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Cognitive Behavioural Therapy
We are what we think! And the way we think when we have an Anxiety Disorder only perpetuates the Disorder. Cognitive therapy assists us in seeing the damage our thoughts cause.
Cognitive Behavioural Therapy is a series of strategies specifically targeted to an individual's Disorder. These can include cognitive therapy, relaxation, breathing techniques and introceptive exposure.
Working with a Cognitive Therapist can be extremely empowering as we learn to take control over our thought patterns, instead of our thought patterns controlling us. Armed with our cognitive skills we can then go back to situations and/or places we have avoided and practice our cognitive skills.
Quoting from an interview in our Article section where Chris Edwards, clinical psychologist, explains CBT :
Quote "I think we have to look at it historically because the cognitive principles are derived from the work of our earlier philosophers such as Socrates and Epitites. Epitites said that it is not the things of this world that hurt us but what we think about them. So it taught us that within regard to a whole range of emotional disorders that our thoughts are very important.
Regardless of the cause of your anxiety disorder your thoughts about the Disorder are very important. In particular, with panic disorder the thoughts are very important. I think if you a look at what a Panic Disorder is in terms of cognitive theory, a panic disorder is generally seen as misinterpretation of bodily sensations .. that is a catastrophic misinterpretation of bodily sensations. Now, once a person learns to misinterpret these sensations, a pattern tends to be fairly enduring. So the cognitive theory helps a person to assess the evidence which supports or does not support their beliefs about what is happening to them." End Quote
Working with CBT enables us to look at our thought patterns and begin the process of retraining them enabling us to correct our misinterpretations which keep the disorder going. Read the full interview with Chris : CBT
In contrast to the high prevalence, degree of disability and cost to the community these disorders once correctly diagnosed can be easily treated. Over the past decade effective treatments have been developed for many Anxiety Disorders. As already discussed, the most effective treatments are Cognitive Behavioural Treatments. These treatments are time limited, self directed, produce high rates of end state functioning and are cost effective. (1, 3, 4, 5, 6)
Not only are these effective, one Australian study of Panic Disorder showed patients had 'a clear bias toward attributing cause to cognitive factors' (7) As in our experience with clients the study also showed people preferred "cognitive coping strategies" in preference to medication. (Ibid)
1. 'Studies comparing the relative efficacy of pharmacologic and cognitive behavioural interventions report panic free rates above 80% for cognitive behavioural interventions and between 50% and 60% for pharmacotherapy' (3)
Long term studies show many patients require ongoing medication treatment and remain symptomatic despite this ongoing treatment....50 - 80% of patients continue to remain symptomatic at assessments ranging from 1.5 years to 6 years after initiation of medication treatment.... Discontinuation of medications (especially benzodiazepines) show the majority of patients in some studies experience symptoms as bad or worse than pre-treatment levels during discontinuation. (Ibid)
This paper also demonstrates....follow up studies of Cognitive Behavioural Therapy indicate that short term treatment can have lasting beneficial effects. In controlled trials panic free rates in excess of 80% have been reported at follow up periods of 1 - 2 years. (Ibid)
It has also shows 'A ten session program of Cognitive Behaviour Therapy during a medication taper showed 76% were able to successfully discontinue their benzodiazepine medication on schedule and achieved a lower level of symptoms off medication. In contrast only 25% of patients were able to discontinue their medication treatment (Alprazolam (Xanax)- or clonazepam) with a slow taper and physician support programme. (Ibid)
2. One study assessed the cost before and after diagnosis and treatment of 61 people with Panic Disorder. The treatment involved psychotropic drugs including 'Alprazolam (Xanax), tricyclic anti depressants also MOAI' Direct costs prior to diagnosis were
$US 29,158 : After diagnosis $US 46,256 : Indirect cost prior to diagnosis were $US 65,643 after diagnosis $US 13, 883. The increase in Direct costs were associated to the number of psychiatrist consultations which grew from 40 prior to diagnosis to 793 after diagnosis. While the study comments in the conclusion that 'Methods for improving early detection of Panic Disorder may substantially reduce the costs incurred before diagnosis' it does not make mention of improving the direct costs after diagnosis.(2)
3. In comparison a German study looked at the cost effectiveness of Cognitive Behavioural Therapy involving 66 people with Panic Disorder. At a three year follow up Anxiety related health care costs, direct and indirect, decreased by 81%. 'Taking the cost of Cognitive Behavioural Therapy into account the cost benefit ratio for the first two years was 1:5:6. Thus one dollar spent for Cognitive behavioural treatment yielded a saving of 5.6 Dollars in anxiety related costs'.(5)
Whether Panic Disorder is ultimately biological or behavioural in origin, Short term Cognitive Behaviour Therapy has been demonstrated to be not just cost effective, but also effective in providing long term results for people with Anxiety Disorders. Despite the severe disabilities and the costs associated to the Disorders, people can 'pull themselves together' once they are given the appropriate education and cognitive behavioural strategies to do so.
If people are diagnosed within an acceptable timeframe,
given patient education and Cognitive Behaviour skills there is no need
for them to ever use medication. With this approach , the Disorders can
be minimised, the disabilities associated to the Disorders prevented and
the costs of the Disorders substantially reduced.
CBT is considered a 'best practice' in the treatment of Anxiety Disorders.
1 Evans L, (1987), Panic Disorder, A New Definition to Anxiety, Current Therapeutics, 11 : 19 - 21
2.Salvador-Carulla L, et al, (1995), 'Costs and Offset
Effect in Panic Disorders', British Journal of Psychiatry 166 (suppl. 27)
3 Otto M.W., et al. (1994), 'Cognitive-Behavioural Treatment of Panic Disorder: 'Considerations for the Treatment of Patients Over the Long Term', Psychiatric Annals, 24:6
4 Michelson L, et al, (1990), Panic Disorder Cognitive - Behavioural Treatment, Behav. Res. Ther 28, 2, pp 141 - 151
5 Margraf J, et al, (1995) Technische Universitat Dresden, Germany, cited in the World Congress of Behavioural & Cognitive Therapies Abstract Book , Denmark, 1995
6 Evans, L. (1995), 'A Follow-up of an Agoraphobia Treatment
Program', Commonwealth Dept of Human Services and Health
7 Kenardy J., et al, (1988), 'Attribution
of Panic Attacks: Patient Perspective', Journal of Anxiety Disorders, Vol
2, pp 243- 251.
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