____________________________________________________________________________ Anxiety Disorders
EFFECT SIZES OF TREATMENTS FOR PANIC DISORDER, GENERALIZED ANXIETY DISORDER, AND SOCIAL ANXIETY DISORDER Treatment Modality Effect Size a Medications SNRIs 2.25 Benzodiazepines 2.15 SSRIs 2.09 Tricyclic antidepressants 1.83 Psychotherapy Mindfulness therapies 1.56 Relaxation 1.36 Individual CBT/exposure therapy 1.30 Group CBT 1.22 Psychodynamic therapy 1.17 Internet and self-directed therapies 1.11 Eye movement desensitization and reprocessing 1.03 Interpersonal therapy 0.78 Other approaches CBT/drug combination therapy 2.12 Exercise 1.23 a An effect size greater than 0.80 is considered large, indicating that the treatment is effective. CBT = cognitive-behavioral therapy, SNRI = serotonin-norepinephrine reuptake inhibitor, SSRI = selective serotonin re- uptake inhibitor. Source: [224] Table 3
Cognitive Therapy Cognitive therapy teaches patients to evaluate their anxious thoughts objectively. Variants include pure cognitive therapy, cognitive restructuring, meta-cognitive therapy, and uncer- tainty intolerance therapy. Cognitive therapy typically involves 15 to 20 individual sessions [261]. As discussed, effective cognitive therapy/CBT treatment helps patients develop new, alternative strategies to manage worries and habits and cope with life stressors, which reduces the symptoms of anxiety. Cognitive therapy/CBT helps patients to understand [261]: • They cannot control their fears but can control their worrying behavior as a fear response. • Worrying has no protective value, reinforces negative thinking, and increases the risk of escalating anxiety levels in the future. • Worrying does not assist in managing negative future scenarios, and patients are equipped to handle whatever future challenges appear. Cognitive therapy/CBT techniques may be especially helpful for generalized anxiety in later life [120].
Internet-Based CBT Internet-based CBT is delivered by patient-administered media interventions. Components include cognitive restructuring, exposure, problem solving, and applied relaxation, usually over six to eight sessions [261; 262]. Efficacy is demonstrated, with benefits maintained at long-term follow-up. A peer-to-peer cognitive self-therapy program has been found as effective as treatment-as-usual, with a decreased need for therapist contact [120]. Applied Relaxation Applied relaxation teaches the patient a coping skill that will enable him or her to relax rapidly in order to counteract and eventually abort the anxiety reactions. This therapy is different from simple relaxation alone, which is not helpful. Applied relaxation entails having patients relax in actual anxiety- provoking situations. Achieving effective applied relaxation technique requires around 15 individual sessions [261]. Second-Line Options Acceptance and commitment therapy and mindfulness are CBT variants with promising initial results. They teach patients to focus on the present moment and follow actions guided by their values rather than by emotions and anxiety. Effective acceptance and commitment therapy usually involves 10 to 15 individual sessions [261].
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