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Treatments for Anxiety

Anxiety disorders are typically treated with specific types of psychotherapy and/or medication. The treatment choice depends on the problem and the person’s preference. Before treatment begins, a practitioner must conduct a careful diagnostic evaluation to determine whether a person’s symptoms are caused by an anxiety disorder or a physical problem. If an anxiety disorder is diagnosed, the type of disorder or the combination of disorders that are present must be identified, as well as any coexisting conditions, such as depression or substance abuse. Sometimes alcoholism, depression, or other coexisting conditions have such a strong effect on the individual that treating the anxiety disorder must wait until the coexisting conditions are brought under control. Often people believe that they have “failed” at treatment or that the treatment didn’t work for them when, in fact, it was not given for an adequate length of time or was administered incorrectly. Sometimes people must try several different treatments or combinations of treatment before they find the one that works for them.

Psychotherapy

PsychotherapyPsychotherapy involves talking with a trained mental health professional, such as a psychiatrist, psychologist, social worker, or counselor, to discover what caused an anxiety disorder and how to deal with its symptoms.

Cognitive-Behavioral Therapy
Cognitive-behavioral therapy (CBT) is very useful in treating anxiety disorders. The cognitive part helps people change the thinking patterns that support their fears, and the behavioral part helps people change the way they react to anxiety-provoking situations.

For example, CBT can help people with panic disorder learn that their panic attacks are not really heart attacks and help people with social phobia learn how to overcome the belief that others are always watching and judging them. When people are ready to confront their fears, they are shown how to use exposure techniques to desensitize themselves to situations that trigger their anxieties.

People with OCD who fear dirt and germs are encouraged to get their hands dirty and wait increasing amounts of time before washing them. The therapist helps the person cope with the anxiety that waiting produces; after the exercise has been repeated a number of times, the anxiety diminishes. People with social phobia may be encouraged to spend time in feared social situations without giving in to the temptation to flee and to make small social blunders and observe how people respond to them. Since the response is usually far less harsh than the person fears, these anxieties are lessened. People with PTSD may be supported through recalling their traumatic event in a safe situation, which helps reduce the fear it produces. CBT therapists also teach deep breathing and other types of exercises to relieve anxiety and encourage relaxation.

Exposure-based behavioral therapy has been used for many years to treat specific phobias. The person gradually encounters the object or situation that is feared, perhaps at first only through pictures or tapes, then later face-to-face. Often the therapist will accompany the person to a feared situation to provide support and guidance.

CBT is undertaken when people decide they are ready for it and with their permission and cooperation. To be effective, the therapy must be directed at the person’s specific anxieties and must be tailored to his or her needs. There are no side effects other than the discomfort of temporarily increased anxiety.

CBT or behavioral therapy often lasts about 12 weeks. It may be conducted individually or with a group of people who have similar problems. Group therapy is particularly effective for social phobia. Often “homework” is assigned for participants to complete between sessions. There is some evidence that the benefits of CBT last longer than those of medication for people with panic disorder, and the same may be true for OCD, PTSD, and social phobia. If a disorder recurs at a later date, the same therapy can be used to treat it successfully a second time.

Medication

PillsMedication can be combined with psychotherapy for specific anxiety disorders, and this is a good treatment approach for many people. Medication will not cure anxiety disorders, but it can keep them under control while the person receives psychotherapy. Medication must be prescribed by physicians or psychopharmacologists who either offer psychotherapy themselves or work as a team with psychologists, social workers, or counselors who provide psychotherapy. The principal medications used for anxiety disorders are antidepressants, anti-anxiety drugs, and beta-blockers to control some of the physical symptoms. With proper treatment, many people with anxiety disorders can lead normal, fulfilling lives.

In 2008, the Institute of Medicine (IOM) conducted a review of randomized, controlled trials of medications for PTSD. It  concluded that no drugs have adequate data showing efficacy in treating PTSD, including:

  • SSRIs
  • Prazosin
  • Anticonvulsants
  • Olanzapine (Zyprexa) and risperidone (Risperdal)
  • Benzodiazepines
  • Phenelzine and brofaromine (Consonar)
  • Other drugs, including naltrexone, cycloserine (Seromycin), or inositol

Only exposure-based therapies (CBT) had solid evidence to support benefit

Before taking medication for an anxiety disorder: 

  • Ask your doctor to tell you about the effects and side effects of the drug. 
  • Tell your doctor about any alternative therapies or over­the­counter medications you are using.
  • Ask your doctor when and how the medication should be stopped. Some drugs can’t be stopped abruptly but must be tapered off slowly under a doctor’s super­vision.
  • Work with your doctor to determine which medication is right for you and what dosage is best.
  • Be aware that some medications are effective only if they are taken regularly and that symptoms may recur if the medication is stopped. 

Self-Guided Exposure

rope-course-smThere are also alternative treatments for anxiety. Exercise, travel, meditation, and yoga have demonstrated marked longterm improvement in symptoms. These treatments require a change in lifestyle. Permanent changes, that alter your path for the sake of both your physical and mental health. Journeys provide an excellent way to kickstart your transition to a new way of living. The types of journeys depend on the individual and the  anxieties they are suffering from. The most important aspect is that the journey is tailored to the individual. The success rates of psychotherapy and medications are based on statistical averages and neither is tailored specifically to the individual. By taking your therapy into your own hands, at your own pace significant, longterm improvements can be achieved.

Some might argue that they just can’t afford these types of journeys but the real question is “can you afford not to?”