Wednesday, March 16, 2016

What works: Anxiety and Depression Treatments

Depression and anxiety are emotional disorders that reduce quality of life, increase suffering, impair our relationships, and endanger our long-term health. What's worse is that they are also extremely common. Depression and anxiety are known to affect 19 and 29% of individuals, respectively, not to mention that depression and anxiety co-occur at a rate of almost 50%. These statistics are particularly astonishing to me as a clinical psychologist because our field has developed a number of effective, non-invasive treatments that just don't seem to get into the lives of the people who need them most. In fact, a large national study recently found that most people suffer with anxiety and depression for about 10 years before they get treatment. A decade of unnecessary suffering. 

There are many reasons for this: some people don't live close enough to mental health providers, many people don't believe they have a problem (after all anything that sticks around for 10 years would just become the new normal), many people don't believe that seeing a psychologist would help, and many people can't afford the time or money it would cost. Luckily, how to effectively treat anxiety and depression is an active area of research, including questions such as what works for whom, and how can these effective treatments be delivered. 

An older approach to treating anxiety and depression was to identify which problem was more pressing and severe, and then treat the disorders sequentially. However, basic psychological science research suggests that underlying brain structures, symptoms, and behaviors for depression and anxiety are the same. This means that they can likely be treated with the same interventions. With this realization, clinical psychological scientists began to test the effectiveness of depression treatments on anxiety disorders, and anxiety treatments on depressive disorders. What emerged from these studies were "transdiagnostic" treatments for depression and anxiety. The transdiagnostic approach to treating emotional disorders is to identify and address the common maladaptive psychological, behavioral, and interpersonal processes that underlie psychological distress and impede well-being. But the million dollar question is, "Do they work?" 

Last year Dr. Jill Newby at the University of New South Wales and her colleagues published a meta-analysis examining the effectiveness across all of the existing clinical trials using transdiagnostic treatments for depression and anxiety. After scouring the published literature, they identified 47 studies that examined the effectiveness of transdiagnostic treatments for depression, anxiety, and quality of life for adults. The 47 studies varied in the type of treatment used (e.g., mindfulness vs cognitive behavioral therapy (CBT)), size (e.g., group vs individual), and delivery (e.g., internet-based vs face-to-face). The results of this meta-analysis represent effectiveness for transdiagnostic treatment for 1,109 patients compared to 992 controls. 

They found that transdiagnostic treatments had a large and significant overall effect on decreasing depression and anxiety symptoms as well as increasing quality of life. They also found that these benefits were maintained for up to 6 months following treatment completion. They also examined delivery characteristics for treatments and found that anxiety symptoms improved the most when treatment was delivered individually or over the internet compared with in a group format. Depression symptoms were most effectively treated over the internet, followed by face-to-face and group formats. They also looked at whether the content and approach to therapy influenced patient outcomes. They found that anxiety symptoms improved more in CBT-based treatments, while there was no difference in effectiveness between CBT- and mindfulness-based treatments for depression symptoms. In other words, both work just as effectively for treating depressive symptoms. 

To summarize, patients with anxiety and depression were better off if they received transdiagnostic treatment than if they didn't. Further, internet-based CBT is likely the best bet for how to effectively treat your symptoms. This is good news because internet-based treatments are wiping out many of the common barriers to getting treatment. They are flexibly scheduled, cost-effective, and accessible. It's not surprising then that internet-based treatments for depression and anxiety are becoming a topic of national discussion. We wrote about it at the launch of Maventhe future of health care, and UCLA's Raphael Rose Ph.D. was featured on the topic in Vogue magazine just this month. Based on the national statistics, one in three of you is struggling with depression and/or anxiety. Getting mental health services used to be nearly impossible and quite stigmatizing to navigate. All of that has changed. The only question now is what are you waiting for? 

Newby, J. M., McKinnon, A., Kuyken, W., Gilbody, S., & Dalgleish, T. (2015). Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood.Clinical psychology review40, 91-110.

1 comment:

  1. Thanks a ton for sharing this post. My mom is trying to deal with depression and anxiety. Truly, I am fed up of her taking anti depression anxiety supplements. Looking for a permanent treatment. Someone just told me that a chiropractic Port Credit provides effective depression and anxiety treatment. Planning to visit there soon.


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