Managing male anxiety: A CBT group approach

Mental Health Nursing,  Sep 1999  by McKenna, Brian,  O'Neill, Kevin

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The results of a questionnaire administered to participants in anxiety management groups revealed clear attitudinal differences towards anxiety and group participation between male and female group members. BRIAN McKENNA and KEVIN O'NEILL report on the provision of single-sex anxiety management groups and an effective screening protocol for group inclusion. Mental Health Nursing 1999: 19,5: 23-27

In November 1996, while working within the local community mental health team (CMHT), we were to be involved in a team reflection exercise which focused upon concerns identified in relation to the local anxiety management groups (AMGs) being run by nursing staff on behalf of the CMHT.

It was acknowledged that AMGs were known to be effective in both the short term 1,2 and the long term.3 While early studies failed to find clear evidence of differential efficacy when comparing two or more active treatments in the management of anxiety, more recent studies have found that a comprehensive cognitive behavioural therapy (CBT) approach has proved superior to benzodiazepine medications45 and has been shown to produce significantly better results than behaviour therapy, relaxation training and non-directive counselling at outcome and follow-up analysis at six to 12 months respectively.6,7

Our initial review of the local groups established that the predominant treatment approach comprised a 'mixed' therapeutic method that resulted in a somewhat fragmented and ad hoc approach being delivered by individual therapists. In relation to general issues, it was established that there existed clear problems in relation to: poor first attendance rates

high attrition rates

poor-moderate therapeutic outcomes

non-attendance and attrition rates were significantly higher among males.

In an effort to understand the differences in attendance and attrition rates and explore possible attitudinal differences towards anxiety across the sexes, a short questionnaire was completed by a sample of males (n=20) and females (n=20) known to suffer from anxiety-related conditions. Results highlighted that there existed clear differences in the perception of anxiety between males and females. Although both groups perceived anxiety to be a normal response to problems experienced in their lives, the following differences emerged: 7I per cent of males felt that suffering from anxiety was a sign of weakness compared to only 30 per cent of females who affirmed this belief

86 per cent of males found it embarrassing to admit that they were suffering from anxiety while only 30 per cent of the female group suffered in a similar way

86 per cent of males felt it was unacceptable to show emotion but only 10 per cent of the female group agreed with this statement.

Finally, when asked for their preferred group format 86 per cent of males stated their preference for a single-sex male-only anxiety management group, in contrast to 8o per cent of females who expressed no preference for any particular format.

In summary male clients appeared to be significantly more likely to perceive anxiety as a sign of weakness, had more difficulty in admitting that anxiety had become a serious problem in their lives and were more reluctant to attend mixed-sex anxiety management groups.

Facing up to this challenge our remit was to: devise and implement an effective screening protocol for group inclusion devise a local standard anxiety management package for implementation across the local groups provide single-sex anxiety management groups as an alternative to mixed-sex groups devise an audit protocol to evaluate the efficacy of the single-sex group approach and compare the same with previous group outcomes. As part of a local trust initiative we were to take advantage of the resources of the audit department.

An open referral system allowed clients to be referred to the groups via general practitioners, consultant psychiatrists, psychologists, social workers or through referral from a CMHT member. All potential client referrals were processed through the CMHT allocations procedures and clients considered high priority were excluded at this juncture while those deemed moderate or low priority were processed for screening interviews, with a standard letter being sent inviting them to meet a member of the CMHT to discuss their problems.

The majority of the clients selected for the screening interviews tended to meet the diagnostic criteria for generalised anxiety disorder (GAD), while a few would have attracted a diagnosis of panic disorder and one or two others would have been classified as suffering from anxiety disorder not otherwise specified.8

GAD is known to be a chronic condition with a high relapse rate9 and clinical trials indicate that a wide variation exists in treatment response, yet clin-- ical reviews suggest that the CBT approach has been found to be the most effective treatment paradigm in the management of GAD.10

The screening interviews were to be of some go minutes duration and, in an effort to promote engagement and underpin the development of a collaborative therapeutic relationship, the clients would be encouraged to discuss their perceptions of their current symptoms, and present their rationale for their current behaviours.