Panic
Anxiety Education
Management Services
The Politics of Anxiety
Disorder Treatments - Who
suffers
EFFECTIVE
TREATMENT
COGNITIVE
BEHAVIOURAL TREATMENT
In contrast to the
high prevalence, degree of
disability and cost to the
community these disorders
once correctly diagnosed
can be easily treated. Over
the past decade effective
treatments have been
developed for many Anxiety
Disorders. As already
discussed, the most
effective treatments are
Cognitive Behavioural
Treatments. These
treatments are time
limited, self directed,
produce high rates of end
state functioning and are
cost effective. (12,
16,17,18,19)
Not only are these
effective, one Australian
study of Panic Disorder
showed patients had 'a
clear bias toward
attributing cause to
cognitive factors' (28) As
in our experience with
clients the study also
showed people preferred
"cognitive coping
strategies" in
preference to medication.
(Ibid) Unfortunately, as
previously stated, these
treatment services are not
available to the majority
of our client group.
Four definitive papers,
albeit one by default,
demonstrate the long term
benefits of short term
Cognitive Behavioural
Treatment.
1. 'Studies
comparing the relative
efficacy of pharmacologic
and cognitive behavioural
interventions report panic
free rates above 80% for
cognitive behavioural
interventions and between
50% and 60% for
pharmacotherapy' (16)
Long term studies show
many patients require
ongoing medication
treatment and remain
symptomatic despite this
ongoing treatment....50 -
80% of patients continue to
remain symptomatic at
assessments ranging from
1.5 years to 6 years after
initiation of medication
treatment....
Discontinuation of
medications (especially
benzodiazepines) show the
majority of patients in
some studies experience
symptoms as bad or worse
than pre-treatment levels
during discontinuation.
(Ibid)
This paper also
demonstrates....follow up
studies of Cognitive
Behavioural Therapy
indicate that short term
treatment can have lasting
beneficial effects. In
controlled trials panic
free rates in excess of 80%
have been reported at
follow up periods of 1 - 2
years. (Ibid)
It has also shows 'A ten
session program of
Cognitive Behaviour Therapy
during a medication taper
showed 76% were able to
successfully discontinue
their benzodiazepine
medication on schedule and
achieved a lower level of
symptoms off medication. In
contrast only 25% of
patients were able to
discontinue their
medication treatment (Alprazolam
(Xanax)- or clonazepam)
with a slow taper and
physician support programme.
(Ibid)
2. One recent
study assessed the cost
before and after diagnosis
and treatment of 61 people
with Panic Disorder. The
treatment involved
psychotropic drugs
including 'Alprazolam (Xanax),
tricyclic anti depressants
also MAOI' Direct costs
prior to diagnosis
were
$US 29,158 : After
diagnosis $US 46,256 : Indirect
cost prior to diagnosis
were $US 65,643 after
diagnosis $US 13, 883.
The increase in Direct
costs were associated
to the number of
psychiatrist consultations
which grew from 40 prior to
diagnosis to 793 after
diagnosis. While the study
comments in the conclusion
that 'Methods for improving
early detection of Panic
Disorder may substantially
reduce the costs incurred
before diagnosis' it does
not make mention of
improving the direct costs
after diagnosis.(13)
3. In comparison
a German study looked at
the cost effectiveness of
Cognitive Behavioural
Therapy involving 66 people
with Panic Disorder. At a
three year follow up
Anxiety related health care
costs, direct and indirect,
decreased by 81%. 'Taking
the cost of Cognitive
Behavioural Therapy into
account the cost benefit
ratio for the first two
years was 1:5:6. Thus one
dollar spent for Cognitive
behavioural treatment
yielded a saving of 5.6
Dollars in anxiety related
costs'.(19)
4. A recent
Australian study also
demonstrates the
effectiveness of short term
CBT which represents a cost
effective intervention
which quickly restores
functioning. (18)
Even though we are a
consumer organisation we
also have been able to
demonstrate the
effectiveness of a short
term education management
strategies. An evaluation
study of our Panic Anxiety
Management Workshops show
at a follow up at three
months a significant
decrease in the major fears
and symptoms. (26)
PREVENTION
Anxiety Disorders
represent the most common
Mental Health problem in
Australia. The Commonwealth
can play a pivotal
role in helping to prevent
our client group from ever
reaching the "Serious
Mental Disorder' category.
Not only are the severe
disabilities related to
Anxiety Disorder
preventable, the
development of these
Disorders as we have
already stated, can be
minimised and in some cases
prevented, with early
diagnosis and appropriate
treatment.
This is one of the most
common complaints by our
client group. "If I
had been diagnosed...if I
had received proper
treatment from the
beginning none of this,
(the disabilities) would
have happened." The
costs to the Health care
system and the 'apparent
indifference' by all
governments to these costs
are also one of the most
common complaints.
OTHER SERVICES
As people are able
to gain control over their
lives through Cognitive
Behavioural Therapy, there
is little need for our
client group to access
other services such as
housing, ongoing medical
support, Case Management
and/or Social Work
services, support through
services such as HAAC and
or family/carer support.
Although there is a
demonstrated need for
clients who have had a
Disorder for a number of
years to have access to
services such as the
Commonwealth Rehabilitation
Service to enable them to
return to the workforce.
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