Bridging the Gap between Biological and Psychological Perspectives in the Treatment of Anxiety Disorders

Presidential Address -- Allocution presidentielleAbstract. The applicability and usefulness of behavioural and cognitive treatment approaches for anxiety disorders is now well established. Various and different theoretical mechanisms have been proposed to explain their therapeutic effects on anxiety. Today's research suggests that the psychological variables mediating change in behavioural and cognitive therapy for anxiety disorders are similar. Furthermore, the effects of drug and psychological treatment for anxiety disorders appear to be mediated by the same psychological and neurobiochemical variables. It is postulated that a better understanding of the interaction between these variables will lead to new, significant advances in the treatment of anxiety disorders.Some of our most prominent scholars think that anxiety serves a protective function. For others, it is at the very root of what it means to be human. Still others believe that our very ability to adapt and plan for the future depends on anxiety. Without denying the potential advantages of being anxious, it is equally important to recognize that, for many individuals, anxiety is a curse something they could live without. In our society, individuals spend billions of dollars yearly to rid themselves of anxiety. More people visit their physician for anxiety than for coughs and colds.The aim of this paper is to provide an overview of the research and theorizing about the behavioural and cognitive treatment of anxiety and panic. It is also to discuss directions for future research.What Is Anxiety? The feelings of anxiety, worry, fear, and panic are quite universal and easy to recognize. Many individuals use these terms interchangeably (e.g., Clark, 1986; Rapee, 1996) while others believe that these terms have distinct meanings (e.g., Antony & Barlow, 1996). There are several definitions of anxiety in the literature and it is beyond the scope of this paper to review them. As far as the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association, 1994) reflects a consensus among clinicians, one may refer to it for an acceptable definition. In the DSM-IV, anxiety is defined as an "apprehensive anticipation of future danger or misfortune accompanied by a feeling of dysphoria or somatic symptoms of tension. " This definition implies that anxiety is a future-oriented state, functioning to motivate the organism to behave in such a way that future danger is averted. Experiences of anxiety, however, can become overwhelming. When they do, anxiety disorders may develop.What Are Anxiety Disorders? The anxiety disorders are a group of psychological problems that affect behaviour, thoughts, feelings, and physical sensations. Their key features include excessive anxiety, fear, worry, and avoidance. The most prevalent anxiety disorders listed in the DSM-IV (American Psychiatric Association, 1994) include panic disorder with and without agoraphobia (PDA and PD, respectively), social phobia, specific phobia, obsessive-compulsive disorder (OCD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD). Other relevant disorders include acute stress disorder (similar to PTSD, except with a shorter duration), anxiety disorder due to a general medical condition, substance-induced anxiety disorder, agoraphobia without a history of panic disorder, and anxiety disorder not otherwise specified.Panic Disorder with and without Agoraphobia. The essential feature of PD and PDA is the occurrence of recurrent unexpected attacks of panic (i.e., attacks coming out of thin air, in places where there is nothing to fear) about which there is persistent concern. Although generally lasting only a few minutes, panic attacks cause a person to feel as if he or she is having a heart attack, dying, or going crazy. They are often described as "the most terrifying experience I've ever had. …