While trying better to
understand someone else
in my family, the
expert advice I got was that anxiety is nearly always genetic, that is, nature and not nurture. And the expert claimed that it is known that psychotherapy, e.g., as suggested in the OP, doesn't work for anxiety or some of its other symptoms, obsessive-compulsive disorder, social phobia, paranoia, hysteria, psychopathic-passive.
For more, there is
David V. Sheehan, M.D.,
The Anxiety Disease.
where he argues that, even
after controlling on various
obvious candidate variables,
anxiety disease is four times
more common in human females than
human males. He conjectures that
the difference is so great that
at some time the disease must
have had some reproductive
advantage.
Or, some people come from just
horrible backgrounds and still
do not suffer from anxiety
disease, while other people
come from apparently ideal
backgrounds and do suffer.
Of course, a child gets from
their parents both nature and
nurture, so we have to suspect
that can be difficult to
separate the two.
Still, IMHO, on this
quite serious subject, the OP is a bit
too simplistic.
> And the expert claimed that it is known that psychotherapy, e.g., as suggested in the OP, doesn't work for anxiety or some of its other symptoms, obsessive-compulsive disorder, social phobia, paranoia,
That's an interesting bit of advice. English NICE recommends psychotherapy for front line treatment of anxiety. https://www.nice.org.uk/guidance/qs53
My info was first hand from the Chief of Psychiatry, Westchester County Hospital, NY, USA. He seemed darned serious, bright, well informed, enormously experienced, and competent.
The interesting thing IMO is that CBT is actually about totally ignoring the "underlying reasons" of your problem, and instead it's about literally hacking your mind to deal with the symptoms. Drugs are a hardware solution, CBT is a software solution, and all that searching for problems in your life is mostly attempts at patching up datasets provided by third parties.
Sort of... it's learning to recognize when your brain starts looping and giving you the skills to be able to hit ctrl + c, while at the same time teaching you how to not write loops in the first place.
GAD and PTSD and all that spectrum are coping mechanisms, they're just maladaptive. CBT teaches you how to cope productively.
(personal opinion incoming), I think a person can get to the point where they need an SSRI as a stepping stone to even have the energy/capability to benefit from CBT, then they learn adaptive behavior, then they can dump the SSRI and let their new skills handle day-to-day life.
The "underlying reasons" are only useful inasmuch as you know what to look for so you can proactively start coping/remove yourself from maladaptive situations, but IMO most people try way too hard with the "why" stuff. The only thing that matters is "what now?"
I share your personal opinion. I'm actually in the process of that, and I can attest from my experience that it would not be possible for me to benefit from CBT without first getting an SSRI therapy - I was stuck so deep in anxiety loops that even the keyboard interrupt handler was starved for resources. SSRIs reduced my problems to something I'm struggling with - before drugs I was unable to function as a productive member of society at all.
(Ironically, some of my present problems are indeed caused by life conditions - exactly the conditions I inflicted upon myself during the period before I started taking drugs.)
I followed your link to that paper -- sure, CBT, once unwind the acronym, sounds fine. That's what I thought would work on the patient in my family (by marriage, not by birth). But CBT didn't work. Not even a little, not a chance.
And the patient was just awash in cognitive ability -- brilliant, actually. Or, maybe the brilliance caused seeing more threats and, thus, more anxiety.
The usual suspects, say, SSRIs, etc. didn't work, either. The result was, right, the worst possible, and of course there are hints that SSRIs can contribute to that result.
Much of the problem was social phobia, e.g., as in the link. Well, it was strongly in common to the mother and all three daughters. So, nature or nurture? If just nurture, maybe CBT, etc. should have worked. But, gotta tell you, at least on the social phobia part, nothing made a dent. All three of the daughters had at least talk therapy, and, no help at all. None.
If CBT can work, as in the link, fine, no, terrific. But, for anyone facing the problems mentioned in the link, need to keep in mind that for a specific case the averages don't have to matter and have to entertain that maybe CBT won't work.
Just why the Chief was so down on talk therapy, or CBT if that is close enough, I don't know. But, we're talking 20+ years ago.
It can be serious stuff, and darned tough to deal with.
Or, the Chief's summary remark went: "Get the patient all calmed down, stable, happy, and then suddenly there will some little event, say, a new file folder of work, and the patient will be all stressed out again."
Or, in my intuition, provide something like a padded cell life for the patient, and things could look fine. But, try to have the patient address the real world, and just some random, new event, say, where there might be some risk that they would have to think through and handle, and they could get all "stressed out" again -- sleepless nights, GI problems, tears, depression, clinical depression, etc.
I'm no expert, but, again, overall IMHO the OP is a bit simplistic.
I'm sorry to hear that story. I hope this doesn't come off cruel because it isn't meant to be, but there are always outliers -- people for whom the gold standard, or any standard, just doesn't work. It's not a good idea to dismiss a well-studied treatment universally shown to be effective because we don't know if it'll work in a specific case. It's important not to anchor a patient -- already living on the edge -- with thoughts that 'maybe this isn't going to work for me'. On average, most people are average.
What we do know is that CBT is exceptionally good at handling most cases. No single treatment (for any disorder) works equally well/at all for all patients, but of course medicine is concerned with helping the largest population efficiently.
I hope one day we understand the brain better, to the point that people like your relative don't have to suffer anymore.
> I'm sorry to hear that story. I hope this doesn't come off cruel because it isn't meant to be, but there are always outliers -- people for whom the gold standard, or any standard, just doesn't work.
I urge caution. The Chief 20+ years ago was darned well informed. Talk therapy and anxiety disease had been going for most of the 20th century. I don't know when cognitive approaches started, but, since they are an obvious approach, gotta guess that they have been understood for a long time.
> It's not a good idea to dismiss a well-studied treatment universally shown to be effective because we don't know if it'll work in a specific case.
Right, "dismiss" would be wrong. Trying it as a first step, if only since it's relatively easy and just a mild intervention, sure.
If you and the NLM, etc. link are correct, then it's news in the last 20 or so years.
From the Sheehan data, the Chief, and some more evidence, I have to guess that often, not just for an outlier, genetics can be an important cause. Sure, even then, maybe something cognitive can help one compensate.
My main point here is simple -- IMHO, the OP looks too simplistic.
It isn't, necessarily, the best solution for everyone anyway.
CBT is based on challenging negative thoughts, assuming that those thoughts are manufactured or, at least, grossly exaggerated. That kinda puts you in a corner if those thoughts are factual.
ACT (Acceptance and Commitment Therapy) has more recent science behind it and gives you strategies on how to minimize the effect of unhelpful thoughts, factual or not.
Short term CBT style (which is recommended first line treatment) and long form therapies such as psychdynamic counselling. These long form talking therapies tend not to be useful for anxiety.
For more, there is
David V. Sheehan, M.D., The Anxiety Disease.
where he argues that, even after controlling on various obvious candidate variables, anxiety disease is four times more common in human females than human males. He conjectures that the difference is so great that at some time the disease must have had some reproductive advantage.
Or, some people come from just horrible backgrounds and still do not suffer from anxiety disease, while other people come from apparently ideal backgrounds and do suffer.
Of course, a child gets from their parents both nature and nurture, so we have to suspect that can be difficult to separate the two.
Still, IMHO, on this quite serious subject, the OP is a bit too simplistic.