Vol 4 n° 3 - Anxiety I
Past issues Contributors How to publish Contributions and comments Home
 
onpharmacological treatments for anxiety dis- orders—although of varied orientations—are unequally represented in the literature. The bulk of the research is devoted to behavior therapy (BT) and, more recently, to cognitive therapy (CT) methods. Both CT and BT tech- niques are used in combination by the vast majority of clinicians and researchers under the label of cognitive behavior therapy (CBT). Relaxation methods have been used as the main technique in anxiety disorders or stud- ied as a control condition in some randomized controlled trials (RCTs). Some relaxation techniques, such as Ost’s applied relaxation,1-3 are in fact made of several cognitive and behavioral techniques. Psychoanalytic (or psycho- dynamic) therapies, hypnotherapy, Rogerian nondirec- tive therapy, supportive therapy (ST), and psychological debriefing for posttraumatic stress disorder (PTSD) have been evaluated in RCTs and meta-analyses.Transcranial neurostimulation  and  psychosurgery  techniques  have been studied in obsessive-compulsive disorders (OCDs). Some  preliminary  data  exist  for  sympathectomy  in ereutophobia. Hence an evidence-based review of all these nonpharmacological methods is possible. Panic disorder and agoraphobia CBT in panic disorder and agoraphobia Panic disorder and agoraphobia are treated using two basic strategies: exposure (in imagination and in vivo or interoceptive exposure) and cognitive restructuring. 3 0 5 C l i n i c a l   r e s e a r c h Nonpharmacological treatments for anxiety disorders Jean Cottraux, MD, PhD Keywords:  anxiety  disorder;  meta-analysis;  controlled  trial;  cognitive-behavior therapy; psychological therapy; debriefing; psychosurgery Author affiliations: Jean Cottraux, MD, PhD, Anxiety Disorder Unit, Hôpital Neurologique, Lyon, France Address  for  correspondence:  Jean  Cottraux,  MD,  PhD,  Anxiety  Disorder Unit, Hôpital Neurologique, 59 boulevard Pinel, 69394, Lyon, France (e-mail: cottraux@univ-lyon1.fr) An evidence-based review of nonpharmacological treat- ments for anxiety disorders is presented. The vast major- ity of the controlled research is devoted to cognitive behavior therapy (CBT) and shows its efficiency and effectiveness in all the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) anxiety disorders in meta-analyses. Relaxation, psychoanalytic therapies, Rogerian nondirective therapy, hypnotherapy, and supportive therapy were examined in a few con- trolled studies, which preclude any definite conclusion about their effectiveness in specific phobias, agorapho- bia, panic disorder, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD). CBT was clearly better than psychoanalytic therapy in generalized anx- iety disorder (GAD) and performance anxiety. Psycho- logical debriefing for PTSD appeared detrimental to the patients in one high-quality meta-analysis. Uncontrolled studies of psychosurgery techniques for intractable OCD demonstrated a limited success and detrimental side effects. The same was true for sympathectomy in ereu- tophobia.  Transcranial  neurostimulation  for  OCD  is under preliminary study. The theoretical and practical problems of CBT dissemination are discussed. Dialogues Clin Neurosci. 2002;4:305-319. N