Center for Cognitive Therapy
Mark E. Oakley, Ph. D.
There are several distinct disorders included in the domain of anxiety disorders. Posttraumatic Stress Disorder and Obsessive-Compulsive Disorder are discussed in separate sections of this website. Some of the more common Anxiety Disorders include Panic Disorder, Agoraphobia, Specific Phobias, Social Phobia, and Generalized Anxiety Disorder. Cognitive-Behavioral Therapy has received extensive scientific evidence as being an effective treatment for this wide array of Anxiety Disorders.
Anxiety is one of the most common reasons that cause people to seek psychotherapy. Cognitive Therapy has proven to be extremely successful at alleviating anxiety. When compared to medications, Cognitive Therapy is the only therapy to consistently produce results equivalent to medications. Perhaps more important, in terms of relapse when treatment stops, Cognitive Therapy is significantly superior to medications. Individuals who complete a full course of psychotherapy typically maintain their improvements when treatment ends much more effectively then individuals who receive only medications.
Scientific research has shown that anxiety is related to inaccurate thinking. Individuals who have problems in these areas make certain unique errors in thinking that are readily identifiable. Cognitive therapy involves learning skills that allow you to see the connection between thoughts and feelings of anxiety, to appraise the accuracy of these thoughts creating anxiety, and if they are inaccurate, to make them more accurate.
Panic Disorder involves recurrent unexpected panic attacks that are defined as a discrete period of intense fear or discomfort in which four (or more) of the following symptoms are present and where these symptoms developed abruptly and reached a peak within 10 minutes:
- palpitations, pounding heart, or accelerated heart rate
- trembling or shaking
- sensations of shortness of breath or smothering
- choking sensations
- chest pain or chest discomfort
- nausea or abdominal distress
- feeling dizzy, unsteady, lightheaded, or faint
- disrealization (feelings of unreality) or depersonalization( feeling detached from oneself)
- fear of losing control or going crazy
- fear of dying
- parasthesias (numbness or tingling sensations)
- chills or hot flashes
Panic attacks can be extremely intense and frightening, in part, because they can resemble medical problems and often prompt emergency room visits. When a person has recurring, unexpected panic attacks, is afraid of having more or worries about what they mean or the consequences, and makes changes in his/her behavior as a result of these panic attacks, this is considered to be a "panic disorder".
Agoraphobia can occur as a result of panic attacks, although it may also occur with or without panic disorder . Agoraphobia is a fear of places or situations where a panic attack may occur or from which escape might be difficult or be embarrassing or in which help might not be available in the event of a panic attack or panic symptoms. The individual fears in these situations that he or she will have a panic attack.
Fortunately, there have been a number of well conducted scientific studies that have demonstrated a high degree of success with Cognitive-Behavioral treatments for Panic Disorder and Agoraphobia. Over a course of 20 to 25 sessions, the efficacy rates range from 85% to 90%. Furthermore, upon treatment termination most patients tested 1 year later maintained improvement.
Specific phobias involve a marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (e.g., flying, driving, heights, animals, receiving an injection, seeing blood, etc.). Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response. Phobic situations are either avoided or endured with intense anxiety or distress. This avoidance , anxious anticipation, or distress interferes significantly with the person's normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
Cognitive-Behavioral treatment for specific phobias involves helping you to confront what you fear rather than avoiding it. Avoidance perpetuates the fear due to the fact that when you avoid, a test of your beliefs that are the foundation of your fears, is not possible. Your therapist will help you to gradually confront your fears so that it is not overwhelming and teach you methods to relax while you do this. Depending upon the nature of what you fear, Cognitive-Behavioral treatments have demonstrated in controlled scientific trials to produce 74% to 94% improvement. Although some patients may use antidepressant or antianxiety medications, these procedures do not require the use of medications.
Social phobia (Social Anxiety Disorder) is a marked and persistent fear of social or performance situations in which embarrassment or rejection may occur. Exposure to the social or performance situations almost invariably provokes an immediate anxiety response and these situations are avoided or endured with intense anxiety or distress. This avoidance , anxious anticipation, or distress interferes significantly with the person's normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia. Social Phobia is very common. More than one out of eight people will suffer from social phobia at some point in their lives. People with social anxiety often have automatic thoughts about what will happen in social situations. They typically predict performing poorly in ways that would be embarrassing or lead to rejection. As a result of these anticipated consequences and resulting anticipatory anxiety, social situations are avoided.
Cognitive-Behavioral Therapy (CBT) involves identifying and changing thoughts that create fear and avoidance. A number of scientific studies have shown that CBT is helpful for social phobia, usually within a 20 session format. People usually continue to feel better in social situations even after therapy is concluded.
Generalized Anxiety Disorder (GAD) involves excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events or activities where the individual finds it difficult to control the worry. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The anxiety and worry are associated with at least three (or more) of the following symtoms:
- restlessness or feeling keyed up or on edge
- feeling easily fatigued
- difficulty concentrating or mind going blank
- muscle tension
- sleep disturbance
Approximately 7% of the population will suffer from GAD. It has been estimated that about 30% of the causes of GAD are inherited. Inaccurate thinking is a significant causative factor in GAD. People with GAD seem to be worried that bad things will happen most of the time. They predict that horrible things will happen and that when they feel anxious it means that something bad is more likely to happen. Many people who worry feel that their worry provides some protection and that if they do not worry bad things are more likely to happen.
Cognitive-Behavioral Therapy has proven to be more effective than medications in the treatment of GAD and leads to a reduction of medications when they are utilized. About 50% of patients who receive this type of treatment show significant improvement that is maintained when treatment is concluded. CBT will help you to identify and change your beliefs about the costs and benefits of worrying.
During the course of treatment for GAD you will also learn to distinguish between productive vs. unproductive worry and to understand the difference between anxiety that is normal and facilitative vs. anxiety that is debilitative and counterproductive. In addition to Cognitive Therapy, adjunctive techniques such as Applied Relaxation Training, Problem Solving, and Time Management may be very helpful.