Anxiety Drugs, Therapy, or Both?

Panic attacks, crippling phobias, a mind that won’t rest and social situations that make the heart pound are all anxiety disorders that require attention. Anxiety disorder is different from the daily, and possibly helpful, “butterflies” people get when feeling a healthy level of anxiety. There are different schools of thought about how to treat anxiety, but more and more practitioners and major institutions agree that a combination of medications and talk therapy offers the best prognosis.

Why Drugs

Physicians who prescribe medications for anxiety have been presented with a patient who is probably losing a significant amount of functioning because of anxiety. The doctor may see a chemical problem before him, not a psychological problem. It is proven that making more serotonin, a neurotransmitter, available in the brain will reduce the levels of depression and anxiety in most patients. Thus, the physician’s goal is to reduce that person’s mental pain and get them functioning again, and usually the fastest way to feel better can often be found in the pharmacy. The problem, aside from a drug’s side effects, is that the medication almost never cures the root problem.

Medications can be helpful for chronic anxiety; however, if there is underlying trauma or a set of negative thought patterns, those will continue. For instance, phobias will not permanently go away without therapy, no matter how strong the drugs given.

Why Therapy

Therapists see chronic anxiety as having a root cause. They see trauma and less than ideal thought patterns as the culprit. Sometimes the trauma has been repressed, and the patient is not even aware that some event or situation from the past is affecting them. Counseling may help bring the trauma to the conscious mind, which in itself, can lessen the effects of the trauma. Sometimes a person has a set of beliefs or thought patterns that are detrimental. Counseling may help identify those beliefs or thought patterns and create healthier ideas. Counseling can also help identify behaviors that are not useful. If counseling can bring understanding to a condition such as anxiety, it should be easier to cope.

There are hundreds of types of “talk” therapy, psychotherapy, but here is a list of the most common and accepted:

  • Cognitive Behavioral Therapy (CBT) - CBT attempts to change thoughts in order to change behavior to something more productive.
  • Exposure Therapy- Previously called “progressive desensitization,” it is to gradually reduce specific phobias. It is a type of CBT.

  • Acceptance and Commitment Therapy (ACT) -A type of CBT that focuses on “noticing” aspects of the client’s life without judging.

  • Dialectical Behavioral Therapy (DBT)-Using CBT along with Eastern meditation to achieve acceptance and mindfulness. Especially good for borderline Personality Disorder.

  • Interpersonal Therapy (IPT) – Looks deeply at the family and social relationships the client has.

  • Eye Movement Desensitization and Reprocessing (EMDR)- attempts to “reprogram” the mind using memories, visions and physical stimulus.

  • Freudian analysis – looks deeply at family of origin issues and how they manifests into current behavior.

A few visits with a counselor may be successful with eliminating very minor anxiety, but when the anxiety really interferes with a person’s life more needs to be done. There really can be a physiological/chemical reason the anxiety sufferer feels the way they do. Not every problem is “in the mind,” many behavior or psychological problems are actually from a lack or excess of neurotransmitters. Some studies have shown that counseling and other therapies can, indeed, have an effect on the neurotransmitters, but probably not to the level needed in severe cases.

Length of Treatment for Anxiety

As mentioned, many types of drugs for anxiety can work immediately. Valium and Xanax will have an almost immediate effect on anxiety. If antidepressants are given, they are used as part of a regimen, taken daily, and the effects could last as long as the medications are taken. But using antidepressants does not produce an instant result. To reach full benefit, doctors recommend they be taken for at least two weeks. Psychotherapy may have a small but immediate result. It might feel very good at first to have someone to talk to who understands the problem. That might be followed by a small let-down. And full treatment could take weeks or months. The American Psychological Association has indicated that significant results from psychotherapy can be seen in 8 to 10 weeks.

An Argument for Both

There are few practitioners who would see chronic anxiety in a patient and just throw drugs at the problem. The medications are for symptom management. The underlying problems would remain. Even if all the symptoms were abated by the medications, then there would still be an adjustment to a life of taking pills. Psychotherapy can look at the emotional and social implications of the disorder. It can help with stress management. It can help teach coping strategies. But in many cases, the psychotherapy alone is not enough to reduce symptoms to a functional level. Most institutions recommend a combination of medications and psychotherapy for the successful treatment of anxiety disorder.

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