8: Alternatives to talking therapy

Question 1

what is the UK’s approach to treating anxiety?

Answer 1

Step 1 : Identification and assessment; education about GAD and treatment options; active monitoring
Step 2 : Low-intensity psychological interventions (i.e., self help and psychoeducation)
Step 3 : High Intensity Intervention OR Drug treatment (SSRI, or SNRI).
Step 4 : Complex drug/psychological treatment; multiagency teams

Question 2

what does SNRI stand for?

Answer 2

serotonin and norepinephrine reuptake inhibitors

Question 3

what is Canada’s first line of anxiety treatment?

Answer 3

CBT, SSRI, SNRI, pregabalin, antidepressants

Question 4

what is the USA’s recommended treatment for anxiety?

Answer 4

there are no universal clinical guidelines

Question 5

What in the family of anxiety & related disorders does the American Psychiatric Association have guidelines for?

Answer 5

PTSD, OCD & panic disorder

Question 6

what the the UK’s treatment for depression?

Answer 6

Less severe PHQ<16:CBT, behavioural activation, exercise, anti depressant
More severe PHQ > 16: CBT, behavioural activation, anti depressant, group exercise

Question 7

what is Canada’s recommended treatment for depression?

Answer 7

psychoeducation
therapy (behavioural activation CBT, interpersonal therapy)
exercise
SSRIs, SNRIs

Question 8

what is the USA’s recommended treatments for depression?

Answer 8

therapy: CBT, interpersonal therapy, mindfulness cognitive therapy, psychodynamic therapy
antidepressants
combined treatments
exercise (if others not effective)

Question 9

give an example of an SSRI

Answer 9

escitalopram

Question 10

give 3 examples of an SNRI

Answer 10

duloxetine, venlaflaxine, pregabalin

Question 11

what are the limitations of pharmacological therapies for anxiety

Answer 11

the acceptability of medications is quite low so there is low continuation of use compared to placebos

Question 12

how to anti-anxiety medications compare to placebos on effectiveness

Answer 12

they are more effective but the effect size varies a lot

Question 13

how do antidepressants compare to placebos?

Answer 13

small effect size, higher withdrawal rates

Question 14

how do exercise interventions vary between UK, US & Australia?

Answer 14

UK= group exercise/any increase in physical activity
US= any dose of aerobic exercise of resistance training
Australia= combination of strength and vigorous aerobic exercise at least 2-3 times a week

Question 15

is exercise more effective for treating anxiety or depression?

Answer 15

depression, but can treat both

Question 16

what are the most effective exercises for depression?

Answer 16

walking/jogging, yoga, strength training and dancing

Question 17

out of GAD, MDD, OCD & panic disorder, which does not benefit from combined treatment (pharmacological & psychological)?

Answer 17

GAD

Question 18

what proportion of cardiovascular disease patients have depression or anxiety?

Answer 18

1/3

Question 18

how does anxiety/depression affect healthcare outcomes of patients with CVD?

Answer 18

Increased anxiety/depression is associated with increased morbidity, mortality and reduced quality of life.

Question 18

3 parts of cardiac rehabilitation?

Answer 18

exercise, education, stress management/relaxation

Question 18

how does cardiac rehabilitation help anxiety/depression?

Answer 18

While CR does reduce symptoms of anxiety and depression, but not all patients benefit from CR, with 30% of patients experiencing elevated anxiety and depression

Question 19

how effective is CBT for CVD related anxiety/depression

Answer 19

a little bit - inappropriate because if you’re asking people why they’re worried about having a heart attack and they’ve just had one, you can’t convince them that this belief is unfounded

Question 20

what is the most effective treatments for CVD related anxiety/depression?

Answer 20

metacognitive therapy & cardiac rehabilitation