Treatment of Anxiety Disorders
- Anxiety Disorders are treatable.
- Psychotherapy has an excellent track record for treating anxiety disorders.
These are the two most important facts to remember when it comes to the treatment of Anxiety Disorders. Some common approaches to treating Anxiety Disorders include:
Cognitive Behavioral Therapy (CBT)
CBT is touted as the most effective treatment for many anxiety disorders (ref. 1, 4). First, there is solid body of research that supports CBT’s efficacy in treating anxiety disorders (ref. 1, 2, 3, 4). Second, CBT is theoretically a good fit for the treatment of many anxiety disorders because many anxiety disorders are characterized by irrational thinking, e.g., fears of things that realistically are not particularly dangerous. For example, people who are afraid of flying know that flying is statistically far safer than driving, while those who have suffered Panic Attacks often realize quite quickly that while frightening and upsetting, Panic Attacks are not physically harmful. Thus, CBT, which focuses on thoughts and beliefs, is a good fit for many anxiety disorders.
How does CBT work: Therapists help clients examine, challenge and dismiss fears and beliefs that underlie and fuel their anxiety symptoms. For example, a therapist would help a client with OCD recognize that his ritualistic behavior is clearly superstitious and that there is no connection to counting to 14 before entering a room and preventing future catastrophes. CBT also utilizes behavioral interventions and assignments, where clients are asked to practice new behaviors to help them overcome anxiety in different situations. For example, a therapist would help a client with a social phobia set specific goals and work to implement them, (e.g., identify social situations where the client is uncomfortable, set up a specific plan for beginning to talk with or interact with others in these situations, systematically practice talking to and interacting with others in increasingly challenging situations, and review and monitor progress over time). Finally, CBT is an active and directive therapy, in which therapists help clients set goals and target specific symptoms, give homework and actively monitor progress. Thus, CBT’s structured and focused approach is a good fit for many anxiety sufferers, who often feel out of control and overwhelmed.
Behavioral Therapies and Relaxation Strategies. These approaches are often used in the treatment of anxiety disorders, but are most commonly used in conjunction with CBT or insight oriented psychotherapy.
Insight Oriented Psychotherapy
Thirty years ago one of the raging debates in psychotherapy was whether cognitive and behavioral therapies merely treated symptoms, while leaving underlying problems untouched, or if insight oriented therapies in their search for deeper issues, did not really help resolve specific symptoms and problems. If we have learned anything from this debate it is that there is some truth to both arguments. There are times when focusing on relieving specific symptoms is all that is needed. However, there are other times when symptoms are connected to unresolved conflicts or to past losses and/or traumas. Thus, there are times when insight oriented therapy, with its emphasis on increased self-awareness and understanding, is what is needed to help overcome anxiety. In addition, there is recent research which supports the efficacy of short term psychodynamic or insight oriented therapy in the treatment of anxiety disorders (ref. 5).
How does Insight Oriented therapy work with Anxiety Disorders: There are many instances in which anxiety symptoms reflect (are a sign) that individuals are struggling to resolve conflicts, come to terms with past losses and traumas, or overcome problems in their lives. An insight oriented approach helps clients become more aware of and achieve a greater understanding of their feelings, wishes, and fears. As individuals achieve an increased understanding of themselves and work through conflicts, self-doubts and fears they often find that the specific symptoms that brought them to therapy lessen or go away completely. Insight oriented therapy can be a particularly effective approach for those who are not only seeking to alleviate specific symptoms but are also looking to gain a greater understanding of themselves.
Therapists have become increasingly aware of how current relationships affect our psychological well-being. Thus, marital or relationship conflicts, family stresses, and other life stresses can be a source of anxiety (underlie anxiety disorders). In these instances, the most effective treatment for anxiety may involve addressing and resolving family and relationship problems. In addition, when one family member is experiencing significant problems with anxiety, this may disrupt family functioning. Moreover, family members’ reactions to anxiety symptoms may inadvertently reinforce or exacerbate symptoms. Thus, family or marital/couples therapy may be a needed component in the treatment of anxiety disorders.
While medication is widely used in treating anxiety disorders a number of experts have argued that medication treatment should be used primarily as an adjunct to therapy. There is significant concern that while anxiety medications can help suppress anxiety symptoms that these medications do not help resolve anxiety symptoms.
Several classes of medications are used in treating anxiety disorders. Quick acting anxiety reducing medications Xanax (alprazolam), Klonopin (Clonazepam), Valium (Diazepam), and Ativan (Lorazepam) are often used to help manage anxiety symptoms. These medications lower anxiety but tend to be short acting, can have sedating effects, and are potentially addictive. Longer acting medications such Prozac (fluoextine), Zoloft (sertraline), Effexor (venlafaxine), and Celexa (citalopram) are used for more long term management of anxiety symptoms. These medications tend to take 3-6 weeks to reach a therapeutic level in the blood stream, but have been shown to be helpful for some anxiety suffers. Physicians often prefer these medications because they do not carry addictive risks. Finally, other medications such as beta blockers are used to treat anxiety.
It is important to keep in mind that all medications carry risks of side effects. As noted above, the quick acting anti-anxiety medications can be habit forming and addictive, while the longer acting medications have their own set of side effects. Therefore, it is important to work closely with a physician when considering and utilizing medication treatment.
References and source material for this article includes:
Ref. 1. Beck, A., Emery, G., and Greenberg, R. Anxiety disorders and phobias: A Cognitive Perspective. Basic Books, 2005.
Ref. 2. Ingen, D., Freiheit, S., & Vye, C. From the Lab to the Clinic: Effectiveness of cognitive-Behavioral Treatments for Anxiety Disorders. Professional Psychology: Research and Practice 2009, Vol. 40, No 1, 69-74.
Ref. 3. Butler, A.C., Chapman, J.E., Forman, E.M., & Beck, A.T. The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review 2006, No. 26, 17-31.
Ref. 4. Steward, R.E., & Cambless, D.L. Cognitive-Behavioral Therapy for Adult Anxiety Disorders in Clinical Practice: A Meta-Analysis of Effectiveness Studies. Journal of Consulting & Clinical, 2009, Vol. 77, Issue 4 (August).
Ref. 5. Leichsenring, F., Salzer, S., Ulrich, J., Kachele, H, et al. Short-Term Psychodynamic Psychotherapy and Cognitive-Behavioral Therapy in Generalized Anxiety Disorder: A Randomized, Controlled Trial. American Journal of Psychiatry
(August, vol. 166, #8).
Bourne, E. The Anxiety & Phobia Workbook, Fourth Edition. New Harbinger Publications, 2005.
Morris, T.L., & March, J.S. eds. Anxiety Disorders in Children and Adolescents. Guilford Press, New York, 2004.
Website for the National Institute of Mental health