CBT in the Treatment of GAD

The main feature of Generalised Anxiety Disorder (GAD) is extreme and overwhelming fear as mention by (Wells, 2002). According to DSM-IV for a correct diagnosis of GAD to be obtained, the patient must have been over-worrying excessively every day for six months and over. The patient expects the worst to happen as they overthink events and situation that is normal for most of the population. (American Psychiatric Association, 1994). The main symptoms of GAD are restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, and sleep disturbance.

Cognitive-behaviour therapy (CBT) is the integration of behavioural therapy, established in the 1950s to 1970s, and cognitive therapy established in the 1960s. Generally, it tries to deal directly with a client’s obvious symptoms through both cognitive and behaviour approaches. Cognitive theories target illogical views which are believed to be the underpinning of behavioural and emotional problems. CBT is well-established in the treatment of anxiety disorders. Within this essay I will outline and critically evaluate the theory and practical treatment of generalised anxiety disorder (GAD) using CBT method.

In understanding how CBT interventions are used in treating GAD, we must understand the model of worry that it is founded. Beck (1976) fashioned the most commonly used types of anxiety model, which connects feelings and thinking. In this model, it is the client’s thoughts and images connecting to an expected danger that instantly precede, and cause anxiety attacks. By evaluating their environment, anxious clients exaggerate both the prospect and severity of an adverse event occurring and so take self-protective action (Blackburn, 1995).

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There are different types of interventions are used for treating GAD, and this includes both directive and non-directive therapies. According to research carried out by (Fisher & Durham 1999), they observed the usefulness of different interventions and that the number of clients achieving complete recovery. Their result showed that the most positive interventions in their meta-analysis were CBT, which achieved a recovery of 51% and applied relaxation, which achieved a 60% recovery.

Cognitive Restructuring or Challenging Negative Thoughts is one of the CBT intervention used to treat GAD. They generally concentrate on two main aspects: cognitive work intended at challenging the client’s beliefs and thought processes as well as behavioural work intended in educating the client anxiety management strategies (Wells, 2002). According to Borkovec (2002), it defines the cognitive facet of CBT as concentrating on the way the client sees the world and trying to transfer this into a correct balance. Mostly, this is done by eliciting how the client sees situations worryingly. The client is then encouraged to apply rational thought processes to their observations and to challenge the way they are thinking. The therapist will try to displace these fundamental thought processes with cognitive clarifications that will not lead to increased anxiety. Clients are usually given a thought log and encourage to practice identifying and recording thoughts that they have during severe events and resulting consequence as homework. They are encouraged to focus mainly on thoughts that provoke anxiety for them. Once they become more proficient at recognizing their negative thoughts, then they will be able to start challenging them, and the consequence will then be that though they were nervous during the task but realize that the consequence was not as unfortunate as they expected. This will make it easier next time they encounter the same thought. 

Relaxation Training. This treatment technique entails educating client who worries excessively, on how relaxation is an essential part of the healing process. (Borkovec, 2002). This treatment method entails schooling the client in different methods for relaxing the body such as meditation, progressive muscle relaxation, and relaxing imagery. Clients are encouraged to repeat these relaxation exercises even when they are not anxious, so they feel comfortable with their application. In some conditions, clients will be exposed to situations which make them anxious in order to provide genuine exercise chances.

Mindfulness Training. The mindfulness training is the art of focusing on the here and now and also to be aware of the moment and not focus so much on the future. The client is encouraged and offered training that will assist them to focus on the present rather than worry about future events which they have no control over. (Borkovec, 2000).

Systematic Exposure. This is a process that encourages the client to face their fears and test their theories / worst-case scenarios. By doing so, it should allow the person to make peace and stop triggering anxiety. This could be done through experiments. For instance, a client who is afraid of heights could be encouraged to start conquering their fear of this by going into a tall building and looking out through the closed window and while this is going on their level of anxiety should be monitored to ensure that they are not overexposed. This should be increased gradually throughout the therapy sessions and at each time, increase the level of the exposure until they reach a stage where they are comfortable going out into the balcony and looking down below with minimal anxiety. (Wilkson et al. 2011) 

Stimulus control. This is about informing the client to allocate a period each day dedicated to worrying. During this time, they would put into practice their cognitive skills.  Two other methods that could be used are behavioural activation strategies, and this is to motivate the client to participate in more favourable activities and imagery rehearsal methods which involve practicing new responses to external signals likely to cause worry (Borkovec, 2000).

Researches have shown that Cognitive-behavioural therapy can be as effective as medication in treating some mental health problems, but it may not be adequate or suitable for everyone.

It is beneficial in cases where drugs alone have not been successful. Also, it can be accomplished in a reasonably short period compared with other talking therapies.  It shows useful and practical tactics that can be used in everyday life, even after the treatment has finished. Research shows that 80% of patients treated recover adequately and can lead to a healthy life.

CTB has no side effect, unlike medication for the treatment, and as such, it can be used over a long-term period.

Adversely for CBT to be effective, the client should be willing to commit to the treatment plan in order to benefit from the session. If the client is unwilling to commit, then it will be difficult for the therapist to help, so co-operation from the client is highly essential.

The client often finds attending regular CBT sessions and carrying out any extra work between sessions time-consuming. Hence some client never completes their sessions .it is suitable for people with more complex mental health needs, as it requires controlled sessions. It involves client challenging their emotions and anxieties, and they may experience initial periods where they are anxious or emotionally uncomfortable, thereby not fully willing or are not prepared to deal with it.

As it focuses on the client’s present issues and the ability to change themselves, i.e., their thoughts, feelings, and behaviours, but does not address any more extensive glitches in systems or families dynamics as this usually have a substantial impact on people’s health and wellbeing. Critics argue that because CBT only addresses current problems and focuses on specific issues. It does not address the possible underlying causes of mental health conditions, such as an unhappy childhood. It is not suitable for treating mental disorders in the long term. It should be used in conjunction with other types of therapy, like psychodynamic therapies for long term cure.

CBT does not investigate genetic factors, interpersonal factors like social life. Abnormal thoughts do not always cause anxiety disorders. Additionally, it does not consider the fact that sometimes a third party might be responsible for client mental disorder, for example, victims of bullying.

References

• Borkovec, T.D., 2002. Life in the future versus life in the present. Clinical Psychology: Science and Practice, 9(1), pp.76-80.
• Fisher, P.L. and Durham, R.C., 1999. Recovery rates in generalized anxiety disorder following psychological therapy: an analysis of clinically significant change in the STAI-T across outcome studies since 1990. Psychological medicine, 29(6), pp.1425-1434.
• Wells, A., 2002. Emotional Disorders and Metacognition.: Innovative Cognitive Therapy. John Wiley & Sons.
• Borkovec, 2000).