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Cognitive Therapy for Anxiety Disorders: Current Status and Future Challenges

  • Freda McManus (a1), Nick Grey (a2) and Roz Shafran (a3)

This paper reviews recent theoretical, conceptual and practice developments in cognitive-behaviour therapy (CBT) for anxiety disorders. The empirical status of CBT for anxiety disorders is reviewed and recent advances in the field are outlined. Challenges for the future development of CBT for the anxiety disorders are examined in relation to the efficacy, effectiveness and cost-effectiveness of the approach. It is concluded that the major challenge currently facing CBT for anxiety disorders in the UK is how to meet the increased demand for provision whilst maintaining high levels of efficacy and effectiveness. It is suggested that the creation of an evidence base for the dissemination of CBT needs to become a priority for empirical investigation in order effectively to expand the provision of CBT for anxiety disorders.

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Reprint requests to Freda McManus, Oxford Cognitive Therapy Centre, The Warneford Hospital, Oxford OX3 7JX, UK. E-mail:
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M. E. Addis , C. Hatgis , A. D. Krasnow , K. Jacob , L. Bourne and A. Mansfield (2004). Effectiveness of cognitive-behavioural treatment for panic disorder versus treatment as usual in a managed care setting. Journal of Consulting and Clinical Psychology, 72, 625635.

D. H. Barlow , L. B. Allen and M. L. Choate (2004). Towards a unified treatment for emotional disorders. Behaviour Therapy, 35, 205230.

T. A. Brown , L. A. Campbell , C. L. Lehman , J. Grisham and R. B. Mancill (2001). Current and lifetime co-morbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology, 110, 585599.

D. M. Clark (1986). A cognitive model of panic. Behaviour Research and Therapy, 24, 461470.

D. M. Clark , A. Ehlers , F. McManus , A. Hackmann , M. Fennell , H. Campbell , T. Flower , C. Davenport and B. Louis (2003). Cognitive therapy versus fluoxetine in generalized social phobia: a randomized placebo-controlled trial. Journal of Consulting and Clinical Psychology, 71, 10581067.

D. M. Clark , A. Ehlers , A. Hackmann , F. McManus , M. Fennell , N. Grey , L. Waddington and J. Wild (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 74, 568578.

D. M. Clark , P. M. Salkovskis , A. Hackmann , H. Middleton , P. Anastasiades and M. Gelder (1994). A comparison of cognitive therapy, applied relaxation and imipramine in treatment of panic disorder. British Journal of Psychiatry, 164, 759769.

D. M. Clark , P. M. Salkovskis , A. Hackmann , A. Wells , J. Ludgate and M. Gelder (1999). Brief cognitive therapy for panic disorder: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 67, 583589.

M. G. Craske , T. J. Farchione , L. B. Allen , V. Barrios , M. Stoyanova and R. Rose (2007). Cognitive behaviour therapy for panic disorder and co-morbidity: more of the same or less of more? Behaviour Research and Therapy, 45, 10951109.

A. Ehlers (1995). A 1-year prospective study of panic attacks: clinical course and factors associated with maintenance. Journal of Abnormal Psychology, 104, 164172.

A. Ehlers and D. M. Clark (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319345.

A. Ehlers , D. M. Clark , A. Hackmann , F. McManus and M. Fennell (2005). Cognitive therapy for PTSD: development and evaluation. Behaviour Research and Therapy, 43, 413431.

A. Ehlers , D. M. Clark , A. Hackmann , F. McManus , M. Fennell , C. Herbert and R. Mayou (2003). A randomised controlled trial of cognitive therapy, self-help booklet, and repeated early assessment as early interventions for PTSD. Archives of General Psychiatry, 60, 10241032.

I. C. Fedoroff and S. Taylor (2001). Psychological and pharmacological treatments of social phobia: a meta-analysis. Journal of Clinical Psychopharmacology, 21, 311324.

E. B. Foa , E. A. Hembree , S. P. Cahill , S. A. M. Raunch , D. S. Riggs , N. C. Feeny and E. Yadin (2005). Randomized trial of prolonged exposure for post-traumatic stress disorder with and without cognitive restructuring: outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 73, 953964.

R. C. Howard (1999). Treatment of anxiety disorders: does specialty training help? Professional Psychology: Research and Practice, 30, 470473.

R. C. Kessler , W. T. Chiu , O. Demler and E. Walters (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617627.

M. King , O. Davidson , F. Taylor , A. Haines , D. Sharp and R. Turner (2002). Effectiveness of teaching general practitioners skills in brief CBT to treat patients with depression: randomised controlled trial. British Medical Journal, 324, 947.

K. Mannix , I-M. Blackburn , A. Garland , J. Gracie , S. Moorey , B. Reid , S. Standart and J. Scott (2006). Effectiveness of brief training in cognitive behaviour therapy techniques for palliative care practitioners. Palliative Medicine, 20, 579584.

D. S. Mennin , R. G. Heimberg , C. L. Turk and D. M. Fresco (2005). Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behaviour Research and Therapy, 43, 12811310.

J. J. Miller , K. Fletcher and J. Kabat-Zinn (1995). Three-year follow-up and clinical implications of a mindfulness-based stress reduction intervention in the treatment of anxiety disorders. General Hospital Psychiatry, 17, 192200.

E. Mortberg , D. M. Clark , O. Sundin and A. Wistedt (2006). Intensive group cognitive therapy and individual cognitive therapy versus treatment as usual in social phobia: a randomized controlled trial. Acta Psychiatrica Scandinavica. 115, 142154.

L. G. Ost , P. Salkovskis and K. Hellstrom (1991). One session therapist directed exposure vs. self-exposure in the treatment of spider phobia. Behavior Therapy, 22, 407422.

R. Rapee , M. J. Abbott , A. Baillie and J. E. Gaston (2007). Treatment of social phobia though pure self -help and therapist-augmented self help. British Journal of Psychiatry, 191, 246252.

P. M. Salkovskis (1985). Obsessional-compulsive problems: a cognitive-behavioural analysis. Behaviour Research and Therapy, 23, 571583.

P. M. Salkovskis , D. M. Clark , A. Hackmann , A. Wells and M. Gelder (1999). An experimental investigation of the role of safety-seeking behaviours in the maintenance of panic disorder with agoraphobia. Behaviour, Research and Therapy, 37, 559574.

P. M. Salkovskis , A. Hackmann , A. Wells , M. Gelder and D. Clark (2007). Belief disconfirmation versus habituation approaches to situational exposure in panic disorder with agoraphobia: a pilot study. Behaviour, Research and Therapy, 45, 877885.

D. E. Sholomskas , G. Syracuse-Siewert , B. J. Rounsaville , S. A. Ball , K. F. Nuro and K. M. Carroll (2005). We don't train in vain: a dissemination trial of three strategies of training clinicians in cognitive-behavioural therapy. Journal of Consulting and Clinical Psychology, 73, 106115.

N. Sibrava and T. D. Borkovec (2006). Worry and cognitive avoidance. In G. Davey and A. Wells (Eds.). Worry and Psychological Disorders: theory, assessment, and treatment (pp. 239258). West Sussex, UK: Wiley and Sons.

S. W. Stirman , R. J. DeRubeis , P. Crits-Christoph and A. Rothman (2005). Can the randomized controlled trial literature generalize to nonrandomized patients? Journal of Consulting and Clinical Psychology, 73, 127135.

J. D. Teasdale , Z. Segal and J. M. Williams (1995). How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help? Behaviour Research and Therapy, 33, 2539.

S. T. Walters , S. A. Matson , J. S. Baer and D. M. Ziedonis (2005). Effectiveness of workshop training for psychosocial addiction treatments: a systematic review. Journal of Substance Abuse Treatment, 29, 283293.

J. Wild , A. Hackmann and D. M. Clark (2007). When the present visits the past: updating traumatic memories in social phobia. Journal of Behaviour Therapy and Experimental Psychiatry, 38, 386401.

M. Zimmermann , W. McDermut and J. I. Mattia (2000). Frequency of anxiety disorders in psychiatric outpatients with major depressive disorder. American Journal of Psychiatry, 157, 13371340.

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Behavioural and Cognitive Psychotherapy
  • ISSN: 1352-4658
  • EISSN: 1469-1833
  • URL: /core/journals/behavioural-and-cognitive-psychotherapy
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