Treatment of individuals struggling with stress, crisis, and coping is a large part of the generalized social work practice. As a practitioner, it is important to be able to compare and contrast different treatment options that will benefit individuals. Anxiety components affect individuals as the most common mental illness in today’s society. The symptoms effect all aged individuals and has a variety of hinderances on daily life. Statistically, females have a higher percentage to suffer with anxiety while males only slightly lower.
There is a high amount of individuals that experience anxiety during adolescent (13-18) into young adulthood (18-24). Which combined with the stages of development, can hinder an individual’s ability to meet healthy milestones for future success with stress, crisis, and coping.
Currently, a universal intervention to treat anxiety does not exist; therefore, more comparison studies are needed to inform practitioners on the options available. There is several different types of treatment for individuals suffering from anxiety. It’s hard to pinpoint one intervention or one model that works better than any others.
The social work practitioners take a generalist approach to be able to cover a wide variety of mental health concerns. It is imperative to understand and know the differences between treatment interventions to be able to empower an individual to be successful with their treatment.
Cognitive Behavioral Therapy (CBT) is one of the most common forms of treatment for anxiety today. It has been used over several years and has a large success rate with several studies to support is success.
Alternatively, Mindfulness-based therapy has been used in the treatment of several forms of anxiety as well. It is a newer approach as compared to CBT but has shown great outcomes. The two interventions are compared and contrasted to give pros and cons for both. Ultimately, each person is different and can respond differently to all interventions. Multiple techniques are proven to benefit individuals with quicker results and higher longevity of maintaining recovery.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), lists the diagnosis criteria for generalized anxiety disorder (GAD) as: excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events or activities. According to the National Institute of Mental Health (NIH), “An estimated 31.1% of U.S. adults experience any anxiety disorder at some time in their lives” (2017). Left untreated, anxiety disorders have been linked to various health risks such as, gastrointestinal disorders, chronic respiratory disorders, heart disease and stroke (Harvard, 2018).
In addition to generalized anxiety disorder, other forms of anxiety include panic disorder or phobia-related disorders. Panic disorder is defined when an individual suffers from a panic attack that seems to happen spontaneously and are then fearful of another attack. About 3% of Americans suffer from panic disorder and it is twice as likely to affect women than their counterpart (2017). Phobia-related disorders consist of individuals who have excessive or unreasonable fears about specific objects places or situations. Individuals who experience phobias usually understand the fear is irrational regardless, it will cause them extreme anxiety (The Anxiety and Depression Association of America ADAA, 2017).
The Anxiety and Depression Association of America (ADAA) shows 40 million (18%) of adults in the United States, age 18 and older, experience anxiety every year. Additionally, An estimated 31.9% of adolescents have any anxiety disorder (2017). Many adolescent and young adults experience overwhelming anxiety paired with a lack of healthy coping skills. Obsessing over negative thoughts and body image as well as, trouble socializing causes additional stress and increased physical symptoms. This population is also at a higher risk of resorting to risky behaviors as a result of untreated anxiety and poor social skills. (Van Oort et.al., 2011)
Due to the different types of anxiety disorders and a wide variety of causes, there is not a one size fits all treatment. In addition to the anxiety, individuals can also have a co-occurring mental or physical health condition or stressful environment. Some treatments include medication, cognitive-behavioral therapy, exposure therapy, group therapy, and meditation mindfulness therapy.
Cognitive-Behavioral Therapy (CBT) was introduced by Dr. Aaron T. Beck; a psychiatrist at the University of Pennsylvania in the 1960’s. During his research on depression, Dr. Beck found that the patients had streams of sporadic negative thoughts he referred to as automatic thoughts. These automatic thoughts focused on producing negative ideas of the world, the future, and/or the patients themselves. Dr. Beck found that if the patient could identify and evaluate these negative automatic thoughts, they would start to think realistically. In turn, this would change their behavior functioning and would feel better emotionally. Since starting CBT, thousands of studies have continued to show the effectiveness of the treatment in a wide variety disorders. (Beck, 2016)
Over the last three decades, cognitive-behavioral therapy (CBT) has turned into the first-line psychosocial care for people with depression, anxiety, and other disorders. CBT is a psycho-social intervention that is evidence-based practice for improving mental health. (Field et. al., 2015) Guided by empirical research, CBT focuses on the development of personal coping strategies that target solving current problems and changing unhelpful patterns in cognitions (e.g. thoughts, beliefs, and attitudes), behaviors, and emotional regulation (Benjamin, 2011). Originally, CBT was designed for the treatment of depression; now it is used for several mental health conditions including anxiety.
The process for CBT consists of the practitioner breaking down the individual’s problems if into situations, thoughts, emotions, physical feelings, and actions. This allows the individual to see the behavior and responses to situations and the relationship between them (James et.al., 2013). After identifying negative patterns, the individual then replaced that with positive thoughts and actions to initiate change in behavior.
Another intervention used in the treatment of anxiety is mindfulness psychotherapy. Its origin is found in ancient Buddhist traditions until the 1970’s. The founder of mindfulness-based stress reductions program Jon Kabat-Zinn, combined the Buddhist principles into science and medicine (Haydicky et.al., 2012). “At the beginning of the 21st century, Zindel Segal, Mark Williams, and John Teasdale built upon Kabat-Zinn’s work to develop Mindfulness-based Cognitive Therapy (MBCT)” (Chiesa & Malinowski, 2011). Mindfulness may is understood as the state of becoming more aware of one’s physical, mental, and emotional condition in the present moment, without becoming judgmental. Participants pay attention to experiences like bodily sensations, thinking patterns, and feelings. Then the individual will accept them without being influenced by them. Mindfulness practices help participants control their thoughts, instead of being controlled by them. (Chiesa & Malinowski, 2011)
Several of the mindfulness-based models are similar with only slight variations. For example, mindfulness stress reduction and cognitive therapy both use meditation but only MBCT uses the cognitive and behavioral component. Other forms such as dialectal behavioral therapy (DBT) and acceptance and commitment therapy (ACT) focus on the thoughts experienced in the state of mindfulness. (Hays, 2018)
Mindfulness-based approaches have largely increased over the past decade based on its ability to be versatile with other therapy orientations and with virtually any diagnosis. In a study published by the Journal of Psychiatry Research, “anxious people who took a mindfulness course where they learned several different strategies reacted to stress better and had a lower hormonal and inflammatory response than people who didn’t practice mindfulness.” (Oaklander, 2017). Another study compared the effects of both mindfulness meditation and interactions with a therapy dog to see what effects each had on the anxiety and the stress level of college students. With the therapy dog, there was a decrease in stress and anxiety, suggesting it to be an effective treatment. However, when using mindfulness meditation sessions, the student’s anxiety level lowered more than the experiences with the therapy dog. (Shearer et al., 2016)
Both intervention hold excellent recovery rates for the individuals that are participating in treatment; however, each individual is different. With the help of a practitioner, participants can find the intervention that works best for them. Cognitive Behavioral Therapy and Mindfulness-based therapies utilize the participants self-awareness and reflection. Recently many practitioners have been combining the use of the traditional CBT with Mindfulness techniques to give a more holistic approach and keep individuals in the present when their anxiety is future-orientated. “Anxiety is that dread or fear of some future anticipated event.” (Cho, 2016).
The advantages of CBT include its history of effectiveness in treating mental health disorders and based on the structure it can be experienced in many different formats such as groups and books. The focus a CBT is retraining your thoughts and changing your behavior to feel better. This can cause some disadvantages. If only focused on CBT, a participant will not be addressing other problems that affect their wellbeing including current family systems and underlining causes such as traumatic childhood experiences. CBT is summarized as fighting against unpleasant symptoms like automatic negative thoughts; than Mindfulness-based therapy is focused on the accepting the unpleasant thoughts (Spence, 2011). Some participants will need more flexibility to adapt to changing their perspective by embracing their negative thoughts. That is where mindfulness-based therapies focus and shows to be a good alternative for individuals who refuse CBT or find it ineffective.
Part of the draw to Mindfulness-based therapies is its ability to be secular, even though many of its core qualities drive from the Buddhism. Therefore, it can apply it to anyone’s belief system and still encouraged spiritual growth. However, being less structured can allow for selective interpretations for studying results and the application of the technique (Brown et.al., 2012). A definition of mindfulness has been interpreted as a mental state but also viewed as a skill set. Without a clear definition, it can cause outcomes to be skewed and practitioners or individuals may not get the full benefit from the techniques.
The implications regarding cognitive behavioral therapy suggests the short term therapy is a form of behavioral treatment. It helps individuals problem-solve and see the relationship between their thoughts, feelings, and beliefs. It helps individuals learn their perceptions are the influencing factor on how they respond in situations. Reviewing mindfulness-based therapies, it implies more of a lifestyle. It helps individuals accept the symptoms they are suffering from and to be able to work with them. Regarding anxiety specifically, it allows individuals to be present in the moment rather than indulging in their fear of the rational future scenarios.
As future social work practitioners, is important to be able to be flexible and meet the client where they are. We have to be able to use a treatment option that is ethical, empirically reviewed thoroughly, evidence based, and effective for the individual’s needs. After reviewing both intervention as possible treatments for anxiety, I recommend using both would be the most benefiting for participants. This is based on the facts that both complement each other’s disadvantages and could benefit individuals.