Anxiety disorder is a clinical issue that needs psychiatric care and normally affects children and teenagers and has a prevalence rate of 3-24% (Cartwright, McNicol & Doubleday, cited in Alan & Kazdin, 2010, p. 61).
Normally, anxiety disorders are chronic and recurrent and their only remedy is seeking medical treatment since they affect life in various ways. They have a negative effect on a child’s academic performance, interfere with social interaction, lower the degree of self-confidence, and even at times lead to low self-esteem and generally makes a child’s life to be dull. According to a survey conducted by World Health Organization (WHO) World Mental health Survey Initiative revealed that anxiety is the most common disorder in almost all countries. Some examples of anxiety disorder are specific phobia (GAD) and separation anxiety and studies have shown that girls tend to suffer from anxiety more than boys do (Breton et al cited in Clark and Beck, 2009, p.11).
Symptoms associated with anxiety disorder include palpitations, irritable bowel syndrome, faintness, non-cardiac chest pain, dizziness, and vertigo. Anxiety disorders end up causing so much loss in terms of economic loss associated with treatment, hence the need to come up with a more cost effective way to treat the disorder (Clark and Beck, 2009, p.12). This research paper will focus on the effectiveness of cognitive behavioral therapy as a treatment modality for anxiety disorders.
Rationale Professional Nursing and Background Information
According to Borcovec and Whisman as cited in (Leahy and Holland, 2000, p. 120), cognitive behavioral treatment has proven to be more effective in treatment of GAD than non-directive treatment, benzodiazepine, or placebo. Cognitive behavioral therapy leads to reduction in the use of benzodiazepines, maintains gains that are clinically significant, and continues to improve even after therapy is over. Research conducted by various scholars show that cognitive behavioral treatment is better as compared to behavior therapy in that it continues to produce good outcome six months after therapy termination (Butler et al cited in Leahy and Holland, 2000, p120).
Most anxiety disorders are because of beliefs or some behaviors hence the reason CBT pays attention to how such distracting beliefs and behaviors contribute to development of psychological difficulties and how to handle them over time. CBT helps the patient differentiate between productive and unproductive worries, realize that too much worry is detrimental to their health, analyze how the clients jump to conclusions, and be able to differentiate facts from anxiety.
This topic is important to the nursing profession in that CBT helps both the client and the psychiatrist know how symptoms fit together and take the necessary measures in order to reduce symptoms. CBT has models that are used for assessment and treatment and familiarity with them makes new clinicians to be at ease with therapy process. These are very helpful since new nurses are not very confident administering therapy to clients but CBT helps them overcome their anxiety too. In addition, getting the clients informed about the models makes the client have a deeper understanding about their problems and know how to go about them and this makes the healing process a lot easier.
Current Professional Peer-Reviewed Literature
Over the past five years, professionals with medical expertise have realized the importance of using CBT in treatment of anxiety disorders. It has been found to be an effective tool that can be used to teach the community on the importance of prevention and resilience. As it is generally known, prevention is better than cure and if anxiety disorders can be prevented, then the society will benefit since there will be an enormous reduction in the monetary and other anxiety disorder associated costs (Barret, 2010).
Originally, behavioral therapy focused on achieving good behaviors change measures based on principles of behavioral and cognitive science. However, with increased scientific research and development, CBT is currently viewed as a representative of evidence-based psychological approaches to alleviating psychopathology and enhanced functioning. Some suggestions have been made on the expected major trends in development of CBT, which include; competency based training, replacement of single-diagnosis treatment manuals with modular transdiagnostic interventions, emphasis on clinical outcomes assessment with a simultaneous return to a more idiographic focus, adoption of technology in service delivery and perpetual discovery of new pharmacological agents that will improve psychological treatment (Barlow, 2010).
Policy makers in the government and health ministries have realized the importance and efficiency of CBT in treating anxiety disorders and in response to that, they have allocated considerable amount to be used in disseminating treatment via a series of financial and regulatory incentives and mandates. Wood 2006 reviewed the literature on CBT and came to accept the fact that family participation is necessary when administering CBT to patients with anxiety disorders and especially so in children.
Family cognitive behavioral therapy (FCBT) has consistently yielded a high percentage of patients who respond to the treatment and more often than not, outperformed CBT programs that did not involve the family. FCBT is keen to involve the parent who plays a role in helping the child overcome the disorder. The parent is supposed to give alternate choices to the child when the child can’t make a decision on his or her own rather than making the decision for the child. The parent should also allow the child to learn through trial and error method and avoid criticizing emotional responses by labeling and accepting such responses (wood, 2006).
Compton and colleagues as cited in Rosenbaum & Covino (2005) conducted a literature review and assessed current information on CBT as treatment for anxiety related disorders in children and adolescents. They looked at 21 random studies that had been used to evaluate efficiency of CBT as treatment for anxiety disorders. Out of the 21 studies, 19 of them involved a semi-structured clinical review. In 13 out of the total studies, Anxiety Disorders Interview Schedule and Child-Parents versions were used (ADIS-C/P). Findings from the study revealed that CBT helps both parents and children overcome anxiety through different treatment strategies depending on a child’s condition or situation. These treatment sessions include but not limited to systematic desensitization, gradual exposure therapy, muscle relaxation, and family sessions.
The review also assessed the impact of follow-up and follow-up designs. Findings showed that follow-up made within a range of one month to six years helped in maintaining gains from treatment for a long period of time. However, the review showed that there are puzzles concerning the effectiveness of combining CBT with medication. According to Kessler et al as cited in Stein, Hollander and Rothbaum (2009), the most common disorders have been found to be generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder (PD), post traumatic stress disorder(PTSD), and social anxiety disorder (SAD).
Literature review conducted by Stein et al (2009) shows that these disorders have been very expensive both in terms of medication and psychotherapy treatment and not forgetting the indirect costs associated with educational, social and employment issues.
There has been some improvement in treatment of these anxiety disorders in that, in the past, these disorders were treated with benzodiazepines that were not very effective in terms of their long-term use and habituation though even to date, they are still prescribed. Some of the benzodiazepines still prescribed include diazepam and lorazepam with an addition of newer ones such as clonazepam and alprazolam. On the contrary to the use of benzodiazepines, cognitive behavioral therapy has found it way as an effective remedy for most of the anxiety disorders.
Analysis of the Positions Found In the Literature
From the literature review, cognitive behavioral therapy seems to be more efficient as treatment for anxiety disorders. It is a gradual process as opposed to pharmacotherapy (Medication) which is an immediate and rapid process that gives short-term benefits. Although pharmacotherapy treatment is effective in reducing distress rapidly and is preferred by other patients who may not be willing to receive other therapeutic procedures, CBT seeks to regain self-esteem and self-confidence of the patient and its efficacy is to a large extent accepted. However, it is important to consider the time that it takes before yielding results.
Cognitive behavioral therapy requires that a lot of time is assigned to the process (about 12-14 weeks) before getting any substantial results or benefit. It is not all about time but also the efforts exerted towards making the process a success and the consistency required in exerting such efforts. Time alone is an issue to most people and especially in the current world.
CBT and especially Family Cognitive Behavioral Therapy emphasizes on the importance of parents getting involved with the process. It is a very ideal idea, but looking at how their schedules are normally tight, it might be difficult for them to give the process enough time. Most parents live home for work before dawn and get back at dusk. They rarely have enough time to rest or know how their children spent their day since, by the time both leave and come back, they find the children asleep.
The children too need to go to school and more often than not, they are overwhelmed by the voluminous amount of assignment they are expected to complete before the next day at school. It would therefore be prudent to conclude that time is a major factor in limiting the efficacy of cognitive behavioral treatment. People have different beliefs and perceptions. Whereas some patients can rely on cognitive behavioral therapy without additional medication, others have stereotypes and believe that they cannot rely on CBT alone and so it must come in handy with CBT therapy. This reduces CBT’s efficacy since it does give or convince clients’ up to 100% that they can rely on it without additional treatments.
It is therefore necessary to come up with mechanisms that can give CBT a hundred percent approval by the patients and those close to them such as parents. Another point to be criticized is on how the government and policy makers in the health ministries have supported use of CBT as treatment for anxiety disorders by donating some amount to be used in dissemination of treatment to them. This is a very courteous gesture though it is just but like designing a product and failing to deliver it to the clients to whom it was designed for.
Provision of money can be termed as the product while failure to deliver the product to clients can be associated with failure by the policy makers to come up with effective strategies to be used in disseminating the treatment. This means that a proper system should be put in place to identify those who have anxiety disorders but they are unaware or they have chosen to keep quiet and haven’t sought any treatment, those who have the disorder but are unwilling to use CBT due to stereotype or lack of adequate information or those who know about CBT but don’t know how to go about it.
As much as CBT is effective as a treatment for anxiety disorders, research has shown that treatment of all anxiety disorders has to a great extent been overtaken by Selective Reuptake Inhibitors (SSRI) group of antidepressants to the extent that the anxiety disorders have acquired the name “serotonergic disorders” (Aouizerate et al cited in Pinder, 2007) This makes it difficult to make a clear conclusion as to whether CBT are still effective.
There has been increased concern with regard to anxiety disorders whose prevalence rate has risen in children and adolescents. Many and varied treatment options have been invented while others have been improved overtime. Cognitive Behavioral Therapy has for a long time been perceived as a better remedy or solution to deal with anxiety since it addresses the real issues that cause anxiety disorders. It is undisputable that low self-esteem and lack of self-confidence are two aspects that affect a person’s life in a very negative way. The loss associated with them is enormous both in time or money lost due to reduced or total lack of productivity as well as denial of educational and social life among other losses.
From the study, CBT has been successful though not fully but to a large extent in addressing these issues and it can be said that it has been efficient. Nonetheless, considering huge investment in terms of time that is required, it was difficult to measure the level of CBT efficiency considering that time is a very valuable asset to all human beings and it can never be rewound back. It would therefore be wise to take advantage of advancement in technology and design ways or mechanisms that can be used to make CBT more efficient by making the process shorter. In addition to that, mechanisms can also be put in place to combine and integrate CBT with other medical treatments give long-term and more satisfying benefits in the most effective and efficient manner.
Importance of This Topic to the Nursing Profession in Future
The role of nurses is changing and becoming more diverse with time, thus nurses need to understand and be to manage patient’s symptoms. There is also increased role to offer psychiatrically services by nurses. Therefore, this study has been relevant in that it gives an insight on how psychiatrically challenges such as anxiety can be handled using cognitive behavioral approach. The great emphasis given on the need to observe a patients symptoms and characteristics before treatment and designing ways to handle the client in a way that he or she will be receptive were very critical.
This is because, in the nurse profession, one deals with so many patients and not only those with anxiety disorders but also others who suffer from other diseases. All these people behave differently and have different attitudes, some of them being hostile while others are docile. Being able to manage their symptoms and attitudes enables a chance to create an initial rapport with the patient and be able to share and get relevant information that will be of use in assisting the patient heal. Models used in cognitive b behavioral therapy are also of great importance to future nurses since they help both the nurse and the patient gain confidence. The fact that even nurses are usually less confident when new in their profession is enough justification that the cognitive behavioral therapy will continue to be of use to the nursing profession.
Anxiety disorders are normally chronic and recurrent. It is therefore important to treat them early enough since they do not remit without treatment. Cognitive behavioral therapy has been of great importance and has helped many patients cope up with this disorder and enjoy life once more. CBT has its strength in that it helps in building good behavior that in return helps patients regain self-esteem and self-confidence and in doing sure alleviates both the direct and indirect costs that would have been incurred. However, the fact that CBT consumes a lot of time cannot be ignored thus making its efficacy questionable since efficiency must take consideration of the resources utilized. The puzzle still lies in whether CBT can be combined with other treatment to improve on efficiency.
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