By Sam Archibald, Content Team Academic

Anxiety is one of the most prevalent mental health disorders affecting children and adults and can have huge implications for their development and general well-being. CBT can be effective in the short term and is superior to no treatment at all and is found to reduce symptoms and improve function for young patients (Cuijpers et al., 2014) (James et al., 2020). Rates of anxiety are constantly rising and understanding the efficacy, cost-effectiveness and applicability of CBT and other approaches is becoming more crucial to find the best way to support each client and be able to administer each type of treatment quickly to minimise symptoms and stop potential longer-term drawbacks of anxiety. I will analyse studies on anxiety and treating it to determine whether CBT should be the only treatment offered to those with anxiety or if offering a wider range of treatments is the best way for therapists to approach this issue.

While CBT’s structured approach is effective for many, it does not work the same way for every client. Each person has unique preferences and needs in therapy, and it is important to consider these differences (Swift & Callahan, 2009). This paper will explore the strengths and limitations of CBT, arguing that it should not be the only treatment option for anxiety. Instead, CBT should be one of several evidence-based approaches tailored to everyone’s situation. By recognizing different therapeutic needs, we can help clients engage more fully in their healing process and potentially increase their chances of long-term success.

Evidence for Cognitive behavioural therapy on anxiety

Evidence suggests that Cognitive behavioural therapy can be effective for children and adolescents suffering from anxiety disorders. Research shows that CBT is a more effective treatment for anxiety disorders than just leaving adolescents on waiting lists or having no treatment (Cuijper et al., 2014) (Twomey et al., 2015) (James et al., 2020). For example, James (2020) found that there was a remission rate of 49% for the main anxiety disorder when treated with CBT, compared to only 18% for those on a waiting list or receiving no treatment. Highlighting the need for anxiety issues to be confronted in some way. CBT is proven to help reduce anxiety symptoms in close to half of the participants. Scott (2005) stated that anxiety disorders are the most commonly diagnosed mental illnesses among adolescents, with recorded prevalence rates of 17.3% (Kashani & Orvaschel, 1988). The high rates of this diagnosis and lack of research have encouraged more studies on anxiety in adolescents in recent years, it was found that children with these disorders need to be identified and treated immediately to have the greatest chance of reducing the symptoms they are showing (Scott, 2005). Multiple sources I have reviewed all point to the fact that adolescents need treatment as soon as symptoms are showing, Cognitive Behavioural Therapy can be a quick solution to at least reduce the negative effects experienced from anxiety disorders in the short term before a full personalised plan can be set to assist the client.  

Cognitive behavioural therapy also is valuable in improving the lives of adults as well as adolescents. Loenric et al. (2015) assessed response rates for a variety of anxiety disorders and found that after being treated, they found 49.5% post-treatment and 53.6% long-term response rates. Which was lower than the original estimation of response rates but still showed a significant improvement in the client’s symptoms. The fact a high percentage of response rates were present among all various anxiety disorders shows that CBT is effective among a wide range of different issues not only specific types of anxiety. Multiple methods of measuring the effects of the CBT were used, like observing behaviours, self-reporting, and physical measures. After analysing all available measures an overall decrease in negative symptoms was found, showing how CBT is effective in multiple ways. For example, the client feels better, behaves in a more positive calm manner and can even show lower heart rates and cortisol levels (Roelofs & Peters, 2001) (Loenric, 2015).

To conclude CBT shows great efficacy for managing anxiety disorders in both children and adults. The fact it can be effective across multiple types of anxiety highlights how versatile the treatment can be. Although it is shown to help clients in the short term by reducing symptoms and improving behaviours, I believe that it should not be the only intervention used on clients suffering from anxiety because an approach using other types of treatments could be more effective, each client benefits most from their own individualised treatment plan to support themselves in the long term.

Evidence against Cognitive behavioural therapy on anxiety

On the other hand, James et al. (2020) found little to no evidence supporting that CBT is superior to or even as an alternative treatment. Cuijpers et al (2014) found no significant differences in positive results between several types of psychotherapy, suggesting that the differences in effectiveness may only be very minimal if at all. Showing that other types of approaches can have a similar number of benefits and so providing no reason CBT should be the only treatment offered to those with anxiety disorders. Findings also suggested that the effectiveness of cognitive behavioural therapy is influenced so heavily by factors like how everyone reacts to the treatment in each study, or the quality of each study conducted that it is hard to truly find that CBT is superior to other treatments. Clients all have individual needs and can respond to CBT very positively or negatively depending on their characteristics or past experiences in life. CBT has rarely been proven superior to other treatments some studies might not be fully accurate due to the substantial number of other factors that could have affected the study and not been disclosed.

Findings suggest that CBT is not overly useful in the long term (James et al., 2020). DiMauro et al. (2013) found that even though initial treatment significantly helped to reduce symptoms in the client, the long-term benefit of CBT was not as strong as hoped for by researchers. Maintaining the benefit of the original CBT was proven to be harder as time went on with factors like individual characteristics and treatment being personalised to each client influencing longer-term effectiveness more than just sticking with basic CBT therapy (DiMauro et al., 2013). This furthers my point on how exploring other approaches to therapy, as well as CBT, is crucial to finding the correct treatment for everyone over the long term.

Tolin (2010) also pointed to the fact CBT is not the only treatment that is effective for treating anxiety disorders by creating a quantitative review comparing CBT to other psychotherapies like psychodynamic, interpersonal, and supportive therapies. CBT did result in being superior to psychodynamic therapy and the amount of people significantly affected by the CBT was recorded as small to moderate (Tolin, 2010). As well as highlighting the fact that CBT is not superior to all other therapy approaches, I think that a broader understanding of what makes treatments effective and when they are most effective is needed (James et al., 2020). Most studies fail to recognise other factors that can help reduce anxiety but instead put all reduced feelings of anxiety down to the type of treatment they are receiving at each time.

Efficacy when comparing Cognitive behavioural therapy

Baardseth et al. (2013) while conducting a clinical review of the literature comparing CBT to other approaches including Tolin’s study (2010) that I stated earlier also compared CBT to other approaches. It was found that while CBT was found to be superior for clients with anxiety disorders, the evidence is based on only four studies two of which were written before 1973 (Baardseth et al., 2013). With so few studies having been done describing CBT as superior to other approaches like psychodynamic the truth of the results is not fully clear as more research in the area is needed to better establish an accurate view on the efficacy of CBT. Furthermore, the fact two of the four studies predated 1973 lowers the validity of the findings in these four studies. Outdated research might not reflect treatment practices or even experiences patients might have now. For a more clear and accurate understanding of the efficacy of CBT future research needs to use a wider range of more recent studies that includes all the different therapeutic approaches.

Cost-benefit, client choice and therapist skills impacting what therapy to use

One positive of cognitive behavioural therapy is that it is cost-effective for treating anxiety disorders because it involves a structured approach which is proven to show results very quickly meaning fewer sessions are required for results to show, reducing cost (ophuis et al., 2017). CBT can also be delivered in different formats like individual, group, or online therapy. Approaches like group therapy can reduce costs as more than one client can be treated at one time, reducing the time and cost of individual therapies. Online therapy can reduce travel costs for both the client and therapist as well as not having to pay for the site at which the therapy would take place, also increasing accessibility.

I would say that client choice plays an influential role in my belief that CBT should not be the only therapeutic approach offered to treat anxiety. Research shows that allowing clients to choose their therapeutic approach and only being guided by therapists leads to higher satisfaction rates and better overall outcomes (Swift & Callahan, 2009). Though CBT can be effective in results and cost, some people could feel as though it is the approach that best suits them and can prefer psychodynamic therapy which is less structured and delves deeper into emotional issues and personal past (Swift & Callahan, 2009). Clients could be more in control of their mental health and how to better it by feeling as though they chose how to help themselves and can want to take a more active role in their improvements.

Some therapists could also be better equipped for different approaches to CBT and being able to recommend a treatment they are best suited to delivering can ensure the client gains the maximum benefits possible from the therapy. Having CBT as the only approach usable to treat CBT could prove to be ineffective as certain therapists can have a substantial amount more training and prefer different approaches, forcing both clients and therapists into CBT would be detrimental as the range of options for therapy helps make therapy individual to suit each client’s individual needs and make the client feel heard and that the therapist has their best interests at heart.

Conclusion

To conclude, while cognitive behavioural therapy shows high efficacy for treating anxiety in children and adults in the short term, we must recognise that it should not be the only therapeutic approach offered. The fact each client has a varied response to therapy in general shows how important personalising treatment is and client choice in what therapy to use significantly improves client satisfaction and active engagement (Swift & Callahan, 2009). Some clients react better to psychodynamic therapies or humanistic approaches that explore emotional issues deeper, although we must recognise that CBT is very cost-effective and can be implemented in lots of diverse ways and is very structured.

 Furthermore, most therapists have unique training and strength in different approaches to therapy and restricting treatment options to just CBT can stop clients from benefiting fully from the therapy most suited to them, minimising potential progress (Norcross, 2011). The fact anxiety disorders possess many distinct levels of complexity proves the need for a more personalised approach and several types of therapy can explore all unique experiences the client has had. By acknowledging the multiple levels of anxiety disorders therapists can create individualised plans to help a client’s well-being in the long term as well as short term and restricting treatment to only CBT limits how individualised therapists can make each treatment.

References

– Baardseth, T. P., Goldberg, S. B., Pace, B. T., Wislocki, A. P., Frost, N. D., Siddiqui, J. R., … & Wampold, B. E. (2013). Cognitive-behavioural therapy versus other therapies: Redux. Clinical psychology review, 33(3), 395-405.

 – Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G., Hollon, S. D., & Van Straten, A. (2014). The effects of psychotherapies for major depression in adults on remission, recovery and improvement: a meta-analysis. Journal of Affective Disorders, 159, 118 126.

– DiMauro, J., Domingues, J., Fernandez, G., & Tolin, D. F. (2013). Long-term effectiveness of CBT for anxiety disorders in an adult outpatient clinic sample: A follow-up study. Behaviour research and therapy, 51(2), 82-86.

 – James, A. C., Reardon, T., Soler, A., James, G., & Creswell, C. (2020). Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane database of systematic reviews, (11). – Kashani, J. H., & Orvaschel, H. (1988). Anxiety disorders in mid-adolescence: A community sample. American Journal of Psychiatry, 145(8), 960–964.

– Loerinc, A. G., Meuret, A. E., Twohig, M. P., Rosenfield, D., Bluett, E. J., & Craske, M. G. (2015). Response rates for CBT for anxiety disorders: Need for standardized criteria. Clinical psychology review, 42, 72-82.

– Norcross, J. C. (2011). Psychotherapy relationships that work: Evidence-based responsiveness. Oxford University Press. – Ophuis, R. H., Lokkerbol, J., Heemskerk, S. C., van Balkom, A. J., Hiligsmann, M., & Evers, S. M. (2017). Cost-effectiveness of interventions for treating anxiety disorders: A systematic review. Journal of Affective Disorders, 210, 1-13.

– Roelofs, J., & Peters, M. L. (2001). Cognitive behavioural therapy in chronic pain: A review and new directions. Pain, 92(3), 31–32. – Scott, R. W., Mughelli, K., & Deas, D. (2005). An overview of controlled studies of anxiety disorders treatment in children and adolescents. Journal of the National Medical Association, 97(1), 13.

– Sigurvinsdóttir, A. L., Jensínudóttir, K. B., Baldvinsdóttir, K. D., Smárason, O., & Skarphedinsson, G. (2020). Effectiveness of cognitive behavioural therapy (CBT) for child and adolescent anxiety disorders across different CBT modalities and comparisons: a systematic review and meta-analysis. Nordic Journal of Psychiatry, 74(3), 168-180.

– Swift, J. K., & Callahan, J. L. (2009). The impact of client treatment preference on outcome: A meta-analysis. Journal of Consulting and Clinical Psychology, 77(3), 449 457. – Tolin, D. F. (2010). Is cognitive–behavioural therapy more effective than other therapies?: A meta-analytic review. Clinical psychology review, 30(6), 710-720.

– Twomey, C., O’Reilly, G., & Byrne, M. (2015). Effectiveness of cognitive behavioural therapy for anxiety and depression in primary care: a meta-analysis. Family Practice, 32(1), 3-15.