Texas Medical Center

Combination Therapy Works Best to Overcome Anxiety, Phobias

SPIDER-MAN—Peter Norton, Ph.D., above, director of the University of Houston’s Anxiety Disorder Clinic, says phobias like fear of spiders often co-exist with other anxiety disorders. (Photo by Thomas Campbell)


By Melissa Carroll  |  University of Houston

Whether it’s a phobia like a fear of spiders or another anxiety-based disorder, new research shows patients improve the most when they’re treated simultaneously with two techniques.

Peter Norton, Ph.D., associate professor of clinical psychology and director of the Anxiety Disorder Clinic at the University of Houston, spent 10 years conducting four clinical trials funded by the National Institutes of Health, and concludes that cognitive-behavioral therapy – a type of treatment with a specific time frame and goals – helps patients understand the thoughts and feelings that lead to their anxiety better than any other technique. In standard cognitive behavioral therapy, patients no longer avoid but instead confront the source of their anxiety, thereby learning to overcome it.

But Norton found that results are even better when cognitive behavioral therapy is combined with a transdiagnostic approach – a treatment that addresses multiple co-existing anxiety disorders, as opposed to just one.

“A large number of patients have more than one anxiety disorder, and the treatment of only one anxiety disorder does not necessarily lead to the resolution of others,” Norton said. “A transdiagnostic approach uses a treatment that applies one set of principles across all types of anxiety disorders,” he explained.

In Norton’s studies, patients receiving transdiagnostic treatment in conjunction with cognitive behavioral therapy showed considerable improvement, especially when they were being treated for a disease or condition that co-exists with a primary disease, like depression.

The combination treatment was more effective than cognitive behavioral therapy combined with other types of anxiety disorder treatments, like relaxation training.
“When we use a transdiagnostic approach, we see a much bigger impact on co-existing diagnoses,” said Norton.

In Norton’s studies, people with more than one disorder experienced a greater than two-thirds reduction in their secondary diagnosis when treated with transdiagnostic therapy, compared to only 40 percent of patients who showed that sort of remission in their secondary diagnosis without transdiagnosic therapy.

“The transdiagnostic treatment approach is more efficient in treating the whole person rather than just treating one diagnosis at a time,” he said.

Norton defines anxiety disorders as when anxiety and fear are overwhelming enough to negatively impact a person’s day-to-day life. Anxiety disorders include panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, social anxiety disorder, specific phobias and generalized anxiety disorder. Often anxiety disorders occur with a secondary illness, such as depression, substance or alcohol abuse.

Norton says his studies’ findings will guide further development and interventions for how clinical psychologists, therapists and social workers treat people with anxiety disorders.