The Comparison of Cognitive Behavior Therapy with Psychopharmacological Intervention for Women with Anxiety Disorders (GAD, SAD & OCD)

doi:10.4236/psych.2012.329127

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Psychology

2012. Vol.3, Special Issue, 84 1-847

Published Online September 2012 in SciRes (http://www.SciRP.org/journal/psych) http://dx.doi.org/10.4236/psych.2012.329127

The Comparison of Cognitive Behavior Therapy with

Psychopharmacological Intervention for Women with Anxiety

Disorders (GAD, SAD & OCD)

Abdollah Alizadeh1*, Gayane Shahverdyan2, Ahm a d Etemadi3

1Yerevan State University, Yerevan, Armenia

2Faculty of Philosophy a nd P sychology, Yerevan St a t e University, Yerevan, Armenia

3Faculty of Psychology Ed u ca ti on Sc ie n ce s, Allameh Tabatabaei University, Tehran, Iran

Email: *[email protected]

Received May 22nd, 2012; revised July 5th, 2012; accepted August 4th, 2012

The first aim of the present research is to determine the effectiveness of Cognitive Behavior Therapy

(CBT) in comparison to psychopharmacological intervention on Iranian women with Anxiety disorders.

The second aim of the research is to find the relationship between the irrational beliefs and maladaptive

thinking with anxiety disorder and the third aim of the research is to investigate which method of treat-

ment causes more satisfaction in the patient. In regard to the research issue, the sample included 300

women with the average age of 18 to 45 who were selected randomly of those patients with anxiety dis-

orders (general anxiety disorder GAD, obsessive compulsive disorder OCD, social anxiety disorder SAD)

who referred to counseling and mental health centers and private offices in Eslamshahr city (Tehran state).

They were divided into 6 groups: 1) The first three groups with one of these three disorders (GAD, OCD

and SAD) referred to Cognitive Behavior Therapy voluntarily; 2) The other three groups with the same

disorders referred to the psychiatrist for the psychopharmacological intervention voluntarily. The psy-

chopharmacological intervention course was at least 6 months and the total period of CBT was 12 to 16

sessions (held every week). The diagnosis interview was performed on the basis of DSM-IV-TR 2000

before the treatment. Then the check-list SCL90-R test was performed after diagnosis by the psychologist

and in the next session the Jones’ irrational beliefs test (IBT) was performed. Research method is of the

quasi-experimental method with pre-test and post-test. Generally, the present study findings verify the

positive effect of the cognitive-behavior therapy on the change of irrational beliefs, maladaptive thinking

and the decrease of symptoms and in the end the research points out that CBT causes more satisfaction

than the other treatment in patients; while the psychopharmacological intervention just decreases the

symptoms of the disorders, less than CBT. At the end of treatments, both of groups answered to the satis-

faction of treatment questioner. It showed that patients were more satisfied with CBT than psychophar-

macological intervention. The result of the research showed that CBT not only decreased the symptoms of

anxiety disorders but also changed the patients’ irrational beliefs, maladaptive thinking and thinking

methods. It should be mentioned that such a phenomenon is accompanied by attaining new social skills

and in the end, the effect of CBT will be more permanent and stable and patients are not caught in a kind

of recovery-relapse cycle.

Keywords: Cognitive Behavior Therapy; Psychopharmacological Intervention; Anxiety Disorders

Introduction

Anxiety disorder is a blanket term covering several different

forms of abnormal and pathological fear and anxiety. Condi-

tions now considered anxiety disorders only came under the

aegis of psychiatry at the end of the 19th century. Gelder, Ma-

you & Geddes (2005) explain that anxiety disorders are classi-

fied in two groups: continuous symptoms and episodic symp-

toms.

Current psychiatric diagnostic criteria recognize a wide vari-

ety of anxiety disorders. Recent surveys have found that as

many as 18% of Americans may be affected by one or more of

them.

The term anxiety covers four aspects of experiences an indi-

vidual may have: mental apprehension, physical tension, physic-

cal symptoms and dissociative anxiety. Anxiety disorder is

divided into generalized anxiety disorder, phobic disorder, and

panic disorder; each has its own characteristics and symptoms

and they require different treatment (Gelder et al., 2005). The

emotions present in anxiety disorders range from simple nerv-

ousness to bouts of terror (Barker, 2003). Anxiety disorders are

among the most common psychiatric disorders, occurring in 5%

- 18% of all children and adults (Costello, 1995). Anxiety dis-

orders are often associated with impairment in academic, social

and personal functioning (Pine, 1997). Significant comorbidity

including depression (Kovacs, 1989), substance abuse (Kushner,

1990) and subsequent adult anxiety, major depression and sui-

cide attempts, highlight the need for effective and readily ac-

cessible treatments. However, the evidence base for treatment

of anxiety in women is relatively limited. The initial trials of

cognitive-behavioral therapy (CBT) (Kendall, 1994; Barrett

*Corresponding author.

A. ALIZADEH ET AL.

1996; Kendall, 1997) were positive (Kendall, 1997). The aim of

CBT is to help the women to identify possible cognitive deficits

and distortions, to reality-test them, and then to teach new skills

or challenge irrational thoughts and beliefs, and replace them

with more rational thinking (Kindal, 1990). More specifically,

CBT is a psyc hol ogic al mod el th at inv olv es he lpin g the women to:

1) recognize anxious feelings and bodily or somatic reactions to

anxiety; 2) clarify thoughts or cognitions in anxiety-provoking

situations (i.e. unrealistic or negative attributions and expec-

tations); 3) develop coping skills (i.e. modifying anxious self-

talk into coping self-talk); and 4) evaluate outcomes. The be-

havioral training strategies include: modeling, reality exposure

(in-vivo exposure), role-playing and relaxation training. The be-

havioral treatment is based upon the premise that fear or anxi-

ety are learnt responses (classically conditioned) that can be

“unlearnt”.

CBT identifies habitual ways in which patients distort in-

formation (e.g., automatic thoughts) and teaches patients to

identify and respond to their dysfunctional thoughts and beliefs,

using a variety of techniques to change thinking, mood, and

behavior.

Research Support, one of the main reasons CBT has become

so popular is because of how much research has demonstrated

its effectiveness. There are a large number of well-constructed

experiments that have shown it to be highly useful in treating

depression and anxiety disorders, including GAD. The key

factors for it to be helpful are buying in to the belief that it will

help, completing relevant assignments and a willingness to con-

front uncomfortable thoughts, although many CBT techniques

can be difficult to do at First, for most people the remission of

GAD is well worth the struggle.

The Aim of Research

The first aim of the present research is to determine the ef-

fectiveness of Cognitive Behavior Therapy (CBT) in compare-

son to psychopharmacological intervention on Iranian women

with Anxiety disorders. The second aim of the research is to

find out the relationship between the irrational beliefs and mal-

adaptive thinking with anxiety disorder and the third aim of the

research is to investigate which method of treatment causes

more satisfaction in the patients.

Object of Res e arc h

The object of research is Iranian women with anxiety disor-

ders, especially GAD, ASD & OCD who referred to mental

health center, and private office to be treated with CBT and the

psychopharmacological intervention. The total number of the

sample is 300 women: 150 women with OCD, GAD and SAD

who received CBT and the other 150 women with OCD, GAD

and SAD who received psychopharmacological intervention.

The individuals’ age range is 18 - 45.

Hypotheses

1) Irrational beliefs and maladaptive thinking have a central

role in developing anxiety disorders; we must change them into

rational beliefs and adaptive thinking or decrease them in order

to treat anxiety disorders in a better way. It is just possible by

using cognitive-behavior therapy (CBT) because it decreases

irrational beliefs more than psychopharmacological intervene-

tions.

2) While the psychopharmacological interventions attend to

the physiological aspects of symptoms of GAD, SAD & OCD,

CBT directs to change maladaptive thinking patterns and teach

social skills and it makes patients more satisfied and ultimately

decreases anxiety disorders symptoms more than psychophar-

macological interventions.

3) As the symptoms of anxiety disorders through CBT de-

crease, the comorbidity depression diminishes too. This fact

proves that there is an inner connection between depression and

anxiety.

Method of Intervention

The psychopharmacological intervention course was at least

6 months and the total period of CBT was 12 to 16 sessions

(held every week).The diagnosis interview was performed on

the basis of DSM-IV-TR 2000 before the treatment. Then the

check-list SCL90-R test was performed after diagnosis by the

psychologist and in the next session the Jones’irrational beliefs

test (IBT) was performed. In the end, the satisfaction of treat-

ment inventory was performed on the sample of the research.

Research Instruments

As it is mentioned, two tests and an inventory were used,

Jones’ irrational beliefs test (IBT) which assessed irrational

beliefs and thoughts and the checklist SCL90-R which used to

assess the patients’ mental health.

The SCL-90 is one of the most used tests in diagnosing psy-

chological problems. It is a self-report questionnaire originally

oriented towards symptomatic behavior of psychiatric outpa-

tients (Derogatis et al., 1973) and it is reviewed on the clinical

experiment of Psychometric analysis and its final form were

provided in 1976. Validity and reliability of both tests have

been approved in the intended society by some researchers

many times.

Treatment Satisfaction Inventory

This is a kind of inventory that has been made by researcher.

It consists of 10 questions with 5 parts that pays attention to

different aspects of both treatments and measures the patients’

attitudes toward them. In the following part, the aspects of

questionnaire are being offered.

1) Feeling of satisfaction of gaining the goals;

2) Feeling of satisfaction of the treatment process;

3) Selectivity of the treatment to disorder;

4) Being active during treatment;

5) Feeling of satisfaction of the factors;

6) The fear of treatment;

7) The patient’s attitude toward the therapist’s devotion of

enough time to his problem;

8) Introducing the treatment to others by the patient;

9) Negative attitude toward the treatment aspects;

10) Fear of social limitations in the future.

Method of the scoring of treatment satisfaction inventory:

This questionnaire consists of ten questions in which each

question has 5 scales based on Likert 5-degree scale, one the

testees (subjects) check off. The total score of it lies in the

range of 10 to 50; in some of questions, low scores suggest the

more satisfaction and the low concern; while in some of them,

high scores show the more satisfaction of the subjects (testes).

842

A. ALIZADEH ET AL.

been represented in the Table 1. For example in the following question, the high score (5) is the

sign of more satisfaction. The outcome results of the comparing of the mean of the de-

pendent variable (irrational beliefs posttest) in the interaction of

the treatment groups with the groups of patients with anxiety

disorders have been presented in the following table (Table 2).

1) Have you achieved what you expected of the treatment as

we are getting to the end of its course now?

Completely (5) Very much (4) partly (3) No (2) Not at all (1) The first row of the above table shows that as a result of the

appropriate matching of treatment groups, the pretest of the

irrational beliefs in the two treatment groups of each disorder is

the same and with 95% confidence there is no significant dif-

ference between the pretests, that is expectable (F(1293) = .22, P

> 0/05). The second row of the Table 2 shows that there is no

significant difference between the posttest scores of three

groups of patients with anxiety disorder after the adjustment of

the pretest effect, and with 95% confidence the adjusted post-

tests of the irrational beliefs in three groups of 150 patients is

the same F(1293) = .33, P > .05). In contrast, the third row shows

that generally there is a significant difference between the mean

of the posttest scores of two groups of treatments (each group

of 150 patients) and with 99 % confidence the mean of the

posttest scores of the irrational beliefs in the psychopharma-

cological group is greater than the CBT (F(1293) = 1411.28, P <

0/01).

The Scientific Innovation

1) It is the first time tha t the combi nat ion of CBT & RE BT is

used in the treatment of anxiety disorders (SAD, GAD & OCD)

in comparison to psychopharmacological intervention in Iranian

society.

2) Providing a comprehensive and complete treatment pat-

tern with eight dimensions (Figure 1) that could be used by the

other therapists and cause a kind of confidence in patients and

professionals that a complete treatment has been done and pos-

sibility of relapse will reach to the least level.

3) Offering a satisfaction questionnaire of treatment and

measuring the amount of patients ‘satisfaction, confidence and

interest to the treatment method.

4) The superiority of CBT over psychopharmacological in-

tervention in decreasing both the irrational beliefs and symp-

toms of anxiety disorders. In response to the first hypothesis, the forth row of the Table

2 shows that there is a significant difference (.05) between the

mean of the adjusted posttests in the interaction of the treatment

groups with anxiety disorders. Regarding the adjusted means in

Table 1, the amount of means of three groups of anxiety disor-

5) The illustration of the inner relationship of anxiety disor-

ders and depression, in this way that by decreasing the anxiety

symptoms, the comorbidity depression diminishes.

Result

Table 1.

The data analysis method, in order to answer the questions of

research and conclude, the SPSS program has been used for

analysis in the two following discusses;

The adjusted mea ns of the irrational beliefs posttest.

CBT Psychopharmacological intervention

Anxiety

disorders Mean SD Mean SD

GAD 202.2 3.93 327.9 3.93

SAD 208.6 3.94 333.3 3.94

OCD 208.8 3.93 337.7 3.93

1) Descriptive statistics (mean-standard deviation);

2) Inferential statistics Analysis of Co-Variance (ANCOVA).

The investigation of hypotheses

Before the presentation of the results of covariance analysis,

the adjusted means of the treatment groups and disorders have

Chan ging of

irrational

beliefs

Attaining

dispu te ski lls

with

irrationals

belief

Decreasing

of symptoms

Replacing

maladaptive

thoughts wi th

adaptive

thoughts

Identifying

cognitive

distortions

Increasing

Self-efficacy

Confronti n g wi th

fearful situations

inste ad of esc a pe

and avoidance

Avoidance

Research

Identifying the

difference

betwe en beh a v ior

and feelings

Figure 1.

A comprehensive and complete treatment pattern with eight dimensions.

Table 2.

The results of covariance analysis for the posttest of the irrational beliefs after the adjustment of the pretest effect.

Source of changes df SS MS Statistic (f) Sig Effect size Eta2

The irratio nal beliefs pretest 1 171.26 171.26 .22 .64 .001

Anxiety disorders 2 508.87 254.44 .33 .72 .002

Treatment groups 1 1087881.12 1087881.12 1411.28 .00 .83

Anxiety disorders treatment grou p s 2 6299. 84 3149.92 4.09 .02 .03

Error 293 225866.39 770.87

Total 300 2. 364 × 107

A. ALIZADEH ET AL.

ders (each group of 50 patients) that participated in CBT is

lower than the amount of means of the other three groups (each

group of 50 patients) which participated in psychopharma-

cological intervention. This shows that the CBT is more effect-

tive than psychopharmacological intervention in decreasing the

irrational beliefs of the patients with anxiety disorders, as the

observed statistics of crucial measure in 0.05 level with degree

of freedom = 1293 is greater (F(1293) = 4.09, P < 0/05). In the

following Figure 2 the adjusted means for three groups of

anxiety disorder and for two methods of treatment have been

illustrated.

The outcome results of the comparison of the mean values of

the dependent variable (disorder symptoms posttest) in the in-

teraction of treatment groups with the groups of patients with

anxiety disorders have been presented in the following table

(Table 3).

The first row of the table represents that as the result of the

appropriate matching of the treatment groups, the pretest of the

disorder symptoms in two treatment groups is the same and

with 95% confidence there is no significant difference between

the pretests which is expectable (F(1293) = 3.73, P > 0/05). Ac-

cording to the second row of the Table 3, it is observable that

there is no significant difference between the posttest scores of

the three groups of patients with anxie ty disorder after adjus t ing

the pretest effect and with 95% confidence the adjusted post-

tests of the disorder symptoms in three groups of 100 anxiety

patients is the same (F(1293) = .81, P > 0/05). In Contrast, it is

observable through the third row of the table that there is a

significant difference between the mean of posttest of two

groups of treatment (each group of 150 patients) and with 99 %

confidence the mean of adjusted posttest scores of disorder

symptoms in psychopharmacological group is greater than that

of CBT (F(1293) = 384.62, P < 0/01) In response to the second

hypothesis, the forth row of the Table 3 shows the significant

difference in level 0.01 between the adjusted means of the

posttests in the treatment groups’ interaction with anxiety dis-

orders. With regard to the adjusted means of the Table 3, it is

observable that the means of the disorder symptoms in three

groups (each group = 50 patients) of anxiety disorders that par-

ticipated in CBT is lower than the means of three other groups

Figure 2.

The adjusted means for three group s o f an xi et y disorder and for two methods.

Table 3.

The results of the covariance analysis for posttest of the disorder symptoms after the adjustment of the pretest effects.

Effect size Eta2 Sig Statistic (F) MS SS df Source of changes

.02 .06 3.73 265.01 2 65.01 1 The symptom of disorders pret est

.01 .45 .81 31.86 63.73 2 Anxiety disorders

.57 .00 384.62 15151.16 15151.16 1 Treatment groups

.07 .00 11.52 454 907.99 2 Anxiety disorders treatment groups

39.39 11541.96 293 Error

265.01 2800027.85 300 Total

844

A. ALIZADEH ET AL.

(each group = 50 patients) that participated in the psychophar-

macological intervention. This position represents that the CBT

is more effective in the treatment of anxiety disorders than the

psychopharmacological intervention. Thus with the 99 % con-

fidence, the observed statistics is greater than the crucial value

with 1 and 293 degree of freedom (F(1293) = 11.52, P < 0/01). In

the following diagram (Figure 3) the adjusted means of the

disorder symptoms for three groups of anxiety disorder and two

groups of treatment has been shown.

The results of the covariance analysis and adjusted means in

Table 4, represents that CBT decreases all of the subscales of

the symptoms of the disorders in patients with anxiety disorder

more than the psychopharmacological intervention. But de-

crease of depression symptom is the aim of the hypothesis (3).

The result of the investigation shows that the mean of the cog-

nitive-behavior therapy (.84) in 0.01 level is lower than the

Figure 3.

The adjusted means of disorder symptoms for two groups of treatment and for three groups of p a ti e n ts wi t h a n x ie t y disorder.

Table 4.

The adjusted mean, standar d d e viation and the result of cova riance analysis of subscales a nd indexes of disorder for anxiety disorders.

Psychopharmacological Intervention CBT

Effect of Size Statistic SD M SD M SCL 90-R, Subscales

Eta2 (97 & 1) F

.22 **

8.85 .02 .85 .02 .64 Somatization

.05 **

16.71 .02 1.12 .02 .98 Obsessive (compulsive questions)*

.09 **

28.83 .02 1.21 .02 1.07 Interpersonal sensitivity

.05 **

13.22 .02 .95 .02 .84 Depression

.23 **

87.26 .02 1.21 .02 .93 Anxiety

.17 **

61.66 .03 1.69 .03 1.35 Hostility/aggression

.02 *

6.44 .02 1.4 .02 1.31 Phobic

.20 **

76.32 .03 1.67 .03 1.36 Paranoid ideation

.11 **

36.07 .01 .97 .01 .84 Psychoticism

.00 .71 .02 1.09 .02 1.06 Additional Questions

.55 **

360.13 .53 103.3 .53 88.87 GSI

.00 .30 .22 68.16 .22 67.99 PST

.40 197.53** .01 1.52 .01 1.30 PSDI

A. ALIZADEH ET AL.

mean of the psychopharmacological intervention so that the

observed statistics (5.68) is greater than the crucial value F(1297)

= 5.68, P < 0/05). Therefore, with 99% confidence the symp-

toms of comorbidity depression in patients with anxiety disor-

ders with CBT decrease.

With regard to the adjusted means of Table 4, it is obvious

that the means of the all subscales especially the anxiety symp-

toms, paranoid thoughts and depression in the posttest of the

cognitive-behavior therapy is significantly lower than those of

the psychopharmacological Intervention and the researcher’s

hypothesis areaccepted. According to the obtained results, the

researcher’s three hypotheses are approved.

Discussion

As the Tables 1 and 2 and the Figure 2 show, CBT de-

creases the irrational beliefs and has a significant effect on them,

but the psychopharmacological intervention hasn’t had any

effects on decreasing the irrational beliefs. What is the impor-

tance of the dec rease of the irrat ional beliefs in anxious patients?

To answer this question, we refer to Albert Ellis’ point of view.

Albert Ellis states that anxiety and emotional disorders are

caused by the irrational beliefs and illogical thinking. In his

opinion, emotions and thoughts are not different and separate

reactions. It could be mentioned in this way that as far as the

irrational beliefs exist, the emotional disorders remain as usual.

Individuals continue up the disorders and irrational behavior by

retelling them to themselves. In Ellis’ point of view, when an

individual becomes captive of irrational thoughts, probably he

puts himself in kind of feeling like anger, resistance, defense,

guilty, anxiety, numbness, fatigue, lack of control and help-

lessness. All the people’s emotional problems are caused by

their magical and superstitious thinking that are not experimen-

tally valid.

When an individual’s mental structure usually becomes full

of the irrational beliefs, his emotions also are effected by those

beliefs and finally the individual’s behaviors become irrational,

too. Therefore, the first step is to reform our beliefs so that our

emotions don’t become effected by them. Awareness of the

beliefs, dominance on emotions, controlling and managing

them in different situations could immunize us against the irra-

tional beliefs. The other appropriate way to overcome these

beliefs and prevent life conflicts and quarrels is to replace the

irrational beliefs with the rational beliefs (Albert, 1992). In this

research, CBT was used to help the patients to change their

thinking method through dispute methods which are common

in CBT and REBT (Socrates method, asking and changing their

self-talk and etc.). In this way, they can challenge their mal-

adaptive thinking methods and the irrational beliefs. In this part,

other researchers’ findings related to this research have been

mentioned to confirm the findings. One research has been done

in psychiatric institute in Iran (Mehryar et al., 2000) and its

issue was “comparing the effectiveness of the CBT and the

psychopharmacological intervention in treating the generalized

anxiety disorder”. The research findings showed that the CBT

is effective in decreasing anxiety, thoughts and unhealthy atti-

tudes and improving the patients’ interpersonal relationship.

But the psychopharmacological intervention (Benzodiazepines

and tricycle anti-depression) has just been effective in decreas-

ing anxiety level. This survey showed that the interpersonal

relationships and cognition distortions in patients who received

CBT improved more than the other group which received drugs.

The other research has been done on the students of Allameh

University in Iran which was supposed to investigate the rela-

tionship between their irrational beliefs and mental health. The

used instruments in this research were SCL90-R, IBT. The

result showed that there is a relationship between the irrational

beliefs and mental health and we can anticipate students’ men-

tal health through their irrational beliefs (Houshang, Peyman, &

Sepideh, 2002).

The other research investigated the relationship between

maladaptive thinking and the suicidal ideation in wives with

injured feelings and found that there is a significant relationship

between them. This finding is in accordance with the result of

the findings of Lester and Golding’s research (Keslo et al.,

1989, 1998).

Another research which was conducted in this field surveyed

the high rate of the irrational beliefs in patients who attempted

suicide through self-burning in Tehran and it found that these

women’s irrational beliefs were higher than the normal people

(Kamal, 2000)

Tables 3 and 5 and Figure 3, represent that the symptoms of

disorders which were measured by SCL-90 R, have decreased

in CBT more than the other group which was treated by the

psychopharmacological intervention. This research and previ-

ous researchers’ findings confirm that the decrease of the symp-

toms of disorder will not be permanent and resistant and the

possibility of relapse goes up in those who just get the psy-

chopharmacological intervention. Therefore, the patients get in-

to some kind of relapse and recovery circle and after some time

patients develop a kind of helplessness that in Martin Seligman’

opinion is the cause of depression (learned helplessness).

The present research findings showed that CBT causes more

changes in patients’ psychological aspects and attitude in com-

parison to the psychopharmacological intervention.

The gained changes as the result of CBT in patients remained

more resistant after the intervention in all aspects of treatment

satisfaction. These findings are in accordance with other re-

searches’ findings with the same issue. Kat and his colleagues

showed that drug therapy for high blood pressure is not just

sufficient to improve the patients’ life quality and the use of

psychological approaches is necessary. The reason to such

claim is that most patients with major hypertension don’t have

the clear illness symptoms and long-term and even life-long

taking of anti-hypertensive drugs such as Atenolol, Cilazapril,

Verapamil and Propranolol in a long time makes the patients’

attitude to them negative. Therefore, drug therapy just has a

positive effect on decreasing hypertension and could not change

patients’ negative attitude to their own illness and take its ill

role; but CBT could have a positive effect on improving the

patients’ life quality along the drug therapy. One of the things

that predict the success of the treatment and decrease the sever-

ity and negative effects of the illness is to implement the thera-

peutic recommendations and it could be only achieved through

CBT.

Table 5.

The adjusted means of posttest scores for disorder symptoms.

CBT Psychopharmacological in.

Anxiety disordersMean SD Mean SD

GAD 89.83 .89 103.1 .92

SAD 89.97 .89 100.9 .89

OCD 86.81 .90 106.02 .89

846

A. ALIZADEH ET AL.

Conclusion

The result of this research emphasizes on the importance of

the role of irrational beliefs and maladaptive thinking in indi-

viduals’ development to anxiety disorders. It points out that

disputing the irrational beliefs, maladaptive thinking and cogni-

tive distortion by CBT and REBT which the patients learn dur-

ing the treatment can be changed into an individual skill, and

individuals by using this skill can confront the provoking-

anxiety situations easily.

A complete and comprehensive treatment is one that beyond

decreasing the symptoms of the disorder includes the men-

tioned eight elements of the research model. Except this, it is

possible that a patient gets into a recovery and relapse process.

As the results of the researches show, the effect of psy-

chopharmacological intervention is not as stable as the effect of

CBT. Most of the patients who are treated just by drugs become

involved in relapse again; at last this issue possibly leads the

patients to a learned helplessness.

Depression is usually accompanied by anxiety disorders, and

vice versa. The three studied disorders in this research are

highly accompanied by depression, and anxiety and depression

have an inter relationship. It could be said that there is a rela-

tionship between these disorders. According to Dr. Johan Ros-

qvist, if anxiety disorders are not treated, they finally could lead

into depression disorders. In other words, the ultimate outcome

of anxiety is depression.

Considering this point that the irrational beliefs and mal-

adaptive thinking are the main cores of anxiety disorders, it is

necessary to teach people how to confront with these kinds of

attitudes in a comprehensive way. It is a kind of prevention that

is not only effective but also economical.

Briefly, the research findings point out that through training,

individuals can prevent the development of anxiety disorders

and depression that generally originate from the irrational be-

liefs and maladaptive thinking. It is also possible in other places

such as schools, colleges, etc.

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