A Comparative Analysis: CBT and Psychodynamic Therapy for Anxiety

This essay provides a comparative analysis of Cognitive Behavioral Therapy (CBT) and psychodynamic therapy as treatments for anxiety disorders. The introduction highlights the nature of anxiety and the need for psychological interventions. The main body delves into the core concepts, goals, and roles of therapists and patients in both CBT and psychodynamic approaches. CBT emphasizes practical, skill-based solutions and modification of negative thought patterns, while psychodynamic therapy focuses on uncovering unconscious content and understanding the past to address present anxieties. The essay discusses the working mechanisms of both approaches, considering individual differences and presenting research findings, including a study comparing short-term psychodynamic therapy and CBT for generalized anxiety disorder. The conclusion summarizes the key differences and similarities, emphasizing the effectiveness of both therapies while highlighting the structured, time-limited nature of CBT versus the longer-term, insight-oriented approach of psychodynamic therapy.

Compare and contrast two psychological
approaches CBT psychodynamic person centred
as treatments for anxiety Use research evidence
to support your argument

Table of Contents
INTRODUCTION...........................................................................................................................3
MAIN BODY..................................................................................................................................3
CONCLUSION................................................................................................................................9
REFERENCES..............................................................................................................................11

INTRODUCTION
This study will discuss about psychological approaches through which anxiety can be
treated. Anxiety is concerned with response of body to stress and this is a feeling in which
individuals feel fear or apprehension about what is going to happen. Anxiety sometimes might
require clinical assistance and in this there are different psychological approaches through which
anxiety can be treated. In this report cognitive behavioural therapy and psychodynamic therapy
for treatment of anxiety will be compared. Cognitive behaviour therapy is a type of
psychotherapeutic treatment which is done to help people learn how they can identify and change
destructive thought patterns that negatively influence behaviour and emotion of individuals.
Psychodynamic psychotherapy has primary focus to reveal unconscious content from the psyche
of individual and this effort is done to alleviate psychic tension.
MAIN BODY
Concept
Cognitive behaviour therapy focuses on finding practical, skill-based solutions to
problems that individuals are facing in present day. This means that for the treatment of anxiety
individuals practical, skill-based solutions are found for the problems of patient (Stefini and
et.al., 2017). This means that in CBT, negative though patterns are recognised and through
concrete skills thoughts, behaviours and skills are changed. In other words, in CBT, root cause or
problems that cause anxiety are not identified and emphasis is placed on finding solutions to
problems.
Psychodynamic therapy on the contrary is a therapy that focuses on insights and this
therapy looks at past to understand present of the patient. This means that when individuals face
anxiety through psychodynamic psychotherapy, root cause of their anxiety is identified. Through
this root cause, present of the person is understood and individual is treated by helping them gain
insight about how their early life experiences affect their present day. There are several reasons
because of which individuals can experience anxiety and in this they will be helped to
understand these reasons and their effect in form of anxiety.
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Goals of CBT and Psychodynamic Therapy
This is concerned with reason for therapeutic treatment given to patients and what is the
end result that each of these therapies will achieve regarding treatment of anxiety disorder.
Goal of CBT is to re-energize reality testing of person experiencing anxiety and to teach
them how to evaluate and modify their thinking. This means that in CBT person experiencing
anxiety disorder is helped by increasing their ability to test reality and also by teaching them how
they can evaluate and modify their thinking (Soares and et.al., 2018). Modification is done so
that individual can avoid or overcome thoughts that are the reason for their anxiety.
Goal of psychodynamic therapy on the other hand is to make individual aware of their
unconscious feelings. This means that in this, individuals are helped through enabling them to
understand their unconscious feelings and this way their anxiety disorder is treated. Unconscious
feelings and behaviour has a major role to play in causing anxiety disorder in individual and this
is why identification and treatment of them is very important for treatment of anxiety disorders.
Role of therapist
Role of therapist is concerned with how and what extent therapist gets involved in
treatment of anxiety disorders in people. In different approaches role of therapist differ on the
basis of their active involvement and also on the basis of nature of involvement by therapist.
Therapist plays major role in success of treatment and approaches for treatment that is
adopted for treatment of anxiety disorder. Role of therapist in CBT is to listen, teach and
encourage client. This means that they listen to client and understand their situation and
problems they are facing and in context of this study their role to understand anxiety disorder in
client or patient. Teaching client about how clients or patients can adopt changes in their life and
encouraging them to adopt changes in their life (Lindegaard and et.al., 2020). This is because
this approach of treating anxiety is mainly based on finding practical and skill based solutions
and changing thoughts and behaviours of individual.
In contrast to CBT role of therapist in psychodynamic psychotherapy is to uncover
painful emotions that have been warded off for many years in person experiencing anxiety. Role
of therapist also include providing a secure space to patient so that they can experience their
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negative feelings. Other than this, therapist play very important role in encouraging client to
share their emotions and feelings and also to help clients in identifying recurring patterns of their
thoughts and emotions and behaviour. Therapist also help client in identifying their deep rooted
problems that are cause behind their anxiety disorder. In this therapy, therapist is also required to
provide an environment in which patients with anxiety disorder can express their memories,
fantasies and impulses and share their insights.
Role of patient
Patient is the one who is suffering from or who is experiencing anxiety disorder. Their
role is concerned with extent to which patients are actively involved in their treatment. Active
involvement is concerned with being decision-maker rather than merely following what is being
said by the therapist.
In psychodynamic psychotherapy patient have a very important but key role in therapy is
played by therapist because they are the one to encourage individual to express their thoughts
and feelings (Munder and et.al., 2019). They undertake different methods such as
communication and listening and enable patient to share their problems and reason for anxiety.
In contrary to CBT Role of patient in CBT is central role because this involves changing
behaviour and thoughts and even though they are guided by therapist, patient is required to play
important role in changing their thoughts and behaviour. Patient is also required to undertake
different actions when they are recommended and instructed by therapist.
Working of approaches
This is concerned with how both the psychological approaches are implemented for the
treatment of anxiety disorder in individuals. This is because ways in which approaches are
planned and then implemented are different and this also creates basis for difference in
psychological approaches for treatment of anxiety disorder.
In psychodynamic psychotherapy, therapist and client seat in front of each other and
therapist talks with client and at the same time therapist also listen to client when they are
speaking. In this therapist focus on helping client to explore and gain information and knowledge
of causes of anxiety disorder and their aim is to enable address their own issues as they develop
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knowledge and information. This means that when clients are looking for long term solution of
their anxiety disorder, in such situation psychodynamic psychotherapy can be useful for them.
However, in contrast to this CBT involves brief and time-limited therapy and treatment
and have a clear focus on goals rather than experiences and causes of anxiety disorder
(Leichsenring and Steinert, 2019). As compared to psychodynamic psychotherapy, CBT is a
highly structured process in which directives are determined to achieve specific goals of client
with anxiety disorder. In this cognitive problems or anxiety is treated by breaking thoughts and
feelings into smaller parts and by implementing a mechanism for copying to induce positive
changes in behaviour of individuals with anxiety disorder.
Consideration about individuals
This is concerned with extent to which both the approaches place emphasis on individual
personality and thoughts while treatment. This means that whether the treatment is based on
individual personality or treatment is generalised. A generalised treatment is one in which
everyone is considered equal and all patients are treated with same therapy and treatment
whereas in personalised approach treatment is personalised as per requirement of individuals.
CBT does not place any significant emphasis on individual differences and every
individual is considered to be similar and this is why an extremely structured process is adopted
for treatment through this approach. Not considering individuals can lead to making things
superficial in which only current issues are faced and childhood and past experiences are
ignored. This approach can be unsuitable with individuals who are having complexities in their
anxiety disorder and only current condition of individual is considered and all other aspects of
their life are ignored.
In contrast to this, psychodynamic psychotherapy considers that each individual is unique
and unconscious mind needs to be explored. The reason behind exploring unconscious mind is
that everyone has feelings and behaviours that they are unaware of and these feelings and
behaviours can contribute in anxiety disorders in individuals (Hoffart and Johnson, 2017).
Knowledge of unconscious mind allows opportunity through which choices can be considered
again by individuals and changes can be placed along with identifying possibility in individuals.
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In this therapy because focus is placed on individual their personality is also focused and this
also encourages free expression of individuals.
Different papers to compare CBT and Psychodynamic Psychotherapy
Generalised anxiety disorder is characterised by tension that is chronic, pervasive and
uncontrollable and this is often associated with somatic complaints. In a paper by Leichsenring
and et.al (2009) that was developed with objective to compare short-term psychodynamic
therapy and CBT regarding treatment outcome of generalised anxiety disorder. In this paper
patients with generalised anxiety disorder were randomly selected for receiving either CBT or
Short-term psychodynamic psychotherapy.
Among these patients 29 patients received cognitive behavioural therapy and 28 patients
received psychodynamic psychotherapy (Leichsenring and et.al., 2009). During treatment of
generalised anxiety disorder it was identified that in CBT 27 among 29 patients completed their
treatment and 2 patients moved or did not completed their treatment. Those who completed their
treatment 26 among them followed up and 1 patient among them required further treatment.
Among 28 patients who received psychodynamic psychotherapy 25 patients completed
their therapy and 1 patient had problem in developing therapeutic relationship with treatment
provider. 2 patients moved and did not complete their treatment. Among 25 patients who
completed their treatment 23 patients followed up and 1 required further treatment and 1 patient
developed severe somatic disease.
In this paper it was identified that both these papers had significant improvements in
measures of anxiety and depression and in terms of effect as well as in terms of process, no
significant difference was identified. Along with this, in terms of dropout rates of patients both
the therapies and treatments were same. The difference identified in these methods was that in
CBT was superior in measures of train anxiety, worrying and depression. In this research, results
of both these type of treatments were that both CBT and short-term psychodynamic
psychotherapy no significant difference in outcomes were found. However in measures of trait
anxiety, worry, and depression CBT was found to be superior as compared to psychodynamic
psychotherapy. This means that both these therapies are useful and effective for treatment of
generalised anxiety treatment.
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This research did not outline much difference in CBT and psychodynamic psychotherapy
because in terms of outcome there was not much difference. However, there are several
differences in these approaches of treating anxiety disorders because their basic concept is
different from each other. In terms of time involved in treatment of anxiety treatment CBT is
short-term treatment which lasts 2-3 months in 8 to12 weekly sessions (McCarthy and et.al.,
2018). Psychodynamic psychotherapy takes long time that is around 7-12 months. Other than
this, while treating anxiety disorder there is no set date in psychodynamic psychotherapy and is a
long term treatment which can last from several months to many years. A short-term
psychodynamic psychotherapy is known as brief psychodynamic psychotherapy and in this
psychodynamic psychotherapy, therapist works on identifying what is blocking patient from
progress and as the reason is identified and uncovered therapy comes to end.
 Actions that are taken for treatment of anxiety disorder in CBT includes a typical action
plan in which certain activities are included and these activities are-
 Recording of negative and bad thoughts that individuals have so that individuals can look
at them and challenge them
 Writing statements by individual to respond to negative thoughts that they are having
throughout the day
 Individuals when recognise a positive change they are required to practice positive
reinforcement
In contrary to this, actions taken for treatment in psychodynamic psychotherapy are mainly based
on condition and situation of individual rather than having a predefined set of activities and
actions for treatment of anxiety disorder (CBT vs. Psychodynamic Therapy: What's the
Difference?, 2021).
Depression and psychodynamic psychotherapy paper, outlined difference in CBT and
psychodynamic psychotherapy, that psychodynamic psychotherapy places higher emphasis on
certain aspects that are affect and emotional expression, exploration of patients’ tendency to
avoid topics, identifying behavioural patterns, feelings and relationships in individuals that are of
recurring nature, influence of past on present, interpersonal experiences of individual,
relationship between patient and therapist, identification of wants, and desires. In other words, in
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psychodynamic psychotherapy focus on internal world of patient is also placed and therapist has
developmental perspective and also a person centred approach (Ribeiro, Ribeiro and von
Doellinger, 2018). This means that as compared to CBT, psychodynamic psychotherapy involves
several elements that can be very helpful in treatment of anxiety in individuals with a focus on
providing them long term benefit.
Even though both the papers discussed above outline that when CBT and psychodynamic
psychotherapy are compared there is no significant difference in both these approaches for
treating anxiety. Paper by Leichsenring says that CBT is superior and this has been further
discussed in paper by Kaczkurkin. This paper outlined different types of anxiety disorders that
can be treated by CBT. This paper outline efficacy of exposure for anxiety disorders, exposure
here is concerned with Exposure-based therapy that is used in CBT. Post-traumatic stress
disorder is an anxiety disorder that is treated with prolonged exposure treatment and significant
improvements in Post-traumatic stress disorder have been resulted through prolonged exposure
treatment (Kaczkurkin and Foa, 2015). Obsessive compulsive disorder is also a type of anxiety
disorder which is treated by CBT, in this anxiety disorder exposure and response prevention is
used by therapist and use of Exposure and response prevention therapy for OCD resulted in
superior outcomes. Panic disorder is another type of anxiety disorder that is treated with
exposure therapy and Meta analysis outlined that in treating Panic disorder exposure therapy’s
performance was better when compared to no treatment. Generalised anxiety treatment has been
discussed earlier in this study and this paper also outlined that CBT is very effective in treatment
of generalised anxiety disorder. Social anxiety disorder, this is another anxiety disorder and CBT
was very effective and meta-analysis outlined that in social anxiety disorder cognitive therapy
performed better than exposure therapy and both of them together worked better. This paper
further discussed about cognitive therapy in regard with anxiety disorders discussed above and
all these disorders were improved as a result of cognitive therapy.
CONCLUSION
On the basis of above discussion it can be concluded that psychological approaches
discussed in study were CBT (Cognitive Behavioural Therapy) and psychodynamic
psychotherapy. There are several differences in terms of how therapies are implemented and how
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patients are treated with use of different therapies. Further on the basis of role of patient and role
of therapist differences in both approaches were discussed in study. However, analysis of certain
papers outlined that in terms of effectiveness and usefulness of approach there is no significant
difference and both the approaches are useful and effective. However, in one of the paper though
difference was not recognised CBT was considered superior than psychodynamic psychotherapy.
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REFERENCES
Books and Journals
Hoffart, A. and Johnson, S.U., 2017. Psychodynamic and cognitive-behavioral therapies are
more different than you think: Conceptualizations of mental problems and
consequences for studying mechanisms of change. Clinical Psychological
Science. 5(6). pp.1070-1086.
Kaczkurkin, A.N. and Foa, E.B., 2015. Cognitive-behavioral therapy for anxiety disorders: an
update on the empirical evidence. Dialogues in clinical neuroscience. 17(3). p.337.
Leichsenring D Sc, F and et.al., 2009. Short-term psychodynamic psychotherapy and cognitive-
behavioral therapy in generalized anxiety disorder: a randomized, controlled
trial. American Journal of Psychiatry. 166(8). pp.875-881.
Leichsenring, F. and Steinert, C., 2019. The efficacy of psychodynamic psychotherapy: an up-to-
date review. In Contemporary Psychodynamic Psychotherapy (pp. 49-74). Academic
Press.
Lindegaard, T and et.al., 2020. Internet-based psychodynamic therapy vs cognitive behavioural
therapy for social anxiety disorder: A preference study. Internet interventions. 20.
p.100316.
McCarthy, K.S and et.al., 2018. Twelve-month outcomes following successful panic-focused
psychodynamic psychotherapy, cognitive-behavioral therapy, or applied relaxation
training for panic disorder. The Journal of clinical psychiatry. 79(5). pp.0-0.
Munder, T and et.al., 2019. Focusing on Patients’ Existing Resources and Strengths in
Cognitive-Behavioral Therapy and Psychodynamic Therapy: A Systematic Review and
Meta-Analysis. Zeitschrift für Psychosomatische Medizin und Psychotherapie. 65(2).
pp.144-161.
Ribeiro, Â., Ribeiro, J.P. and von Doellinger, O., 2018. Depression and psychodynamic
psychotherapy. Brazilian Journal of Psychiatry. 40(1). pp.105-109.
Soares, M.C and et.al., 2018. Comparison of clinical significance of cognitive-behavioral therapy
and psychodynamic therapy for major depressive disorder: A randomized clinical
trial. The Journal of nervous and mental disease. 206(9). pp.686-693.
Stefini, A and et.al., 2017. Cognitive-behavioral and psychodynamic therapy in female
adolescents with bulimia nervosa: a randomized controlled trial. Journal of the
American Academy of Child & Adolescent Psychiatry. 56(4). pp.329-335.
Online
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CBT vs. Psychodynamic Therapy: What's the Difference? 2021. [Online]. Available Through: <
https://blog.zencare.co/cbt-vs-psychodynamic-therapy/ >.
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