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Anxiety refers to a state of worry and fear over an unwanted event, situation or stimulus. It is diagnosed as a disorder when the fear is out of proportion to the stimuli, which inevitably disrupts the individuals life. If left untreated, anxiety disorders can have a detrimental impact on the individuals life, such as inability to work, form normal social relationships or develop comorbid disorders, which results in further difficulty to treat the disorder effectively. Anxiety disorders are one of the most common mental disorders that negatively affect the worldwide population, yet only 30% seek treatment to overcome them (Lépine, 2002). Various psychological therapies have been developed in order to treat those with anxiety disorders, in particular Cognitive-Behavioural Therapy (CBT). CBT is a psychological therapy developed to alter the negative maladaptive thoughts and behaviours of the patient into positive ways of dealing with the fearful situation or stimuli (Beck, 2001) and has become the most popular method used in clinical practice (Craske, M. G., 2010).
This essay will focus on the efficacy of psychological therapies for treating anxiety disorders. Firstly, it will talk about one of the most common and effective methods of psychological therapy CBT and how it can be used to treat various anxiety disorders in particular, GAD. It will also explore the generalisability of this method to other disorders such as PTSD, as well as alternative psychological therapies such as EMDR. This essay will also acknowledge some of the key evidence against psychological therapies and its efficacy, before summarising the strong evidence for the use of such methods.
Firstly, the effectiveness of psychological therapy is in the use of CBT as a means of treating Generalised Anxiety Disorder (GAD). GAD is a persistent and common anxiety disorder, whereby the patient experiences unfocused worry and anxiety that is not connected to recent stressful events, although it can be aggravated by certain situations for over 6-months (Tyrer, Balwin, 2006). A clinical trial took place comparing a sample of 65 adults diagnosed with GAD and randomly placed them into 3 conditions: CBT, Applied Relaxation (AR) and wait-list control (WL). Follow-up sessions were in place at 6, 12 and 24 months after, which used the same standardised self-report questionnaires and clinician ratings as the pre-test and post-test, to assess GAD and related symptoms. It was established that CBT and AR were equally superior to WL in the post-test. However, CBT led to a significant decrease in the patients level of worry during the treatment and continued to decrease this post-treatment. Therefore, this study supports the effectiveness of psychological therapies on treating GAD (Dugas et a. 2010).
Moreover, individual differences such as age influence the efficacy of psychological therapies (CBT particularly) on GAD. Although CBT is found to be superior in regard to effectiveness when compared to a wait-list control condition, it is in fact inferior to nondirective, pharmacological treatment in treating GAD in elderly patients. This is due to the fact that elderly patients with GAD are more likely to have suffered the disorder for longer and have other coexisting psychiatric disorders, such as depression, which may increase the severity of GAD. These in turn make it harder to successfully treat the individual with the use of psychological therapies (Flint, 2005). Therefore, this research limits the efficacy of psychological therapies due to its inability to be used effectively on other individuals.
On the other hand, research suggests that children may differ to elderly patients in responsiveness to psychological therapies. A study was conducted on the effectiveness of CBT on 16 children and adolescents (ages 7-17) diagnosed with GAD. The CBT was aimed at their beliefs and worry, negative problem orientation, tolerance for uncertainty and cognitive avoidance strategies. A total of 13 participants (81%) lost their diagnosis of GAD (DSM-IV), another 2 participants still had GAD but improved and one participant did not improve from the treatment (Payne et al. 2011). This research supports the efficacy of psychological therapies on treating anxiety disorders in children, specifically GAD.
Furthermore, Psychological therapies have been shown to be effective in treating Post-Traumatic Stress Disorder (PTSD). PTSD is an anxiety disorder caused by experiencing a very distressing event and results in the patient reliving the traumatic event through nightmares and flashbacks. Paunovic & Öst (2001) conducted a study on 16 refugee outpatients diagnosed with PTSD to investigate the efficacy of CBT and exposure therapy in the treatment of PTSD . They found that both CBT and exposure therapy resulted in significant improvements after treatment and at the 6-month follow-up. CBT resulted in a 53% reduction in PTSD symptoms, 50% reduction on generalised anxiety and 57% reduction on depression, compared to the results of exposure therapy, providing a 48% reduction on PTSD symptoms, 49% reduction on generalised anxiety and 54% reduction on depression. These results show that there was not a significant difference between the efficacy of CBT and exposure therapy as a treatment of PTSD. This thereby supports that both psychological interventions are effective treatments for PTSD in refugees.
Moreover, many factors influence psychological therapies effectiveness on treating PTSD. Factors such as neuroticism, availability of social support and past history have an effect on the development of chronic PTSD (Ormel & Wohlfarth,1991) and their contribution to the failure of resolving symptoms (McFarlane & Yehuda, 1996). These factors affect the development of PTSD, but they may also affect the efficacy of the treatment. Tarrier et al., (2000) investigated the predictors of clinical outcome for the patients involved and sought to identify factors that may correlate with a positive or negative response to CBT or imaginal exposure treatment for those suffering with PTSD. They found that other factors such as gender, suicide risk, duration of the therapy, comorbid disorders, number of missed therapy sessions, all had large effects on the outcome of the therapy. Those who had a shorter duration of the therapy or a low suicide risk had a better outcome. It was confirmed at the 6-month follow-up, treatment type was not significantly associated with the outcome of treatment (Tarrier et al., 2000). Therefore, this suggests that the efficacy of psychological therapies in treating anxiety disorders, such as PTSD are solely dependent on individual differences and other factors.
Additionally, gender also influences the efficacy of psychological therapies as a treatment for PTSD. Tarrier et al., (2000) also demonstrated that females responded better to the CBT treatment than males. It is proposed that this is associated with the higher psychoticism scores achieved by the males. They were more likely to miss the therapy appointments as well as rating treatment as less feasible. Females are more expressive of their psychological difficulties and tend to engage in psychological therapies more than men. This resulted in the females achieving a better outcome than males (Tarrier et al, 2000). This is supported by Liddon et al., (2017) who found that men are less inclined to seek help for psychological issues and that men and women show significant differences in coping behaviour and help-seeking. Women are more open to sharing emotion and ultimately preferred psychotherapy more than men. Whereas, men are more open to sharing information and thus significantly preferred support groups (Liddon et al., 2017). Therefore, this research illustrates that gender can have a significant impact on the effectiveness of psychological therapies in treating anxiety disorders.
Alternatively, Trauma- Focused CBT (TF-CBT) that was developed by Cohen, Mannarino, and Deblinger (2006) has been successful in reducing PTSD symptoms in children. TF-CBT is similar to the method of CBT in treating other anxiety disorders. However, due to the various factors that influence the effectiveness of psychological therapies on PTSD, it involves trauma-focused exposure techniques to prevent and treat PTSD. (Ramirez de Arellano, et al. 2014). Cohen et al. (2004) investigates the efficacy of TF-CBT and Child Centred Therapy (CCT) for treating PTSD in sexually abused children, in which 89% met the full diagnostic criteria for DSM-IV PTSD. It was found that the children who received TF-CBT had a greater improvement in depression behaviour problems, shame, abuse-related attributions and PTSD than those treated with CCT. Therefore, this study demonstrates the efficacy of psychological therapies on treating PTSD in younger patients. However, this form of CBT was directed to treat children and adolescence who were sexually abused. Consequently, the psychological therapy may be limited in its effectiveness for treating older patients or those who have developed PTSD from other traumatic events, such as terrorism attacks or natural disasters.
Overall, psychological therapies can result in significant improvements in the symptoms of anxiety disorders. As illustrated by the research accumulated in this essay, psychological therapies are the most common yet effective intervention for anxiety disorders, achieving short-term and long-term alleviation of symptoms. This essay is focused on the efficacy of psychological therapies on PTSD and GAD, including the individual differences and factors that may affect the clinical outcome. Therefore, the strength of evidence supporting the use of psychological therapies is directed towards the alleviation of PTSD and GAD. However, these individual differences and factors could potentially be extraneous factors and consequently limit the validity of the research findings. In addition, some of the research reviewed in this essay used a method of self-report in pre-test, post-test and in follow-up sessions, which may result in various biases, further exacerbating the methodological issues that limit the accuracy of the findings.
There are many psychological therapies that have been developed or adapted to alleviate various anxiety disorders. For example, considering the factors involved in PTSD in sexually abused children and adapting the original CBT into TF-CBT to alleviate PTSD symptoms (Cohen, Mannarino, and Deblinger, 2006). This thereby implies that one psychological therapy may not be as effective in alleviating an anxiety disorder in one individual, however, another psychological therapy may lead to a significant improvement. Conversely, in some cases, pharmacological interventions are a more suitable and superior treatment compared to psychological therapies. As mentioned above, pharmacological treatment is more effective in elderly patients diagnosed with GAD, due to the greater severity of the disorder (Flint, 2005). Ultimately, there is strong evidence that supports the use of psychological therapies in treating individuals diagnosed with GAD and PTSD, which thereby concludes that there is strong evidence for the use of psychological therapies in treating anxiety disorders.
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