Cognitive Behavioural Therapy (CBT) and Cognitive Therapy (CT)

Research studies indicate that anxiety disorders can effectively be treated with the use of psychopharmacological as well as cognitive behavioural therapies (Stein & Sareen, 2015). It should be mentioned in this context that the interventions aim different targeted symptoms. Therefore, it is important to make use of a strategic combination of different treatment interventions so as to improve the outcome of the symptoms and at the same time improve the quality of life of the affected individuals.

As stated by Nathan and Gorman (2015), the first line psychotherapeutic interventions are used for managing the symptoms of Generalized Anxiety Disorder (GAD). Research studies suggest that the administration of cognitive behavioural therapy is effective in treating Generalized Anxiety Disorder. The Cognitive Behavioural Therapy typically uses a combination of different therapeutic interventions. The key elements covered in the therapy comprises of imparting education about psychological wellbeing, exposure to worries and insecurities, inducing relaxation and incorporating a problem solving approach. In addition to these, the therapy also incorporates the components of cognitive restructuring as well as the consideration of interpersonal psychotherapy (Cuijpers et al., 2014). The most important aspect of the cognitive behavioural therapy makes use of the exposure procedures directed to individuals. Research studies mention that the cognitive behavioural therapy follows a person-centred approach and makes use of a minimum of 12-20 sessions in order to bring about an improvement in the quality of symptoms (Marganska et al., 2013). While dealing with children who are affected with Generalized Anxiety Disorder, the central focus of the therapy is on the child and the immediate care providers. The therapeutic routine is similar to that of adults and makes use of components such as psycho-education, training to improve coping skills and in vivo exposure to positive thought content. 

In addition to this, the administration of Cognitive Therapy (CT) has also been found to elicit positive effect on the deteriorating symptoms of the patient. It is important to note here that the Cognitive therapy differs from the cognitive behavioural therapy and focuses on the objective evaluation of the anxious through content of the affected individuals (Paxling et al., 2013). Also, variations of cognitive behavioural therapy such as pure cognitive therapy, meta-cognitive therapy and cognitive restructuring are used as therapeutic interventions to treat patients who are suffering from Generalized Anxiety Disorder (GAD). The administration of cognitive therapy also involves a person-centred approach and the treatment extends over 15-20 sessions (Paxling et al., 2013).

Applied Relaxation

In this context, it should be mentioned that the technique of Applied Relaxation includes imparting education to the patient about coping skills to manage their anxiety. The coping skill helps in promoting quick relaxation and enables the patient to manage their reactions related to anxiety in a better manner (Baer, 2015). It is important to note in this context, that the applied relaxation theory is different from the relaxation theory and makes use of anxiety provoking situations so as to promote tranquillity and relaxation among the affected individuals. This treatment is also person-centred in approach and extends over 15 sessions. While dealing with minors who are suffering from Generalized Anxiety Disorder (GAD), parents are educated not to foster the anxious temperament of the children. It is critical to note in this context that while dealing with children and adolescents aged in between 6 to 17 years, a family centred approach is adapted (Lissek et al., 2014). Also, while dealing with adolescents, making use of group therapy has also been reported to have positive effect. The therapeutic session for minors include a treatment package of approximately 12-20 sessions (Holzel et al., 2013). However, while administering group therapy, the session can be curtailed to a minimum of 8 sessions. 

In addition to this, it should be noted that the treatment routine for Generalized Anxiety Disorder also involves the use of pharmacological interventions. The use of mild sedatives as well as tranquillisers have been reported to improve symptoms of sleep abnormalities as well as irritation. The prescription and administration of FDA approved medications for adults include Venlafaxine, Duloxetine and Paroxetine (Lissek et al., 2014). Studies also report the administration of non-FDA approved medications that are used for managing the symptoms of GAD and these medications include, Sertraline and Fluoxetine (Hoge et al., 2013). Also, Sertraline is used for the treatment of GAD in children and Fluvoxamine is used in case of adolescents. The dose of the medications vary on the basis of the intensity of the symptoms.

Research studies further indicate that a combination of using an antidepressant or a sedative such as benzodiazepine along with cognitive behavioural therapy can help in fostering an efficient recovery (Lader, 2015). Research studies typically suggest that a combination therapy is more effective than a mono-therapy while treating Generalized Anxiety Disorder in children as well as adolescents (Yoshinaga et al., 2015). 

A second line of treatment interventions for managing the symptoms of Generalized Anxiety Disorder includes fostering acceptance and commitment therapy combined with mindfulness among affected individuals. The central theme of the therapies relies upon making the patients focus on the present moment and address the moment on the basis of their values and belief and not be guided their emotions and impulse (Yoshinaga et al., 2015). In case of children, the central focus of the treatment intervention is to impart awareness about excessive worrying (American Psychiatric Association, 2013). The therapy is individual directed and usually extends up to 10-15 sessions. In addition to this the use of internet based interventions such as administering web-based CBT, cognitive restructuring as well as reinforcing relaxation sessions help in promoting recovery (Paxling et al., 2013). The web based therapeutic intervention extends over a time period of 6-8 sessions (Nathan & Gorman, 2015).

Pharmacological interventions

The second line of treatment also includes the administration of pharmaceutical drugs such as Benzodiazepines and Buspirone in adults. In case of children, Venlafaxine is generally prescribed but the drug is not approved by the FDA (American Psychiatric Association, 2013).

In addition to this administration of interpersonal psychotherapy as well as motivational interviewing also help in promoting recovery among the patients (Hoge et al., 2013). Further, a number of alternative therapies are also used for promoting recovery in patients but are not backed by evidence-based research studies. The alternative therapies include, the use of passion flower, kava and aromatherapy to obtain relief (Cuijpers et al., 2014). However, the alternative therapies are not backed by substantial scientific evidences and hence are not commonly recommended to patients. 

A large number of research studies suggest that psychiatric nurses are extremely efficient in disseminating psychotherapies such as CBT and CT. Research studies further indicated that mental health nurses were also able to effectively conduct MSE in order to diagnose the mental health disorders (Stein & Sareen, 2015; Paxling et al., 2013). However, with reference to the Australian context, the role of the mental health nurses remains largely restricted to referral to psychotherapists and promoting health literacy among patients. In addition to this, nurses also show empathy and disseminate awareness about the mental health condition of the affected patient to the family members and proceeds with the treatment routine by adapting a family centred practice (Marganska et al., 2013). In addition to this, nurses also build on the five domains of the mental health recovery model so as to foster optimism in the patient and promote recovery. Apart from monitoring the medication routine, nurses also take care of the dietary intake of the patient and help in maintaining a safe therapeutic environment. Nurses also educate patients with self-management strategies and empower them to take ownership of their responsibility to take medication on time (Baer, 2015; Lader, 2015). Also, nurses take care of the psychological distress caused to the family members. 

References:

Adaa.org (2019). Generalized Anxiety Disorder (GAD) | Anxiety and Depression Association of America, ADAA. [online] Adaa.org. Available at: https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad [Accessed 27 Mar. 2019].

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Baer, R. A. (Ed.). (2015). Mindfulness-based treatment approaches: Clinician’s guide to evidence base and applications. Elsevier.

Bystritsky, A., Khalsa, S. S., Cameron, M. E., & Schiffman, J. (2013). Current diagnosis and treatment of anxiety disorders. Pharmacy and Therapeutics, 38(1), 30.

Cuijpers, P., Sijbrandij, M., Koole, S., Huibers, M., Berking, M., & Andersson, G. (2014). Psychological treatment of generalized anxiety disorder: a meta-analysis. Clinical psychology review, 34(2), 130-140.

Hoge, E. A., Bui, E., Marques, L., Metcalf, C. A., Morris, L. K., Robinaugh, D. J., … & Simon, N. M. (2013). Randomized controlled trial of mindfulness meditation for generalized anxiety disorder: effects on anxiety and stress reactivity. The Journal of clinical psychiatry, 74(8), 786.

Hölzel, B. K., Hoge, E. A., Greve, D. N., Gard, T., Creswell, J. D., Brown, K. W., … & Lazar, S. W. (2013). Neural mechanisms of symptom improvements in generalized anxiety disorder following mindfulness training. NeuroImage: Clinical, 2, 448-458.

Lader, M. (2015). Generalized anxiety disorder. Encyclopedia of psychopharmacology, 699-702.

Lissek, S., Kaczkurkin, A. N., Rabin, S., Geraci, M., Pine, D. S., & Grillon, C. (2014). Generalized anxiety disorder is associated with overgeneralization of classically conditioned fear. Biological psychiatry, 75(11), 909-915.

Marganska, A., Gallagher, M., & Miranda, R. (2013). Adult attachment, emotion dysregulation, and symptoms of depression and generalized anxiety disorder. American Journal of Orthopsychiatry, 83(1), 131.

Nathan, P. E., & Gorman, J. M. (Eds.). (2015). A guide to treatments that work. Oxford University Press.P.90

Paxling, B., Lundgren, S., Norman, A., Almlöv, J., Carlbring, P., Cuijpers, P., & Andersson, G. (2013). Therapist behaviours in internet-delivered cognitive behaviour therapy: analyses of e-mail correspondence in the treatment of generalized anxiety disorder. Behavioural and cognitive psychotherapy, 41(3), 280-289.

Stein, M. B., & Sareen, J. (2015). Generalized anxiety disorder. New England Journal of Medicine, 373(21), 2059-2068.

Yoshinaga, N., Nosaki, A., Hayashi, Y., Tanoue, H., Shimizu, E., Kunikata, H., … & Shiraishi, Y. (2015). Cognitive behavioral therapy in psychiatric nursing in Japan. Nursing research and practice, 2015.