Synopsis
This article reviews the ways in which cognitive and behavioral treatments for depression and anxiety have been advanced by the application of mindfulness practices. Research on mindfulness-based interventions (MBIs) has increased exponentially in the past decade. The most common include Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT). MBIs have demonstrated efficacy in reducing anxiety and depression symptom severity in a broad range of treatment-seeking individuals. MBIs consistently outperform non-evidence-based treatments and active control conditions, such as health education, relaxation training, and supportive psychotherapy. MBIs also perform comparably to cognitive-behavioral therapy (CBT). The treatment principles of MBIs for anxiety and depression are compatible with those of standard CBT.
Introduction:
Generalized anxiety disorder (GAD) is a common form of anxiety disorder. Selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and benzodiazepines (BZs) are the most commonly prescribed medications for GAD, but little is known about the relative efficacy of these pharmacological treatments.
Areas Covered:
This study provides a meta-analytic review of the efficacy of these medications in the treatment of adults with GAD.A comprehensive literature search yielded 54 articles reporting 56 unique studies with 12,655 participants treated with either pill placebo (6,191 participants), SSRIs (16 trials, 2,712 participants), SNRIs (17 trials, 2,603 participants), or BZs (23 trials, 1,149 participants). The overall combined effect size was modest to moderate (Hedges’ g = 0.37, p< 0.0001). Effect sizes decreased significantly over time. SSRIs (Hedges’ g = 0.33) and SNRIs (Hedges’ g = 0.36) demonstrated significantly lower effect sizes than BZs (Hedges’ g = 0.50).
Expert opinion:
These findings were not due to differences in treatment length or publication year. The results of this study suggest that the most common forms of pharmacotherapy for adult GAD are moderately effective, with BZs being the most effective drug.
Cognitive-behavioral therapy (CBT) that is tailored to the unique clinical features of body dysmorphic disorder (BDD) is currently the psychosocial treatment of choice for BDD. Researchers have made great strides in understanding the cognitive-behavioral processes that contribute to the development and maintenance of BDD. CBT for BDD is based on this theoretical understanding and has been shown to be highly effective in reducing BDD symptom severity and associated symptoms. The key components of CBT include identifying and rationally disputing maladaptive appearance-related thoughts, and exposure with response prevention for feared and avoided situations. CBT for BDD also integrates educating the patient on the mental and behavioral processes involved in the BDD experience with mindfulness/perceptual retraining (e.g., techniques aimed at helping patients to view their appearance with a neutral, global, and aware perspective) to augment the therapeutic process. Advanced cognitive strategies are used to address negative core beliefs. Because BDD is typically characterized by poor or absent insight, motivational interviewing is often needed to overcome ambivalence towards treatment.
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