Anxiety disorders constitute symptoms such as excessive fear and subsequent avoidance, typically in response to a specific object or situation and in the absence of true danger. They have a high prevalence, of about 18% and lifetime rates of about 29% (Kessler et al.,2010).
Similarly, Panic disorder is an anxiety disorder characterized by recurrent unexpected episodes of sudden panic and fear. The unexpected panic attack has no obvious cue or trigger at the time of occurrence (Kessler et al.,2006). Cognitive therapy (CT) is considered a benchmark in the psychotherapeutic treatment of anxiety disorders. The hallmark features of CT are problem-focused intervention strategies that are derived from learning theory as well as cognitive theory principles. Various meta-analyses and reviews of these meta-analytic findings regarding the efficacy and effectiveness of CT have been published in recent years and have concluded that it has been effective in treating anxiety disorders (Otte, 2011).
Cognitive therapy targets distorted thoughts using several techniques such as identifying irrational thoughts, examining the evidence for and against negative automatic thoughts, challenging them, and being able to relate to other people in more adaptive ways. A study comparing transdiagnostic cognitive therapy with relaxation training in anxiety disorder patients found both treatments to be equally beneficial, although relaxation training was associated with a higher dropout rate (Otte, 2011). However, there are certain limitations as well. Most meta-analyses of CT for anxiety disorders involve studies that differ largely in control procedures, waitlist, and placebo interventions that were evaluated with or without randomization while some studies did not mention any control groups. Various randomized controlled trials have shown positive effects of CT in the treatment of panic disorder with or without agoraphobia with dependable efficacy and effectiveness (Bilet et al.,2020). The more important question is how results from research studies in well-controlled conditions (efficacy) generalize to real-world settings in naturalistic surroundings (effectiveness).
Meta-analyses have shown that approximately 60% of youth recover from anxiety disorders and experience substantial symptom reduction following treatment (Warwick et al., 2017). However, not much attention has been paid if the treatment outcomes are maintained in the long term. Relapse can cause unfavorable consequences at the individual, family, and societal levels, due to delayed emotional, social, academic, and vocational problems.
However, consistency with attending the therapy sessions as well as implementing the interventions discussed, have shown modest long-term results amongst patients (Cooper et al.,2017).
Digital cognitive therapy is cost-effective and accessible across people and geographies and may reduce difficulties with attending appointments in people such as time constraints and stigma.
A recent meta-analysis identified 29 RCTs identified the effects of smartphone interventions on anxiety and panic symptoms and found these to be higher than any control condition, with a small effect size (Gu et al.,2020). Although both individual and group CT are equally effective, individual therapy is related with a larger effect size, faster improvement in symptoms, and higher adherence. Another meta-analysis showed that digital/internet-based CT is superior to waitlist and placebo control while being similar to face-to-face and group CT (Linardon etal.,2019). Thus, CT in all forms either in-person or digital have proven to be effective for anxiety and panic disorders.
References
1- Kessler RC., Berglund P., Dernier O., Jin R., Merikangas KR., Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005; 62:593–602.
2- Kessler RC., Ruscio AM., Shear K., Wittchen HU. Epidemiology of anxiety disorders. Curr Top Behav Neurosci. 2010; 2:21–35.
About the Author.
With comprehensive knowledge of Psychology and being people-oriented, Stuti is familiar with various adult mental health settings. Since completing her MSc in Mental Health Studies from King’s College London, she has been working as a Psychologist in Mumbai, which involves working with clients on a regular basis, providing therapy, and other organizational duties. Her interest involves working in clinical settings and conducting studies in specific research areas.
