Anxiety Disorders ____________________________________________________________________________
COMMON COMPONENTS OF CBT USED IN THE TREATMENT OF ANXIETY DISORDERS Cognitive Strategies Cognitive restructuring, behavioral experiments, and related strategies target exaggerated perception of danger (e.g., fear of negative evaluation in SAD). Therapy provides corrective information regarding the level of threat and can also target self-efficacy beliefs. Arousal Management Relaxation and breathing control skills help control increased anxiety levels. Exposure Encourage patients to face fears.
Patients learn corrective information through experience. Extinction of fear occurs through repeated exposure. Successful coping enhances self-efficacy. Safety Response Inhibition and Surrender of Safety Signals
Patients wean from and relinquish use of their usual anxiety-reducing safety signals and behaviors (e.g., presence of a companion, need for reassurance, knowing the location of nearest exit or toilet), which decreases negative reinforcement. Coping with anxiety without using anxiety-reducing behavior enhances self-efficacy, allowing patients to learn adaptive self- efficacy beliefs. Source: [120] Table 2
Acceptance and Commitment Therapy Acceptance and commitment therapy views psychologic events as a set of ongoing interactions between whole organisms and contexts defined historically and situationally. Acceptance and commitment therapy states that analyzing problematic behaviors but excluding the contexts that participate in the event misses the nature of the problem and pathways for its solution. This approach promotes a conscious posture of openness and acceptance of all psychologic events, including those deemed “negative” or “irrational.” In acceptance and commitment therapy, when patients feel frustrated, afraid, angry, or anxious, this represents an opportunity to examine how powerful events in the present can become barriers to growth [159]. Some evidence suggests acceptance and commit- ment therapy may be as effective as CBT in anxiety disorder treatment, including panic disorder [151; 160; 161]. Acceptance-based skill training differs from traditional coping skills training by de-emphasizing control (over physiology or thoughts) to focus on acceptance of panic-related sensations and cognitions as they occur from moment to moment. Patients learn to pay nonjudgmental attention to thoughts, feelings, images, and bodily sensations. Thoughts are viewed as an ongoing process distinct from self, rather than events with literal meaning (cognitive defusion). Efficacy of acceptance approaches has been shown in patients with panic disorder/ agoraphobia [162].
Third-Wave Therapies Mindfulness-based cognitive therapy, acceptance and com- mitment therapy, compassionate mind training, extended behavioral activation, metacognitive therapy, and schema therapy are diverse approaches originating from CBT. These modalities place greater importance on the form rather than content of patient cognitions. These third-wave therapies help patients develop more adaptive emotional responses to situa- tions by focusing on the function of cognition. Mindfulness and acceptance are used in anxiety disorders to help patients observe symptomatic processes without overly identifying with or reacting to them in ways that perpetuate distress [154]. Mindfulness Mindfulness involves attending to relevant aspects of experi- ence in a non-judgmental manner. The goal of mindfulness is to maintain moment-by-moment awareness; disengage oneself from strong attachment to beliefs, thoughts, or emotions; and develop a greater sense of emotional balance and well-being. An aim of mindfulness practice is to take greater responsibil- ity for one’s life choices. Some evidence supports the efficacy of this approach in GAD and panic disorder [155; 156; 157]. Mindfulness versus active control was compared in ability to reduce negative thought intrusions activated by a worry- induction procedure. Negative thought intrusions significantly increased with progressive muscle relaxation and focused attention but not with brief mindfulness meditation, suggest- ing mindfulness might target anxiety by reducing negative elaborative processes that maintain worry [158].
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