New research has shown that people with anxiety disorders, such as obsessive compulsive disorder and phobias, show the most improvement when treated with cognitive-behavioral therapy (CBT) in combination with a "transdiagnostic" approach - a model that allows one set of principles across all anxiety disorders. The researchers added that the combination of treatments help improve symptoms in several anxiety disorders, such as fear of flying, spiders, or public speaking.
According to Peter Norton, associate professor in clinical psychology and director of the Anxiety Disorder Clinic at the University of Houston (UH), the combination had better results compared with any other type of therapy, such as relaxation training.
After four unconnected clinical trials in a 10 year span, Norton set out to find out whether a treatment that applies one set of principals with any kind of anxiety disorder is more beneficial to patients.
According to Norton, an anxiety disorder is when anxiety and fear become so overpowering in a person's life that they begin to see negative impacts in their daily routine. Obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), panic disorder, social anxiety disorder, specific phobias, and generalized anxiety disorder are all types of anxiety disorders, Norton explained.
These disorders can also develop with a secondary illness, such as alcohol or drug abuse and depression. Norton explained that there are special treatments for each sickness but that each treatment does not differ too much - just in very specific ways.
"The Diagnostic and Statistical Manual of Mental Disorders (DSM) has been an important breakthrough in understanding mental health, but people are dissatisfied with its fine level of differentiation. Panic disorders are considered something different from social phobia, which is considered something different from PTSD.
The hope was that by getting refined in the diagnosis we could target interventions for each of these diagnoses, but in reality that just hasn't played out."
While studying as a graduate student in Nebraska, he had the idea to run a group treatment for social phobia. After not being able to get enough people together on the same night, 10 years of research on the transdiagnostic treatment began.
Norton explained "What I realized is that I could open a group to people with anxiety disorders in general and develop a treatment program regardless of the artificial distinctions between social phobia and panic disorder, or obsessive-compulsive disorder, and focus on the core underlying things that are going wrong."
Pairing CBT with Transdiagnositc TreatmentCognitive-behavioral therapy (CBT) is a type of treatment that helps patients explore and understand their thoughts and feelings that impact their behaviors with a specific time frame and goals. Norton considers this therapy to be the most effective. He wanted to see what would happen when he paired CBT with the transdiagnostic treatment.
Patients undergoing the transdiagnostic approach showed substantial improvement, especially while treating a comorbid disease. A comorbid disease is one that can co-exist with a primary disease and stand on its own as a specific disease, like depression.
"What I have learned from my past research is that if you treat your principal diagnosis, such as social phobia and you hate public speaking, you are going to show improvement on some of your secondary diagnosis. Your mood is going to get a little better; your fear of heights might dissipate. So there is some effect there, but what we find is when we approach things with a transdiagnostic approach, we see a much bigger impact on comorbid diagnoses.
In my research study, over two-thirds of comorbid diagnoses went away, versus what we typically find when I'm treating a specific diagnosis such as a panic disorder, where only about 40 percent of people will show that sort of remission in their secondary diagnosis.
The transdiagnostic treatment approach is more efficient in treating the whole person rather than just treating the diagnosis, then treating the next diagnoses."
Norton suggests that his studies can lead the way to further advancements for how therapists, clinical psychologists, and social workers treat people with anxiety disorders.
What is an anxiety disorder?According to Medilexicon's medical dictionary, Anxiety Disorders are:
"A group of disorders involving various manifestations of anxiety that are grouped together nosologically in the DSM. These include panic disorder (see also panic attack), specific phobia, formerly simple phobia (see phobia); social phobia that was formerly called social anxiety disorder; obsessive-compulsive disorder (OCD); stress disorder (PTSD); acute stress disorder; generalized anxiety disorder (GAD); and anxiety disorders secondary to medical conditions or substance-induced or not otherwise specified."
Anxiety is a normal human feeling people experience when confronted with danger, threat, or when stressed. When a person becomes anxious, they will usually feel tense, uncomfortable and upset. Some life experiences can cause anxiety, such as a relationship breakdown, serious illness, major accident, job loss, or the death of a close friend or family member.
A feeling of anxiety which is appropriate to a situation is very different from the symptoms of an anxiety disorder. Anxiety disorders are not just one illness - they are a group of illnesses in which the sufferer has a persistent feeling of high anxiety, tension and extreme discomfort.
Only when a person's level of anxiety becomes so bad that they cannot properly function in their daily life and do what they want to do, is a diagnosis of anxiety disorder possible.
According to the Mental Health and Workforce Division of the Australian Government Department of Health and Ageing, anxiety disorders affect approximately 1 in every 20 people at any given time. Symptoms and signs usually start in early adulthood, but can appear earlier or later.
A study carried out at Stanford University School of Medicine reported in the American Journal of Psychiatry that patients with generalized anxiety disorder have abnormalities in the way their brain naturally (unconsciously) controls emotions. (Link to article)
Anxiety disorders usually hit people unexpectedly, for no apparent reason. Signs and symptoms may include:
- a feeling of impending doom
- a sensation of choking
- a feeling that you have lost control
- abdominal distress
- pins and needles
Anxiety disorders can seriously impact on how a person behaves, thinks and feels. Left untreated, the patient's life may become significantly disrupted.
There are several types of anxiety disorders, such as:
- OCD - obsessive-compulsive disorder
- Panic disorder
- PTSD - post-traumatic stress disorder
- Social phobia (also known as social anxiety disorder) - Researchers from Rhode Island Hospital, USA, demonstrated that obese people with social anxiety linked only to their weight may have symptoms as severe as social anxiety disorder patients do. Their findings clash with the criteria for social anxiety disorder in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). (Link to article)
- Phobias (phobic disorders) - the largest single category of anxiety disorders. Includes all cases which are triggered by a specific situation or stimulus. According to the World Health Organization (WHO), between 5% and 12% of all people are affected by phobic disorders.
Sufferers usually anticipate dreadful consequences from having to encounter whatever they are frightened of, which can be an animal, place, bodily fluid, or a situation (such as flying). Even though the sufferer understands that his/her fear is disproportional to the real potential danger, they are still overcome with fear.