Outcomes of Self-help Efforts in Anxiety Disorders

Amy J Morgan; Anthony F Jorm

Disclosures

Expert Rev Pharmacoeconomics Outcomes Res. 2009;9(5):445-459. 

In This Article

Abstract and Introduction

Abstract

Anxiety disorders are prevalent mental disorders that are a significant burden on the community. There are effective treatments available, but many people do not seek treatment and there is a lack of professionals available to provide evidence-based treatment to all those with anxiety disorders. Recently, there has been increased attention on ways to cost effectively meet the demand for treatment with minimal cost to health services. Self-help efforts have been proposed to play a role, either as an initial minimal treatment in stepped-care models of treatment, or as strategies undertaken by an individual to prevent a full disorder developing. This review examines what is known from randomized controlled trials about the efficacy of self-help interventions for anxiety disorders.

Introduction

Anxiety disorders are a group of mental disorders that have shared features of overwhelming fear or persistent anxiety that interferes with normal daily activities. They include panic disorder (with or without agoraphobia), generalized anxiety disorder, specific phobia, social phobia, obsessive–compulsive disorder, post-traumatic stress disorder and acute stress disorder.[1] Anxiety disorders are the most prevalent class of mental disorder. Community surveys estimate the 1-year prevalence of anxiety disorders as 10.6% and the lifetime prevalence has been estimated at 16.6%.[2] Anxiety disorders have a substantial negative impact on quality of life, leading to poorer mental and physical health, social and family relationships, and functioning at work and home.[3] Recommended treatment of anxiety disorders involves prescription of selective serotonin reuptake inhibitors or serotonin–norepinephrine reuptake inhibitors and/or cognitive–behavioral therapy (CBT), which have established evidence bases of efficacy.[4] The cognitive component of CBT usually involves patient education and challenging distorted thinking, while the behavioral component involves graduated exposure to feared stimuli, and learning applied relaxation and anxiety management skills.

Studies in the community show that there is a large unmet need for treatment of anxiety disorders[5] and those who are treated often do not receive good quality, evidence-based care.[6] The lack of clinical resources available for treatment of anxiety disorders and their burden on society has stimulated interest in cost-effective alternatives to meeting unmet requirements. Some have argued that access to psychological therapies could be improved through a new service model where structured self-help materials are not marginalized but are provided to patients as the default intervention.[7] Another strategy to tackle the large unmet need for treatment of anxiety disorders without overly burdening clinical resources could be health promotion campaigns about effective self-help strategies, in a similar way to how messages of risk-reduction strategies are promoted to prevent physical illnesses such as heart disease.[8] In addition to being a cost-effective solution to unmet need for treatment, self-help approaches also have other advantages, such as increasing an individual's sense of privacy and control over their health.

Self-help approaches are not well defined and have different meanings for consumers and clinicians. Clinicians tend to conceptualize self-help as professionally developed resources based on CBT, which can be delivered with no professional support (unguided self-help), as a partial replacement or supplement to face-to-face therapy, or as an independent intervention with minimal therapist contact (guided self-help).[9] By contrast, consumers have a much broader conceptualization of self-help approaches, including life-style activities, social support, exercise and volunteering.[10] Clinicians tend to be less enthusiastic regarding the merits of self-help approaches compared with the public[11] or mental health consumers.[10,12] Complementary and alternative therapies (many of which can be used as self-help) along with other self-help approaches are commonly used by those experiencing anxiety symptoms.[13,14] For the reasons cited previously, self-help for anxiety is worth investigating. A previous systematic review published in 2004 evaluated the evidence for a broad range of self-help interventions for anxiety disorders and found that kava, exercise, relaxation training and bibliotherapy had promising evidence of efficacy.[15] This current review aims to provide an up-to-date picture of the research evidence for a broad definition of self-help efforts in anxiety disorders.

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