Evidence-based psychological treatment guidance
Cognitive behavioural therapy (CBT) has the strongest evidence for treatment efficacy of anxiety disorders relative to other forms of psychotherapy (e.g., Cuipers et al., 2014; Hofmann et al., 2012; Wolitzky et al., 2008). CBT uses a multimodal approach and targets: cognitive symptoms of excessive and irrational fear and worry; behavioural symptoms of avoidance, excessive preparation and/or procrastination, and poor problem-solving and decision-making skills; and physiological symptoms, notably muscular tension, restlessness and irritability. Common CBT components in anxiety disorder interventions are outlined below.
- Psychoeducation about the nature of anxiety is a core initial component in the treatment of all anxiety disorders. Self-monitoring is typically introduced in the initial sessions and utilised throughout treatment to encourage objective observation and reflection on anxiety responses across various contexts.
- Relaxation training techniques are utilised for anxiety disorders characterised by prominent somatic symptoms, including GAD and panic disorder, and comprise progressive muscle relaxation, breathing exercises, applied relaxation training (including cue-controlled relaxation) and guided imagery.
- Cognitive restructuring is used to identify and challenge unhelpful, maladaptive thoughts and beliefs that maintain dysfunctional thinking patterns, and is typically integrated into all CBT interventions for anxiety disorders.
- Exposure techniques, including graded in vivo, interoceptive and imagery techniques, as well as behavioural tests, are also a core CBT component for anxiety disorders tailored to the specific type of anxiety diagnosis (e.g., social situations for SAD).
- Problem-solving training offers an additional specific CBT component for treatment of GAD, while social skills training can be particularly relevant in the treatment of SAD.
Source: APS, 2017