Anxiety Disorders and Cognitive Behavioral Techniques

Cognitive-behavioral therapy is the most effective in treating anxiety disorders because it uses performance-based and cognitive interventions to change the way a patient thinks, feels, and behaves. Cognitive-behavioral therapy (CBT) is of particular value for patients of the elderly group and children. It is applied with the external environment as well as with the personal processing of the world. A cognitive-behavioral therapist is an educator, consultant, and diagnostician.

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As a consultant, the therapist helps sort through experience and solve problems. As an educator, the therapist influences the patient to acquire vital cognitive skills and strengthen behavior control. As a diagnostician, the therapist gathers relevant information and determines the best therapy for the client based on the specific situation. Anxiety disorders are psychological problems that distort the usual order of life. Cognitive-behavioral therapy, as the most effective tool in treating anxiety disorders, restores the normal lifestyle and empowers an individual to control his behavior and cognition.

Anxiety disorders involve an inappropriate or excessive state of arousal characterized by feelings of fear, uncertainty, or apprehension (Harvey, 2006, p.1). In most cases, the anxiety response is not caused by the real threat; however, it can paralyze the individual into withdrawal. Anxiety disorders are classified into the following categories:

generalized anxiety disorder, panic disorder, phobias, post-traumatic stress disorder, obsessive-compulsive disorder, and separation anxiety disorder (seen in children). Anxiety disorders are caused by a combination of genetic, physical, and psychological factors; therefore, treatment should include consideration of all of these factors.

As James Tighe, clinical nurse research fellow noted, the first step of treating anxiety disorders is to understand how anxiety works (2006, p. 1). Anxiety can be self-treated; however, the effectiveness of relaxation is lower compared to cognitive-behavioral therapy. Relaxation techniques reduce the severity of the physical symptoms while psychological symptoms are not treated. Therefore, relaxation is not a solution to anxiety disorders.

Cognitive-behavioral therapy, on the contrary, is much more effective in treating anxiety disorders and can be adapted for use with the youngest patients, the preschoolers for example. The so-called cognitive-behavioral play therapy (CBPT) “incorporates cognitive, behavioral, and traditional play therapies” (Knell, 1998, p. 28). CBPT is based on the cognitive therapy of emotional disorders and cognitive principles of therapy.

However, little progress in treating phobias, and the major emphasis is made on helping individuals to undermine habits of behavioral and cognitive avoidance (Brewin, 1996, p. 40). On a theoretical level, original behavioral therapies are inadequate in treating anxiety disorders and there is a need to adopt more sophisticated cognitive approaches taking into account such factors as memory, attention, and revaluation of the unconditioned stimulus. The debate over cognitive-behavioral therapy for treating anxiety concerns the role of cognitive vs. behavioral components.

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“Until recently only behavioral techniques such as desensitization, flooding, or response prevention were widely accepted as effective in treating anxiety disorders, but now the effectiveness for some disorders of cognitive methods used alone or in combination with behavioral techniques is clear” (Brewin, 1996, p. 43).

Moreover, there is no empirical evidence proving the superiority of cognitive techniques to behavioral methods. Cognitive and behavior therapies emphasize the importance of different cognitive systems but both are consistent with the understanding of human cognition and behavior. Cognitive-behavioral therapy is psychotherapy; it helps to alter anxious disorders and mistaken beliefs giving body anxiety-producing messages (Cohen, 2007, p. 1). For example, overcoming negative self-talk involves creating a positive attitude about the self and the world. Replacing negative beliefs with empowering truth helps to heal the roots of anxiety.

Medication used to treat anxiety disorders is not as effective as cognitive-behavioral therapy.

Medications known as tranquilizers may lead to physical dependence and result in the recurrence of anxiety symptoms when the medication is stopped. Moreover, medication is not effective in treating long-term anxiety (Cohen, 2007, p. 1).

According to information provided by the Anxiety Disorders Association of America, patients with anxiety disorders have the choice of five treatment options: behavior therapy, cognitive therapy, cognitive-behavioral therapy, relaxation techniques, and medication (‘Guide to Treatment’, p.1). Behavior therapy modifies and helps gain control over unwanted behavior. Patients learn how to cope with difficult situations and have control over life.

Cognitive therapy changes unproductive or intrusive thought patterns. Patients examine feelings and learn to separate realistic from unrealistic thoughts. Relaxation techniques help patients develop the ability to cope with the physical symptoms contributing to anxiety. Medication can be very effective in the treatment of anxiety disorders; however, it should be used in conjunction with other therapies. The majority of therapists use a combination of behavioral and cognitive therapies because the patient is granted an opportunity to learn recovery skills that can be widely applied in a lifetime.

Cognitive therapy is based on the following empirical assumptions (Tursi and Cochran, 2006, p. 388):

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  1. perception and experience are active processes involving inspective and introspective data;
  2. cognition is a synthesis of external and internal stimuli;
  3. the appraisal of a situation is evidence in cognition;
  4. cognition is a steam of consciousness reflecting the patient’s configuration of himself;
  5. psychological therapy empowers the patient to learn about cognitive distortions.

The fundamental premise of cognitive-behavioral therapy is that thoughts about events lead to emotions and therapy works by changing these detrimental thoughts. Cognitive-behavioral therapy helps patients become more realistic and more objective.

The goal of counseling is cognitive restructuring and cognitive-behavioral therapy fulfills this goal effectively.

Moreover, cognitive-behavioral therapy does not mold patients into one unified way of thinking but rather provides patients with the opportunity to modify detrimental behavioral, cognitive, and affective styles. “The literature suggests that CBT can be effective in the treatment of certain childhood disorders” (Kendal and Panichelli-Mindel, 1995, p.108). This therapy is found to be superior to wait-list conditions and alternative psychological treatments. In addition, CBT is found to be very effective in the treatment of aggression. CBT interventions remain promising and research findings suggest applications for general anxiety disorders.

There is a growing use of cognitive-behavioral therapy by mental health professionals. CBT is a short-term treatment and places high value on relative brevity and low cost (Hopkins, 2006, p.1). It is worth adding that CBT is the most researched form of therapy and hundreds of studies support its effectiveness and safety for treating anxiety disorders and depression. Cognitive-behavior therapists use a wide variety of techniques focusing on present problems rather than their causes. Because of this, CBT produces tangible and quick results. It involves simple exercises to change distorted thoughts and inappropriate behaviors. For example, CBT includes homework assignments that can be practiced and reinforced every day.

According to the fundamental principles of cognitive-behavioral therapy, errors in thinking lead to anxiety and self-defeating behaviors. Cognitive-behavioral therapists help patients to identify and change errors in thinking and behaviors and to alleviate anxiety or depression (Hopkins, 2006, p.1). Studies show that CBT offers effective treatment for panic disorders and as many as 70% of all patients show a considerable reduction of panic and anxiety (Whalen and Mckinney, 2007, p. 14). People suffering from anxiety disorders misinterpret normal physiological responses as signs of something dangerous.

Finally, cognitive-behavioral therapy can be used in either an individual or a small group approach. Nevertheless, it is important for all members of a group to receive large amounts of individual approaches. Treatment has to be rather intensive and the patient has to be motivated to change his cognition and behavior. Despite the apparent high success rate of cognitive-behavioral treatment, there are some areas of concern. In particular, it may take longer for a cognitive-behavioral approach to achieve tangible results compared with pharmacological treatments. In addition, treatment compliance is problematic for many patients. Over-reliance on homework assignments and practice exercises apart from the actual treatment. Therefore, clients who fail to complete homework often fail in treatment.

In conclusion, the cognitive-behavioral treatment creates long-term results, however, requires more time to produce tangible gains for clients. According to the conducted research, cognitive-behavioral therapy is found to be effective in treating anxiety and panic disorders compared with other therapy options. In addition, cognitive-behavioral therapy is more effective than cognitive or behavioral therapies because it is a combination of both.

Cognitive-behavioral therapy does not exclude the treatment with medication and is highly effective with children and the elderly. Nevertheless, cognitive-behavioral therapists do not pay attention to the causes of anxiety disorders but teach patients how to overcome anxiety in the everyday life.

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References

Brewin, C 1996, ‘Theoretical Foundations of Cognitive-Behavior Therapy for Anxiety and Depression’, Annual Review of Psychology, vol. 47, pp. 33-59.

Cohen, H 2007, ‘Treatment for Anxiety’, Psychcentral.com. Web.

‘Guide to Treatment’, Anxiety Disorders Association of America. Web.

Harvey, S 2006, ‘Anxiety disorders’, University of Maryland Medical Center. Web.

Hopkins, J 2006, ‘Could You Benefit From Cognitive-Behavioral Therapy?’ Depression and Anxiety Special Report. Web.

Kendal, P & Panichelli-Mindel, S 1995, ‘Cognitive-Behavioral Treatments’, Journal of Abnormal Child Psychology, vol. 23, no. 1, pp. 107-125.

Knell, S 1998, ‘Cognitive-Behavioral Play Therapy’, Journal of Child Psychology, vol. 27, no. 1, p. 28.

Tighe, J 2006, ‘Anxiety disorders’, BBC. Web.

Tursi, M & Cochran, J 2006, ‘Cognitive-Behavioral Tasks Accomplished in a Person-Centered Relational Framework’, Journal of Counseling and Development, vol. 84, no. 4, pp. 387-401.

Whalen, J & Mckinney, R 2007, ‘Panic Disorder: Characteristics, Etiology, Psychosocial Factors, and Treatment Considerations’, Annals of the American Psychotherapy Association, vol. 10, no. 1, pp. 12-21.

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