SNM660 Evidence Based Practice

Introduction

Generalized anxiety disorder refers to persistent, excessive and unrealistic worry about everyday things. However many treatment options are available. These include different therapy options and medications or a combination of both. Since anxiety disorders differ considerably from person to person hence therapy should be tailored according to the specific diagnosis and symptoms experienced by the client. The paper published by Bandelow, Michaelis and Wedekind in 2017 titled “Treatment of anxiety disorders” mentions that different types of therapy options are currently available such as cognitive behavioral therapy, exposure therapy, acceptance and commitment therapy, dialectical behavioral therapy and interpersonal therapy. Apart from psychotherapy, medications such as SSRIs (selective serotonin reuptake inhibitors), SNRIs (selective serotonin and norepinephrine reuptake inhibitors), antidepressants, and benzodiazepine are also effective for treating generalized anxiety disorders (Bandelow, Michaelis & Wedekind, 2017). This essay aims to outline and describe the current and most accepted treatment options for generalized anxiety disorders, the preferred treatment that I would chose as a clinician for my consumer, its potential drawbacks and the role of nurse’s in the provision of effective treatment.

The Current Most Accepted Treatments For Anxiety Disorders

Meta analysis conducted by Warwick et al., in 2017 have shown that CBT or cognitive behavioral therapy is a highly effective, well established and a long lasting treatment option that focuses on the understanding of the patient and changes the behavioral and thinking patterns. Cognitive therapy focuses on negative thoughts and how those cognitions contribute to anxiety whereas behavior therapy examines how the patient behaves and reacts in situations that trigger their anxiety. 60% of individuals show marked reduction in symptoms after treatment (Warwick et al., 2017). According to Gibby, Casline and Ginsburg, the long term benefits of CBT are usually observed between a period of 12- 16 weeks (Gibby, Casline & Ginsburg, 2017). They have mentioned in their study that in CBT the patient is involved actively in their recovery and learn skills which are useful throughout the life. The patients must practice their skills repeatedly in order to see any improvement.

Zbozinek and Craske in 2017 published a paper where they mentioned the importance of exposure therapy which is a form of CBT where fear and anxiety responses are reduced gradually by exposing the patient to a feared object or a situation where they learn to become less sensitive to it over time (Zbozinek, & Craske, 2017).

Center and Lynch in 2018 discussed the shared features and differences with ACT and DBT techniques. Acceptance and commitment therapy or ACT utilizes strategies of mindfulness and acceptance along with a behavioral change as a way to cope up with unwanted feeling, thoughts. Dialectical behavioral therapy or DBT integrates CBT techniques and combines them with change and acceptance. It teaches mindfulness and interpersonal skills to the patients which helps them to tolerate distress and regulate their emotions in an orderly manner (Center & Lynch, 2018). Interpersonal therapy or IRT is a form of psychotherapy that addresses interpersonal issues. It involves sessions hourly sessions every week that last for at least 12- 16 weeks. Bandelow, Michaelis and Wedekind have mentioned the different type of medications that are currently used for treating anxiety disorders. These fall into four main classes of which SSRIs are the first choice of medications that are used to treat panic attacks and anxiety disorders (Bandelow, Michaelis,& Wedekind, 2017).

Which Treatment i Would Chose As a Clinician For My Consumer

As a clinician I would choose the cognitive behavioral therapy for my consumer. This is because CBT unlike medications treats more than just the symptoms of the disorder. Since my consumer is suffering from anxiety disorder, their negative thoughts fuel the negative emotions of fear and anxiety. A study conducted by Carpenter et al. in 2018 examined the efficacy of CBT based on randomized placebo controlled trials. 41 students were included in the study and findings demonstrated that CBT was more efficacious in comparison to the placebo group. Thus I chose CBT as it will be an effective option in helping in the identification of the underlying causes that result in fears and worries for the patient and teach them how to cope up with the situation, relax and view the situations in a less frightening way so as to decrease the level of panic and anxiety that is generated. Large sample size allowed Carpenter et al. to conduct a robust analysis where it was found that CBT helps in the development of problem solving as well as better coping skills by identifying the negative thoughts, challenging them and replacing them with thoughts that are realistic and calming.  CBT thus provides tools which help in overcoming anxiety and teaches the patients how to use the tools making it an effective treatment option (Carpenter et al., 2018).

David, Cristea and Hofmann in 2018 mentioned why cognitive behavioral therapy is the current gold standard of psychotherapy. They mentioned that CBT emphasizes on getting better rather than on feeling better. It corrects problematic underlying assumptions that affect the self esteem of the individual and in this way provides results that last long term by correcting the cause of the problem. Cognitive behavioral therapy is also cross- cultural in nature meaning it focuses on the goals of the consumer rather than imposing the goals of the clinician on the consumer and allows the patient to work actively together with the therapist making it a process in which both are involved equally (David, Cristea & Hofmann, 2018). CBT offers help in the long run too by making the patient fully equipped with appropriate skills that they can utilize later in life when another situation arises that they were previously unable to handle. Thus this makes cognitive behavioral therapy as my preferred treatment option for my consumer.

Key concerns of Cognitive Behavioral Therapy

Although CBT is the preferred first line of therapy for patients suffering from anxiety disorders it is also associated with a few concerns which should be discussed with my consumer before proceeding with this option. Schuster et al. conducted a study in 2018 where the concerns of CBT were discussed. They have rightfully mentioned that cognitive behavioral therapy is not a quick fix. In this therapy, the therapist will guide, encourage and advise the patient but they cannot do it on behalf of the patient. The patient/ client have to be actively involved in the session in order to achieve the best results possible. The client must understand that in order to overcome anxiety they have to first confront it. This can make them feel more anxious for a short period of time however the consumer must be encouraged to focus on long term benefits (Schuster et al., 2018).

CBT is structured in nature and comprises of short sessions which makes it more complex for people who are suffering from other mental health needs and/ or learning difficulties. CBT fails to address wider problems in families or symptoms that play a role on the health and the well being of the individual. It focuses only on the capacity of the individual to change themselves and their feelings, thoughts and behavior which makes CBT a narrow minded therapy option. Potential side effects of cognitive behavioral therapy include feeling angry, sad and/ or upset. One may cry after a challenging session. It exposes the patient to their negative feelings which can cause temporary stress and anxiety. CBT is not for everyone as it requires commitment and confrontation with emotions. I would discuss these concerns of CBT treatment with the consumer.

Nurse’s Role In Potential Treatments

Molin et al. conducted a study to 2018 to evaluate the feasibility and effects of nursing interventions on mental health patients. Nurses perform various tasks so that positive outcomes for the patient is achieved. Nurses play a crucial role in the treatment of anxiety disorders. They assess the patients and establish a rapport so as to make them feel at ease and relaxed and ally distress by reassuring and explaining all the treatment protocols before hand. They ask the patient various questions such as their past medical history, the medications they are taking, and when their last physical examination was conducted. This allows in making a differential diagnosis of the patient’s condition which is essential before starting therapy. A complete physical as well as mental examination of the patient to rule out any other medical or psychiatric conditions which may alter the treatment for anxiety and may contribute to negative patient outcomes (Molin, Lindgren, Graneheim & Ringnér, 2018). Nurses provide patient health education about causative factors, evidence- based interventions, symptoms, and other techniques that promote health such as anger management and stress techniques (Antai-Otong, 2016).

Gerogianni et al. have mentioned in their study the importance of non- pharmacological methods in treating anxiety disorders among which one is provision of education and information by nursing professionals. They have mentioned how nurses continuously assess patients for their level of self harm which ensures that safety of patients suffering from generalized anxiety is maintained. They also play a role in helping not only the patient but also their family to cope with the situation. They provide mental, emotional and spiritual support to patients during the constant changes that they face every day in their lives (Gerogianni, Babatsikou, Polikandrioti & Grapsa, 2019). In this way nurses play a crucial and a significant role in the potential treatment of anxiety disorders.

Conclusion

Thus in conclusion, this essay focused on generalized anxiety disorder, outlined ad described the various treatment options available and highlighted the preferred treatment option I would chose as a clinician which is the cognitive behavioral therapy (CBT) treatment option. This essay describes briefly the advantages as well as disadvantages of CBT and highlights the importance of nurses in providing effective treatment so that positive outcomes for the patient can be achieved.

References

Antai-Otong, D. (2016). Caring for the Patient with an Anxiety Disorder. Nursing Clinics, 51(2), 173-183. https://doi.org/10.1016/j.cnur.2016.01.003  

Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in clinical neuroscience, 19(2), 93. https://dx.doi.org/10.31887%2FDCNS.2017.19.2%2Fbbandelow 

Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers, M. B., Smits, J. A., & Hofmann, S. G. (2018). Cognitive behavioral therapy for anxiety and related disorders: A meta‐analysis of randomized placebo‐controlled trials. Depression and anxiety, 35(6), 502-514. https://doi.org/10.1002/da.22728 

Center, T., & Lynch, T. R. (2018). Radically Open Dialectical Behavior Therapy: Shared Features and Differences With ACT, DBT, and CFT. RADICALLY OPEN, 41(3), 142. https://d1wqtxts1xzle7.cloudfront.net/56245938/RO_Paper_Published.pdf?1522942502=&response- content-disposition=inline%3B+filename%3DGroup_Radical_Openness.pdf&Expires=1623136066&Signature=IUZOL6DUaIpbMbs9hWTTz~v

David, D., Cristea, I., & Hofmann, S. G. (2018). Why cognitive behavioral therapy is the current gold standard of psychotherapy. Frontiers in psychiatry, 9, 4. https://doi.org/10.3389/fpsyt.2018.00004 

Gerogianni, G., Babatsikou, F., Polikandrioti, M., & Grapsa, E. J. I. U. (2019). Management of anxiety and depression in haemodialysis patients: the role of non-pharmacological methods. International urology and nephrology, 51(1), 113-118. https://link.springer.com/article/10.1007%2Fs11255-018-2022-7 

Gibby, B. A., Casline, E. P., & Ginsburg, G. S. (2017). Long-term outcomes of youth treated for an anxiety disorder: A critical review. Clinical child and family psychology review, 20(2), 201-225. https://doi.org/10.1007/s10567-017-0222-9 

Molin, J., Lindgren, B. M., Graneheim, U. H., & Ringnér, A. (2018). Time Together: A nursing intervention in psychiatric inpatient care: Feasibility and effects. International journal of mental health nursing, 27(6), 1698-1708. https://doi.org/10.1111/inm.12468 

Schuster, R., Pokorny, R., Berger, T., Topooco, N., & Laireiter, A. R. (2018). The advantages and disadvantages of online and blended therapy: survey study amongst licensed psychotherapists in Austria. Journal of medical Internet research, 20(12), e11007. https://preprints.jmir.org/preprint/11007 

Warwick, H., Reardon, T., Cooper, P., Murayama, K., Reynolds, S., Wilson, C., & Creswell, C. (2017). Complete recovery from anxiety disorders following Cognitive Behavior Therapy in children and adolescents: A meta-analysis. Clinical Psychology Review, 52, 77-91. https://doi.org/10.1016/j.cpr.2016.12.002 

Zbozinek, T. D., & Craske, M. G. (2017). The role of positive affect in enhancing extinction learning and exposure therapy for anxiety disorders. Journal of Experimental Psychopathology, 8(1), 13-39. https://doi.org/10.5127%2Fjep.052615 

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