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Back To Blog > Is CBT the Only Answer in the Treatment of Anxiety and Depression?


This post is by Monica Velici of Sparta Health

Anxiety and depression have been found to predict lower quality of life among neurotypical adults (1). These conditions predict a sharp decrease in quality of life, and an increase in caregiver burden and service use (2,3) and are associated with significant impairments in adaptive functioning - for example, the inability to communicate and express thoughts and feelings to others, inability to care for own health, work, and daily chores. These disorders are also associated with impairments in family, academic, and social functioning. Anxiety disorders are the most prevalent mental health disorders among children, adolescents, and adults. Depression onset is said to occur during adolescence, being associated with a substantial impairment in global life domains (or areas of life), such as family and social life (4).

Given the regularity with which anxiety and depression co-occur, in combination with their effect on functioning, quality of life, and adult outcome (referring to how an individual affected by anxiety and depression turns out to be in adulthood, both cognitively and in terms of personality/behaviour), it is important to consider how best to prevent and manage these disorders (5). To date, the most used mechanism of treatment is talking therapy, such as Cognitive Behavioural Therapy (CBT) (6,7), which includes among others, modelling and exposure.

Research has shown that CBT has a medium-effect size (effect sizes measure the magnitude of how useful CBT is in managing depression i.e. the larger the effect size the stronger the relationship between CBT and depression management) in treating depression symptoms in the general adolescent population, however it might have a lower success in treating children (8). Prior reviews of outcomes for anxiety in adults have given mixed results (9-11). These reviews suggested that CBT can be potentially less effective for older adults compared to younger adults because of the effect of cognitive decline due to aging and high rates of psychiatric comorbidity (12). On the other hand, CBT used in the treatment of anxiety and depression in the adult population has proven to be effective, especially for anxiety disorders (13), however, only smaller effects were observed for the CBT treatment of depression (14).

Yet, CBT has been found to not be effective for every individual and is not the only psychological therapy recommended for anxiety and depression (15). Creative psychotherapies, such as art, music, and dance movement therapies (DMT) have proved to be effective in lowering anxiety and depression symptoms. A study (16) found that music therapy lowers depression in adults, with a further (17) arguing that music therapy reduces emotional responses (such as anxiety) in children. Art therapy proved to be effective especially in reducing depressive symptoms in women (18) and lowering anxiety symptoms in children (19). Although small, the body of research on DMT argues that such therapy has a positive impact on lowering depression and anxiety symptoms and improving social functioning for both children and adults.

Other non-CBT approaches, such as Mindfulness and Cognitive Enhancement Therapy (CET) have also proved to reduce co-occurring mental health symptoms (20, 21). Keng et al., (2011) reviewed 16 randomized controlled trials (RCTs), where participants are randomly assigned to experiment groups, on mindfulness and its treatment efficacy and highlighted substantial improvement in positive affect (those emotions and feelings that individuals experience and display), empathy, and quality of life. Similarly, mindfulness was found to reduce anxiety and depression symptoms in both clinical (including autism) and non-clinical populations. Moreover, a feasibility study investigating CET effects in social cognition showed that CET was effective in managing emotion regulation and social-cognitive behaviours, such as social anxiety in youths (21). Particularly, participants were able to produce faster gains in social cognition, leading to lower social anxiety levels.

In conclusion, although CBT is the most widely recommended treatment for anxiety and depression both in young and adult populations, current literature advises that other psychological therapies should be considered when clinicians formulate treatment recommendations. As discussed, creative psychotherapies, as well as Mindfulness and CET, have shown good results in managing anxiety and depression and these approaches should be considered and administered during psychological treatment where appropriate.

About Monica Velici

Monica joined Sparta Health in February 2020 as part of the rehabilitation service support team. She has a degree in Psychology, an MSc in Clinical Neurodevelopmental Sciences, and a keen interest in dementia and mental health. Monica aims to become a fully accredited therapist.

References

  1. Olatunji, B. O., Cisler, J. M. & Tolin, D. F. (2007). Quality of life in the anxiety disorders: a meta-analytic review. Clinical Psychological Review. 27, 572–81.
  2. Cadman, T., Eklund, H., Howley, D., Hayward, H., Clarke, H., Findon, J. et al. (2012). Caregiver burden as people with autism spectrum disorder and attention-deficit/hyperactivity disorder transition into adolescence and adulthood in the United Kingdom. Journal of the American Academy of Child and Adolescent Psychiatry. 51, 879–88. https://doi.org/10.1016/j.jaac.2012.06.017.
  3. Joshi, G., Wozniak, J., Petty, C., Martelon, M. K., Fried, R., Bolfek, A. et al., (2012). Psychiatric comorbidity and functioning in a clinically referred population of adults with autism spectrum disorders: a comparative study. Journal of Autism and Developmental Disorders. 43, 1314–25. https://doi.org/10.1007/s10803-012-1679-5.
  4. Higa-McMillan C. K., Francis, S. E., Rith-Najarian, L., Chorpita, B. F. (2018). Evidence base update: 50 years of research on treatment for child and adolescent anxiety. Journal of Clinical Child & Adolescent Psychology. 45(2), 91–113. https://doi.org/10.1080/15374416.2015.1046177.
  5. Propper, L., Orlik, H. (2014). Pharmacotherapy of anxiety and repetitive behaviors in autism spectrum disorders. Child and Adolescent Psychopharmacology News. 19, 5–14. doi: 10.1521/capn.2014.19.1.5
  6. Williams, K., Wheeler, D. .M, Silove, N. & Hazell, P. (2010). Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD). Journal of Evidence-Based Medicine. 3, 231. doi: 10.1111/j.1756-5391.2010.01106.x
  7. Weersing, V. R., Jeffreys, M., Do, M. T., Schwartz, K. T. G. & Bolano, C. (2016). Evidence base update of psychosocial treatments for child and adolescent depression. Journal of Clinical Child & Adolescent Psychology. 46(1):11–43. doi:10.1080/15374416.2016.1220310.
  8. Hendriks, G. J., Oude Voshaar, R. C., Keijsers, G. P. J. et al., (2008). Cognitive-behavioural therapy for late-life anxiety disorders: A systematic review and meta-analysis. Acta Psychiatrica Scandinavica. 117, 403-411
  9. Gonçalves, D. C. & Byrne, G. J. (2012). Interventions for generalized anxiety disorder in older adults: Systematic review and meta-analysis. Journal of Anxiety Disorders, 26, 1-11
  10. Gould, R. L., Coulson, M. C. & Howard, R. J. (2012). Efficacy of cognitive behavioral therapy for anxiety disorders in older people: A meta-analysis and meta-regression of randomized controlled trials. Journal of the American Geriatrics Society. 60, 218-229
  11. Ayers, C. R., Sorrell, J. T., Thorp, S. R. et al., (2007). Evidence-based psychological treatments for late-life anxiety. Psychology and Aging. 22, 8-17
  12. Hall, J., Kellett, S., Berrios, R.E. et al., (2016). Efficacy of Cognitive Behavioral Therapy for Generalized Anxiety Disorder in Older Adults: Systematic Review, Meta-Analysis and Meta-Regression. The American Journal of Geriatric Psychiatry, 24 (11), 1063-1073. doi: 10.1016/j.jagp.2016.06.006
  13. Cape, J., Whittington, C., Buszewicz, M., Wallace, P. & Underwood, L. (2010). Brief psychological therapies for anxiety and depression in primary care: meta-analysis and meta-regression. BMC Medicine. 8 (38), 1741 – 7015
  14. Butler, A. C., Chapman, J. E., Forman, E. M. & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review. 26, 17-31
  15. White, S. W., Simmons, G. L., Mazefsky, C. A. (2018). Psychological treatments targeting anxiety and depression in adolescents and adults with autism spectrum disorder: Review of the latest research and recommended future directions. (2018). Current Psychiatry Reports. 20 (10), 82.
  16. Maratos, A., Gold, C., Wang, X., & Crawford, M. (2008). Music therapy for depression. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD004517. doi: 10.1002/14651858.CD004517.pub2.
  17. Gold, C., Wigram, T., & Elefant, C. (2006). Music therapy for autistic spectrum disorder. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD004381. doi: 10.1002/14651858.CD004381.pub2.
  18. Thyme, K. E., Sundin, E. C., Stahlberg, G., Lindstrom, B., Eklof, H., & Wiberg, B. (2007). The outcome of short-term psychodynamic art therapy compared to short -term psychodynamic verbal therapy for depressed women. Psychoanalytic Psychotherapy. 21(3), 250-264. doi:10.1080/02668730701535610
  19. Beebe, A., Gelfand, E.W., & Bender, B. (2010). A randomized trial to test the effectiveness of art therapy for children with asthma. Journal of Allergy & Clinical Immunology. 126(2), 263-266. doi: 10.1016/j.jaci.2010.03.019
  20. Cachia, R. L., Anderson, A. & Moore, D. W. (2016). Mindfulness in individuals with autism spectrum disorder: a systematic review and narrative analysis. Journal of Autism and Developmental Disorders. 3 (2), 165–178
  21. Eack, S. M., Greenwald, D. P., Hogarty, S. S., Bahorik, A. L., Litschge, M. Y., Mazefsky, C. A. & Minshew, N. J. (2013). Cognitive enhancement therapy for adults with autism spectrum disorder: results of an 18-month feasibility study. Journal of Autism and Developmental Disorders. 43, 2866–2877
  22. Keng, S. L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: a review of empirical studies. Clinical Psychology Review, 31, 1041–1056. doi: 10.1016/j.cpr.2011.04.006
Mindfulness

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