A Study to Investigate Cognitive Behavioral Therapy (CBT) Combined with Xanax Prescriptions for Children Diagnosed with Separation Anxiety
Jenny Grijalba
Florida International University
A Study to Investigate Cognitive Behavioral Therapy (CBT) combined with Xanax Prescriptions for Children Diagnosed with Separation Anxiety.
Abstract
This research paper aims at finding out if cognitive behavioral therapy (CBT) combined with medications particularly Xanax prescriptions for children diagnosed with separation anxiety whose parents are in immigration proceedings, is more effective treatment than when CBT is used alone to treat such mental problem. The method adopted for this study is to subject two groups to a test: a Xanax prescription for 3 months alongside another control group that will attend a cognitive behavioral therapy for 3 months. The research adopts an assumption that combining CBT intervention with medications such as Xanax is more effective in treating separation anxiety than when CBT is used alone. Whereas the paper adopts a comparative approach to the research problem, the discussion will be confined to a scope characterized by a few factors such as CBT, Xanax prescriptions, children with separation anxiety, and children as the preferred group in the population.
Keywords: Cognitive-Behavioral Therapy, Separation Anxiety, Anxiety Disorders.
Literature Review
Introduction
Several studies have been carried out to examine the effectiveness of different psychopharmacological interventions and therapies in treating anxiety disorders both in children and adults. In this section, this research paper provides a comprehensive analysis and deeper insight into the existing literature concerning the treatment of separation anxiety in children who parents are engaged in immigration proceedings. Cognitive and behavioral therapies (CBT) have been applied widely in an attempt to manage a broad range of disorders. Studies have found CBT to be effective on a wide variety of disorders and other mental health issues in living that and not necessarily/usually categorized as psychiatric health cases in children and adults. Similarly, physicians widely recommend or prescribe different forms of psychoactive medications as remedies to a wide range of psychiatric disorders in both children and adults (Locke, Kirst & Shultz, 2015). Some of these psychoactive medications recommended or rather prescribed for treating mental disorders include Xanax or precisely a group of alprazolam drugs. In the recent few years, a combination of therapies and medications has become popular as physicians or psychiatrists try to find the most effective approach to psychiatric disorders that can offer patients long-term benefits or the ones that can easily manage such cases and prevent them from reoccurring quite often or even treat different mental disorders.
A Review of Literature
According to Bystritsky, Khalsa, Cameron & Schiffman (2013), psychopharmacological and cognitive behavioral therapies can effectively treat anxiety disorders both in children and adults since these interventions work or function based on varying symptom targets. Cognitive Behavioral Therapies (CBT) and medications typically used for treating nonpsychotic and psychotic disorders. Patients diagnosed with any mental problem classified as non-psychotic or psychotic disorders for example anxiety disorders due to different factors such as separation can obtain treatment through various options including both psychopharmacological and cognitive behavioral interventions. The fact that medications and CBT for nonpsychotic and psychotic disorders have different symptom targets makes them effective when combined (Bystritsky, Khalsa, Cameron & Schiffman, 2013). Generally, findings have shown that CBT can function and deliver similar or better results as when medications are used to treat non-psychotic disorders without resulting in some problematic side effects. In their research, Bystritsky et al. (2013) examined the effectiveness of Cognitive Behavioral therapy when combined with medications and when used alone. The combination of drug therapy and treatment using CBT has depicted mixed results in supporting one method over the other; although this bias depends on the type of anxiety disorder in question (Bystritsky et al., 2013). In their research, therefore, the team of researchers thus established that the degree of responsiveness to drug therapy and CBT varied considerably depending on the type of anxiety disorder that was being investigated for example, patients diagnosed with social disorder responded more responsive to medication. However, the choice of whether to use drug therapy or CBT or both was affected by a couple of external factors including the cost of CBT, availability of a therapist, patient preference, and the costs of medications (Bystritsky et al. 2013). Furthermore, the study supported a view that CBT could be used alone as a standalone therapy (self-administered) or therapist directed CBT in place of using a combination. Nonetheless, the use of CBT alone may experience severe challenges because studies have not widely examined the relapse rates for CBT.
In comparison between medications and interventions with cognitive behavioral therapies, evidence presented in different studies has also indicated that medications usually work although they do so only on condition that the patient keeps taking them; however, CBT can reduce the risk of subsequent symptoms from recurring long after medication or treatment (Dunlop & Davis, 2008). Apparently, CBT may be considered or applied by doctors as an effective alternative to medications in different groups of patients diagnosed with non-psychotic disorders in many cases. Whereas a combination of the two treatment methods is likely to yield better results, a large body of evidence indicates that the two interventions tend to be more effective when used individually. Therefore, this study seeks to examine if it is effective to combine psychopharmacological intervention with CBT to treat anxiety disorders or find out if it is effective to use CBT alone. Generally, findings conclude that CBT can perform any function that medications can do in as far as treating nonpsychotic disorders are concerned (Locke, Kirst & Shultz, 2015). Similarly, findings also indicate that medications such as Xanax are likely to work a little quicker compared to CBT with results likely to be observed in a matter of weeks. However, there is a myriad of benefits when the two methods are combined or when applied in sequence. The study thus concluded that to create long-term management arrangements for anxiety disorder associated depression or not should involve plans for acute care, long-term care, and breakthrough or episodic symptoms. However, a combination of therapy using benzodiazepines and antidepressants in relevant clinical settings was found to boost outcomes when compared to monotherapy given to some patients (Dunlop & Davis, 2008). Thus, considering using both drug therapy and CBT intervention may be successful in treating anxiety disorders such as separation anxiety.
While classifying anxiety as a panic disorder, Pull and Damsa (2008) claimed that the effective treatment of anxiety is obtained by combining pharmacotherapy for panic disorder with cognitive therapy (CBT). Some of the effective pharmacological treatment options considered in pharmacotherapy were identified by the researchers to include selective serotonin reuptake inhibitors, several forms of benzodiazepines, tricyclic antidepressants and norepinephrine reuptake inhibitors (Pull & Damsa, 2008). According to this article, drugs or psychotic medications offer a wide range of options to treat psychiatric and non-psychotic disorders. Seemingly, the available treatment options for managing symptoms and treating anxiety disorders are similar in children and adults; however, the dosage and period of treatment varies in children and adults depending on the type of anxiety disorder being treated. In the pharmacotherapy category, benzodiazepines including Xanax are used to treat anxiety either individually or combined with other forms of therapy particularly CBT. For instance, the researchers found in this article that treatment results found regarding CBT compared well with the use of pharmacotherapy but, evidence indicates that CBT is as effective as medications. However, the article further found that combining drug therapy or medication with CBT is a superior to the use of CBT alone or antidepressant pharmacotherapy although only during the acute stage of treatment (Pull & Damsa, 2008). Unfortunately, the study published in this article revealed that long-term studies regarding treatments that combine medication and CBT for anxiety disorders associated with or without agoraphobia yield little benefit as well as in monotherapies.
Ham, Waters & Oliver (2005) also recognized CBT and Xanax drugs as some of the methods for treating anxiety disorders. The article further noted like in the previous resource that agoraphobia has a significant influence on the effectiveness of the method adopted or preferred for treating anxiety. Regardless of the factors considered when selecting the effective method for treating anxiety disorders, drug therapy options include benzodiazepines such as Xanax prescriptions. According to the article, Xanax prescriptions are as effective in reducing anxiety symptoms and occurrence of attacks as the commonly administered antidepressants (Ham, Waters & Oliver, 2005). Xanax prescriptions, as well as other benzodiazepines, are said to offer several benefits in treating anxiety disorders, for example, patients easily tolerate Xanax drugs and that they are associated with a short onset of action. However, the articles also outline the shortcomings of using pharmacotherapy particularly benzodiazepines, for instances, they are likely to cause depression and that they are linked with severe effects during and after therapy is discontinued. With the above shortcomings, CBT comes in as a non-drug therapy alternative with some of CBT activities including panic management, cognitive restructuring and applied relaxation among other activities (Ham, Waters & Oliver, 2005). The article also supported the use of self-administered or therapist-directed CBT in treating anxiety or panic disorder. Although CBT tends to yield good results in managing the effects of anxiety disorders, this article also supported the combination of the two approaches in response to separation disorder instead of using CBT alone (Harris, 2017). Even though research shows that benzodiazepines such as Xanax and CBT are effective independently in treating anxiety, there is no sufficient evidence that rank one method over the other. These methods all have shortcomings when each approach is applied alone (Harris, 2017). Hence, a combination of Xanax prescriptions plus some form of cognitive behavioral approach yields the greatest benefit as revealed in a meta-analysis of short-term studies.
Crits-Christoph, Newman, Rickles, Gallop, Gibbons, Hamilton, Ring-Kurtz, & Pastva (2011) alleged both drug therapy and cognitive behavioral psychotherapy (CBT) had been broadly examined as methods for treating generalized anxiety disorders (GAD). The common CBT options or treatment remedies for anxiety disorders include cognitive restricting as well as applied relaxation. CBT thus offers a significant support to patients in terms of treating and managing the symptoms the anxiety by engaging the patients in education to help the understand the nature of anxiety and enabling them gain the knowledge on how to determine the signs of relapse of anxiety issues (Rector, Bourdeau, Kitchen, & Joseph-Massiah, 2008). However, studies have argued that CBT is not a sufficient and most effective approach to treating anxiety problems both in kids and adults. Specifically, the article presented a study that was carried out to assess the efficiency of combined cognitive behavioral therapy (CBT) and Xanax prescriptions compared to when medications such venlafaxine XR or Xanax is applied alone in treating anxiety disorders (Crits-Chrstoph et al. 2011). Unlike other studies, however, this article gave the opposite expectation by stating that combining the two methods does not offer better results, but medication is considered to be effective.
Nguyen, Mirbaba, Khaleghi & Tsuang (2017) provided a different perspective by linking co-morbid anxiety with disorders associated with alcohol use. In the article, Nguyen and other researchers claimed that anxiety and disorders related to alcohol intake are highly co-morbid and widespread in the United States. However, the study noted the serious challenge of diagnosing and treating co-occurring conditions of anxiety disorders by claiming that research is yet to fully establish the effective ways of diagnosing and treating these conditions. According to this study, there is need to evaluate existing body of evidence about best available treatment options for patients with double diagnosed conditions (Nguyen et al. 2017). In a different study, Bystritsky (2006) point to some anxiety disorders that are resistant both to CBT and medications such as Xanax. Unlike in other studies, in this article Bystritsky reported that whereas anxiety disorders are treatable and respond well to different interventions including medications and therapy options such as CBT, findings indicate that some anxiety disorders are likely to resist treatment. For instance, only 60 percent of patients diagnosed with anxiety disorders respond to CBT and treatment options to any considerable degree (Bystritsky, 2006). The failure to respond to treatments is thus another challenge faced when treating patients diagnosed with diagnosed with anxiety disorders. In this case, a combination of medications and CBT becomes a logical option to responding to various anxiety disorders, particularly anxiety that occurs in children as a result of separation from their parents who are engaged in the immigration proceedings.
Methods
Participants
The study recruited participants through different methods including media advertising, referrals from healthcare practitioners such as primary care doctors, mailings and normal hospital visits by patients. Men and women aged between 19 and 24 were asked to take part in a 3 months study within a community-based facility that was under the management of health care professionals and nursing researchers. For one to be eligible to take part in the study they were required to be aged above 19 and below 24 years; should be a parent and must have taken part in immigration activities.
Instruments
A demographic questionnaire was first utilized in the selection of participants and subsequently applied in classifying eligible subjects into appropriate groups. The specific questions involved in developing the questionnaire were based on critical factors such as socio-economic aspects, age, ethnicity and other factors that influence health status and wellbeing. The categories of scales include the frequency of attacks and fear rating scales with different scores over 3 months (12 months) of therapy with the help of Hamilton Anxiety (HAM-A). Other instruments included therapists involved in examining the participants both in test and control groups.
Procedures
Participants were first selected based on gender and age and classified in one as test subjects and others as a control. The therapists identified and separated test and control groups which were observed for 3 months. The independent variable was identified as Xanax prescription which also represented the test group. Individuals associated with the same levels of separation anxiety were put under observation with Xanax prescription for 3 months while the remaining participants attended a cognitive behavioral therapy for the same period of time and measure. Children separation anxiety was determined using the Child Behavioral Checklist or Youth Self Report.
Intended Analysis
To identify whether light therapy had an effect on children diagnosed with separation anxiety a t-test analysis was conducted. In order to measure the differences between various factors that influence the response rate to treatments, D and t-test were used.
Research Questions
a.) Which method between cognitive behavioral therapy (CBT) and medications such as Xanax (an alprazolam; a drug belonging to the class benzodiazepines) is effective in treating anxiety disorders (separation anxiety)?
b.) How does the combination of CBT and medications such as Xanax differ in treating anxiety disorders as compared to when CBT is used alone?
c.) Do you recommend using a combination of CBT and Xanax prescriptions or using either of the two methods, individually?
Study Objective
The fundamental aim underlying this research is to find out whether it is effective to treat anxiety disorders by combining CBT with medications (Xanax) or to apply CBT alone.
Formal Hypothesis
The study is founded on an assumption that Xanax prescriptions used along with CBT therapy are more effective than CBT alone in treating separation anxiety for children whose parents are in immigration proceedings.
References
Bystritsky, A. (2006). Treat-Resistant Anxiety Disorders. Molecular Psychiatry 11, pp.805-814.
Bystritsky, A., Khalsa, S. S., Cameron, M. E., & Schiffman, J. (2013). Current Diagnosis and Treatment of Anxiety Disorders. Journal of Pharmacy and Therapeutics 38(1), pp.30-38.
Crits-Christoph, P., Newman, M. G., Rickels, K., Gallop, R., Beth, M., Gibbons. C., Hamilton, J., Ring-Kurtz, S., & Pastva, A. M. (2011). Combined Medication and Cognitive Therapy for Generalized Anxiety Disorder. Journal of Anxiety Disorder 25(8), pp.1087-1094.
Dunlop, B. W., & Davis, P. G. Combination Treatment with Benzodiazepines and SSRIs for Comorbid Anxiety and Depression: A Review. Prim Care Companion Journal of Clinical Psychiatry 10(3), pp.222-228.
Ham, P., Waters, D., & Oliver, M. N. (2005). Treatment of Panic Disorder. American Family Physician 71(4), p.733-739.
Harris, M. (2017). Worried Sick. Anxiety Disorders take a Toll on Body and Mind. Retrieved May 31, 2017, from http://www.aama-ntl.org/docs/default-source/other/ma17-cec.pdf?sfvrsn=2
Locke, A. B., Kirst, N., & Shultz, C. G. (2015). Diagnosis and Management of Generalized Anxiety Disorder and Panic Disorder in Adults. American Family Physician 91(9), p.617-624.
Nguyen, A., Miraba, M., Khaleghi, F., & Tsuang, J. (2017). Current Treatment options for Co-Morbid Anxiety and Alcohol use Disorders: A Review. Journal of Addictive Behavior and Therapy 1(1), p.1-9.
Pull, C., & Damsa, C. (2008). Pharmacotherapy of Panic Disorder. Neuropsychiatry Disorder Treatment 4(4), p.779-795.
Rector, N. A., Bourdeau, D., Kitchen, K., & Joseph-Massiah, L. (2008). Anxiety Disorders: An Information Guide. Centre for Addiction and Mental Health. Retrieved May 31, 2017, from https://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/Acute-Stress-Disorder/Documents/anxiety_guide_en.pdf
Appendix A
Demographic Questionnaire