Enhancing current treatments for anxiety disorders.

Abstract

Although there continue to be new developments in cognitive behavioral treatments for anxiety disorders, most of these advances have focused on refining existing treatments, rather than on developing new techniques. Many of the fundamental strategies that are successfully used for treating anxiety disorders today (e.g., cognitive restructuring, in vivo exposure, interoceptive exposure, imaginal exposure, relaxation training, response prevention, skills training) have been established for some time now. Instead of developing novel treatments for anxiety disorders, the focus of recent research has been on improving existing treatments and disseminating empirically supported interventions. Examples of recent innovations have included (a) using existing cognitive-behavioral therapy (CBT) techniques for new anxiety-based problems, such as hypochondriasis (Clark et al., 1998; Visser & Bouman, 2001), (b) using CBT in new settings, such as primary care (Power, Simpson, Swanson, & Wallace, 1990; Price, Beck, Nimmer, & Bensen, 2000), (3) delivering existing treatments in new ways, such as incorporating new technology (Newman, Consoli, & Taylor, 1999; Rothbaum, Hodges, & Smith, 1999), (4) delivering treatments more quickly (e.g., Clark et al., 1999), and (5) broadening cognitive and behavioral treatments to include aspects of other approaches, such as family therapies (Daiuto, Baucom, Epstein, & Dutton, 1998; Van Noppen, Steketee, McCorkle, & Pato, 1997). Roemer and Orsillo’s proposed treatment (this issue) for generalized anxiety disorder (GAD) is an example of how traditional CBT can be modified and (ideally) improved upon for a particular problem. The treatment described by the authors is exciting for a number of reasons. First, GAD is often considered to be among the most treatment resistant of the anxiety disorders, suggesting that existing treatments are not as effective as they could be. Adding mindfulness and acceptance-based strategies to standard GAD treatments makes practical sense in light of the fact that these approaches appear to be useful for a number of other conditions previously thought to be resistant to long-term change (e.g., borderline personality disorder; substance use disorders). More important, as reviewed by Roemer and Orsillo, the proposed treatment makes theoretical sense in the context of recent research on the nature and treatment of worry and GAD. Still, Roemer and Orsillo’s article (this issue) gives rise to a number of important issues and questions regarding which strategies should be most helpful for treating anxiety disorders, based on current theory and research; what common and unique elements exist across various psychological treatments for anxiety-based problems; and what directions should be taken as existing treatments continue to be refined and improved upon. The remainder of this commentary provides a brief summary of these issues.