Evidence-Based Reviews

Using CBT effectively for treating depression and anxiety

Current Psychiatry. 2014 June;13(6):45-53

References

1. Collins K, Westra H, Dozois D, et al. Gaps in accessing treatment for anxiety and depressions: challenges for the delivery of care. Clin Psychol Rev. 2004;24(5):583-616.
2. Foa EB, Gillihan SJ, Bryant RA. Challenges and successes in dissemination of evidence-based treatments for posttraumatic stress: lessons learned from prolonged exposure therapy for PTSD. Psychological Science in the Public Interest. 2013;14(2):65-111.
3. Rahman A, Malik A, Sikander S, et al. Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Lancet. 2008;372(9642):902-909.
4. Aguilera A, Muench F. There’s an app for that: information technology applications for cognitive behavioral practitioners. Behavior Therapist. 2012;35(4):65-73.
5. Dimidjian S, Hollon SD, Dobson KS, et al. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. J Consult Clin Psychol. 2006; 74(4):658-670.
6. Hollon SD, Jarrett RB, Nierenberg AA, et al. Psychotherapy and medication in the treatment of adult and geriatric depression: which monotherapy or combined treatment? J Clin Psychiatry. 2005;66(4):455-468.
7. Cuijpers P, Hollon SD, van Straten A, et al. Does cognitive behaviour therapy have an enduring effect that is superior to keeping patients on continuation pharmacotherapy? A meta-analysis. BMJ Open. 2013;3(4):1-8.
8. Stewart R, Chambless D. Cognitive-behavioral therapy for adult anxiety disorders in clinical practice: a meta-analysis of effectiveness studies. J Consult Clin Psychol. 2009;77(4): 595-606.
9. Wright JH, Basco MR, Thase M. Learning cognitive behavior therapy: an illustrated guide. Arlington, VA: American Psychiatric Publishing; 2006.
10. Barlow DH, Craske MG. Mastery of your anxiety and panic. 4th ed. New York, NY: Oxford University Press, Inc.; 2007.
11. Foa EB, Yadin E, Lichner TK. Exposure and response prevention for obsessive-compulsive disorder: therapist guide. New York, NY: Oxford University Press, Inc.; 2012.
12. Dugas MJ, Robichaud M. Cognitive-behavioral treatment for generalized anxiety disorder. New York, NY: Routledge; 2007.
13. Zlomke K, Davis TE. One-session treatment of specific phobias: a detailed description and review of treatment efficacy. Behav Ther. 2008;39(3):207-223.
14. Foa EB, Hembree E, Rothbaum B. Prolonged exposure therapy for PTSD: emotional processing of traumatic experiences. Therapist guide. New York, NY: Oxford University Press, Inc.; 2007.
15. Resick PA, Schnicke MK. Cognitive processing therapy for rape victims. London, United Kingdom: Sage Publications; 1996.
16. Whittal ML, Robichaud M, Woody SR. Cognitive treatment of obsessions: enhancing dissemination with video components. Cognitive and Behavioral Practice. 2010;17(1):1-8.
17. Westra H, Arkowitz H, Dozois D. Adding a motivational interviewing pretreatment to cognitive behavioral therapy for generalized anxiety disorder: a preliminary randomized controlled trial. J Anxiety Disord. 2009;23(2): 1106-1117.
18. Dobson KS. The science of CBT: toward a metacognitive model of change? Behav Ther. 2013;44(2):224-227.
19. Kabat-Zinn J. Full catastrophe living. Using the wisdom of your body and mind to face stress, pain, and illness. Revised edition. New York, NY: Bantam Books; 2013.
20. Hayes SC, Strosahl KD. Acceptance and commitment therapy. The process and practice of mindful change. 2nd ed. New York, NY: The Guilford Press; 2012.
21. Hofmann S, Sawyer A, Witt A, et al. The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol. 2010;78(2): 169-183.
22. Arch J, Eifert G, Davies C, et al. Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders. J Consult Clin Psychol. 2012;80(5):750-765.
23. Brown TA, Campbell LA, Lehman CL, et al. Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. J Abnorm Psychol. 2001;110(4):585-599.
24. Norton P, Barrera T. Transdiagnostic versus diagnosis-specific CBT for anxiety disorders: a preliminary randomized controlled noninferiority trial. Depress Anxiety. 2012;29(10):874-882.

Transdiagnostic CBT. Recent research18 suggests that mood and anxiety disorders may have more commonalities than differences in underlying biological and psychological traits. Because the symptoms of anxiety and depressive disorders tend to overlap, and their rate of comorbidity may be as high as 55%,23 so-called transdiagnostic treatments have been developed. Transdiagnostic treatments target impairing symptoms that cut across different diagnoses. For example, patients with depression, anxiety, or substance abuse might share a common difficulty with regulating and coping with negative emotions.

In a preliminary comparison trial,²⁴ 46 patients with social anxiety disorder, panic disorder, or GAD were randomly assigned to transdiagnostic CBT (n = 23) or diagnosis-specific CBT (n = 23). Treatments were based on widely used manuals and offered in 2-hour group sessions across 12 weeks. Transdiagnostic CBT was found to be as effective as specific CBT protocols in terms of symptom improvement. Participants attended an average of 8.46 sessions, with similar attendance in each protocol. Fourteen participants (30%) discontinued treatment, similar to attrition rates reported in other trials of transdiagnostic and diagnosis-specific CBT.

Transdiagnostic treatments may facilitate the dissemination of empirically supported treatments because therapists would not be required to have training and supervision to competency in delivering multiple manuals for specific anxiety disorders. This could be attractive to busy practitioners with limited time to learn new treatments.

Bottom Line
Efficacy of cognitive-behavioral therapy (CBT) for depression and anxiety is well established. Although no specific technique defines CBT, a common practice is to educate an individual about interrelationships between behaviors/activities, thoughts, and mood. CBT techniques can be customized to treat specific anxiety disorders, such as panic disorder, obsessive-compulsive disorder, and generalized anxiety disorder.

Disclosures
The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.

Using CBT effectively for treating depression and anxiety

References

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