On an on-line message board I frequent someone recently posted questions abut how others have coped with anxiety.  I was pleased to see so many people willing to be honest with their struggles with anxiety, but sadly disappointed to see that only a very small minority used anything beyond medication to manage their anxiety.  While they may have been "managing" their anxiety with the medication, they were not learning to take control of the anxiety, and are unnecessarily dependent on medication for relief.

Please do not get me wrong...I firmly believe that there are times when medication is an absolute necessity.  However, I also firmly believe, based on research, that no one's anxiety should be treated with medication alone.  Research has documented the effectiveness of Cognitive Behavioral Treatment (CBT) in the treatment of anxiety, such that some studies have found CBT to be more effective than medication and some have found that the combination of CBT and medication is more effective than medication alone.  One of the greatest benefits of CBT seems to be in its long-term effectiveness, as recurrence of anxiety is much lower for individuals who have undergone CBT, compared to those who were treated with medication alone.  There has also been some data to suggest that, in terms of long-term outcome, CBT alone is better than a combination of CBT and medication because individuals who take medication attribute improvements to the medication, rather than to the skills they learn in CBT, and may therefore be less likely to use those strategies after discontinuing medication.

 

What is CBT?  CBT is a set of therapeutic strategies that directly teach individuals strategies and skills for reducing anxiety.  Individuals may first be taught strategies for improving physiological relaxation (e.g., slow, relaxed breathing; pleasant imagery).  They are then taught to identify "automatic" thoughts that come in anxiety provoking situations (e.g., I'm going to fail this test.  I'll never find a spouse.  I'll never finish all the work my boss gave me).  After identifying anxiety provoking thoughts, individuals are then taught how to logically evaluate those thoughts.  This includes self-questioning such as "Has that ever happened before?  Is there any evidence that suggests it will happen?  Is there any evidence that suggests it is not likely to happen?  If it does happen, so what...what would it really mean?" Etc.  The next step involves using this logical examination to create more reality based thoughts that are not likely to lead to anxiety (e.g., "I've never actually failed a test.  I did study for the test and I think I understood everything.  Even if I do not do well, I can bring my grade up in later assignments").  Another important part of CBT is exposure, which essentially means the person challenges themselves by being in situations that typically provoke anxiety, so that they can use their learned strategies and reduce anxiety in that situation via habituation (i.e., the longer we are in a feared situation with nothing bad happening, the less anxiety we feel over time). 

 

CBT can be effective for children, adolescents and adults and can help with a variety of mood difficulties including anxiety, depression and anger.