ANXIETY
May 20, 2019

It Pays to Be Tenacious

Cognitive behavior therapy teaches mental skills like remaining persistent and optimistic in the face of difficulties. They really do help.

Depression, anxiety and panic disorders can be very debilitating; they can affect peoples’ livelihoods and physical health. They are also very common. Treatment usually involves psychological therapies and medications. One of the psychotherapies used to help people with these conditions is cognitive behavioral therapy (CBT). Its goal is to teach people more helpful ways of thinking about issues that come up in their lives.

The idea is that by practicing the mental strategies CBT teaches, people with depression or anxiety or panic disorders will be able to cope with difficulties better. However, the association between CBT and long-term mental health outcomes is not well understood. So investigators at The Pennsylvania State University looked at how the coping strategies taught in CBT affected patients' mental health outcomes over almost two decades.

Cultivating persistence, optimism and resilience can be good for mental health.

“I was interested in understanding the link between coping strategies therapists usually equip their clients with in eight to 16 sessions, and the risk of people experiencing common mental health issues over a long period of time,” Hani Zainal, corresponding author on the study, told TheDoctor.

The strategies emphasized in cognitive behavioral therapy include persisting to reach a goal (“When I encounter problems, I don’t give up until I solve them.”), self-mastery (“I can do anything I set my mind to.”) and positive reappraisal (“I can find the positive, even in the worst situations.”). All are designed to reduce the risk of a person's developing major depressive disorder, generalized anxiety disorder and panic disorder.

The researchers looked at mental health data of nearly 3300 adults from the Midlife Development in the United States dataset. Participants' responses were collected in three “waves” over 18 years — in 1995-96; in 2004-2005; and in 2012-2013. The average age of participants was 45.6 years; 89 percent were white; and 42 percent were college-educated.

People in the study were asked to rate their own abilities in goal persistence, self-mastery and positive reappraisal. They were also evaluated for symptoms of major depressive disorder, generalized anxiety disorder and panic disorder.

Giving up may offer temporary emotional relief, but the resulting disappointment and regret can increase the risk of setbacks.

Those who reported greater goal persistence during the first wave of data collection in the mid-90s, and those who said they maintained a sense of optimism, were less likely than others to develop depression, anxiety or a panic disorder over the 18-year study period. Unsurprisingly, people who had fewer mental health issues at the beginning of the study were more persistent in trying to achieve their goals and also tended to be more optimistic.

Cultivating persistence, optimism and resilience can be good for mental health, said Zainal, a Ph.D. candidate in clinical psychology at Penn State. “Aspiring toward personal and career goals can make people feel their lives have meaning.” However, giving up on goals or having a cynical attitude can be detrimental for mental well-being.

Unlike the findings of previous studies, self-mastery had no effect on participants’ mental health during the 18-year period. That finding was surprising, said Michelle Newman, co-author on the study and a professor of psychology and psychiatry at Penn State. This could have been because self-mastery is a relatively stable part of a person’s character, so participants’ use of self-mastery would not easily change over time.

The findings may have implications in clinical practice for patients with depression, anxiety and panic disorders, Newman and Zainal believe. “Therapists can help patients understand the vicious cycle caused by giving up personal and professional aspirations,” said Zainal. Reconsidering and adjusting your goals can be the right thing to do at times, but faith in persistence is still important. “Boosting patients’ optimism and resilience by committing to a specific course of action to make dreams come true despite obstacles can lead to a better mood and a sense of purpose.” Giving up may offer temporary emotional relief, but the resulting disappointment and regret can increase the risk of setbacks.

The study is published in the Journal of Abnormal Psychology.

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