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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