How Cognitive Behaviour Therapy Effective For The Treatment Of Anxiety Disorders?

Research Methodology

This research proposal is based on a topic which can be considered a huge social problem also. This is so because such people who are affected from anxiety disorders cannot enjoy a normal social life. They struggle to make friends and also they are not able to behave normally at the different platforms as like normal people do. The research proposal is divided into few sections such as the research methodology, review of literature, and the gaps identified. The research methodology section describes the methods which will be used for the proposed research. The proposed research work will be based upon both qualitative and the quantitative form of research approaches. It also covers the literature review section where three articles have been chosen and reviewed as well. The research proposal folds up with a gap in the literature review section and also the conclusive section.

There have been quite a number of research works on the chosen topic and have also produced the different outcomes. Some studies have found CBT as an effective process to get rid of anxiety disorder whereas some have not. Additionally, improving the quality of life of the affected person is a challenge not only to the medical industry but also the family which the affected person belongs to. The topic is being chosen to find some valuable elements regarding the prospect of CBT in treating the anxiety disorder. This would not only attract more future studies on the similar topic but would also produce some valuable findings for the medical industry and to the families as well.

Anxiety disorder is a collection of fear and anxiety. Fear is for reacting to the current events whereas anxiety is about worrying for the future. Such tendency may cause or produce physical symptoms like shakiness and fast heart rate. Anxiety disorder can be of number of types like panic disorder, specific phobia, social anxiety disorder, agoraphobia, generalized anxiety disorder and more. The classification is based on the physically evident symptoms. Notably, one person can also have a number of disorders (Hayes 2016). The causes of anxiety disorders can be both genetic and the surrounding social environment. Risk factors for people with anxiety disorders include poverty, child abuse and family history of anxiety disorders. Anxiety disorder should never be left untreated as there is no other way to overcome the issue. To be eligible for the treatment or be identified as affected from a disorder, one needs to be in the similar state for at least six months. Anxiety disorder can be treated in numerous ways like counseling, lifestyle changes and medications (Newman et al. 2015).

Review of Literature

About 12% of the population on an average gets affected from an anxiety disorder. Approximately between 5-30% of people are affected from it at some point in their lives. The rate of occurrence is close to double in females than males. It generally becomes evident before the age of 25. The most common of the disorders are specific phobia and social anxiety disorder. The effect is more observable on those who are aged between 15 and 35. The occurrence becomes less common in people after the age of 55 (Cuijpers et al. 2014).   

The chapter introduces the methodologies which will be followed in the proposed research work. This is indeed a very important part of the research work as it mainly covers a quantitative and qualitative approach to get some data and support the research arguments with numeric values & the other evidences. Different methods will be used to cover the methodology section; however, study will focus on CBT trials on the chosen respondents. CBT trials would help to know whether the treatments have made any differences to the affected people.

There are number of philosophy which is generally used in the research works. Three of the most popular philosophies are Positivism, Interpretivism and Post-Positivism. For the proposed research work on the chosen topic “Positivism” will be used as the research philosophy. The positivism philosophy considers a scientific approach to the already established facts. The philosophy uses the deductive approach, hypothesis testing and the empirical evidence. Qualitative methods such as the structured & diagnostic interview and diagnostic reports will be used. Scientific methods are used to analyze the larger sample sets. The ontological view of the chosen policy is that the world is objective and does not depend on the people’s subjective experience. The epistemological view is that the world is full of knowledge and such knowledge is communicable between mediators (Lewis 2015).

It is important to identify the best approach for the chosen research topic or else the productivity will hamper. The research can be both qualitative and quantitative or it can just follow one of the approaches. For the chosen research topic, qualitative approach will only be used. Qualitative approach will be used to get the numerical values of people suffering from anxiety disorders and benefitted from the CBT trials. The result will produce some interesting figures suggesting whether the CBT trials were effective in controlling or reducing the anxiety disorders. Moreover, results would encourage future research works on the same topic (Bauer 2014).

Anxiety Disorders and CBT

The strategy for the research would be to consider a number of studies that had already been conducted on people affecting from the anxiety disorders. Such studies will also include the number of CBT trials. The number of participants would be huge depending on the number of CBT trials. This would help to get the varying results. Moreover, results will help to understand whether the CBT trials can effectively reduce the time span spent in treating the people with anxiety disorders. The data will be calculated with the help of scientific method such as SPSS. This software is selected for capturing and analyzing the data because it facilitates the organizing of data in a way which is rarely possible with the normal excel sheet (Choy 2014).

Data will be stored in the SPSS. This will be used in place of the excel sheet because it gives or facilitates a much better way to organize the collected samples. An excel sheet does not provide the organizing of data the way an SPSS does. Additionally, SPSS is a much better tool than the excel sheets in calculating the collected samples (Lushey and Munro 2015).  

As mentioned, samples of the trials will be captured in the SPSS. Data stored in SPSS will be valuable after days, months and even years because of the fact that SPSS provides an organized way of storing or capturing the data. Hence, the results will remain stored and can be compared with the future results if more research works are conducted on the similar topic. Diagnostic

The field of literature is a qualitative approach to understand the chosen research topic. Evidences are traced in scholarly journal articles, genuine website resources, government reports and others.

Three chosen journal articles will be used in the literature review section of this study. Different key words have been used in the different literatures such as cognitive behavioral therapy, anxiety disorders, children, adolescents, social anxiety disorder, quality of life and life satisfaction.

Cognitive behavioral therapy	CBT is a psycho-social intervention which is a widely used evidence based method to treat the mental illness. It targets to treat the unhelpful patterns such as beliefs, thoughts and attitudes. According to few works, CBT treatments are effective while others claim it a moderately effective way.
Anxiety disorders	An anxiety disorder is a state which creates the sense of fear and worries in people. Fear is about the current situation like making a social interaction and speaking in front of a large audience.
Children	Children are generally those who have grown bigger but are not matured enough to make the decisions. The age limit for children varies with countries. In general, the age of 16 is assumed as the maturity level at which children are now the decision maker.
Adolescents	Adolescence is a transition stage from a child to an adult.
Social anxiety disorder	Social anxiety disorder is a fear which people have for being rejected in a competition or being viewed as stupid, boring and awkward. They have fear for the inferior qualities from being noticed in public. They are not expressive and do not have the good social bonding with others.
Quality of life	Quality of life is nothing but the nature of life which varies from one people to another. Some people have good life whereas some do not. There may have different perspectives for the definition of life; however, it is the number of diseases which makes the life challenging. For example, people with different types of anxiety will probably have more challenge in their lives than others who do not have the anxiety disorders.
Life satisfaction	Life satisfaction in general means the fulfillment of varieties of desires. People may have the varying choices for their satisfaction; however, nobody would ever what to be affected from serious diseases. People affected from one or few of serious diseases would certainly feel their life as being filled with huge challenges.

(Source: Dumay and Cai 2015)

Figure 1: Search Strategy Diagram

(Source: Created by author)

Articles	Author	Journal	Study Type	Theory	Comments
Article 1	(Hudson, J.L., Rapee, R.M., Lyneham, H.J., McLellan, L.F., Wuthrich, V.M. and Schniering, C.A., 2015)	Behaviour Research and Therapy	Qualitative & quantitative	Cognitive Behavior Theory	The work provides evidences for children responses to CBT based on anxiety diagnoses types
Article 2	(Ebert, D.D., Zarski, A.C., Christensen, H., Stikkelbroek, Y., Cuijpers, P., Berking, M. and Riper, H., 2015. Internet and computer-based cognitive behavioral therapy for anxiety and depression in youth: a meta-analysis of randomized controlled outcome trials. PloS one, 10(3), p.e0119895.)	PloS one	Quantitative and the use of mixed effect model	A meta-analysis model focussing on youth having the anxiety disorders	Computer-based CBT based treatments have been found effective for youth. Future research should focus on its long-term benefits.
Article 3	(Hofmann, S.G., Wu, J.Q. and Boettcher, H., 2014)	Journal of Consulting and Clinical Psychology	Quantitative	Cognitive Behavior Theory in relation to social anxiety disorders	CBT based therapies are moderately effective in treating people suffering from anxiety disorders and improving the standard of quality of life.

Table 1: Search Summary Table

(Source: created by author)

“Comparing outcomes for children with different anxiety disorders following cognitive behavioral therapy”

The chosen work was done by (Hudson, Rapee, Lyneham, McLellan, Wuthrich, and Schniering 2015). The work was conducted in the year 2015. It was conducted in the Macquarie University in New South Wales, Australia. Children with anxiety disorders were being studied to identify the impact of cognitive behavioral therapy. Some of the highlights of the research work are as follows:

• Results were not the same for children with different anxiety disorders
• Children with social anxiety disorder has responded poorly to the CBT trials than children with other general disorders
• Children with generalized anxiety disorder have better response to the trials than children with other anxiety
• Future research works are needed to find or suggest the effective treatments to the children with social anxiety disorder

Positivism Philosophy

In the chosen article, a clinical sample has been utilized. The chosen clinical sample had the reports of 842 children and the adolescents from the age of 6 to 18. The chosen samples were assessed with the help of the diagnostic interview, child-report and the parent-report. Diagnostic interview contains a number of medically related questions. Parent-report is the views and perspectives of parents for CBT based treatments of anxiety disorders. Child-report is the views of children who had undergone the CBT treatments (Newman et al. 2015). It can be said that the researchers have managed to find the effective strategies to collect the data. However, the researchers have apparently missed on including the medical reports of the institutions where the CBT trials were conducted. The data collection in this way would have produced the diverse results. Hence, the findings could have been much better and diverse as well than the authors have ended with.  

The findings of the study suggest that children diagnosed with social anxiety disorder have responded poorly to the CBT trials than children with other set of anxieties. The authors have given their justification on why there are differences in between the results. However, it is imperative to make an empirical examination of why children with social anxiety disorder have not responded to the test. Children with GAD showed a much better response to the CBT trials. Children affected from OCD showed better response on one measure. The authors have identified the needs for randomised clinical trials to attain the empirical evidences on what could be the better ways of treating children with social anxiety disorders.

“Internet and computer-based cognitive behavioural therapy for anxiety and depression in youth: a meta-analysis of randomized controlled outcome trials”.

The research was being done by Ebert et al. (2015) in 2014. The article was published in 2015.

The study is aimed at understanding the impact of computer based cognitive behaviour test (CBT). Children and youth have been considered for the chosen study. The main purpose of the study was to identify whether face-to-face CBT treatments can be avoided for computer based treatments. The research was conducted hoping that the results would add more dimensions to the treatment of anxiety disorders in children and adolescents. Till the time the research was conducted; the face-to-face treatments with CBT trials had only existed. Online treatment with CBT trials is less time consuming and quite approachable as well (Loerinc et al. 2015). The result has indeed found the method as effective in treating the children and adolescents with CBT trials. The research claims that the process is time-saving and can be used at times when face-to-face interaction would not be feasible.

Qualitative Research Approach

There are still a very few evidences on whether the online treatment would be a reliable approach. It is also very difficult to say anything for the online treatment based on the research work. This is for a fact that parents’ involvement in the treatment process with CBT has so far been felt an effective process. They can provide some very useful information which the affected children and adolescents may also struggle to recall. Children spend healthy times with their parents which is also why parents are aware of so many things of their children. For a better treatment with cognitive behaviour therapy (CBTR), it is important for medical professionals to have related information of the affected people. There should be a number of ways of finding such information. Parents and children based reporting is one of those ways which generates or produces valuable information for the medical professional (Hudson et al. 2015).

The authors have considered a very productive and interesting topic indeed. Expectedly, similar topic will attract more studies in future; however, the empirical evidence will only suggest whether the chosen strategy will remain a part of the CBT treatment. The research was done with the children and adolescents. There are other groups left untreated such as the adult and elderly people. There is the need for more studies with the adult and elderly people, so that, diverse information are generated. There is a need for sufficient evidence on the productivity of the online based CBT treatments, so that, it is considered a potential move.    

“Hofmann, S.G., Wu, J.Q. and Boettcher, H., 2014. Effect of cognitive-behavioral therapy for anxiety disorders on quality of life: a meta-analysis. Journal of consulting and clinical psychology, 82(3), p.375.”

The study was carried out by Hofmann, Wu and Boettcher (2014). It was published in the year 2014. The study had chosen a different yet related argument to proceed with. The study is based on analyzing whether the CBT treatments are handful in raising the quality of life. CBT treatments have been thought as effective in treating the Anxiety disorders patients; however, very fewer evidences are available whether it also improves the life.

The research has identified 44 different studies that cover 59 different CBT trials. The number of participants was close to 3,300. Those people had received the cognitive-behavioural therapy for anxiety disorders diagnosed in them. The researchers were able to conclude that CBT treatments for anxiety disorders people is effective but to a moderate level. Additionally, the researchers were also able to know that CBT trials through the internet are less effective than a face-to-face treatment.

Methodology for the Research Work

The findings are contradicting the facts of few articles that suggest CBT trials effectively work upon the empirical evidences to enhance its case understanding and also the level of treatment standard. It rather gives a different idea and claims that CBT trials are moderately effective in treating anxiety disorders in people. Such facts just open up ways for numerous studies on the effectiveness of CBT in treating the anxiety disorders. Unless and until there are huge evidences of the effectiveness of CBT, this would not be considered a reliable option to proceed with (Brenninkmeijer et al. 2018). However, the study claims that the internet based delivery of CBT trials is less effective than a face-to-face CBT trial. There is a need for more studies on the internet based CBT trials, so that; productivity of the treatment mode is identified.

The chosen articles and its reviews have helped to understand the research question. The research question had raised a point regarding the reasons behind CBT’s effectiveness in treating the anxiety disorders in children, adolescents, adult and the elderly people. The literature review section has indeed identified that CBT trials provide a comparative analysis of parent-report, patient-report and the medical-reports. It also governs that patients are observed during and after the CBT treatments to identify whether the treatments have raised their quality of life.  

The chosen articles have produced the mixed results like CBT is moderately effective or is very effective. In either of the outcomes, studies have not denied the importance of CBT for treating the anxiety disorders patients. However, it has not found so much of evidences on the effectiveness of internet-based CBT treatments (Boettcher et al. 2014).

Conclusion 

In summary, this can be said that the chosen topic is an interesting one for research studies for various reasons. It is interesting because some studies have found CBT an effective mode of treating the anxiety disorders patients. It is also exciting because quite a number of studies have found CBT a moderately effective way to treat the anxiety disorders. It is appealing because it speaks about an enhanced dimension of treatments with CBT through the internet based resources. Internet based treatments should be more reliable; however, chosen studies have found this a less effective than a face-to-face CBT trial.

References 

Bauer, G.R., 2014. Incorporating intersectionality theory into population health research methodology: Challenges and the potential to advance health equity. Social science & medicine, 110, pp.10-17.

Capturing Data with SPSS

Boettcher, J., Åström, V., Påhlsson, D., Schenström, O., Andersson, G. and Carlbring, P., 2014. Internet-based mindfulness treatment for anxiety disorders: a randomized controlled trial. Behavior therapy, 45(2), pp.241-253.

Brenninkmeijer, V., Lagerveld, S.E., Blonk, R.W., Schaufeli, W.B. and Wijngaards-de Meij, L.D., 2018. Predicting the effectiveness of work-focused CBT for common mental disorders: The influence of baseline self-efficacy, depression and anxiety. Journal of occupational rehabilitation, pp.1-11.

Choy, L.T., 2014. The strengths and weaknesses of research methodology: Comparison and complimentary between qualitative and quantitative approaches. IOSR Journal of Humanities and Social Science, 19(4), pp.99-104.

Cuijpers, P., Sijbrandij, M., Koole, S., Huibers, M., Berking, M. and Andersson, G., 2014. Psychological treatment of generalized anxiety disorder: a meta-analysis. Clinical psychology review, 34(2), pp.130-140.

Dumay, J. and Cai, L., 2015. Using content analysis as a research methodology for investigating intellectual capital disclosure: a critique. Journal of Intellectual Capital, 16(1), pp.121-155.

Ebert, D.D., Zarski, A.C., Christensen, H., Stikkelbroek, Y., Cuijpers, P., Berking, M. and Riper, H., 2015. Internet and computer-based cognitive behavioral therapy for anxiety and depression in youth: a meta-analysis of randomized controlled outcome trials. PloS one, 10(3), p.e0119895.

Hayes, S.C., 2016. Acceptance and Commitment Therapy, Relational Frame Theory, and the Third Wave of Behavioral and Cognitive Therapies–Republished Article. Behavior therapy, 47(6), pp.869-885.

Hofmann, S.G., Wu, J.Q. and Boettcher, H., 2014. Effect of cognitive-behavioral therapy for anxiety disorders on quality of life: a meta-analysis. Journal of consulting and clinical psychology, 82(3), p.375.

Hudson, J.L., Keers, R., Roberts, S., Coleman, J.R., Breen, G., Arendt, K., Bögels, S., Cooper, P., Creswell, C., Hartman, C. and Heiervang, E.R., 2015. Clinical predictors of response to cognitive-behavioral therapy in pediatric anxiety disorders: the Genes for Treatment (GxT) study. Journal of the American Academy of Child & Adolescent Psychiatry, 54(6), pp.454-463.

Hudson, J.L., Rapee, R.M., Lyneham, H.J., McLellan, L.F., Wuthrich, V.M. and Schniering, C.A., 2015. Comparing outcomes for children with different anxiety disorders following cognitive behavioural therapy. Behaviour Research and Therapy, 72, pp.30-37.

Lewis, S., 2015. Qualitative inquiry and research design: Choosing among five approaches. Health promotion practice, 16(4), pp.473-475.

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

Lushey, C.J. and Munro, E.R., 2015. Participatory peer research methodology: An effective method for obtaining young people’s perspectives on transitions from care to adulthood?. Qualitative Social Work, 14(4), pp.522-537.

Newman, M.G., Castonguay, L.G., Jacobson, N.C. and Moore, G.A., 2015. Adult attachment as a moderator of treatment outcome for generalized anxiety disorder: Comparison between cognitive–behavioral therapy (CBT) plus supportive listening and CBT plus interpersonal and emotional processing therapy. Journal of consulting and clinical psychology, 83(5), p.915.