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Anxiety disorders can be treated in many different ways. Although some methods appear to be more effective than others, is that to say that the other methods are wrong and will not give people the help that they are seeking? Should different methods be combined to create results even greater? The more commonly practiced treatments are the biological view, the cognitive view, and the cognitive-behavioral view; there are many more, but these seem to be more of common knowledge (Comer, 2014). Focusing mainly on cognitive therapy in this paper, in order to compare the differences in the effects of each method, we must research how each treatment is handled and its success rate and/or longevity of success.
Treating Anxiety Disorders, Including Obsessive Compulsive Disorder, and the Stress that Accompanies Them: Cognitive Therapy in Comparison
In order to fully understand what you are dealing with while treating a patient with an anxiety disorder, one must have a full comprehension of what exactly anxiety is. Accompanied by stress and fear, anxiety itself can get somewhat lost in translation. It is commonly believed that fear and anxiety traits go hand and hand, but recent research shows this is not the case (Sylvers, Lilienfeld, & LaPrairie, 2011). So often, people are treated on the basis of their fear and anxiety being the same disorder, but should it not be diagnosed separately? When a person’s anxiety gets bad enough, it can cause somatic symptoms. In the DSM-5, the category of anxiety disorders has been picked apart and significantly simplified, and multiple disorders have been removed as being an anxiety disorder; obsessive-compulsive disorder is now in the category “obsessive-compulsive and related disorders” (Wittchen, Heinig, & Beesdo-Baum, 2014). Considering anxiety disorders are often comorbid with what now are considered to be in different groupings in the DSM-5, it can be very difficult to properly diagnose and treat these disorders, since disorders such as obsessive-compulsive disorders share so many characteristics and symptoms with anxiety disorders.
Anxiety can be described as “the central nervous system’s physiological and emotional response to a vague sense of threat or danger” (Comer, 2014). Anxiety is extremely common among all age groups and gender, with many cultural, economic, and environmental factors affecting our daily lives. In some cases, anxiety sensitivity is age-related. In a cross-sectional study, researchers found that anxiety sensitivity and experimental avoidance is much more significant in young adults compared to older adults who show more mindfulness. This study showed researchers that there is indeed a correlation between anxiety sensitivity, experimental avoidance, and mindfulness (Mahoney, Segal, & Coolidge, 2015).
Fear can be described as “the central nervous system’s physiological and emotional response to a serious threat to one’s well being “(Comer, 2014). It is thought that the brain of a person with an anxiety disorder does not know how to properly terminate fear (Milad, Rosenbaum, & Simon, 2014). Fear being anything from a sudden shock, such as a squirrel running out into the road in front of your car, to another car pulling out in front of you and you having to slam on your brakes. Both of these fears should disintegrate after a short time, but with someone who struggles with an anxiety disorder, the fear has only begun.
Stress can be described as a “specific response by the body to a stimulus, as fear or pain, that disturbs or interferes with the normal physiological equilibrium of an organism” (Dictionary, 2016). Stress is made up of two components: stressors and stress responses. When one responds to stress, their sympathetic nervous system is activated, and the “fight-or-flight” response kicks in to defuse the situation. When stress becomes bad enough, it affects your cardiovascular system and often results in death. Major stress can cause hypertension and strokes (Hering, Lachowska, & Schlaich, 2015). Understanding how to reduce your stress is vital to living a healthy life, but for someone with an anxiety disorder that is much easier said than done, so therapies and treatments must come into effect as extra help for people with these disorders.
With anxiety disorders being one the most common of all mental health problems, often occurring alongside with another mental disorder, finding the most effective way to treat them is highly important (Kroenke, Spitzer, Williams, & Lowe, 2010). While cognitive-behavioral therapy focuses on first understanding one’s own thought processes and fears, then changing the thoughts to affect them in a more positive way, one biological theory is that by modifying the brain’s mPFC-amygdala circuitry, fear will consequently be eliminated from someone with an anxiety disorder. The release of dopamine into the basolateral amygdala is thought to aid in this process by depressing the activity of the intercalated cell nuclei, typically under times of stress and fear, when dopamine is released in high dosages (Bukalo, Pinard, & Holmes, 2014). With this knowledge, it seems cognitive-behavioral therapy and this particular biological theory would do great things for the brain when combined as a treatment.
Psychoneuroimmunology is “the connection between stress, the immune system, and illness” (Comer, 2014). Psychoneuroimmunology helps us understand the relationship between the immune system and the central nervous system. It has substantial research on major depressive disorder, with promising results in most cases. Researchers question whether or not cytokines do play as major of a role in anxiety as we have come to believe (Hou & Baldwin, 2012). If this is indeed the case, this is where the somatic symptoms come into play, and researchers unfortunately still struggle with ways to treat anxiety disorders when they reach this degree of self-destruction.
Cognitive theory proposes that getting to the root of the problem itself can treat abnormal functioning of the brain. By recognizing the, as most cases can be described, illogical thinking processes that people with an anxiety disorder possess, one can use this information to their advantage; ergo, changing their maladaptive assumptions. Having maladaptive beliefs can cause a person to completely overreact to a simple, everyday stressor (Conway, Slavich, & Hammen, 2015). Most people with an anxiety disorder tend to overgeneralize, alas leading to even more unnecessary stressors in their daily life. Overgeneralization, or “the drawing of broad negative conclusions on the basis of a single insignificant event” (Comer, 2014), is a very common cognitive error and has been linked to having a strong correlation to trait anxiety and depression. Similar to overgeneralization, catastrophizing and personalizing (also cognitive errors) seem to be linked to manifest anxiety and anxiety sensitivity (Weems, Berman, Silverman, & Saavedra, 2011). Cognitive therapy is often combined with behavioral therapy, also known as, cognitive-behavioral therapy, or CBT. Behavioral theorists believe that our experiences in life are what cause us to behave the way we do. Common treatments in the realm of behavioral therapy are classical conditioning and systematic desensitization. Research shows that CBT does in fact help in the remission of anxiety disorders. Of 22 randomized controlled trials, 95% of the results show positive rewards when treated with CBT (Cartwright-Hatton, Roberts, Chitsabesan, Fothergill, & Harrington, 2004).
Although cognitive therapy and CBT do show very promising results, it is safe to conclude that these treatments are not fit for every person and every different anxiety disorder. In a study comparing psychodynamic therapy, a therapy that intends to uncover inner conflicts and past traumas, (Comer, 2014) to CBT, the researchers used a symptom questionnaire, with their subject being college students with anxiety disorders. Thirty students were assigned to CBT and 24 students were assigned to psychodynamic therapy (PDT). All of the students completed the symptom questionnaire prior to their assigned therapy, and then once again after a full year of their assigned therapy. After comparing the results of the questionnaires, the researchers found that all 54 students showed a significant decrease in anxiety in both the CBT group and PDT group (Monti, Tonetti, & Ricci Bitti, 2014).
Researchers have been looking more into the biological theory, which is more of a medical perspective than CBT. Recent findings show that sometimes anxiety disorders are associated with educational and social impairments in children; these impairments usually follow people into adulthood. As many as 35-40% of children in CBT do not achieve remission in their anxiety disorders. In a study of 116 children with an anxiety disorder, researchers measured DNA methylation before these children received any CBT, and then measured it once again after the therapy. The children that responded to the CBT had an increase in methylation, while the children that did not respond to therapy had a decrease (Roberts, et al., 2014). A study involving 1768 subjects, ranging from ages 10-12 showed that people with high anxiety levels showed drastically lower evening cortisol levels than people without anxiety. To broaden on their cortisol-anxiety relation research, the researchers also took notice that people with high morning cortisol have noticeably bad anxiety. Further research must be done to fully understand if this is caused by environmental factors, but nonetheless this research does show a correlation between cortisol levels and anxiety (Greaves-Lord, Oldehinkel, Ormel, Verhulst, & Ferdinand, 2009).
Another biological perspective is relaxation training. In a study that compared CBT to relaxation training, researchers grouped 344 patients that were currently being treated for alcohol use disorder (AUD) into two groups: CBT treatment and progressive muscle relaxation treatment (PMRT). All of the patients being treated for AUD had comorbid anxiety disorders (either generalized anxiety disorder, social phobia, or panic disorder). The researchers did their assessments on all 344 patients immediately after their treatment, and then four months after the treatment, which showed drastically decreased alcohol consumption and ample anxiety reduction in the CBT group; the CBT treatment showed to produce significantly better results than the PMRT group. The researchers concluded that teaching the patients that there is a better way to go about their anxiety than to drink (CBT treatment) was a much more effective treatment (Kushner, et al., 2012).
Since anxiety disorders are so prevalent in today’s society, it is important to understand the variances in treatment because one treatment may not be right for everyone. With so many components to the different disorders that anxiety holds, come many distinctions in the way an individual’s brain is affected by it. Cognitive-behavioral therapy does appear to be a leading treatment in treating anxiety disorders, but it also seems to be much more effective when combined with other treatments, such as taking a more medical approach, as in measuring DNA methylation and treating with CBT. Combining psychodynamic therapy with CBT also appears to produce promising results, possibly greater than CBT alone. Anxiety disorders are a serious problem in today’s world, and should of course be treated with much caution. It is safe to say that cognitive-behavioral therapy is an effective treatment for anxiety.
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