Anxiety Depression

A Case Study: Treating Comorbid Post-traumatic stress disorder, Generalized anxiety disorder and Depression, an integrative approach

Cognitive-behavioral Therapy. While several kinds of psychotherapies have proven effective in the treatment of anxiety and mood disorders, research has consistently shown cognitive behavioral therapy (CBT) as the most effective (Cukor, Olden, Lee, & Difede, 2010; Hollon & Ponniah, 2010; Kumariah, Prasadarao, & Raguram, 2009; Spates, Pagoto, & Kalata, 2006). Thus, based on principles of evidence-based practice (a large part which constitutes using the best available research evidence in making decisions about the care of clients) CBT has become the golden standard for treating anxiety and mood disorders (Spring, 2007; Thomason, 2010; Thorn, 2007).

From a cognitive behavioural perspective, anxiety disorders develop through the process of classical conditioning (through association, a previously neutral stimulus comes to elicit the same response as unconditioned stimulus) and operant conditioning (a behaviour is maintained because it serves a beneficial purpose to the organism) (Bourne, 2005; Sadock & Sadock, 2007). For example, you are driving on a freeway (neutral stimulus), you hear a loud bang (unconditioned stimulus), your heart starts to race, and you eventually talk yourself into a panic attack, and later begin to avoid or else endure driving on highways with much distress. In short, you have conditioned a fear of driving on highways. However, the conditioned fear in and of itself does not necessarily translate into an anxiety disorder, it is only when we start avoiding feared stimuli that an anxiety disorder will develop, the reason being that each time we avoid the feared stimuli, our anxiety is relieved. The reward of reduced anxiety reinforces avoidance of feared stimuli and keeps in motion the cycle of anxiety-avoidance-anxiety, which eventually translates into some form of anxiety disorder (Bourne, 2005; Leahy & Holland, 2000).

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