Anxiety is quite a big problem that affects a lot of individuals. Some of those individuals may overlook their anxiety conditions as something that is not that bad or may not want to be labeled with a mental health condition. However, anxiety can be a big problem and can negatively affect their daily life, including their school work, job, etc. Many people with anxiety disorders may suffer from intense, excessive, persistent worry, and fear throughout their everyday life. Therefore, it is important to get the best treatment option in order to live a productive life with anxiety.
Individuals who suffer with anxiety may have various degrees of anxiety and can be diagnosed with several different disorders. Quite often some anxiety disorders can lead to multiple and repeated episodes of fear, worry, and sudden overwhelming feelings, that can reach a severe level within minutes. This is commonly known as a panic attack. Obsessive Compulsive Disorder(OCD) is an anxiety disorder where people have a persistent need to check things over and over again and they usually have the tendency to perform certain routines repedivley. General Anxiety Disorder(GAD) is an anxiety disorder where people have excessive, uncontrollable, and irrational worry. Although it is normal to have stress in your life and feel anxious if it is interfering with your daily life this might be a sign of generalized anxiety disorder.
Many people should consider the fact that it is not that uncommon for a child or an adult to be diagnosed with an anxiety disorder or multiple anxiety disorders like Obsessive-Compulsive Disorder(OCD), Social anxiety disorder(SAD), Generalized anxiety disorder(GAD), Etc. According to anxiety and depression association of America about 40 million people have some form of an anxiety disorder yet only about 36.9 percent of people seek help for this type of illness. But many advancements in medicine and psychotherapy have gave many people different options to treat their anxiety disorders and make them better. Selective Serotonin Reuptake inhibitors (SSRIs) are very common types of antidepressant medications such as Celexa, Lexapro, Prozac, etc. These medications are used to treat many anxiety disorders.
SSRIs work by affecting your brains chemistry, ultimately slowing it down by re-absorption of serotonin. The chemical serotonin communicates with each other to increase the amount of signals between neurons, SSRIs are effective antidepressants that help to control anxiety and mood. For those who are allergic to SSRIs or for those people that SSRIs don’t work well for there is a very common psychotherapy called Cognitive Behavioral Therapy(CBT). CBT focuses on learning how to develop coping strategies that can help solve current problems and help change unhelpful patterns that are in behavior, emotions, and cognitions. This kind of therapy is a very helpful therapy because you learn skills# and coping skills that can help you learn to treat and cope with your anxiety condition.
Within my daily life I know many people who struggle with anxiety disorders. My friends, cousin struggles with OCD and one friend of mine struggles with panic disorder and it has affected her daily life. She is always in constant worry that she will have a panic attack. I found it important to research this topic to find out which is a better treatment option for anxiety cognitive behavioral therapy(CBT), or selective serotonin reuptake inhibitors(SSRIs) to help my friend realize that there are treatment options to help her and to help her decide which is a better option for her based on research. I also wanted to help my friends, cousin that is struggling with OCD. In this paper the evidence of CBT effectiveness is shown as well as the potential dangers of the use of SSRIs.
Many people don’t know that while SSRIs have some potential benefits they also have some potential dangers. Two researchers agree that there are potential dangers in the use of SSRIs. While Kim Wilton and Tracey Walker agree that SSRIs are dangerous they talk about different dangers and risks associated with the use of SSRIs. Kim Wilton talks about the use of SSRIs among children adolescents while Tracey Walker talks about the use during pregnancy. Kim Wilton is a second-year law student and she explains in a section of her paper that there are risks associated with the use of SSRIs in children. One of these risks includes an increase in suicidal thoughts and actions. She says that “Notably, the SSRI Paxil was found to create two times as much suicidal idolization in childhood, compared to a placebo” (Kim Wilton page 90). This is because the child’s brain chemistry is not fully matured yet, but children aren’t the only ones affected by SSRIs. She goes on to say that studies have shown adults to have increase suicidality, but it was a small probability. Although there are dangers to children using SSRIs there are potential dangers to women using SSRIs as well, especially while pregnant as explained by Tracey Walker. The article backs up the potential dangers of using SSRIs during pregnancy. She points out that there are risks involved such as birth defects, miscarriages, preterm birth, growth defects, and other complications with women who take SSRIs during pregnancy. She points out that long-term effects of SSRIs in the children that were exposed during pregnancy are not known but says there is evidence that shows an increased rate of neurobehavior complications that may include a doubling rate in autism. Both Kim Wilton and Tracey Walker point out the major dangers and risks associated with SSRIs and the impacts they can have on our kids during pregnancy and on children. Although the research is different it shows that there are dangers and risks associated with SSRIs. Also, there are potential side effects of using SSRIs common side effects in children are include headaches, diarrhea, sweating, sleep changes etc. while serious side effects can include Serious side effects can include uncontrollable anger and violence, panic attacks, new or worsening anxiety symptoms. Side effects of SSRIs in adults include nausea, increase weight gain, sexual problems, constipation, fatigue.
Although there are potential risks associated with using SSRIs they have proven to be quite effective for treating anxiety disorders in non-responders to CBT as explained by Laura Payne. She questions whether switching to SSRIs or continuing CBT is better for those people who do not respond to CBT after twelve sessions. She explains that the treatment of panic disorder has made many considerable advancements that has led to the short term effectiveness of pharmacological and psychological treatments. In her research she had a total of fifty eight randomized patients twenty four were randomized to continued CBT while thirty four were randomized to SSRI. She points out that there were very little differences in the conditions between the two groups, the SSRI group had a little bit more severe symptom compared to the individuals that were assigned to continued CBT. She points out that at time three in their trial the SSRI group had less severe symptoms than the individuals that were assigned to continued CBT. She goes on to state that fifteen of the twenty three people in the SSRI group had attained responder status while only seven of eighteen people in the continued CBT group had attained responder status. She concluded that there was significantly greater improvement in panic disorder symptoms for individuals who switched to SSRIs after failing to fully respond to CBT. Also SSRIs are recommended as a first line pharmacological treatment to treat anxiety disorders due to its effectiveness. It is also worth noting that SSRIs may take six to eight weeks or substantially more to be fully effective.
Many people have successfully been treated with CBT for their anxiety disorders, researchers agree that CBT is quite effective and useful in treating anxiety conditions. While John Hunsley and Daniel Glenn agree that CBT is effective for treating anxiety John Hunsley adds the effectiveness of specific anxiety disorders while Daniel Glenn looks at CBT and anxiety as a whole. John Hunsley, a researcher at the University of Ottawa, shows that social phobia(SP) or otherwise known as social anxiety disorder can be treated with many forms of CBT with considerable research behind them. In his research, his review included a total of 33 studies that involved a total of 1,193 participants. He concluded that the results had shown marked benefits in patients who had received exposure-based CBT and that they had significant benefits in treatment outcomes. He did another study on CBT treatment in GAD and found that forms of CBT had been quite efficacious across lifespan with evidence to prove its effectiveness in adults and as well as the youth. He says that forms of CBT have also been found to be effective and efficacious in the treatment of OCD. In the article by Daniel Glenn a researcher for University of Los Angeles Department of Psychology, acknowledges that CBT is quite effective in treating anxiety disorders. But he points out in his article that in order for CBT therapy to be effective it depends on the treatment dose and the level of engagement that the patient has. His findings suggest that higher doses of CBT and more patient engagement can be quite effective ways in improving treatment outcomes in CBT. Both John Hunsley and Daniel Glenn acknowledge the effective treatment of CBT, but Daniel Glenn adds the impacts of adding higher doses and patient engagement. Also it is worth mentioning that CBT is recommended as a first line psychiatric treatment.
While CBT can be effective in treating many anxiety disorders it sometimes might not be a reasonable alternative treatment as pointed out by Kim Wilton in a section of her article. Kim Wilton says that not only should clients be told about the benefits and risks of a treatment, but they should also be told about alternative treatment options and the risks and benefits associated with it. She goes on to say that an alternative treatment option for the use of SSRIs would be the use of CBT. She points out that using psychotherapy might not be a reasonable option since some patients might not live somewhere where there is a psychologist available. She acknowledges that even if there is a psychologist available near them it takes a few months to see them and that it could be a major problem because if the patient was severely depressed or was suicidal it might not be the best option for them because of how long you would have to wait for the treatment. Also based on extra research I have done, many researchers seem to agree that CBT can have down sides# one of the down sides many researchers talked about was people with panic disorder may not respond to CBT and may require additional pharmacological treatment. A second down side researchers talked about was that CBT may not be suitable for individuals that suffer with learning disabilities since it relies on learning to cope and find strategies to help people with anxiety disorders and other disorders.
While both CBT and SSRIs are effective alone they show a little effectiveness when combined the two treatments. Two researchers disagree about the combination of pharmacological and psychological treatments. Borwin Bandelow talks about how combined treatment for the use of panic disorder has proven quite effective. While Michael Otto talks about whether or not there are effects related with combined treatment. Borwin Bandelow reviews the effectiveness of combined therapy in a few anxiety disorders. In a section of his article he explains that combined treatment for panic disorder had shown superior to either treatment alone. He says that in comparison there was no evidence that suggested a difference between medication and CBT. but he goes on to say that a combination of medication and CBT was superior to medication alone. He also says that for both ratings a combination of both medication and CBT was more effective than just CBT alone. He also looked at the combination of CBT and medication in GAD though he does acknowledge that only a few studies were available and that there was a low statistical power of the studies. Based on one of the studies the effect size for CBT was higher than lorazepam in GAD. And he concluded that while medication and CBT combined was far superior to medication alone he acknowledges that there was only a small effect in favor of CBT plus medication compared to CBT plus placebo. He points out that CBT plus medication wasn’t superior to CBT alone for patient and clinical practices and that it was less effective on the patient rating. Although CBT and medication appears significantly effective in panic disorders #Michael Otto adds that taking anxiolytic medications while doing CBT can affect the effectiveness of the combined treatment since it may interfere with extinction learning in exposure-based therapies. In a small section of his research he disagrees with Borwin Bandelow that combined treatment can be effective and efficacious in treating anxiety disorders. He believes when reviewed with other literature that it is particularly modest. He says that both pharmacotherapy and CBT offer efficacious and effective treatment for anxiety disorders. He goes on to say the expectation that when combining these treatments that they will provide a powerful treatment option has been met with much disappointment in recent studies of adults. He says that the evidence is quite clear in panic disorders due to recent meta-analytic reviews. He goes on to say that the meta analytic review of the literature shows modest effects for the combined treatment of CBT and pharmacotherapy compared to CBT alone. He explains that a large randomized trial of combined treatment and individual treatments of CBT and fluoxetine were done. The results showed a combination response rate of 54.2% compared to a response rate of 51.7% for CBT alone and a response rate of 50.8% for the SSRI fluoxetine.
In a review of the literature, it appears that SSRIs have significantly dangerous side effects and risks associated with the use of SSRIs in children and pregnant woman and have alarming side effects. These do sound quite dangerous #however the effectiveness of SSRIs are a big factor in considering SSRIs. SSRIs are quite effective in treating panic disorders and are recommended as a first line psychiatric treatment. Overall for SSRIs it seems to have a considerable amount of risks associated with using them and a little bit of effectiveness in treating anxiety symptoms. As far as CBT goes it is a pretty effective treatment in the case of Generalized anxiety disorders, Obsessive compulsive behavior, and Social anxiety disorder. Also, Daniel Glenn reminds us that CBT is quite effective at higher doses and when patients are engaged it shows significant improvement outcomes in patients. But Kim Wilton reminds us that sometimes a psychiatrist might not be in the area you’re in and that for suicidal and severely depressed patients it might not be the best option because of how long the patient would have to wait for treatment. It is also mentioned that CBT may have more down sides such as how some people with panic disorder may not respond to CBT and may require additional pharmacological treatment. And another downside that CBT has is that it may not be suitable for individuals that suffer with learning disabilities since it relies on learning to cope and find strategies to help people with anxiety disorders and other disorders. Something that is also worth mentioning is that CBT is recommended as a first line psychiatric treatment. Overall I Thought that combined treatment of CBT and fluoxetine would show substantially more effectiveness than it did but surprisingly there wasn’t a big difference between combined treatment of CBT and fluoxetine and CBT alone. Based on research I can conclude that the best way to treat anxiety is a combined treatment.