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The Royal College of Psychiatrists Improving the lives of people with mental illness

The Science of Psychiatry: Making an Impact


This piece of research was taken from 'Research and psychiatry - making an impact'

Developing treatment for anxiety disorders

Type of research
Suicide, self-harm
Impact on
Therapy type

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 fear.”

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.

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