Counselling Haverhill

Counselling for Anxiety

Ruby Wax presents BACP award to Dr Tony Weston

If you are reading this perhaps it is because you are (or someone you know is) having problems with anxiety.

Anxiety problems take many forms, for example generalised anxiety, panic, post-traumatic stress, obsessive-compulsive problems or phobia(s). People suffering with anxiety often suffer with depression at the same time. It can be a heavy burden to carry, causing a lot of suffering.

Anxiety and depression problems can be helped by counselling and psychotherapy.

Dr Tony Weston's BACP award winning research showed how clients improved through counselling in terms of their anxiety, depresion and general distress caused by a number of problems such as abuse, addiction, anger, bereavement and relationship difficulties. Dr Weston's private practice is located 11.5 miles south of Addenbrookes NHS Hospital, just off the A1307 (and on the 13 bus route) in the South Cambridgeshire village of Horseheath. He enjoys working with individuals, couples and family groups (e.g. parent and child).

Contact him now on 01223-894896 (phone is answered by a receptionist 24/7) or email him at tony.weston5@btinternet.com to make an initial appointment.

The rest of this page gives you some more information about anxiety problems and Dr Tony Weston's research. Dr Weston was pleased to accept the British Association for Counselling and Psychotherapy (BACP) 2011 award for Outstanding Research Project from Ruby Wax. This was for his research on effective therapy for depression, anxiety and distress e.g. following bereavement, relationship problems, addiction, abuse etc. Participants included 321 clients - including 137 of Dr Weston's own clients - and 27 fellow therapists.

'Anxiety' is a broad term covering several conditions, including¹:

1. Generalised Anxiety Disorder (persistent and excessive worry).

2. Panic Disorder, including panic attacks (sudden onset of intense feelings of terror, together with fear of dying, losing control, having a heart attack or stroke, 'going crazy' or experiencing huge embarrasment).

3. Post-Traumatic Stress Disorder (PTSD, re-experiencing a traumatic event and reminders of the event are avoided and or lead to upset).

4. Acute Stress Disorder (symptoms similar to PTSD immediately following a traumatic event).

5. Obsessive-Compulsive Disorder (OCD, obsessions which cause distress and or compulsions which are attempts to reduce the distress).

6. Phobias e.g. Agoraphobia (fear of places or situations from which escape might be difficult or embarrasing), Social Phobia (fear of exposure to certain types of social or performance situations) and objects or situations that cause fear (which others might see as unreasonable or excessive) such as Animals (dogs, cats, snakes, spiders etc.), Environments (heights, water, storms, etc.), Blood-infection-injury (seeing blood, injury, injection or other invasive medical procedure), Situations (public transport, tunnels, bridges, lifts, flying, driving, enclosed places, etc.) and Other Phobias (fear of choking, vomitting, contracting an illness, etc.).

NOTE: The information provided on this website is for general information only and not intended as a substitute for diagnosis or treatment; if you are concerned about your health please contact an appropriate practitioner.

Clients presenting with 'anxiety' may complain of one or more of the conditions identified above. Research suggests varying rates of prevalence of anxiety disorders, including¹:

1. Generalised Anxiety Disorder; 5% of people will meet the diagnostic criteria during their lifetime and during any one year 3% of people will meet the diagnostic criteria.

2. Panic Disorder, with or without agoraphobia; 1-3.5% of people during their lifetime and during any one year 0.5-1.5% of people.

3. Post-Traumatic Stress Disorder; 8% of people during their lifetime and amongst 'at risk' groups this can be 33-50+% of people e.g. survivors of rape, military combat and captivity, and ethnically or politically motivated internment and genocide.

4. Acute Stress Disorder; 14-33% of people exposed to severe trauma e.g. car accident, witnessing a shooting, etc.

5. Obsessive-Compulsive Disorder; 2.5% of people during their lifetime and 0.5-2.1% of people now.

6. Social Phobia; 3-13% of people during their lifetime.

7. Other Specific Phobias; 7.2-11.3% of people during their lifetime and 4-8.8% of people now.

This page shows outcomes for clients presenting at this counselling service with symptoms of anxiety measured using the Beck Anxiety Inventory, (BAI²). The BAI measures symptoms associated with anxiety disorders, particularly panic and generalised anxiety disorders. At the time of writing there were 62 clients who had started with some level of clinical anxiety and who had a subsequent measurement of their anxiety. NOTE: Some clients were still in progress at the time of their subsequent measurement.

The average start score was 20.8 (SD 9.5), equivalent to a moderate/severe level of anxiety, and the average subsequent score was 7.5 (SD 6.7), equivalent to being not clinically anxious/mildy anxious. These average scores are illustrated in the graph below:

Using the methodology described by Elliott, Greenberg and Lietaer (2004) these average outcomes compare well with the published literature for anxiety outcomes in clinical trials and practice-based studies. The average number of sessions was 7.5 (range 2-30 sessions). At the start of counselling 15 clients (24.2% of the 62 clients) were taking some type of medication prescribed by their doctor for the difficulties they were experiencing (fourteen were taking anti-depressants and one was taking an anti-anxiety medication). At the end of counselling 5 clients (8.1%) were still taking or phasing out anti-depressants. The average observed improvements were not simply due to clients taking concurrent medication.

In addition to looking at average outcomes it is good practice to look also at the proportions of clients achieving 'reliable change' (Jacobson and Truax 1991). All psychological questionnaires suffer with measurement error. In this research changes greater than 9.1 BAI units were found to be 'reliable' at better than 95% confidence, i.e. improvements in individual client anxiety scores of more than 9.1 BAI units are improvements we can rely upon, rather than just being artifacts of the questionnaire used. The following graph shows changes in anxiety scores for all 62 clients:

The bottom axis shows the anxiety score for each client at their first session. The upright axis shows the anxiety score for each client at their subsequent session. For example, at the extreme bottom right of the graph a client started with a BAI score of 42 (severe anxiety) and at a subsequent measurement their score had reduced to 3 (not anxious).

The diagonal line going up at an angle of 45º from left to right is the line of no change. The dotted tramlines either side of this diagonal are the boundaries of reliable change at 95% confidence. The circles representing clients on this graph within these tramlines have not changed sufficiently to be changes we can rely upon, i.e. their changes are within the measurement error of the questionnaire.

'Even under the best circumstances, such as in carefully crafted and controlled clinical trials research, roughly 10% of patients show negative outcome (deterioration), while another 25 to 40% will fail to improve and show no reliable change' (Lambert, Hansen and Harmon 2010, page 149). By extension 50-65% of clients in a typical clinical trial achieve reliable improvement.

The graph above shows that for these 62 clients, one had reliably deteriorated (1.6%, compared with 10% in an average clinical trial), 20 have no reliable change (32.3%, compared with 25-40% in an average clinical trial) and 41 (66.1%, compared with 50-65% in an average clinical trial) have reliably improved.

A further factor which makes these results particularly striking is that clinical trials typically exclude clients who have more than one presenting problem e.g. in this case they might include clients who only have anxiety. This practice-based research includes clients who are usually excluded from clinical trials on the grounds that they may be suicidal, and/or suffering with depression, and/or have a so-called 'personality disorder' and/or may have problems with drink or drugs, in addition to their anxiety.

The lowest line going across the graph is the boundary between 'anxious' and 'not anxious' at the subsequent measurement. Of the 62 clients who started with clinical depression, 31 (50.0%) have a subsequent measurement score that is both below the cut-off for 'anxiety', indicating they no longer meet the criteria for anxiety, and outside of the tramlines, so these improvements are 'reliable' - so called 'reliable and clinically significant improvement' (RCSI, Jacobson and Truax 1991).

One reason why clients do not always achieve reliable and clinically significant improvement in therapy, but by no means not the only reason, is if clients do not have enough sessions to make the changes they say they want to make.

Outcomes for clients presenting with symptoms of severe anxiety are shown in the following graph:

Trauma:

This research suggests improvement in anxiety is often possible with only a relatively small number of counselling sessions, even if there are other co-occuring symptoms.

References:

1. American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition, Text Revision). Washington DC: Author.

2. Beck, A T and Steer, R A (1993) 'Beck Anxiety Inventory Manual'. San Antonio: The Psychological Corporation.

3. Elliott, R, Greenberg, L S and Lietaer, G (2004) 'Research on Experiential Therapies'. In M J Lambert (2004) 'Bergin and Garfield's Handbook of Psychotherapy and Behaviour Change' 5th Edition New York: John Wiley & Sons.

4. Jacobson, N S, and Truax, P, (1991) 'Clinical significance: A statistical approach to defining meaningful change in psychotherapy research'. Journal of Consulting and Clinical Psychology, 59(1), 12-19.

5. Lambert, M J, Hansen, N B, and Harmon, S C, (2010) 'Outcome Questionnaire System (The OQ System): Development and practical applications in healthcare settings'. In M Barkham, G E Hardy and J Mellor-Clark (2010) 'Developing and delivering practice-based evidence: A guide for the psychological therapies' Chichester: John Wiley & Sons.