Developing treatment for anxiety disorders
|Type of research
No one is exempt from the occasional burst of anxiety,
particularly in dangerous or stressful situations. However, people
with clinical anxiety disorders are tormented with this feeling
even when they are not in objective danger or stress. Professor
David Clark and colleagues from the Departments of Experimental
Psychology and Psychiatry at Oxford University have made a
significant advance in helping these people cope.
Panic and social anxiety disorder are two particularly common
forms of anxiety disorder. In panic disorder people experience, and
fear, sudden attacks of anxiety, many of which seem to come ‘out of
the blue’. In social anxiety disorder people experience intense
fear over routine social interactions such as speaking up at work,
meeting strangers or talking on the phone. Often the fear is driven
by the worry of doing something embarrassing or humiliating in
front of other people who then see it has made one anxious.
Professor Clark says “It’s a fear of other people seeing your
In the past, there were few effective treatments for these two
anxiety disorders. Treatment with antidepressants had limited
success and many patients relapsed after they stopped taking the
drugs. Trying a different approach, early behavioural therapies
focused on repeated exposure to the stressful stimulus. However,
fewer than half of patients benefited from this treatment.
Professor Clark’s team decided to focus on the psychological
processes that maintain the anxiety and prevent recovery. In panic
disorder, the team observed that sufferers have a tendency to
misinterpret harmless body sensations such as a rapid heart rate or
intrusive thoughts as a sign of an imminent physical or mental
disaster (e.g. heart attack or the onset of insanity). People adopt
safety behaviours, like sitting down or trying to push the
intrusive thoughts out of their minds, so that they don’t learn
that the sensations are in fact harmless. Sufferers also become
hyper-attentive to their bodies and are able to detect minor
sensations that many others cannot.
The researchers developed a cognitive therapy to specifically
target the misinterpretations, safety behaviours and
hyper-attention. In clinical trials the new therapy was found to be
highly effective and superior to both drugs and behaviour therapy.
These findings were soon confirmed in independent trials in the
Netherlands and Sweden.
In social anxiety disorder, the team considered two key issues:
when sufferers focussed too much on themselves (negative
self-imagery); and the use of safety behaviours, such as talking
fast during a meeting or finding an excuse to avoid the situation
altogether. The researchers used video feedback to help people gain
an accurate impression of how they actually appear, rather than how
sufferers think they appear, and taught people how to let go of
their safety behaviours. The new treatment has now been evaluated
in randomised controlled trials in the UK, Germany and Sweden and
the results show it to be superior to both other psychological
therapies and antidepressants.
As a result of the new therapies, recovery from these two
debilitating disorders can be as high as 70-80%. The National
Institute for Health Care and Excellence (NICE) produced guidelines
in 2011 that recommend both the cognitive therapies developed by
the Oxford group as first choice treatments.
Recently, the government has launched an initiative to Improve
Access to Psychological Therapies (IAPT) within the NHS. The Oxford
group’s therapies have been included in the national IAPT training
curriculum and to date around 2,200 new therapists have learned the
treatments and are delivering them in over 130 local services. A
further 900 therapists will be trained over the next two years,
further increasing access to the treatments.