Anxiety Therapy: What Counts as Success?by Jerry Kennard, Ph.D. Medical Reviewer
Few, if any, qualified therapists will ever talk about a cure for anxiety. They may refer to effective treatment options, but not a cure. This caution is for a reason. It’s not that certain anxiety-related problems can’t be overcome, it’s more that anxiety is a complex issue that still isn’t fully understood. It may subside for short or long periods, and it may return, sometimes in a different or more severe form.
We have to be anxious
We can’t live without anxiety, so to talk about curing it makes little sense. Our brains are hardwired for survival and that means we automatically tune in to potential emotional or physical threats with our fight-or-flight response. If we try to suppress or avoid negative emotions, it only makes us feel angry, worried, afraid, and have other negative thoughts. To take the edge off, some of us turn to drugs, alcohol, comfort eating, or prescription medication.
Anxiety is something of a balancing act. If we get it right, we’ll remain alert and motivated but still capable of knowing when we need to power down. With too little anxiety, we may risk endangering ourselves. If anxiety starts to dominate our lives, we find ourselves constantly on edge, plagued with self-doubt, fearful, panicky and always predicting the worst outcome. That’s when anxiety becomes disordered.
Types of anxiety disorder
In my introductory paragraph I said that anxiety is a complex issue. To some extent the American Psychiatric Association illuminates this very point by listing the various types of anxiety disorder, which are:
Phobias, specific phobias
Social anxiety disorder
Separation anxiety disorder
Every disorder has characteristics that distinguish it from the others, yet anxiety is at the core of each.
What works and what doesn’t
When it comes to evidence-based treatments, all signs point to cognitive behavioral therapy (CBT) as one of the most effective forms of treatment available. What marks the approach out is the number of empirical studies that attest to its relative effectiveness in the treatment of anxiety disorders. Even so, the results of a 2015 meta-analysis published in the Psychological Bulletin, caused a few of us to sit up and take notice. The authors of this particular paper concluded that CBT was roughly half as effective in treating depression as it used to be. The authors raised the spectre of the placebo effect, basically suggesting the early impact of CBT studies as offering a miracle cure had worn thin. The overall message seems to be: If we convince ourselves that a psychological treatment is working, there’s a very good chance it will.
The best option
So CBT isn’t perfect, yet it still remains the gold standard for the psychological treatment for anxiety. So why bother with other forms of therapy? Well, if I take a pill nothing is expected of me other than to remember to take it. That pill may reduce the worst symptoms of my anxiety but it won’t address its causes. CBT is a more active therapy that requires effort on the part of the patient. There is a relationship with a therapist that needs to be established in terms of expectations and boundaries. It’s not always suitable for people with more complex mental health issues and some people simply don’t like the approach, which they feel is too narrow and sterile in its approach. This opens the way for other forms of therapy and perhaps explains why it isn’t unusual to find clients “sampling” various approaches until they find one they are comfortable with.
What counts as success?
If all this sounds a little messy it’s because there are no tidy conclusions when it comes to treating mental health issues. There are no miracle cures but this is a far step from concluding all therapies are worthless. Over the years, many millions of people have been helped with difficult issues that have affected their lives.
If you have ever received psychological treatment for panic attacks, binge eating, or mild to moderate depression, you are most likely to agree that your problems resolved fairly quickly. In many ways this attests to the usefulness of therapy. When a client reports that the worst of their symptoms seem to be behind them, it’s a form of success. They might have other issues and want to know more about anxiety, but that’s a different matter. Yet, what works well for one person might do very little for another. There can be all sorts of reasons for this, not least the fact that many people with anxiety have difficulties with more than one type of anxiety.
For therapists, there’s a lot more to learn. For patients, effective treatment is sometimes a case of trial and error, but relief, at least in some form, is still likely to be out there, and I encourage you to seek it out.