Generalized Anxiety Disorder Ever Since

Generalized Anxiety Disorder

Ever since Mick Jagger wrote about "mother's little helpers,' much of the population has viewed medications as the instant cure for such modern-day maladies as Generalized Anxiety Disorder. It is undeniable that the prevalence of GAD is expanding as the world becomes more complex, global, difficult to comprehend and, one might argue, more mechanistic and less humanistic. Recent studies have shown that, despite the current overwhelming allegiance to medication, cognitive-behavioral interventions are more effective for GAD. Several major investigations and a recent small empirical study confirm that cognitive-behavioral counseling works better and more rapidly than medication intervention without attendant therapy.

Introduction

The National Institutes of Mental Health (NIMH) shows that anxiety disorders are the most common mental illnesses in the United States, with more than 23 million people affected each year (Public Health Reports 2005). Within this population, several varieties of anxiety disorder appear, including panic disorder, obsessive-compulsive disorder, phobias, post-traumatic stress disorder and generalized anxiety disorder (GAD). NIMH defines as "chronic or exaggerated worry and tension; almost always anticipating disaster even though nothing seems to provoke it. Worrying is often accompanied by physical symptoms, like trembling, muscle tension, headache and nausea" (Public Health Reports 2005). This is an adequate definition for the current study.

NIMH also notes that there are several forms of effective treatment for anxiety disorder, among them medication, specific forms of psychotherapy known as behavioral therapy and cognitive-behavioral therapy, or a combination of medication and the non-medication therapies.

Medication, for the purposes of this study, will be taken to mean "any psychotropic drug used to treat anxiety or any drug developed for other purposes that has been found useful in treating some psychiatric conditions, such as the antihistamines that have been found useful for some generalized anxiety disorder patients.

Hypothesis: In Maverick County, generalized anxiety disorder patients function better without medication than with it, if medication is the only or main aspect of treatment.

In order to prove the validity of this assertion, two groups were studied. One group was provided with appropriate medication and minimal therapy of any sort; the second group was provided with no medication but did participate in a well-tested cognitive-behavioral regiment based on the Rational-Emotive therapy of Dr. Albert Ellis, as found in his book (which they were asked to read), a Guide to Rational Living.

Procedure/Method

To ascertain the relative value of medication combined with traditional group therapy vs. cognitive therapies alone in treating generalized anxiety disorder, two groups of young to middle-aged groups were initiated. Each group began with four members, drawn from clients of an Employee Assistance Program; all had developed generalized anxiety disorder after being transferred or otherwise coming under the supervision of various types of ineffective, antisocial, overbearing or micromanaging bosses. All of the participants were looking for other employment, but all had to cope with the situation as is in the meantime; with a soft job market, none expected to be able to wait it out without help and also, many had expressed a need to overcome the anxiety to make the job search possible.

Group a was the group that had agreed to medication. The medications were prescribed according to each patient's needs; no single medication was used by all. Among the medications were:

Antihistamines such as Vistaril ™ and Atarax ™ especially for those who hyperventilated (Schmetzer 2003).

Hydroxyzine for those whose major expression of anxiety was insomnia (Schmetzer 2003).

Inderal ™ was used for those with anticipatory anxiety, for instance, those who had symptoms prior to planned encounters with the problematical supervisor (Schmetzer 2003).

This group met once a week, and began each session with generalized statements about their experience of anxiety during the previous week and whether their anxiety had increased or decreased.

The group met for only an hour each week; during that time, the counselor chose the most common response among the group members and commented on an appropriate emotional response to the issue raised. The group members then commented concerning their own experience with the issue; what their response was and what it would be next time.

At the end of the session, the counselor avoided giving the group an 'assignment' for next week. The group members each maintained two journals, however, one concerning the specifics of their job search and the other containing the specifics of their mental, emotional and physical reactions to their situation.

Group B. took no medication and met for two hours each week. This group was approached through a variety of cognitive methods, with Rational-Emotive Therapy being the major framework of their treatment. At the beginning session, each was taught the 'dispute' method of handling their anxieties developed primarily by Dr. Albert Ellis (ADD HIS BOOK HERE). Each was asked to think about two goals before the next session. The first goal concerned concrete steps they needed to take in their job search. The second goal was to be a benchmark for anxiety reduction, for example, reducing hyperventilation in situations in which they anticipated an unpleasant encounter with the supervisor.

By week six, Group a was reporting diminished physical symptoms of generalized anxiety; however, emotional responses to the triggers were not significantly reduced, at least according to observation and the self-reporting the group did. None had found a new job; only one had begun sending out resumes.

Group B. had experienced significant success in coping with the triggers. They particularly liked the idea that "although it is nice for everyone to like me and treat me well, I won't die if they don't" -- a paraphrase of a Dr. Ellis technique that they had been taught. The physical symptoms had virtually disappeared for this group. One member had actually been so successful at 'disputing' that she had come to an accommodation with her boss through a frank discussion, and was planning on keeping her job, which she liked otherwise very much. The other five members had all begun a job search, and two had had interviews.

All had come to grips with the situation at hand, at least well enough to go to work each day and go home each night to prepare resumes and do other job-hunting tasks. Self-reports also indicated that those with families were having an easier time, as were their families. One member of Group B. had taught her equally overwhelmed husband some of the techniques she had learned.

Review of the Literature

LaTorre (2001) conducted a survey of the possibilities in treating anxiety disorders and concluded that although psychotropic medication often is considered and can be helpful in many cases, it is merely one of a number of interventions possible. Practitioners not limited by this can use equally effective non-pharmacological methods alone or in combination and achieve good results. She noted that studies had shown that cognitive behavioral approaches, similar to the Rational-Emotive therapy described earlier, "allow for an active focus on the client's current problems, while enhancing coping skills" (LaTorre 2001). While La Torre's study did not offer any groundbreaking insights, it is extremely valuable in that it pointed out the advantages not only of combining standard therapeutic techniques, but of using other disciplines as well if they were effective. Among the ones she mentioned were relaxation techniques such as guided imagery and breathing exercises, as well as visualizations and even music therapy to promote change.

Two other interesting studies proceed along similar paths. Nesse (1999) studied the evolution of hope and despair, two emotional conditions that can certainly be considered fellow travelers in respect to generalized anxiety disorder. Nesse wrote:

Events that indicate that our efforts will succeed arouse hope. Events that suggest that our efforts are futile foster despair. We experience hope and despair, not at the beginning or end, but in the midst of our long-term efforts (1999).

While it seems a Pollyanna attitude, Nesse notes that people prefer hope to despair, and also that people prefer it for others (1999), one explanation for people to engage in counseling professions.

Larson and Larson extend beyond hope and despair to investigate the potential of spirituality in emotional health. They suggest that "For a large proportion of either medically ill or mental health patients, spirituality/religion may provide coping resources, enhance pain management, improve surgical outcomes, protect against depression, and reduce risk of substance abuse and suicide" (2003). In other words, it would seem to be possibly highly useful in generalized anxiety disorder treatment, which has elements of depression. They are careful to point out to counselors, however, that "misuse of spirituality/religion to harshly manipulate is linked with mental health harm " (Larson & Larson 2003).

Bowman et al. (1997) investigated the outcomes of adults with generalized anxiety disorder in either self-examination therapy or delayed treatment. "Analyses indicated that participants in self-examination therapy had significantly fewer symptoms of anxiety than did participants in the delayed-treatment group on the outcome measures of this study, which included ratings by trained clinicians and participants" (Bowman et al. 1997).

For the self-examination group, benefits were maintained for three months after the end of treatment. For the delayed-treatment group, significant improvement was shown after they received self-examination therapy. From this study, the LaTorre work and the work of Dia, it is reasonable to conclude that empowerment is conducive to better outcomes in those with generalized anxiety disorder.

Dia (2001) noted that cognitive-behavioral therapy (CBT) is now a respected and proven model of psychotherapy, as noted by a t ask force of the American Psychological Association. In its review, the APA found that CBT "was efficacious for depression, generalized anxiety disorder, social phobia, obsessive compulsive disorder, substance abuse and dependence, agoraphobia, and panic disorder" (Dia 2001).

Kendall and Flannery-Schroeder (2003) examined the issue of treatment for generalized anxiety disorders in youth. Instead of attempting to determine the efficacy of one treatment or another, they wanted instead to determine whether research models were adequate to the task of determining best treatments. They noted that the methodological and design difficulties include procedural matters, as well as, importantly, accurate assessment of anxious distress by researchers and measuring treatment-produced change. Other complicating factors include treatment for comorbid conditions, or even the ingestion of other medications for unrelated medical conditions. In addition, they noted, studies involving children and medications are faced with various ethical guidelines; parents are sometimes hesitant to place their children on medication or, on the other hand, may not be willing to 'risk' having their children in a placebo group. On the other hand, eliminating placebos from studies involving pharmacologicals would also produce a biased result. Studies had shown repeatedly that "anxious adults disproportionately attend to emotionally threatening vs. neutral stimuli. Studies had also shown that among anxious children, the tendency to shift attention to emotionally threatening stimuli and away from neutral ones was present. They had also found evidence that this tendency compromised knowledge and cognitive tasks. "Consistent with previous studies, Martin et al. (1992) found that spider-fearful children were significantly slower to color-name spider-related vs. neutral words while nonfearful children showed no impairment" (Kendall and Flannery-Schroeder 2003).

Kendall and Flannery-Schroeder touched on it, but Ingersoll et al. (2004) took a more extensive look at psychotropic drugs and children in treatment for anxiety disorders. They noted that the paradigm in western medicine is still the alleviation of symptoms using psychotropic medications. They wondered what exactly should be the role of advocacy in that regard vis-a-vis the counseling professions. They were at pains to mention that pharmaceutical companies command a great deal of economic power, a possible prescription for abuse in a "society that overvalues the medical model" (Ingersoll et al. 2004). These researchers examined the possibility that advocacy counseling, which includes social action and social justice-oriented counseling, increases a client's feelings of personal power as well as fostering sociopolitical changes reflecting greater responsiveness to the client's personal needs.

While that sounds a lot like 'pie in the sky,' the authors were interested in the case of children being prescribed psychotropic medications; they found advocacy counseling can help counselors to "critically examine the shortcomings of the medical model and how counseling interventions can address the same symptoms that the medical model claims to treat" (Ingersoll et al. 2004). In short, this process can short-circuit single-minded reliance on medication to solve anxiety problems in children. These researchers also noted that the effectiveness of psychotropic medications used without additional counseling modalities for adults was also an area that would benefit from research.