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  • Should cognitive behavioural therapy (CBT) be the only psychological therapy offered to people with anxiety?

    By Sam Archibald, Content Team Academic

    Anxiety is one of the most prevalent mental health disorders affecting children and adults and can have huge implications for their development and general well-being. CBT can be effective in the short term and is superior to no treatment at all and is found to reduce symptoms and improve function for young patients (Cuijpers et al., 2014) (James et al., 2020). Rates of anxiety are constantly rising and understanding the efficacy, cost-effectiveness and applicability of CBT and other approaches is becoming more crucial to find the best way to support each client and be able to administer each type of treatment quickly to minimise symptoms and stop potential longer-term drawbacks of anxiety. I will analyse studies on anxiety and treating it to determine whether CBT should be the only treatment offered to those with anxiety or if offering a wider range of treatments is the best way for therapists to approach this issue.

    While CBT’s structured approach is effective for many, it does not work the same way for every client. Each person has unique preferences and needs in therapy, and it is important to consider these differences (Swift & Callahan, 2009). This paper will explore the strengths and limitations of CBT, arguing that it should not be the only treatment option for anxiety. Instead, CBT should be one of several evidence-based approaches tailored to everyone’s situation. By recognizing different therapeutic needs, we can help clients engage more fully in their healing process and potentially increase their chances of long-term success.

    Evidence for Cognitive behavioural therapy on anxiety

    Evidence suggests that Cognitive behavioural therapy can be effective for children and adolescents suffering from anxiety disorders. Research shows that CBT is a more effective treatment for anxiety disorders than just leaving adolescents on waiting lists or having no treatment (Cuijper et al., 2014) (Twomey et al., 2015) (James et al., 2020). For example, James (2020) found that there was a remission rate of 49% for the main anxiety disorder when treated with CBT, compared to only 18% for those on a waiting list or receiving no treatment. Highlighting the need for anxiety issues to be confronted in some way. CBT is proven to help reduce anxiety symptoms in close to half of the participants. Scott (2005) stated that anxiety disorders are the most commonly diagnosed mental illnesses among adolescents, with recorded prevalence rates of 17.3% (Kashani & Orvaschel, 1988). The high rates of this diagnosis and lack of research have encouraged more studies on anxiety in adolescents in recent years, it was found that children with these disorders need to be identified and treated immediately to have the greatest chance of reducing the symptoms they are showing (Scott, 2005). Multiple sources I have reviewed all point to the fact that adolescents need treatment as soon as symptoms are showing, Cognitive Behavioural Therapy can be a quick solution to at least reduce the negative effects experienced from anxiety disorders in the short term before a full personalised plan can be set to assist the client.  

    Cognitive behavioural therapy also is valuable in improving the lives of adults as well as adolescents. Loenric et al. (2015) assessed response rates for a variety of anxiety disorders and found that after being treated, they found 49.5% post-treatment and 53.6% long-term response rates. Which was lower than the original estimation of response rates but still showed a significant improvement in the client’s symptoms. The fact a high percentage of response rates were present among all various anxiety disorders shows that CBT is effective among a wide range of different issues not only specific types of anxiety. Multiple methods of measuring the effects of the CBT were used, like observing behaviours, self-reporting, and physical measures. After analysing all available measures an overall decrease in negative symptoms was found, showing how CBT is effective in multiple ways. For example, the client feels better, behaves in a more positive calm manner and can even show lower heart rates and cortisol levels (Roelofs & Peters, 2001) (Loenric, 2015).

    To conclude CBT shows great efficacy for managing anxiety disorders in both children and adults. The fact it can be effective across multiple types of anxiety highlights how versatile the treatment can be. Although it is shown to help clients in the short term by reducing symptoms and improving behaviours, I believe that it should not be the only intervention used on clients suffering from anxiety because an approach using other types of treatments could be more effective, each client benefits most from their own individualised treatment plan to support themselves in the long term.

    Evidence against Cognitive behavioural therapy on anxiety

    On the other hand, James et al. (2020) found little to no evidence supporting that CBT is superior to or even as an alternative treatment. Cuijpers et al (2014) found no significant differences in positive results between several types of psychotherapy, suggesting that the differences in effectiveness may only be very minimal if at all. Showing that other types of approaches can have a similar number of benefits and so providing no reason CBT should be the only treatment offered to those with anxiety disorders. Findings also suggested that the effectiveness of cognitive behavioural therapy is influenced so heavily by factors like how everyone reacts to the treatment in each study, or the quality of each study conducted that it is hard to truly find that CBT is superior to other treatments. Clients all have individual needs and can respond to CBT very positively or negatively depending on their characteristics or past experiences in life. CBT has rarely been proven superior to other treatments some studies might not be fully accurate due to the substantial number of other factors that could have affected the study and not been disclosed.

    Findings suggest that CBT is not overly useful in the long term (James et al., 2020). DiMauro et al. (2013) found that even though initial treatment significantly helped to reduce symptoms in the client, the long-term benefit of CBT was not as strong as hoped for by researchers. Maintaining the benefit of the original CBT was proven to be harder as time went on with factors like individual characteristics and treatment being personalised to each client influencing longer-term effectiveness more than just sticking with basic CBT therapy (DiMauro et al., 2013). This furthers my point on how exploring other approaches to therapy, as well as CBT, is crucial to finding the correct treatment for everyone over the long term.

    Tolin (2010) also pointed to the fact CBT is not the only treatment that is effective for treating anxiety disorders by creating a quantitative review comparing CBT to other psychotherapies like psychodynamic, interpersonal, and supportive therapies. CBT did result in being superior to psychodynamic therapy and the amount of people significantly affected by the CBT was recorded as small to moderate (Tolin, 2010). As well as highlighting the fact that CBT is not superior to all other therapy approaches, I think that a broader understanding of what makes treatments effective and when they are most effective is needed (James et al., 2020). Most studies fail to recognise other factors that can help reduce anxiety but instead put all reduced feelings of anxiety down to the type of treatment they are receiving at each time.

    Efficacy when comparing Cognitive behavioural therapy

    Baardseth et al. (2013) while conducting a clinical review of the literature comparing CBT to other approaches including Tolin’s study (2010) that I stated earlier also compared CBT to other approaches. It was found that while CBT was found to be superior for clients with anxiety disorders, the evidence is based on only four studies two of which were written before 1973 (Baardseth et al., 2013). With so few studies having been done describing CBT as superior to other approaches like psychodynamic the truth of the results is not fully clear as more research in the area is needed to better establish an accurate view on the efficacy of CBT. Furthermore, the fact two of the four studies predated 1973 lowers the validity of the findings in these four studies. Outdated research might not reflect treatment practices or even experiences patients might have now. For a more clear and accurate understanding of the efficacy of CBT future research needs to use a wider range of more recent studies that includes all the different therapeutic approaches.

    Cost-benefit, client choice and therapist skills impacting what therapy to use

    One positive of cognitive behavioural therapy is that it is cost-effective for treating anxiety disorders because it involves a structured approach which is proven to show results very quickly meaning fewer sessions are required for results to show, reducing cost (ophuis et al., 2017). CBT can also be delivered in different formats like individual, group, or online therapy. Approaches like group therapy can reduce costs as more than one client can be treated at one time, reducing the time and cost of individual therapies. Online therapy can reduce travel costs for both the client and therapist as well as not having to pay for the site at which the therapy would take place, also increasing accessibility.

    I would say that client choice plays an influential role in my belief that CBT should not be the only therapeutic approach offered to treat anxiety. Research shows that allowing clients to choose their therapeutic approach and only being guided by therapists leads to higher satisfaction rates and better overall outcomes (Swift & Callahan, 2009). Though CBT can be effective in results and cost, some people could feel as though it is the approach that best suits them and can prefer psychodynamic therapy which is less structured and delves deeper into emotional issues and personal past (Swift & Callahan, 2009). Clients could be more in control of their mental health and how to better it by feeling as though they chose how to help themselves and can want to take a more active role in their improvements.

    Some therapists could also be better equipped for different approaches to CBT and being able to recommend a treatment they are best suited to delivering can ensure the client gains the maximum benefits possible from the therapy. Having CBT as the only approach usable to treat CBT could prove to be ineffective as certain therapists can have a substantial amount more training and prefer different approaches, forcing both clients and therapists into CBT would be detrimental as the range of options for therapy helps make therapy individual to suit each client’s individual needs and make the client feel heard and that the therapist has their best interests at heart.

    Conclusion

    To conclude, while cognitive behavioural therapy shows high efficacy for treating anxiety in children and adults in the short term, we must recognise that it should not be the only therapeutic approach offered. The fact each client has a varied response to therapy in general shows how important personalising treatment is and client choice in what therapy to use significantly improves client satisfaction and active engagement (Swift & Callahan, 2009). Some clients react better to psychodynamic therapies or humanistic approaches that explore emotional issues deeper, although we must recognise that CBT is very cost-effective and can be implemented in lots of diverse ways and is very structured.

     Furthermore, most therapists have unique training and strength in different approaches to therapy and restricting treatment options to just CBT can stop clients from benefiting fully from the therapy most suited to them, minimising potential progress (Norcross, 2011). The fact anxiety disorders possess many distinct levels of complexity proves the need for a more personalised approach and several types of therapy can explore all unique experiences the client has had. By acknowledging the multiple levels of anxiety disorders therapists can create individualised plans to help a client’s well-being in the long term as well as short term and restricting treatment to only CBT limits how individualised therapists can make each treatment.

    References

    – Baardseth, T. P., Goldberg, S. B., Pace, B. T., Wislocki, A. P., Frost, N. D., Siddiqui, J. R., … & Wampold, B. E. (2013). Cognitive-behavioural therapy versus other therapies: Redux. Clinical psychology review, 33(3), 395-405.

     – Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G., Hollon, S. D., & Van Straten, A. (2014). The effects of psychotherapies for major depression in adults on remission, recovery and improvement: a meta-analysis. Journal of Affective Disorders, 159, 118 126.

    – DiMauro, J., Domingues, J., Fernandez, G., & Tolin, D. F. (2013). Long-term effectiveness of CBT for anxiety disorders in an adult outpatient clinic sample: A follow-up study. Behaviour research and therapy, 51(2), 82-86.

     – James, A. C., Reardon, T., Soler, A., James, G., & Creswell, C. (2020). Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane database of systematic reviews, (11). – Kashani, J. H., & Orvaschel, H. (1988). Anxiety disorders in mid-adolescence: A community sample. American Journal of Psychiatry, 145(8), 960–964.

    – Loerinc, A. G., Meuret, A. E., Twohig, M. P., Rosenfield, D., Bluett, E. J., & Craske, M. G. (2015). Response rates for CBT for anxiety disorders: Need for standardized criteria. Clinical psychology review, 42, 72-82.

    – Norcross, J. C. (2011). Psychotherapy relationships that work: Evidence-based responsiveness. Oxford University Press. – Ophuis, R. H., Lokkerbol, J., Heemskerk, S. C., van Balkom, A. J., Hiligsmann, M., & Evers, S. M. (2017). Cost-effectiveness of interventions for treating anxiety disorders: A systematic review. Journal of Affective Disorders, 210, 1-13.

    – Roelofs, J., & Peters, M. L. (2001). Cognitive behavioural therapy in chronic pain: A review and new directions. Pain, 92(3), 31–32. – Scott, R. W., Mughelli, K., & Deas, D. (2005). An overview of controlled studies of anxiety disorders treatment in children and adolescents. Journal of the National Medical Association, 97(1), 13.

    – Sigurvinsdóttir, A. L., Jensínudóttir, K. B., Baldvinsdóttir, K. D., Smárason, O., & Skarphedinsson, G. (2020). Effectiveness of cognitive behavioural therapy (CBT) for child and adolescent anxiety disorders across different CBT modalities and comparisons: a systematic review and meta-analysis. Nordic Journal of Psychiatry, 74(3), 168-180.

    – Swift, J. K., & Callahan, J. L. (2009). The impact of client treatment preference on outcome: A meta-analysis. Journal of Consulting and Clinical Psychology, 77(3), 449 457. – Tolin, D. F. (2010). Is cognitive–behavioural therapy more effective than other therapies?: A meta-analytic review. Clinical psychology review, 30(6), 710-720.

    – Twomey, C., O’Reilly, G., & Byrne, M. (2015). Effectiveness of cognitive behavioural therapy for anxiety and depression in primary care: a meta-analysis. Family Practice, 32(1), 3-15.

  • Understanding Anxiety in Children

    By Mohammed Adil Sethi, Content Team Academic

    Introduction

    Definition of Anxiety and Phobias

    Anxiety is a form of mental health disorder that is commonly related to worry, nervousness, or fearfulness, that is intense enough to affect a person’s level of social functioning. Specific phobias are considered a kind of anxiety disorder, that is characterised by a solid and unreasonable fear of an object, place, or situation.

    Importance of the Topic

    Ensuring good knowledge of anxiety and phobias in children is vital, since these ailments can distort a child’s development process, academic progress, and social engagement. Both delayed development, and mental problems, can be avoided by the early identification and management of such symptoms to enhance the child’s functioning.

    Figure 1: Anxiety and Phobias

    Source: (Davis et al., 2019)

    Different Forms of Anxiety and Phobia in Children

    Generalised Anxiety Disorder (GAD)

    According to DSM IV criteria, children with GAD worry excessively and inappropriately about objects, people, and events. The topics of worry include school, friends, and their family (Davis et al., 2019). This disorder, when it occurs, will take place over a few months during the year.

    Separation Anxiety Disorder

    Separation Anxiety Disorder is a type of anxiety disorder. It may be observed in children who show an abnormally high amount of distress concerning separation from caregivers, or separation from their home environment (Clefberg Liberman and Öst, 2017). It commonly affects children below five years of age, but may occur in school-age children.

    Social Anxiety Disorder

    Social anxious children may suffer from social anxiety disorder, which is characterised by a fear of particular social or performance situations, and experiencing distress when in these situations (Davis et al., 2019). They may also worry that other people will stare or laugh at them.

    Specific Phobias

    These are extreme phobias or irrational fears, which are pegged on specific things or circumstances, like animals, or a certain height, or a fear of being vaccinated (Clefberg Liberman and Öst, 2017). Most of the time, anxiety will result in avoidance reactions.

    Causes and Risk Factors

    Genetic Factors

    Research points out that if a child has been exposed to a family history of anxiety disorders, then there are bigger chances that the child, too, will be a victim (Boyd et al., 2019). These disorders are known to be closely associated with one’s genetics, because they determine the likelihood of being effected.

    Environmental Factors

    External factors, including any stressful event in the life of a child, may lead to a development of anxiety and phobic responses, ranging from the prospect of losing a parent to divorce, to exposure to violence, and so on (Blanco et al., 2020).

    Developmental Factors

    There is, also, an interaction of specific age-related factors that see children become prone to anxiety disorders (Boyd et al., 2019). For example, this could lead to young students developing separation anxiety, while older students may develop social anxiety.

    Symptoms and Diagnosis

    Emotional Symptoms

    The symptoms that parents might observe, in children with anxiety disorders, include cases of excessive worrying, fear, or nervousness (REICH et al., 2018). The child may look or behave like they are more stressed than usual, or even as if they are losing their temper quickly.

    Physical Symptoms

    Specifically, anxiety can include physical symptoms, such as head or stomach-ache, or as experiencing tightened body muscles. This may cause the child to visit the school nurse repeatedly, or involve a need to visit a general practitioner.

    Behavioural Symptoms

    The individual may exhibit certain behaviours, including refraining from situations like school, social events, or other activities (Heimberg et al., 2017). The child may also likely to show signs of poor concentration, and signs of being agitated.

    Diagnostic Criteria

    Categorised under anxiety disorders are anxiety and phobias, whereby medical professionals will diagnose a label through interviews, observation and questionnaires. They will evaluate the usual occurrence, length, and severity of the symptoms, to diagnose the presence of an anxiety disorder.

    Impact on Daily Life

    Academic Performance

    Anxiety may result in the suppression of a child’s learning capacity. Anxiety can cause poor concentration which may lead to poor grades, at a period of time when the learner is least able to engage in activities (Wittchen and Beloch, 2018). Childhood anxiety may be a worry for parents. Play therapy is another beneficial strategy that may assist children, since it allows them to communicate fear reduction via play (Gillian et al., 2019).

    Social Interactions

    Anxiety may make it difficult for children to have, and sustain, relationships with other children. Symptoms, such as avoiding other students, may lead to loneliness, and in an extreme circumstance, they may remain isolated from other people.

    Family Dynamics

    Anxiety disorders can severely test relationships within the family. Alongside this, research has found that issues, such as pressure placed on the parents, and neglect of other siblings, may also be observed (Bowlby, 2021). One may need to fill in the requirements of the family, for one or another reason, to comprehend and react to the child’s state.

    Treatment and Management

    Psychological Therapies

    CBT is helpful in the treatment of anxiety in children. Anxiety is a common childhood concern. CBT may assist them in noticing self-sabotaging thoughts. Other helpful interventions include play therapy, which can benefit younger children, since they can express their decline in fear through play (Gillian et al., 2019).

    Lifestyle Change

    Lifestyle changes should include maintaining a healthy diet, exercising regularly, and getting enough sleep. These changes are beneficial to overall mental and physical well-being.

    Parental Support

    Parents are the pivotal figures in the decision making process. Responding positively to the child, listening to what they say, and engaging in therapy will greatly help the child.

    Case Studies or Examples

    Real-life Examples

    Emmanuela, a ten-year-old female child who has social anxiety, developed a phobia and was unable to speak in class. Emma’s parents took her to CBT sessions, and Emma was gradually able to get better at controlling her anxiety, and progressively become more perceptive to social situations.

    Success Stories

    An example includes a twelve-year-old boy named Jake, who was diagnosed with a specific phobia of dogs. Exposure therapy gradually made Jake confront his fear. The support provided was pivotal, as it would have been difficult for him to face the fear on his own (Elbert et al., 2022). He eventually became well-acquainted with dogs, and as time passed, he received a dog as a pet.

    Conclusion

    Summary of Key Points

    Childhood anxiety and phobias are a rampant problem for many children, and young people, but it can be addressed. This paper identified the various types of these disorders, their causes and symptoms, which are essential factors to consider if an early assessment is required.

    Call to Action

    It is also necessary to discuss childhood anxieties and phobias, and remind people that in such cases, it may be necessary to see a specialist. Some children with disabilities may require the services of personal assistants, and early intervention may positively impact the learner, and their families, as well.

    References

    Blanco, C., Rubio, J., Wall, M., Wang, S., Jiu, C.J. and Kendler, K.S., (2020). Risk factors for anxiety disorders: common and specific effects in a national sample. Depression and anxiety, 31(9), pp.756-764.

    Bowlby, J., (2021). Violence in the family as a disorder of the attachment and caregiving systems. American journal of psychoanalysis, 44(1), p.9.

    Boyd, J.H., Rae, D.S., Thompson, J.W., Burns, B.J., Bourdon, K., Locke, B.Z. and Regier, D.A., (2019). Phobia: prevalence and risk factors. Social psychiatry and psychiatric epidemiology, 25, pp.314-323.

    Clefberg Liberman, L. and Öst, L.G., (2017). The relation between fears and anxiety in children with specific phobia and parental fears and anxiety. Journal of Child and Family Studies, 25, pp.598-606.

    Davis, T.E., Munson, M.S. and Tarcza, E.V., (2019). Anxiety disorders and phobias. Social behavior and skills in children, pp.219-243.

    Elbert, T., Schauer, M. and Neuner, F., (2022). Narrative exposure therapy (NET): Reorganizing memories of traumatic stress, fear, and violence. In Evidence based treatments for trauma-related psychological disorders: A practical guide for clinicians (pp. 255-280). Cham: Springer International Publishing.

    Gillian, B., Anne, C., Mary, M., Peter, A. and Michael, G., (2019). Exposure and anxiety management in the treatment of social phobia. Journal of consulting and clinical Psychology, 52(4), p.642.

    Heimberg, R.G., Holt, C.S., Schneier, F.R., Spitzer, R.L. and Liebowitz, M.R., (2017). The issue of subtypes in the diagnosis of social phobia. Journal of Anxiety Disorders, 7(3), pp.249-269.

    REICH, J., Noyes, R. and Yates, W., (2018). Anxiety symptoms distinguishing social phobia from panic and generalized anxiety disorders. The Journal of nervous and mental disease, 176(8), pp.510-513.

    Wittchen, H.U. and Beloch, E., (2018). The impact of social phobia on quality of life. International clinical psychopharmacology, 11, pp.15-23.

  • Overcoming Anxiety

    By Mohammed Adil Sethi, Content Team Academic.


    This article aims to identify various methods of dealing with the anxiety problem by encompassing cognitive and behavioural therapy (CBT), mindfulness training, and goal setting planning. It also underlines the need to focus on self-care and taking the professional support of specialists to improve people’s mental well-being and foster a resistant capacity.

    Anxiety is a type of mental health issue suffered by millions of people that influence daily living and overall quality of well-being. It’s pervasive nature can lead to constant pressure and can cause cognitive distress in one’s thinking process and emotional functioning. It is important to equip people with anxiety with genuine tools and strategies that will help them manage their anxiety effectively. In this way, using practices like strategies like cognitive-behavioural techniques (CBT), mindfulness practice, and enhanced goal- setting can facilitate clients’ skills to control anxiety and optimize their quality of life.

    2. Understanding Anxiety

     Anxiety is an umbrella term used to describe a wide range of states that can be observed in people’s daily lives, ranging from everyday worries to clinically significant disorders (Huggins, 2024). Normal anxiety is a pathological response to stress, which is normal and physiologically helps a person to prepare for challenging situations. It is temporary and corresponds to the degree of the stressor in question. For instance, experiencing anxiety before a job interview may increase performance due to an increase in awareness and attention. On the other hand, clinical anxiety is defined as excessive, persistent, and irrational worrying that negatively affects daily tasks (LeDoux and Pine, 2016). Other conditions labelled under this category include Generalised Anxiety Disorder (GAD), Panic Disorder, and Social Anxiety Disorder which should be treatable with the assistance of a professional intervention (Cheng and McCarthy, 2018).

    Common symptoms of anxiety contain physical manifestations like high heart rate, sweating, body shaking as well as stomach upsets. Some examples of psychological symptoms include an increased rate of worrying, restlessness, irritability and inability to focus. Triggers include inheritance, abuse genetic predisposition, traumatic experiences, chronic stress and some medications. Timely identification of the aforesaid distinctions and triggers is important towards designing efficient interventions (LeDoux and Pine, 2016).

    3. Cognitive-Behavioural Techniques

     Thought Challenging

    This technique entails recognizing and evaluating the nature of the negative thinking style. People analyse the pros and cons of their ideas and find them prejudiced mostly (Chawathey and Ford, 2016). For instance, the thought “I will fail” requires one to counteract it by recounting previous achievements to get a healthier reaction of “I have succeeded before, and I am now ready”.

    Behavioural Experiments

    Among these is the one that entails putting into practice anxious predictions in real-life situations. For instance, a client diagnosed with social anxiety may go to a social gathering to determine whether their fear of being judged is accurate. Nevertheless, through confronting the fear by noting the outcome, a person can find their anxious prediction is merely exaggerated with their negative thoughts, but in reality they are less anxious (Dagnan, Jackson and Eastlake, 2018).

    Graded Exposure

    In this approach, a person is gradually exposed to frightening and challenging conditions or stimuli. This means that beginning with lower levels of difficulty like speaking in front of a few people, the confidence level is gradually developed as people seize higher levels of difficulty. Generically, it reduces fear reactions and increases resilience (Call, Miron and Orcutt, 2014).

    4. Mindfulness and Relaxation Practices

     Mindfulness Meditation

    Practices like mindful breathing exercises and body scans decrease anxiety through the mindful presence in the current reality. This good practice enables a person to observe their thought process without judging, thereby reducing their impact and strengthening the ability to control emotional regulation (Luberto et al., 2020).

    Deep Breathing

    As diaphragmatic breathing stimulates the parasympathetic nervous system, it helps to counter the effect of stress response and anxiety disorders. It also increases oxygenation and relaxes; thus, it is a practical method for reducing stress in the current interdependence.

     Progressive Muscle Relaxation

    This practice is consciously contracted and then relaxed to enhance the physical body’s awareness to reduce anxiety-related tension. In addition to fighting stress, it also teaches people to orient themselves to signs of physical discomfort at their initial stage.

    5. Goal Setting and Action Planning

     Targeting SMART goals is a tool that helps to maintain motivation and define all components to ensure clear progress tracking. The SMART target, stands for Specific, Measurable, Achievable, Relevant, and Time-bound. For example, the goal of “reducing anxiety” is much more effective than practising 10 minutes of meditation daily for the next month (Jacob et al., 2022).

    Fig: Smart Goal                              

    Source: Author

    Behavioural Activation

    Fig: Behavioural Action            Source: Author

    Behavioural activation entails doing something to change the state of affairs at least by undertaking some simple tasks that exclude withdrawal, which is a common feature of anxiety. For instance, taking a walk or having scheduled social activities can go a long way in improving mood and decreasing anxiety (Cassell, Beattie and Lawrence, 2018).

    6. Seeking Professional Support

    It is highly important for people experiencing anxiety to address the problem with the help of professionals since anxiety treatment entails factors that are more or less outside of self-help options. A specialised form of treatment, Cognitive-Behavioural Therapy (CBT) offers structured interventions aimed at assisting an individual and altering maladaptive thought patterns and behaviours (Reardon et al., 2018).

    Counselling is an approach that involves talking through problems and feelings, while finding healthy ways of dealing with them, on the other hand, coaching entails goal-oriented support like planning, preparing and executing strategies for achieving personal and professional goals.

    7. Self-Care Strategies

    Effective self-care measures are useful in supporting the management of anxiety. Adequate sleep is basic because sleep greatly influences cognition function and emotional regulation. The symptoms of anxiety can be eased if one chooses to stick to a set routine for sleep and ensure that the restful environment can alleviate anxiety. Hunger also should be emphasised; a properly balanced diet with the required amount of nutrients is useful for the brain and significantly helps to normalise mood swings, one should limit caffeine and sugar intake which can lead to anxiety (Pilkington and Wieland, 2020).

     Another significant factor is regular exercise that helps relieves stress due to the production of endorphins in the body. Also, healthy relationships enhance emotional support and nurture a sense of belonging that reduces feelings of anxiety. Engaging with other people, having friends, and participating in community events makes people emotionally stronger and provides a very positive reference to anxiety. People can combine these self-care techniques to make a comprehensive strategy for dealing with anxiety more effectively (Call, Miron and Orcutt, 2014).

    8. Building Resilience

    Building resilience is essential to manage anxiety since the person will be able to bounce back from each failure and be able to handle all stressful situations. Strategies like flexibility enable a person to change easily without getting stressed up in a given situation. Proper problem-solving skills empower people to take actions that help to prevent or solve problems and this helps in preventing feelings of helplessness (Reardon et al., 2018).

    Emotional regulation is another aspect of resilience. It embraces one’s capacity to approach and manage emotions appropriately. Techniques such as mindfulness and cognitive revaluation help in keeping emotional stability and thus prevent anxiety from escalating. Therefore, the improvement of these skills allows the person to develop a strong ground on which they will be able to cope with anxiety and support mental health (Simco, McCusker and Sewitch, 2014).

    Conclusion

    Here are some key tools and techniques that may be useful when experiencing anxiety, which include cognitive behavioural techniques, mindfulness and relaxation strategies, as well as developing accurate and specific SMART goals, and seeking professional help. These strategies enable people to regain control of their mental health status. Self-promoting and helping others with anxiety is important, which will therefore contribute to a healthier mental state.

    References

    Call, D., Miron, L. and Orcutt, H., 2014. Effectiveness of brief mindfulness techniques in reducing symptoms of anxiety and stress. Mindfulness, 5, pp.658-668.

    Cassell, V.E., Beattie, S.J. and Lawrence, G.P., 2018. Changing performance pressure between training and competition influences action planning because of a reduction in the efficiency of action execution. Anxiety, Stress, & Coping, 31(1), pp.107-120.

    Chawathey, K. and Ford, A., 2016. Cognitive behavioural therapy. InnovAiT, 9(9), pp.518-523.

    Cheng, B.H. and McCarthy, J.M., 2018. Understanding the dark and bright sides of anxiety: A theory of workplace anxiety. Journal of Applied Psychology, 103(5), p.537.

    Dagnan, D., Jackson, I. and Eastlake, L., 2018. A systematic review of cognitive behavioural therapy for anxiety in adults with intellectual disabilities. Journal of Intellectual Disability Research, 62(11), pp.974-991.

    Gaesser, A.H., 2018. Befriending anxiety to reach potential: Strategies to empower our gifted youth. Gifted Child Today, 41(4), pp.186-195.

    Huggins, A., 2024. Anxiety to Empowerment: Exercises & Meditations to Stop Stressing & Start Engaging. Llewellyn Worldwide.

    Jacob, J., Stankovic, M., Spuerck, I. and Shokraneh, F., 2022. Goal setting with young people for anxiety and depression: What works for whom in therapeutic relationships? A literature review and insight analysis. BMC Psychology, 10(1), p.171.

    LeDoux, J.E. and Pine, D.S., 2016. Using neuroscience to help understand fear and anxiety: a two-system framework. American Journal of psychiatry, 173(11), pp.1083-1093.

    Luberto, C.M., Hall, D.L., Park, E.R., Haramati, A. and Cotton, S., 2020. A perspective on the similarities and differences between mindfulness and relaxation. Global advances in health and medicine, 9, p.2164956120905597.

    Pepping, C.A., Walters, B., Davis, P.J. and O’Donovan, A., 2016. Why do people practice mindfulness? An investigation into reasons for practising mindfulness meditation. Mindfulness, 7, pp.542-547.

    Pilkington, K. and Wieland, L.S., 2020. Self-care for anxiety and depression: a comparison of evidence from Cochrane reviews and practice to inform decision-making and priority-setting. BMC complementary medicine and therapies, 20, pp.1-15.

    Reardon, T., Harvey, K., Young, B., O’Brien, D. and Creswell, C., 2018. Barriers and facilitators to parents seeking and accessing professional support for anxiety disorders in children: qualitative interview study. European Child & Adolescent Psychiatry, 27, pp.1023-1031.

    Rodricks, K.C., 2023. Examining the influences of anxiety among students, coping styles and the use of self empowerment techniques (Bachelor’s thesis, University of Twente).

    Simco, R., McCusker, J. and Sewitch, M., 2014. Adherence to self-care interventions for depression or anxiety: A systematic review. Health Education Journal, 73(6), pp.714-730.

  • My Experience Living with Social Anxiety

    Caroline Slack, Mindless Mag

    When it started

    I was diagnosed with social anxiety about three years ago, up until then I just thought I was shy. I was having issues adjusting to a new work environment, panicking about having to speak to my manager and worrying about how my new colleagues saw me. It wasn’t my first job, and I had been like that in every job, so I just thought it was me. I didn’t know at the time that there was an issue, that it wasn’t normal. What prompted me to get help was the physical symptoms. I had been waking up with the shakes for quite a few months and I was worried that it was the start of diabetes. It made sense since my mum is also diabetic, so I took her advice and spoke to my GP. The conversation didn’t quite go the way I had expected, instead of asking me about my diet and my sugar intake, he asked me about my moods, my feelings, and whether I had thoughts of hurting myself. To say I was surprised would be an understatement! It was due to that discussion that I was diagnosed with General Anxiety Disorder and Depression, put on medication, referred to mental health and well-being services as part of the NHS and signed off from work for two weeks.

    SilverCloud

    During my two weeks off I had regular mental health check-ins with my GP, I was assigned a well-being support worker and I found myself on an app called SilverCloud. The SilverCloud service is an online service which acts like a mood diary so you can keep track of your moods, and events that are happening. I found it useful as I wasn’t quite sure what was triggering my anxiety. A feature that SilverCloud has is that you can choose which things you share with an allocated professional who then looks over what you’ve shared and sends you weekly comments. It was through sharing my mood diary entries that I was asked if I could have social anxiety. My initial thought was “what is that?” So, off to Google, I went. Reading over the symptoms, I remember feeling a sense of understanding wash over me. Situations I had avoided for years because they made me uncomfortable, but I didn’t know why, suddenly it all made sense. After telling the lady on SilverCloud, that maybe she was right I found myself referred to yet another service, Improving Access to Psychological Therapies (IAMPT). 

    IAMPT

    IAMPT or as it is now known, The NHS Talking Therapies, for anxiety and depression programme, is a service set up to help people access the help they need. In my case, it was determined after another discussion with the mental health and wellbeing service that I would benefit from one-to-one counselling, with a therapist. Due to my triggers being what they were, I was offered the choice of in-person sessions or online sessions given the services secure online messaging service. I chose the latter. Within a week I found myself in my first session. I was allocated a total of eight one-hour long sessions which focused on managing my anxiety and getting myself comfortable doing things that I would have been uncomfortable doing before. Like going shopping on my own, eating in a restaurant on my own and even things as small as wearing a dress in public. It seems like a lot to pack into eight sessions, right? In truth, it was, the technique my therapist introduced me to was something called Exposure Therapy. This involved me making a list of the ten worst situations for me and rating them from one to ten, then working my way down the list from one being the easiest and ten being the hardest. For me number one was shopping on my own, I could do it if I had to, but I wasn’t jumping at the opportunity and number ten was wearing a dress in public. After my eighth, and last session, I took myself into town on a busy Saturday afternoon and sat in my dress and had coffee all on my own with the biggest grin on my face!

    The future

    If I had to say what therapy did for me, it was to encourage the natural stubbornness within me. Instead of shying away and hiding from situations I think I can’t deal with or things I don’t think I can do, I throw myself into them to prove to myself I can do it. It was difficult at first but the more I do it, the more I experience it, the easier it gets. Am I cured? No, I don’t think so. There are still times when I get nervous and I still find it hard to be in a shop during the Christmas rush, but instead of me finding myself in a panic, now I just feel annoyed that it’s busy which I think is pretty normal. Thanks to the CBT therapy combined with my medication that I still take regularly, I now feel like I can live a decent quality of life. I now feel free to discover who I am as a person without the huge storm cloud hanging over my head.

    I share my story in the hopes that it helps others to understand that they’re not alone and help others know that there is help out there and it may only be a phone call away.

  • Help I think I have OCD, what do I do?

    Help I think I have OCD, what do I do?

    The first step is generally visiting your GP. We know how terrifying that is, how finally admitting to the daily torture is difficult – otherwise, OCD wouldn’t be known as the secret! Aware that a lot of people who are drawn in by OCD Awareness Week are those who believe that they have OCD but have no idea where to turn to. So let’s talk about accessing treatment, the best treatments out there and what to expect from your therapist.

    OCD-UK has created a GP Icebreaker which can help to start the conversation. Don’t hesitate to use it – it’s had good results and often GPs are grateful for something to begin with. There’s even a specific one for harm OCD.

    The other option is IAPT, a scheme introduced to improve access to psychological therapies. Some of them offer self-referral. To find a list of the IAPT services near you click here. Otherwise, your GP might be able to refer you to your local Community Mental Health Team (CMHT) and you may be assigned a community psychiatric nurse and will probably see a psychiatrist.

    The gold standard treatment for OCD is a talking therapy called Cognitive Behavioural Therapy (CBT), with or without medication. CBT has cognitive aspects, challenging thoughts and beliefs and behavioural tasks, known as Exposure and Response Prevention (ERP). ERP involves creating a hierarchy of difficult situations and trying them out one by one.

    You see the thing about anxiety is that it ends up by falling. Learning to face the fear without responding with a ritual or avoidance is the key.

    Check out this video where Ashley Fulwood CEO of the charity OCD-UK shares his expert advice on this subject and more over on our YouTube channel 

    Bellsie

  • The fear of fear: Why we panic and what we can do about it.

    The fear of fear: Why we panic and what we can do about it.

    By; Navit Schechter

    As lockdown measures start to ease, many of us are finding the emotional impact of the past few months has taken a toll which we may not recover from quite as quickly. Many of us have been dealing with heightened and sustained levels of stress and anxiety and, in those vulnerable to them, these uncomfortable feelings can lead to or increase panic attacks.

    A panic attack is a sudden, unexpected and intense rush of anxiety that can be extremely frightening and overwhelming to experience. Most panic attacks tend to last between 5 and 20 minutes and usually peak within 10 minutes or less before the feelings of anxiety begin to subside. This rush of anxiety is accompanied by physical symptoms such as shortness of breath, a rapid heart beat and/or feeling dizzy.

    These symptoms can be so intense that they lead you to think that you are going to die, have a heart attack, are going to faint or lose control of your mind, causing even more anxiety. In fact, it is this misinterpretation of physical symptoms that defines a panic attack i.e. when unpleasant or unusual physical symptoms in the body are interpreted as a sign of something dangerous and catastrophic happening, the level of anxiety and panic this creates is known as a panic attack. For example, when heart palpitations which are a normal sign of anxiety are interpreted as a sign of an impending heart attack, this understandably leads to overwhelming feelings of fear and panic.

    As panic attacks are so unpleasant and distressing, many people feel anxious about the thought of having another one which can trigger more panic attacks. Fear of fear and a negative cycle ensues.

    Recognising these unpleasant symptoms for what they are, and allowing yourself to experience them will help you to see for yourself that they are not harmful and dangerous, which will help to break this cycle of panic. This can be very difficult to do by yourself which is why the NICE guidelines recommend a short course of Cognitive Behaviour Therapy (CBT) to help you to break the cycle of panic.

    Although, it may not help you to break the cycle of panic in the long-term, reminding yourself that the symptoms you are experiencing are not dangerous and developing some coping statements can help you deal with feelings of anxiety in the short-term e.g. “I am safe, this is just my anxiety”, “these feelings will pass”, “anxiety can’t hurt me and “I have felt this way before and been fine afterwards”.

    Taking slow, deep breaths in through the nose and out through the mouth, making sure to exhale for longer than you inhale can also help to feel more relaxed in the moment. Next time you feel anxious, try focusing your attention away from yourself and towards your surroundings e.g. focusing on the person you are with or taking out your phone and sending a message. This can help you to see that your physical symptoms of anxiety come and go according to how anxious you feel, rather than being a sign of a real danger.

    Having repeated panic attacks can make life very distressing and every-day tasks hard to deal with. If you find that you are avoiding places where you have had, or think that you might have, a panic attack and this is affecting your day-to-day life then you may benefit from seeking help. Your GP can help to rule out any underlying health concerns and refer you for a course of CBT within the NHS. Alternatively, you can visit the BABCP website at cbtregisteruk.com to find a therapist close to you.

    More about the author; Navit is a qualified and experienced Cognitive Behaviour Therapist and mental health author. She previously worked as a manager and CBT supervisor in a London NHS service but since moving to Cornwall with her family now sees clients privately and online. Navit also writes extensively about mental health, in particular the biological and cultural factors that lead to feelings of anxiety and what we can do to overcome these. In response to the Coronavirus outbreak and the inevitable impact this has on people’s mental health, Navit has written an ebook to give insight and tools to help people manage their feelings of anxiety during the pandemic.

    Navit’s ebook is normally priced at £9.99 but by using the exclusive code ‘nopanic’ you can buy it today for just £6 with a huge discount of 40%!! https://gumroad.com/l/howtostaycalminturbulenttimes

    How can No Panic help?

    No Panic specialises in self-help recovery and our services aim to providing people with the skills they need to manage their condition and work towards recovery.

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