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Edward Lagunas Jr

ENGL 1302-223

Dr. Sharity Nelson

19 March 2022

Coping With Anxiety & Depression: The Alternative Coping Mechanisms to CBT

Anxiety & Depression are the most common mental health issues plaguing the world,

with 1 in 10 people suffering with depression or anxiety. While psychologists have supported

Cognitive Behavioral Therapy (CBT) as the main coping mechanism for anxiety/depression,

others believe that CBT alone is not enough to help cope with anxiety/depression and that other

activities such spending time outside, exercising, and socializing are better coping mechanisms

for individuals with anxiety. “…long waiting lists for CBT may worsen symptoms and long-term

prognosis.” (M. Henriksson et al., 27). “There is evidence that engagement in certain lifestyle

activities [(exercise, social interaction, and spending time outside)] are associated with fewer

symptoms and enhanced quality of life…” (B. Holt-Gosselin et al., 367). CBT is the

recommended coping mechanism when suffering with depression and/or anxiety, but the long

waitlist for CBT indicates a need for alternative coping mechanisms. “Longitudinal research is

essential to validate diagnostic classifications and tailor treatment plans for optimal effectiveness

and efficiency for patients with affective disorders (Gillis et al., 1995; Kendell and Jablensky,

2003; Kraepelin, 1921; Lorenzo-Luaces et al., 2017; McGorry et al., 2016; Penninx et al.,

2011).” (E.C. Solis et al., 1270). Tailor specific treatments for patients with mental health

disorders are necessary; therefore, research for treatments such as CBT (Cognitive Behavioral

Therapy), exercise, exposure to nature, and social interactions are crucial in determining

alternative treatment options that are tailored to the individual. In all, this paper reviews
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scholarly articles on the alternative coping mechanisms for anxiety and how they affect overall

mental health specifically anxiety, with the view that alternative coping mechanisms help more

than standardized CBT treatments. Therefore, the overall effectiveness of exercise, social

interaction, and hobbies will be examined as alternative methods to coping with anxiety.

Exercise has been determined as one of the more effective alternative methods to reduce

anxiety and/or depression in indivduals. “There is empirical support for the role of exercise, …,

as a treatment and protection against depression (Conn, 2010; Danielsson et al., 2014).” (M.

Henriksson et al., 27). Through exercise, individuals can better cope with depression by reducing

the symptoms through psychical activity such as aerobic exercises or weightlifting exercise. “…

changes in exercise were associated with changes in physical quality of life …; individuals who

engaged in more exercise demonstrated greater physical quality of life improvements versus

those who exhibited no change.” (B. Holt-Gosselin et al., 370). B. Holt-Gosselin et al. analysis

of exercise as an alternative coping mechanism supports M. Henriksson et al. in exercise being

used as treatment for depression. However, J. Baker et al. argues the opposite and instead

focuses on CBT as the main method for coping with anxiety “Adolescents who had received

psychological treatment reported a significantly greater reduction in symptom severity than

controls, …” (J. Baker et al., 773). J. Baker et al. reports CBT as being a greater method in

reducing severity compared to controls i.e., exercise, social interactions, and exposure to nature

making the claim that Cognitive Behavioral Therapy is the better coping mechanism.

On the other hand, self-assessed evaluations by individuals also play a role in the

effectiveness of these therapies. For example, Sokol et al. seeks to understand how individuals

with anxiety and/or depression perceive themselves overtime. “Their TSA profile more closely

resembles the consistently positive and linear trajectory of the euthymic group, though it is lower
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overall and appears to be associated with a negative bias regarding their past, present, and future

selves.” (Y. Sokol et al. 337). Researchers Y. Sokol et al. concluded that individuals with anxiety

and/or depression do have a better self-perception overtime, however, it is lower than those who

do not. Therefore, Y. Sokol et al., M. Henriksson et al., and B. Holt-Gosselin et al. conclude that

CBT is not a very effective therapy as it relies on the individual to have positive self-perceptions

after each therapy session, wherein exercise does the opposite and relies on exercise for positive

self-perception making exercise an excellent alternative to Cognitive Behavioral Therapies.

Social interactions have been noted in being necessary for emotional, social, and

behavioral development, and are important for maintaining mental health. As per Holt-Gosselin

et al., “Changes in family/friends engagement were associated with changes in social quality of

life, …, individuals who exhibited greater family/friends engagement demonstrated greater social

quality of life improvements versus those who were less engaged.” (B. Holt-Gosselin et al., 370).

Through social interactions individuals can with anxiety and/or depression exhibit greater quality

of life changes i.e., better mood, greater social interaction, and reduction in anxiety/depression

symptoms. “…only 10.1% of participants with baseline comorbid depression-anxiety were

consistently recovered, 26.0% of the anxiety-only group were consistently recovered, and 32.2%

of the depression-only group were consistently recovered.” (E.C. Solis et al., 1272). Researchers

E.C. Solis et al., however, argue and confirm that individuals suffering from depression and/or

anxiety have a lower success rate at recovering from the symptoms due to the phobias associated

with these mental health issues. “Using the CIDI, participants were first divided into subgroups

at baseline: 1) depression only (single or any combination of MDD and/or dysthymic disorder);

2) anxiety only (single or any combination of panic disorder, social phobia, …” (E.C. Solis et al.,

1270). It can be concluded, because anxiety often includes social anxiety and depression
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sometimes evolves into MDD, preventing indivduals from interacting socially in most

environments which in turn makes social interaction as an alternative coping mechanism less

effective. Wherein B. Holt-Gosselin et al. was able to confirm their claim for exercise being an

excellent alternative to CBT it is evident that social interactions as a coping mechanism is not as

effective in improving quality of life for those suffering from depression as E.C. Solis et al.

claimed and is not an effective alternative to CBT.

Having hobbies that keep the mind from stressors has been generally regarded as an

excellent method for coping with anxiety and depression. “…changes in hobbies engagement

was associated with changes in environmental quality of life, … individuals who were less

engaged in hobbies exhibited greater environmental quality of life improvements versus those

who did not change their engagement…” (B. Holt-Gosselin et al., 371). Research done by B.

Holt-Gosselin et al. has shown that engagement in hobbies exhibited a greater quality of life,

whereas non-engagement exhibited a lower quality of life. However, recent events like the

COVID-19 pandemic has made engagement in hobbies harder due to increase in anxiety and

depression. “we identified 4.0% and 10.5% of the sampled respondents as cases that are at-risk

for excessive mental distress due to coronavirus anxiety and obsession, respectively.” (J.H. Chen

et al., 1135). Research by J.H. Chen et al. indicates that due to COIVD-19 there is greater risk

for anxiety and mental distress. Although, B. Holt-Gosselin et al. has been key in determining

alternative coping mechanisms the research done by J.H. Chen et al. makes hobbies as an

alternative coping mechanism less viable than pre-date COVID-19, however, it is found to be

more effective than social interactions as an alternative to CBT.

Anxiety & Depression are the most common mental health issues plaguing the world,

with 1 in 10 people suffering with depression or anxiety. While psychologists have supported
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Cognitive Behavioral Therapy (CBT) as the main coping mechanism for anxiety/depression,

alternative coping mechanisms such as exercise, hobbies, and social interaction have shown to be

viable alternatives to CBT. Whether an indivduals faces social anxiety, lack of engagement in

hobbies from depression and/or anxiety, or a lack of motivation from exercising due to mental

health issues there are alternative methods that can be used for each of these problems readily

available. However, recent world events have changed the overall effectiveness of these methods

and have even brought to attention a greater need for research under these worrying times. On

the other hand, this goes to show the need for alternative coping mechanisms as COVID-19 has

brought to light how stress can truly affect the individual. Therefore, through alternative avenues

of coping indivduals have a wider array of therapies and methods to better deal with anxiety and

depression, ultimately showing the need for coping mechanisms.

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Annotated Bibliography

Baker, Holly J., et al. “The Effectiveness of Psychological Therapies for Anxiety Disorders in

Adolescents: A Meta-Analysis.” Clinical Child and Family Psychology Review, vol. 24,

no. 4, 2021, pp. 765–782., https://doi.org/10.1007/s10567-021-00364-2.

The authors, Holly J. Baker, Peter J. Lawrence, Jessica Karalus, Cathy Creswell, and

Polly Waite examine how effective psychological therapy is in reducing anxiety disorder

symptoms and remission from primary anxiety disorders. They also examine and compare data

from multiple sets of databases over 2 decades to evaluate what psychological therapies are more

effective in treating anxiety disorders to reach their main points. In all, they examined over 26

studies of symptom severity outcomes, analyses of diagnostic remission outcomes, post

treatment, and remission from primary anxiety disorder. Through examination of the results from

the completed study they are used to assess the best psychological therapy to use when trying to

reduce anxiety within individuals. It is implemented for use of comparisons between the coping

mechanisms available to individuals.

Chen, Juliet Honglei, et al. “Measuring Covid-19 Related Anxiety and Obsession: Validation of

the Coronavirus Anxiety Scale and the Obsession with Covid-19 Scale in a Probability

Chinese Sample.” Journal of Affective Disorders, vol. 295, 2021, pp. 1131–1137.,

https://doi.org/10.1016/j.jad.2021.08.104.

The authors, Juliet Honglei Chen, kwok Kit Tong, Xiaoyu Su, Eilo Wing-yat Yu, and

Anisde M.S. Wu set to validate the Coronavirus Anxiety Scale (CAS) and the obsession with the

COVID-19 Scale (OCS) in Chinese adults. They examine the psychological evaluation of 1011

Chinese adults from June to July 2020 and how their results validate the CAS and OCS scales.

They also compare their results with those of other languages to see if the scales also align with
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the results of other studies done in different languages. In all, their examination of over 1011

Chinese adults and the validation of CAS and OCS are used to confirm the recommendation of

use of these scales to identify and intervene in COVID-19 related anxiety and obsessive

thoughts. Through the examination of over 1000 adults the completed results are important in

how anxiety can be assessed early on in individuals to best mitigate developing anxiety. It is

implanted to bring to light the need for greater research during the COVID-19 pandemic.

Henriksson, Malin, et al. “Effects of Exercise on Symptoms of Anxiety in Primary Care Patients:

A Randomized Controlled Trial.” Journal of Affective Disorders, vol. 297, 2022, pp. 26–

34., https://doi.org/10.1016/j.jad.2021.10.006.

The authors Malin Henriksson, Alexander Wall, Jenny Nyberg, Martin Adiels, Karin

Lundin, Ylva Bergh, Robert Eggertsen, Louise Danielsson, H. Geroge Kuhn, Maria Westerlund,

N. David Aberg, Margda Waern, and Maria Aberg examine how effective exercise is in reducing

anxiety in individuals with anxiety disorders, and how different intensity levels affect said

individuals. They also examine patients using the Beck Anxiety Inventory (BAI) and the

Montgomery Asberg Depression Rating Scale (MADRS-S). In all, 286 patients were selected

using the (BAI) and (MADRS-S) scales and were randomly assigned to two groups one with

exercise programs consisting of cardiorespiratory and resistance training and another group with

control/standard treatment non-exercise groups. Through the examination of 286 patients using

the (BAI) & (MADRS-S) scale the following results can be used to confirm the importance of

exercise in anxiety reduction and can be used to help reduce it in individuals with both anxiety

and depression. Used as a point of comparison for alternative coping mechanism such as the

effectiveness of exercise compared to Cognitive Behavioral Therapy.

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Holt-Gosselin, Bailey, et al. “Greater Baseline Connectivity of the Salience and Negative Affect

Circuits Are Associated with Natural Improvements in Anxiety over Time in Untreated

Participants.” Journal of Affective Disorders, vol. 295, 2021, pp. 366–376.,

https://doi.org/10.1016/j.jad.2021.08.039.

The authors Bailey Holt-Gosselin, Arielle S. Keller, Megan Chesnut, Ruth Ling,

Katherine A. Grisanzio, and Leanne M. Williams examine how natural trajectories of depression

and anxiety relate to neural functions and how engaging in activities such as exercise, hobbies,

and social interactions are impacted by symptom trajectory-circuit relationships. They also

examine patients with anxiety and depression, both untreated with pharmacotherapy or with

behavioral therapy. In addition, six circuits implicated in the symptoms which consist of default

mode, salience, negative and positive affect, attention, and cognitive control under fMRI in task-

free and task-evoked conditions. In all, 262 adults were examined with 60% of the patients

consisting of females and 40% males and were surveyed using the DASS-42, WHOQQOL, and

other custom surveys. Through the examination of 262 patients 24% of patients demonstrated

improvements in anxiety and 26% in depression symptoms the following results can be used as

ways to improve natural anxiety symptoms and are critical in future studies for development of

personalized treatment targets. Used as a main point of comparison and argument for alternative

methods of coping with anxiety and depression compared to Cognitive Behavioral Therapy.
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Sokol, Yosef, et al. “Anxiety and Temporal Self-Appraisal: How People with Anxiety Evaluate

Themselves over Time.” Journal of Affective Disorders, vol. 296, 2022, pp. 309–314.,

https://doi.org/10.1016/j.jad.2021.09.081.

The authors Yosef Sokol, Chayim Rosensweig, Chynna Levin, and Mairav Linzer

examine the association between a singular presence of anxiety and self-appraisal. They also

examine groups of depressed (n=142), anxious(n=95), comorbid depressed and anxious(n=335),

and euthymic individuals (n=535) using the Depression Anxiety and Stress Scales. In all, anxiety

was found to be associated with self-appraisal, especially individuals with anxiety who had

similar positive self-views to the euthymic group but fell short in some points. Whereas those

with depression had a more balanced past-to-present view of themselves, and an improving

present-to-future self-views. Through the examination of the different groups of individuals with

different mental health issues the findings can be used by clinicians for possible interventions

and treatments for anxiety and depression. Used to determine how self-appraisal in indivduals

affects the effectiveness of the alternative coping mechanisms.

Solis, Ericka C., et al. “The 9-Year Clinical Course of Depressive and Anxiety Disorders: New

NESDA Findings.” Journal of Affective Disorders, vol. 295, 2021, pp. 1269–1279.,

https://doi.org/10.1016/j.jad.2021.08.108.

The authors Ericka C. Solis, Albert M. van Hemert, Ingrid V.E. Carlier, Klaas J.

Wardenaar, Robert A. Schoevers, Aartjan T.F. Beekman, Brenda W.J.H. Phenninx, and Erik J.

Giltay examine the possibility of switching diagnoses when examining patients with depression

and anxiety. They also examine patients from the Netherlands Study of Depression and Anxiety

(NESDA) and use psychiatric diagnoses described as ‘consistently recovered,’ ’intermittently

recovered,’ ‘intermittently recurrent’, and ‘consistently chronic’. In addition, the patients are
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given a follow-up every two, four, six, and nine years. Also, the latent class growth analysis

(LCGA) with depressive, anxiety, fear, and worry symptom scores were used to identify the

distinct classes. In all, the study failed to fully capture the persistence of affective symptoms

observed when using dimensional approaches. However, the study was able to confirm that

further research is needed to confirm the impact on long-term prognoses. Used as a way to

determine the effectiveness of the alternative coping mechanisms in indivduals who suffer from

anxiety and depression.