Emerging anxiety treatments advance coping strategies, but more study needed

The good news, says Ryerson researcher Martin Antony, is that effective, evidence-based treatments are now available for all types of anxiety disorders - even those previously considered resistant to treatment.  The bad news, however, is that many people with anxiety disorders do not receive those treatments, and some respond poorly (if at all) to them.

Antony, a psychology professor, is director of Ryerson's anxiety research and treatment lab. He's also a past-president of the Canadian Psychological Association (CPA), which represents psychologists across the country. During the CPA's annual conference in 2010, as Antony's term as president was coming to a close, he delivered an address on "Recent Advances in the Treatment of Anxiety Disorders." That presentation has since been published in the February 2011 issue of the CPA journal Canadian Psychology.

In his address, Antony focused on three emerging approaches for anxiety disorders, and explored new ways to enhance the effects of established treatments. "I chose to focus on emerging areas of research that psychologists - unless they are specialists - may not be aware of," says Antony. 

His first area of focus, attentional training, has received considerable attention in the field of psychology. The treatment is based on the idea that individuals with high levels of anxiety tend to pay more attention to threat-related information, thereby heightening anxiety and worry. Researchers, therefore, have theorized that reducing this bias by training individuals to train their focus on neutral words and information will reduce anxiety symptoms. While the treatment has achieved positive results in a few studies thus far, Antony is cautious, warning that the findings remain to be replicated adequately in subsequent studies.

Virtual reality (VR) treatments, Antony's second topic, involve the common practice of exposing individuals to feared situations and objects (e.g., flying or snakes) as a means of reducing fear. With computer-simulated VR treatments, however, exposure therapy can now be conducted in a psychologist's office, rather than in the field. Antony points out, though, that it remains to be seen if VR exposure therapy is as effective as its more traditional counterpart. Only a small number of studies (primarily for fears of flying or heights) have compared VR exposure to live exposure.

During mindfulness and acceptance-based treatments, meanwhile, clients are encouraged to accept unwanted thoughts and feelings, instead of trying to control or avoid them. While the approach isn't new, research on the use of these strategies is only now emerging.  According to Antony, preliminary findings support these treatments as an effective option for people with certain anxiety disorders. But he says, more research is needed to fully understand how and why mindfulness and acceptance-based treatments work.

Finally, Antony explored recent research on ways to enhance the effects of traditional treatments. Specifically, he reviewed recent positive findings on the combination of exposure therapy with the medication d-cycloserine (a drug that appears to enhance learning), and providing several sessions of motivational interviewing before starting cognitive-behavioral therapy. Motivational interviewing, Antony says, is intended to reduce an individual's ambivalence toward, and fear of, change - and he plans to study the technique further in his own lab.

The bottom line, Antony says, is that work is still needed to address larger issues regarding anxiety disorders. "We know that one size does not fit all when it comes to treatments, so we need to study which treatments work best for particular individuals. We also need to improve access to evidence-based treatments - it's great to have these treatments available, but it's a problem if people can't access them."

Provided by Ryerson University