CBT and anxiety
By Liz Lockhart
The term ‘anxiety disorder’ applies to a wide range of disorders which include phobias, OCD (obsessive compulsive disorder), PTSD, panic disorder and GAD (generalised anxiety disorder). New research suggests that treating all anxiety disorders in the same way with the use of cognitive behavioural therapy (CBT) in conjunction with a ‘transdiagnostic’ approach is the most effective way to treat all such disorders.
A transdiagnostic approach is a model of treatment where the therapist applies one set of principles across all types of anxiety disorder. Peter Norton, a professor in clinical psychology at the Anxiety Disorder Clinic at the University of Houston (UH), suggests that his study shows that this combination is more effective than CBT combined with other types of anxiety disorder treatments such as relaxation training.
He also suggests that therapists treating people who suffer from anxiety disorders can achieve a high level of success by using a treatment that applies one set of principles across all types of anxiety disorders.
Norton’s research was conducted over a ten year period and included four separate clinical trials. Anxiety disorders exist when the level of anxiety and fear become so overwhelming that they begin to have a negative impact on a person’s everyday life, according to Norton. He adds that very often anxiety disorders co-exist with a secondary illness such as depression or substance or alcohol abuse. There are targeted treatments for each diagnosis but, according to Norton, there has been little realisation that the different treatments only differ slightly and they only differ 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,’ Norton says.
Norton began his decade of work using the ‘trasdiagnostic’ treatment approach after he failed to find sufficient people with social phobia who could attend group treatment sessions on the same night. ‘What I realised is that I could open a group to people with anxiety disorders in general and develop a treatment programme 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,’ Norton says.
Norton found that CBT helped his patients to understand the thoughts and feelings that influence their behaviours and was the most effective treatment. However, he found that by using CBT in conjunction with transdiagnostic treatment showed considerable improvement, especially when treating co-morbid diagnoses such as 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,’ Norton said.
‘In my research study, over two-thirds of co-morbid diagnoses went away, versus what we typically find when I’m treating a specific diagnosis such as a panic disorder, where only about 40% 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.’