Cognitive Therapy for Anxiety Disorders

Cognitive therapy has been adapted for the full range of anxiety disorders: generalised anxiety disorder (Beck & Emery with Greenberg, 1985); panic disorder (Clark, 1986; Craske & Barlow, 2001); social phobia (Heimberg & Becker, 2002) and obsessive-compulsive disorder (Frost & Steketee, 2002; Salkovskis, 1985). For generalised anxiety disorder, Chambless & Gillis (1993) computed effect sizes across five studies in which cognitive therapy was compared with one of several control conditions: non-directive therapy (Borkovec & Costello, 1993) or waiting list (Butler etal., 1987, 1991). Substantial effect sizes (1.5-2) at post-test and follow up suggest that cognitive therapy is an efficacious intervention for generalised anxiety disorder. A review of 12 trials of cognitive therapy for panic suggested that 80 % of patients achieved full remission at the end of treatment (Barlow & Lehman, 1996). De Rubeis & Crits-Christoph (1998) reviewed 11 outcome studies of cognitive therapy for panic disorder. Overall, their review suggests cognitive therapy to be efficacious with high proportions of clients with panic, although effects in some studies were less impressive for more avoidant clients. In their review of the literature relating to social phobia, De Rubeis & Crits-Christoph (1998) conclude that there is evidence that the behavioural components of treatment (exposure) lead to clinically significant and enduring change, but the evidence for the additional benefits of cognitive restructuring is weak or not robust across practitioners. However, there is evidence that the cognitive interventions serve a role in the maintenance of gains derived from exposure (Barlow & Lehman, 1996).

Cognitive therapy for obsessive-compulsive disorder is comparatively understudied, and the limited outcome research suggests cognitive therapy produces clinical significant change at termination in the majority of clients, (Emmelkamp, Visser & Hoekstra, 1988; Freeston et al., 1997) with six-month follow ups suggesting the maintenance of gains in at least one study (Emmelkamp, Visser & Hoekstra, 1988).

Cognitive therapy for PTSD typically involves exposure to traumatic memories, behavioural 'stress inoculation' training and cognitive restructuring (Foa & Rothbaum, 1997; Resick & Schnicke, 1992). While there is considerable controversy about which of these elements is effective, there is evidence that as a whole cognitive therapy leads to clinically significant improvements in PTSD symptomatology (Devilly & Spence, 1999; Foa et al., 1999; Marks etal., 1998).

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