February 2015 - grantryancbt

Therapy Help • Youngsters February 23, 2015 By grantcryan 0 Comments

The nature of worry

Several authors have confirmed that all people worry, and often do so as a part of a problem solving process, so worry can be considered a useful strategy. A distinguishing feature of chronic worriers is that when worrying they have difficulty remaining problem solving oriented; they have a tendency to become catastrophe oriented, a part of that process includes the expectation that their worst fears about a anticipated event or one that has already taken place, will come true. Chronic worries seem to perceive themselves as predominately unsafe in this world until proven otherwise; non chronic worriers on the other hand seem to perceive themselves as the antithesis of this view, and as being safe until proven otherwise.

Relatively speaking it was only recently that effective psychological treatments for this problem have been developed and that enough evidence has been collected to show that GAD can be treated successfully.

Most of the early interventions for GAD were based on similar approaches to phobic disorders and used exposure strategies, such as systematic desensitisation as well as relaxation training. The nature of GAD was too broad for such seemingly less developed treatments.

The following treatment approaches are far more robust and have shown to be more effective with the treatment of GAD. In saying that, some of the exposure strategies and relaxation training are still applicable, but are augmented by more thoroughly researched techniques, and a greater understanding of GAD.

Therapy Business • Work February 23, 2015 By grantcryan 0 Comments

Cognitive Behaviour Therapy

Based on the research there seems to be a general consensus that CBT is an effective approach for the psychological treatment of GAD. It has been the most researched and is considered to be the most widely used as an initial approach, (Borkovec, Newman & Castonguay, 2003), (Erickson & Newman, 2005)

According to Durham and Fisher (2007), (up to that time) there had been 30 clinical trials based on DSM diagnostic criteria, the main focus of which was CBT. Newman, (2000), reported that from this research the outcome showed that only 50% of clients with GAD experienced a reduction in symptoms, when compared to non-diagnosed individuals.

The first research trials to asses the effectiveness of CBT for the treatment of GAD included early studies from (Barlow et al., 1984; Barlow, Rapee & Brown, 1992; Blowers, Cobb & Mathews, 1987; Butler, Cullington, Hibbert, Klimes & Gelder, 1987; Lindsay, McLaughlin, Hood, Espie & Gamsu, 1987) and combined relaxation therapy (RT), Anxiety management packages, with a mixture of cognitive therapy (CT) behaviour therapy (BT) and cognitive behaviour therapy.

The studies demonstrated greater improvement compared to a non-directive approach. Two studies by Borkovec et al., (1987, and Butler, Fennell, Robson & Gelder (1991), concluded that CBT was more effective than BT. Chambers and Gillis (1993) in a seven-study meta-analysis reported that CBT was substantially more effective than a wait list or placebo.

A study by Dugas et al., (2003) produced the following outcomes. Treatment was applied to group cognitive behaviour therapy. There were 5-6 groups with 4-6 participants with a total of 52 clients diagnosed with GAD. The treatment was for 14 weekly 2-hour sessions managed by two clinical psychologists. The percentage of clients who no longer met the criteria for GAD were 60% at post, 88% at 6 months, 83%, at 12 months and increased to 95% at a 2 year follow up.

In summary, researchers have confirmed that CBT is an effective and valid treatment approach for reducing pathological worry and somatic symptoms of GAD. In saying this there is still a percentage of clients with GAD who do not seem to benefit from what may be considered the most effective treatment.

In the next part of the review I will explore other possibilities for psychosocial treatments for GAD that attempt to stand alone or are combined with CBT.