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

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