Transdiagnostic CBT Better Than Medication for Alcoholism, Anxiety

Posted on October 28th, 2013
Posted in Alcohol Abuse

Alcoholism is the well-known form of addiction that occurs when the brain develops a chemical reliance on the presence of alcohol. People affected by alcoholism also have unusually high risks for developing any one of several mental health conditions classified as anxiety disorders. In a study published in November 2013 in the journal Behaviour Research and Therapy, a multi-institution research team concluded that use of a form of psychotherapy called transdiagnostic cognitive behavioral therapy (CBT) can potentially reduce the level of alcohol intake in alcoholics afflicted with medically serious anxiety.

Alcoholism and Anxiety

All anxiety disorders involve unusually strong, life-disrupting responses to either normal stressful events in daily life or extraordinarily stressful events that occur only on relatively rare occasion. Two anxiety-related conditions—acute stress disorder and post-traumatic stress disorder (PTSD)—occur in the aftermath of traumatic, seemingly or actually life-threatening situations such as serious accidents or physical or sexual assaults. Compared to the general population, alcoholics have significantly heightened chances of experiencing many of these traumatic situations, and this increased risk helps partially explain the statistical connection between alcoholism and anxiety. In addition, according to the results of a 2012 study published in the journal Nature Neuroscience, the chronic heavy alcohol consumption associated with alcoholism may directly impair the brain’s ability to cope with anxiety-inducing events and regain a state of equilibrium and well-being.

Transdiagnostic CBT Basics

Cognitive behavioral therapy is the umbrella term for a number of psychotherapeutic treatments that focus on educating patients about the dysfunctional ways they handle stressful situations, as well as on helping patients shed their dysfunctional responses and learn new, more mentally beneficial mechanisms for dealing with stress. CBT is particularly noted for its ability to help people reduce the effects of anxiety disorders such as panic disorder, generalized anxiety disorder and specific phobia, as well as PTSD and obsessive-compulsive disorder (two conditions now identified as closely related to anxiety disorders, but deserving of their own separate categories as mental health conditions). Some forms of cognitive behavioral therapy are designed to deal with only one particular disorder. In contrast, transdiagnostic CBT uses a similar or identical set of techniques to address the effects of multiple disorders.

New Findings

In the study published in Behaviour Research and Therapy, researchers from five U.S. institutions compared the usefulness of transdiagnostic CBT to the usefulness of two other treatments for the combined effects of alcoholism and medically serious anxiety: the antidepressant medication venlafaxine (Effexor) and progressive muscle relaxation (PMR) therapy, which uses systematic, purposeful muscle tensing and release to induce a relaxed state of mind. During the study, 81 adults were split into four groups. One of these groups received only transdiagnostic CBT for 11 weeks, while the second received a combination of transdiagnostic CBT and venlafaxine for the same amount of time. The third group received only progressive muscle relaxation for 11 weeks, while the fourth received a combination of PMR and venlafaxine for the same amount of time.

At the end of the treatment period, the researchers found that, on its own, transdiagnostic CBT significantly decreases the level of alcohol intake in alcoholics affected by serious anxiety. Interestingly, when added to transdiagnostic CBT, venlafaxine use does not produce any treatment improvement. Whether used on its own or combined with venlafaxine, progressive muscle relaxation does not contribute to a reduction in alcohol consumption in alcoholics affected by serious anxiety.

Significance and Considerations

As a rule, antidepressant medications like venlafaxine produce their effects in anxiety treatment by helping the brain chemically control the presence of excessive or debilitating anxiousness. In contrast, transdiagnostic cognitive behavioral therapy helps affected individuals confront their anxiousness and learn how to deal with it in a systematic way. The authors of the study published in Behaviour Research and Therapy believe that the intentional, constructive approach of transdiagnostic CBT may effectively eliminate the problems that venlafaxine is meant to address. In turn, this situation may explain why venlafaxine use does not produce improved results in anxious alcoholics also receiving transdiagnostic CBT.

In broader terms, the study’s authors believe their work demonstrates that non-medication-based therapies can successfully produce a meaningful decline in alcohol consumption among alcoholics affected by anxiety disorders. This means that doctors can add these therapies to their treatment options and thereby potentially increase any given alcoholic’s chances of experiencing a long-term recovery from his or her condition.

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