Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-19T23:40:36.644Z Has data issue: false hasContentIssue false
  • English
  • Français

Cognitive Therapy for Anxiety Disorders: Current Status and Future Challenges

Published online by Cambridge University Press:  01 November 2008

Freda McManus ,
Nick Grey  and
Roz Shafran
Freda McManus*
Affiliation:
Oxford Cognitive Therapy Centre and University of Oxford, UK
Nick Grey
Affiliation:
Maudsley Hospital, London, UK
Roz Shafran
Affiliation:
University of Reading, UK
*
Reprint requests to Freda McManus, Oxford Cognitive Therapy Centre, The Warneford Hospital, Oxford OX3 7JX, UK. E-mail: freda.mcmanus@obmh.nhs.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

This paper reviews recent theoretical, conceptual and practice developments in cognitive-behaviour therapy (CBT) for anxiety disorders. The empirical status of CBT for anxiety disorders is reviewed and recent advances in the field are outlined. Challenges for the future development of CBT for the anxiety disorders are examined in relation to the efficacy, effectiveness and cost-effectiveness of the approach. It is concluded that the major challenge currently facing CBT for anxiety disorders in the UK is how to meet the increased demand for provision whilst maintaining high levels of efficacy and effectiveness. It is suggested that the creation of an evidence base for the dissemination of CBT needs to become a priority for empirical investigation in order effectively to expand the provision of CBT for anxiety disorders.

Keywords

Anxiety disorderscognitive-behaviour therapyreview
Type
Treatment Applications
Information
Behavioural and Cognitive Psychotherapy , Volume 36 , Issue 6: Developments in the Theory and Practice of Cognitive and Behavioural Therapies , November 2008 , pp. 695 - 704
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2004). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). Washington, DC: APA.Google Scholar
Addis, M. E., Hatgis, C., Krasnow, A. D., Jacob, K., Bourne, L. and Mansfield, A. (2004). Effectiveness of cognitive-behavioural treatment for panic disorder versus treatment as usual in a managed care setting. Journal of Consulting and Clinical Psychology, 72, 625–635.CrossRefGoogle Scholar
Barlow, D. H. (2002). Anxiety and its Disorders: the nature and treatment of anxiety and panic (2nd ed.). New York: Guilford Press.Google Scholar
Barlow, D. H., Allen, L. B. and Choate, M. L. (2004). Towards a unified treatment for emotional disorders. Behaviour Therapy, 35, 205–230.CrossRefGoogle Scholar
Beck, A. T., Emery, G. and Greenberg, R. L. (1985). Anxiety Disorders and Phobias: a cognitive perspective. New York: Basic Books.Google Scholar
Brown, T. A., Campbell, L. A., Lehman, C. L., Grisham, J. and Mancill, R. B. (2001). Current and lifetime co-morbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology, 110, 585–599.CrossRefGoogle Scholar
Clark, D. M. (1986). A cognitive model of panic. Behaviour Research and Therapy, 24, 461–470.CrossRefGoogle Scholar
Clark, D. M., Ehlers, A., McManus, F., Hackmann, A., Fennell, M., Campbell, H., Flower, T., Davenport, C. and Louis, B. (2003). Cognitive therapy versus fluoxetine in generalized social phobia: a randomized placebo-controlled trial. Journal of Consulting and Clinical Psychology, 71, 1058–1067.CrossRefGoogle ScholarPubMed
Clark, D. M., Ehlers, A., Hackmann, A., McManus, F., Fennell, M., Grey, N., Waddington, L. and Wild, J. (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 74, 568–578.CrossRefGoogle ScholarPubMed
Clark, D. M., Salkovskis, P. M., Hackmann, A., Middleton, H., Anastasiades, P. and Gelder, M. (1994). A comparison of cognitive therapy, applied relaxation and imipramine in treatment of panic disorder. British Journal of Psychiatry, 164, 759–769.CrossRefGoogle ScholarPubMed
Clark, D. M., Salkovskis, P. M., Hackmann, A., Wells, A., Ludgate, J. and Gelder, M. (1999). Brief cognitive therapy for panic disorder: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 67, 583–589.CrossRefGoogle ScholarPubMed
Clark, D. M. and Wells, A. (1995). A cognitive model of social phobia. In Heimberg, R., Leibowitz, M., Hope, D. A., and Schneier, F. R. (Eds.), Social Phobia: diagnosis, assessment and treatment. New York: Guilford Press.Google Scholar
Craske, M. G., Farchione, T. J., Allen, L. B., Barrios, V., Stoyanova, M. and Rose, R. (2007). Cognitive behaviour therapy for panic disorder and co-morbidity: more of the same or less of more? Behaviour Research and Therapy, 45, 1095–1109.CrossRefGoogle ScholarPubMed
Ehlers, A. (1995). A 1-year prospective study of panic attacks: clinical course and factors associated with maintenance. Journal of Abnormal Psychology, 104, 164–172.CrossRefGoogle ScholarPubMed
Ehlers, A. (2006). A Cognitive Model of Post-Traumatic Stress Disorder: theory and therapy. Keynote address presented at BABCP Conference, Warwick, 19–21 July.Google Scholar
Ehlers, A. and Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319–345.CrossRefGoogle ScholarPubMed
Ehlers, A., Clark, D. M., Hackmann, A., McManus, F. and Fennell, M. (2005). Cognitive therapy for PTSD: development and evaluation. Behaviour Research and Therapy, 43, 413–431.CrossRefGoogle ScholarPubMed
Ehlers, A., Clark, D. M., Hackmann, A., McManus, F., Fennell, M. and Grey, N. (2008). Cognitive Therapy for PTSD: a therapist's guide. In preparation.Google Scholar
Ehlers, A., Clark, D. M., Hackmann, A., McManus, F., Fennell, M., Herbert, C. and Mayou, R. (2003). A randomised controlled trial of cognitive therapy, self-help booklet, and repeated early assessment as early interventions for PTSD. Archives of General Psychiatry, 60, 1024–1032.CrossRefGoogle Scholar
Fedoroff, I. C. and Taylor, S. (2001). Psychological and pharmacological treatments of social phobia: a meta-analysis. Journal of Clinical Psychopharmacology, 21, 311–324.CrossRefGoogle ScholarPubMed
Foa, E. B., Hembree, E. A., Cahill, S. P., Raunch, S. A. M., Riggs, D. S., Feeny, N. C. and Yadin, E. (2005). Randomized trial of prolonged exposure for post-traumatic stress disorder with and without cognitive restructuring: outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 73, 953–964.CrossRefGoogle ScholarPubMed
Goisman, R. M., Warsaw, M. G. and Keller, M. B. (1999). Psychosocial treatment prescriptions for generalized anxiety disorder, panic disorder and social phobia, 1991–1996. American Journal of Psychiatry, 156, 1819–1821.CrossRefGoogle ScholarPubMed
Grey, N., Young, K. and Holmes, E. (2002). Cognitive therapy within reliving: a treatment for peritraumatic emotional “hotspots” in posttraumatic stress disorder. Behavioural and Cognitive Psychotherapy, 30, 63–82.CrossRefGoogle Scholar
Grey, N., Salkovskis, P., Quigley, A., Ehlers, A. and Clark, D. M. (2006). Dissemination of Cognitive Therapy for Panic Disorder in Primary Care. Paper presented at BABCP conference, Warwick, 19–21 July.Google Scholar
Hayes, S. C., Strosahl, K. D. and Wilson, K. G. (1999). Acceptance and Commitment Therapy. New York: Guilford Press.Google Scholar
Hofmann, S. G. and Asmundson, G. J. G. (in press). Acceptance and mindfulness-based therapy: new wave or old hat? Clinical Psychology Review.Google Scholar
Hofmann, S. G. and Smits, J. A. (in press). Cognitive-behaviour therapy for adult anxiety disorders: a meta-analysis of randomised placebo-controlled trials. Journal of Clinical Psychiatry.Google Scholar
Howard, R. C. (1999). Treatment of anxiety disorders: does specialty training help? Professional Psychology: Research and Practice, 30, 470–473.CrossRefGoogle Scholar
Kessler, R. C., Chiu, W. T., Demler, O. and Walters, E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617–627.CrossRefGoogle ScholarPubMed
King, M., Davidson, O., Taylor, F., Haines, A., Sharp, D. and Turner, R. (2002). Effectiveness of teaching general practitioners skills in brief CBT to treat patients with depression: randomised controlled trial. British Medical Journal, 324, 947.CrossRefGoogle Scholar
Layard, R. (2006). The Depression Report: a new deal for depression and anxiety disorders. London: Mental Health Policy Group of the Centre for Economic Performance, London School of Economics.Google Scholar
Mannix, K., Blackburn, I-M., Garland, A., Gracie, J., Moorey, S., Reid, B., Standart, S. and Scott, J. (2006). Effectiveness of brief training in cognitive behaviour therapy techniques for palliative care practitioners. Palliative Medicine, 20, 579–584.CrossRefGoogle ScholarPubMed
McManus, F., Sacadura, C. and Clark, D. M. (in press). Why social anxiety persists: an experimental manipulation of the role of safety behaviours as a possible maintaining factor. Journal of Behaviour Therapy and Experimental Psychiatry.Google Scholar
Mennin, D. S., Heimberg, R. G., Turk, C. L. and Fresco, D. M. (2005). Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behaviour Research and Therapy, 43, 1281–1310.CrossRefGoogle ScholarPubMed
Miller, J. J., Fletcher, K. and Kabat-Zinn, J. (1995). Three-year follow-up and clinical implications of a mindfulness-based stress reduction intervention in the treatment of anxiety disorders. General Hospital Psychiatry, 17, 192–200.CrossRefGoogle Scholar
Mortberg, E., Clark, D. M., Sundin, O. and Wistedt, A. (2006). Intensive group cognitive therapy and individual cognitive therapy versus treatment as usual in social phobia: a randomized controlled trial. Acta Psychiatrica Scandinavica. 115, 142–154.CrossRefGoogle Scholar
National Institute for Health and Clinical Excellence (NICE) (2004). Anxiety: management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care. London: NICE.Google Scholar
National Institute for Health and Clinical Excellence (NICE) (2005a). Obsessive-compulsive disorder: core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder. London: NICE.Google Scholar
National Institute for Health and Clinical Excellence (NICE) (2005b). Post-traumatic stress disorder: the management of PTSD in adults and children in primary and secondary care. London: Gaskell and the British Psychological Society.Google Scholar
National Institute for Health and Clinical Excellence (NICE) (2006). Computerised Cognitive Behaviour Therapy for Depression and Anxiety. www.nice.org.uk/TA097.Google Scholar
Ost, L. G., Salkovskis, P. and Hellstrom, K. (1991). One session therapist directed exposure vs. self-exposure in the treatment of spider phobia. Behavior Therapy, 22, 407–422.CrossRefGoogle Scholar
Rapee, R., Abbott, M. J., Baillie, A. and Gaston, J. E. (2007). Treatment of social phobia though pure self -help and therapist-augmented self help. British Journal of Psychiatry, 191, 246–252.CrossRefGoogle Scholar
Rice, D. P. and Miller, L. S. (1998). Health economics and cost implications of anxiety and other mental health disorders in the United States. British Journal of Psychiatry, Suppl. 34, 4–9.CrossRefGoogle Scholar
Roth, A. and Fonagy, P. (2005). What Works for Whom? (2nd Ed.). London: Guilford Press.Google Scholar
Salkovskis, P. M. (1985). Obsessional-compulsive problems: a cognitive-behavioural analysis. Behaviour Research and Therapy, 23, 571–583.CrossRefGoogle ScholarPubMed
Salkovskis, P. M. (1991). The importance of behaviour in the maintenance of anxiety and panic: a cognitive account. Behavioural Psychotherapy, 19, 6–19.CrossRefGoogle Scholar
Salkovskis, P. M., Clark, D. M., Hackmann, A., Wells, A. and Gelder, M. (1999). An experimental investigation of the role of safety-seeking behaviours in the maintenance of panic disorder with agoraphobia. Behaviour, Research and Therapy, 37, 559–574.CrossRefGoogle ScholarPubMed
Salkovskis, P. M., Hackmann, A., Wells, A., Gelder, M. and Clark, D. (2007). Belief disconfirmation versus habituation approaches to situational exposure in panic disorder with agoraphobia: a pilot study. Behaviour, Research and Therapy, 45, 877–885.CrossRefGoogle ScholarPubMed
Sholomskas, D. E., Syracuse-Siewert, G., Rounsaville, B. J., Ball, S. A., Nuro, K. F. and Carroll, K. M. (2005). We don't train in vain: a dissemination trial of three strategies of training clinicians in cognitive-behavioural therapy. Journal of Consulting and Clinical Psychology, 73, 106–115.CrossRefGoogle Scholar
Sibrava, N. and Borkovec, T. D. (2006). Worry and cognitive avoidance. In Davey, G. and Wells, A. (Eds.). Worry and Psychological Disorders: theory, assessment, and treatment (pp. 239–258). West Sussex, UK: Wiley and Sons.CrossRefGoogle Scholar
Stirman, S. W., DeRubeis, R. J., Crits-Christoph, P. and Rothman, A. (2005). Can the randomized controlled trial literature generalize to nonrandomized patients? Journal of Consulting and Clinical Psychology, 73, 127–135.CrossRefGoogle ScholarPubMed
Teasdale, J. D., Segal, Z. and Williams, J. M. (1995). How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help? Behaviour Research and Therapy, 33, 25–39.CrossRefGoogle ScholarPubMed
Walters, S. T., Matson, S. A., Baer, J. S. and Ziedonis, D. M. (2005). Effectiveness of workshop training for psychosocial addiction treatments: a systematic review. Journal of Substance Abuse Treatment, 29, 283–293.CrossRefGoogle ScholarPubMed
Wells, A. (1997). Cognitive Therapy of Anxiety Disorders: a practice manual and conceptual guide. Chichester: Wiley.Google Scholar
Wells, A. and Matthews, G. (1994). Attention and Emotion: a clinical perspective. Hove, UK: Erlbaum.Google Scholar
White, J. (1998). “Stresspac”: three year follow-up of a controlled trial of a self-help package for the anxiety disorders. Behavioural and Cognitive Psychotherapy, 26, 133–141.CrossRefGoogle Scholar
Wild, J., Hackmann, A. and Clark, D. M. (2007). When the present visits the past: updating traumatic memories in social phobia. Journal of Behaviour Therapy and Experimental Psychiatry, 38, 386–401.CrossRefGoogle ScholarPubMed
Westbrook, D., Sedgwick-Taylor, A., Bennett-Levy, J., Butler, G. and McManus, F. (2008). A pilot evaluation of a brief CBT training course: impact on trainees' satisfaction, clinical skills and patient outcomes. Behavioural and Cognitive Psychotherapy, 36, 000–000.CrossRefGoogle Scholar
Zimmermann, M., McDermut, W. and Mattia, J. I. (2000). Frequency of anxiety disorders in psychiatric outpatients with major depressive disorder. American Journal of Psychiatry, 157, 1337–1340.CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.