Treatment Methods of Generalized Anxiety Disorder

Treatment Methods of Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is one of the disabling mental health disorders that are prevalent in the population. The condition causes the patient to worry and have ongoing anxiety about thoughts and events to the extent that they realize it is inappropriate because it impairs their social and occupational functioning.  It is considered a chronic condition because the patients are affected by it up to 6-12 years after the initial diagnosis. The majority of the patients with the condition also have other mood and anxiety-related disorders. Statistics from the National Comorbidity Survey Replication shows that 2.7 of American adults had GAD, and its prevalence was higher in women (3.4%) than in men (1.9%) (NIMH, 2017). 5.7% of American people also get to experience the condition at one point within their life in a degree of mild to serious. Among those who suffer from the condition, 32.3% face serious impairment, and the rest face either mild or moderate. The statistics place it on the map as a condition that has serious potential to cause harm to the wider population and thus one that requires much effort in terms of research.

Background

GAD and the diagnostic and Statistical Manual for mental Disorders got introduced in 1980, and since then, there have been several methods introduced to deal with the issue. Previous research and meta-analysis have shown that pharmacotherapies are effective in treating GAD. However, according to Baldwin &Polkinghorn (2005), psychological methods of treatment are preferred by both the clinicians and the patients. Over time, research invested heavily in psychological remedies and has developed many of them. Several of these treatments belong to the group of cognitive-behavioral therapies (CBT), including applied relaxation and biofeedback techniques, problem-solving techniques, exposure, and restructuring techniques.

The CBT types of therapies focus on anxiety as a circumvention tactic for internal experiences (Behar, Dobrow DiMarco, Hekler, Mohlman, & Staples, 2009). Other types of therapies developed are spiritual therapy, non-directive supportive therapy, psychodynamic therapy. The common therapies delivered to GAD patients are face-face methods. Further research by Dugas et al. (2003) Bowman et al. (1997) and Anderson et al. (2012) have ventured into the fields of group treatments, guided self-help therapy, and internet-based therapy, respectively.

With all these psychological treatment methods available within the market, several meta-analyses have sought to discover which of them performs better. They have looked into previous primary research involving each method and integrated the results with those of other trials to see a comparative difference. Previous meta-analyses failed because they were either too narrow in their focus or did not integrate many trials. Research by Cuijpers et al. (2014) sought to cover these areas by carrying out a meta-analysis of several trials to cover the gaps left out by the previous ones.  They, therefore, focused their attention on getting more trials identifying the effectiveness of psychotherapies,  long term effects of psychotherapies, and the additional use of internet-based, group, and self-help therapies.

Methods used in Meta-Analysis

The meta-analysis by Cuijpers et al. (2014) had a definite inclusion criterion.  The search was made from bibliographical data sourced from PsycInfo, PubMed, Embase and the Cochrane Central Register of
Controlled Trials. The main search terms indicated generalized anxiety and psychological treatments. The search also looked for articles in the reference list of previous major meta-analysis on the same topic. Articles included for the analysis had to have randomized trials using the psychological treatment for GAD in adults and have a control group for comparative purposes. The language was not a limiting factor, and the excluded articles were because of their dismantling nature.

The validity of studies for Meta-analysis was done using the Risk of bias basement tool which looks for: “adequate generation of allocation sequence; concealment of allocation to conditions; prevention of knowledge of the allocated intervention; and dealing with incomplete outcome data” (Cuijpers et al., 2014). Another quality test looked out for the quality of interventions made in the trial by ensuring that each study referred to a reference medical manual, all therapists used in the trial were trained, and there was adherence to treatment integrity. Other factors in consideration for quality checks were the methods of recruiting the participants, target groups, and several sessions. The psychological treatment methods were categorized broadly as CBT interventions and non-CBT interventions.

Findings

The results from the meta-analysis by Cuijpers et al. (2014) show that CBT is more effective in dealing with a generalized anxiety disorder than all the other psychological tools. In the long term, CBT is also more effective than applied relaxation but equally effective over the short term. In comparison to usual care, CBT also has a lasting effect on the patient. They also discovered that the internet base therapies and the face to face therapies had a comparable outcome. The number of studies used to pass these conclusions was few, but they displayed a consistent comparative relationship between the therapy techniques. Further research is due, but the results by Cuijpers et al. serves as a standard for the generalized opinion on treatment methods of GAD.

The meta-analysis brought to light the large effect of the treatment methods on depression. The effect was comparable to the psychological methods used in treating depression (Cuijpers, Andersson, Donker, & van Straten, 2011). The information supports the research by Schoevers, Deeg, van Tilburg, & Beekman (2005) that claimed a relationship between generalized anxiety disorder and depression. Schoevers et al. discovered that GAD comes before the depression sets. Since these two mental health conditions are related, the treatment of GAD would recede the development of depression. Another finding by Cuijpers et al. (2014) was that self-report assessment outcomes were lower compared to the clinician’s ratings. The scenario would be explained as that the patients had a negative bias towards it or the clinicians a positive bias towards the method.

The previous meta-analysis by Siev & Chambless (2007) had found that cognitive-behavioral therapy and applied relaxation have similar effects on a GAD patient. In the analysis by Cuijpers et al. (2014), it was found that cognitive-behavioral therapy performed better than relaxation therapy. However, the number of studies used for the analysis were few and would not produce the credibility to check for the smaller differential effects. More research that would integrate more trials would, therefore, be the best answer to the comparison. Moreover, CBT methods are unified and definite, but the relaxation therapy used in most trials proved to have other additional components, and comparison should only be made for pure relaxation treatment.

The prominent perspective of many mental health forums is that CBT methods are the best for treating GAD patients (Tyrer & Baldwin, 2006). The meta-analysis by Cuijpers et al. proved this factual. Despite the limitations presented by the study, the consistency of results means that the approach is accurate. Therefore, there is a need to uphold the use of psychotherapy in treating GAD in adults. Treatment costs of GAD are quite high, and therefore taking a method that provides the best result would reduce this burden. More research is, however, required within this field to further analyze which CBT methods are more effective than the others to maximize the treatment techniques further.

 

 

References

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Baldwin, D. S., & Polkinghorn, C. (2005). Evidence-based pharmacotherapy of generalized anxiety disorder. International Journal of Neuropsychopharmacology, 8(2), 293-302.

Behar, E., DiMarco, I. D., Hekler, E. B., Mohlman, J., & Staples, A. M. (2009). Current theoretical models of a generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of anxiety disorders, 23(8), 1011-1023.

Bowman, D., Scogin, F., Floyd, M., Patton, E., & Gist, L. (1997). Efficacy of self-examination therapy in the treatment of generalized anxiety disorder. Journal of Counseling Psychology, 44(3), 267.

Cuijpers, P., Andersson, G., Donker, T., & van Straten, A. (2011). Psychological treatment of depression: results of a series of meta-analyses. Nordic journal of psychiatry, 65(6), 354-364.

Cuijpers, P., Sijbrandij, M., Koole, S., Huibers, M., Berking, M., & Andersson, G. (2014). Psychological treatment of generalized anxiety disorder: a meta-analysis. Clinical psychology review, 34(2), 130-140.

Dugas, M. J., Ladouceur, R., Léger, E., Freeston, M. H., Langolis, F., Provencher, M. D., & Boisvert, J. M. (2003). Group cognitive-behavioral therapy for a generalized anxiety disorder: treatment outcome and long-term follow-up. Journal of consulting and clinical psychology, 71(4), 821.

NIMH » Generalized Anxiety Disorder. (2017, November). Nih.Gov. https://www.nimh.nih.gov/health/statistics/generalized-anxiety-disorder.shtml

Schoevers, R. A., Deeg, D. J. H., Van Tilburg, W., & Beekman, A. T. F. (2005). Depression and generalized anxiety disorder: co-occurrence and longitudinal patterns in elderly patients. The American Journal of Geriatric Psychiatry, 13(1), 31-39.

Siev, J., & Chambless, D. L. (2007). The specificity of treatment effects: Cognitive therapy and relaxation for generalized anxiety and panic disorders. Journal of consulting and clinical psychology, 75(4), 513.

Tyrer, P., & Baldwin, D. (2006). Generalized anxiety disorder. The Lancet, 368(9553), 2156-2166.