhibit a lot of pessimism in life as well as extreme anxiety in life. Due to extreme mental activity, it implies that the person suffering from GAD also faces physical challenges. Psychiatrists have always had different approaches to handling mental disorders with success stories varying from one patient to another. Two approaches have been suggested as to have the required remedies for GAD. The CBT and the psychoanalytical approach are the two primary therapies that psychiatrists use in handling the GAD. Both the approaches have advantages and disadvantages. It may therefore be necessary for psychiatrists establish ways of incorporating the two approaches together in order to develop a more effective and comprehensive approach to handling GAD cases. References Behar, E., DiMarco, I., Hekler, E., Mohlman, J., & Staples, A., 2009. Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Retrieved from Journal of Anxiety Disorders 23, 1011–1023: http://www.designinghealth.org/uploads/1/3/8/4/13844497/gad_paper.pdf Dugas, M., & Robichaud, M., 2012. cognitive-Behavioral Treatment for Generalized Anxiety Disorder: From Science to Practice. London: Routledge. Leichsenring, F., Salzer, S., Jaeger, U., Kächele, H., Kreische, R., Leweke, C. Leibing. 2009, “Short-term psychodynamic psychotherapy and cognitive-behavioral therapy in generalized anxiety disorder: A randomized, controlled trial”. American Journal of Psychiatry, 166(8), 875-881. National Institutes of Health., 2007. When Worry Gets out of Control: Generalized Anxiety Disorder. Retrieved from NNIH Publication No. 7-4677: https://education.ucsb.edu/sites/default/files/hosford_clinic/docs/Generalized_Anxiety_Disorder.pdf Otte, C., 2011. Cognitive Behavioral Therapy in Anxiety Disorders: Current State of the Evidence. Retrieved from Dialogues Clin Neurosci. 13(4): 413–421: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263389/ Shedler, J., 2010. March. The Efficacy of Psychodynamic Psychotherapy. Retrieved August 12, 2016, from American Psychological Association: https://www.apa.org/pubs/journals/releases/amp-65-2-98.pdf Simpson, H. B., & Schneier, F., 2010. Anxiety Disorders. NewYork: Cambridge University Press. Strongman, K., 1995. Theories of Anxiety. New Zealand Journal of Psychology, 4-10. Rapgay, L., Bystritsky, A., Dafter, R., & Spearman, M., 2011. New Strategies for Combining Mindfulness with Integrative Cognitive Behavioral Therapy for the Treatment of Generalized Anxiety Disorder. Retrieved from Journal of Rational-Emotive and Cognitive-Behavior Therapy: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3087104/ White, H., 2013, Generalized Anxiety Disorder. The American Journal of Psychiatry, 170(5), 563-4. Read More

According to Dugas and Robichaud (2012), the CBT approach for the treatment of GAD has four primary features. The features include; intolerance of uncertainties, negative problem orientation, cognitive avoidance and positive believes concerning worries. Using this model, a psychologist has to consider the fact that it comprises biological, psychological as well as environmental models (National Institutes of Health, 2007). A major assumption used when adopting the model is that cognitive factors play a primary role in etiology.  The human brain tends to process information from the immediate environment, and this can be useful in the treatment of GAD. The CBT approach intends to eliminate the maladaptive behaviors and replace them with adaptive behaviors through alteration of the antecedents, consequences, and behaviors through learning. Through the CBT approach, psychiatrists can change a patient’s maladaptive cognitive syndromes, self-ill statements, and lack of belief. To establish the efficacy of the approach in the treatment of GAD results from studies revealed that 51 percent of the patients treated using this approach prove to be responsive (Otte, 2011). Other studies have shown that the effectiveness of the model in the treatment of GAD is 92 percent.

According to Behar et al. (2009), CBT has been cited as one of the most recommended treatment approaches for GAD. The use of the CBT approach has proven to incur less expense thus making it the most preferred (Behar et al., 2009). For instance, a single session for mild cases can only last for a few hours. The patient is expected to attend between ten to twenty sessions for the approach to bear fruits. Another advantage of the model that makes it preferable is the fact that the model is natural, unlike other medication approaches that require the use of drugs. As a result, the patient has zero chances of experiencing drugs based on effects that at times require further medical attention. Due to the ability of the approach to be practiced in a face-to-face scenario, the approach has proven to be applicable in many fields. A new form of CBT therapy known as the computerized interactive CBT has been on the rise making it possible for psychotherapy to be offered to more than one individual  (Behar et al., 2009).

To many GAD patients who find it hard to adhere to regular meetings with therapists, the CBT approach stands out as the most convenient and efficient remedy (Dugas and Robichaud, 2012). Besides, the CBT approach has been the most recommended as it entails the collaboration of both the psychiatrist and the patient in achieving the specified set of goals. Both parties develop the goals to overcome the GAD condition and work together to overcome the condition. Goals set by the patient and the psychiatrist are often achievable, time-limited, and specific. Through the therapeutic process, the patient is free to use his or her mind to identify feelings, thoughts, and behaviors, which are responsible for confining them to anxiety (National Institutes of Health, 2007). Psychiatrists can then use the critical approaches to enlighten the patients on the available strategies and options to overcome these daily situations. It has been argued that the CBT approach puts more emphasis on long-term outcomes geared towards making the patient get better as opposed to short-term outcomes meant to make them feel better at the moment. The CBT approach is also structured thus making it easy to monitor and direct the accomplishments made by the patient.

According to Rapgay et al. (2011), certain concerns have been raised about the use of CBT in the treatment of GAD. In some instances, CBT may be an unsuitable method of treatment for some patients suffering from GAD. For instance, CBT has proven to be inefficient for GAD patients with other mental complications. GAD Patients with learning disorders and difficulties have also proven to be resistant to change when the CBT approach is adopted. This is mainly since GAD is primarily a training approach, which makes it complicated to use in situations where the patient has other challenges of grasping the content (Rapgay et al. 2011).

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