For those who suffer from anxiety, many treatment options, including therapy and medication, abound. First, however, it’s important to distinguish the level of anxiety and disorder an individual is experiencing.
The least severe form of anxiety may present itself as occasional nervousness, apprehension and sleeplessness. A person may feel edgy and short tempered. If this sort of anxiety has not presented itself before, and if there is a known cause for worry, such as a health concern or job pressures, then the anxiety is usually considered a normal reaction to life stress and is not deemed a mental health issue. In such cases, a health provider may offer a short-term prescription of sleep inducing medication, or perhaps antianxiety or antidepressant medication, but the specific psychological treatments described below are usually inappropriate and unnecessary. If, however, anxiety persists, becomes worse, or interferes with everyday life, treatment should be sought.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is highly favored in treating most, if not all, anxiety disorders. Many newer treatment modalities use the basics of CBT as their foundation, although they often combine other techniques as well. While newer treatment types continue to increase, CBT remains the backbone of anxiety management.
- CBT focuses on identifying and correcting one’s thoughts that may be distorted, unrealistic, or simply unhelpful. CBT seeks to find and modify those core thoughts to be more logical and productive.
- Core or automatic thoughts are ideas about one’s self and the world that reflect how people see the world and their place in it. A core thought may be, “I’m helpless to change my life” or “I’m not lovable.” People who experience anxiety may have core thoughts of simply being helpless in life.
- CBT doesn’t spend a great deal of time looking for the cause of those thoughts, as it is not focused in the past. Instead, CBT is present focused and seeks to change problematic behavior by changing the thoughts that precede them.
Using CBT techniques, a therapist helps individuals challenge those thoughts and reframe them. Relabeling or reframing are core techniques in CBT. Here are some other CBT techniques used to treat anxiety.
Systematic Desensitization: Individuals are gradually exposed to what they fear in small measured steps. For example, an individual with a snake phobia might be exposed to photos of snakes while the therapist helps the client relax. The goal is to associate relaxation with the place or thing that generates fear. If photos are not used, the therapist might ask the client to imagine their feared object. Obviously, this must be done very carefully or the individual could experience even more trauma and distress upon exposure. If the situation allows, exposure may be real and actual, such as going to a zoo to see snakes.
The length of time for exposure varies considerably and depends on the client’s level of distress during exposure. Some exposure protocols take weeks, while others may run for 2-3 hours.
Interoceptive exposure: Individuals are required to induce the symptom of panic attacks in controlled environments. The goal is to teach individuals that the physical discomfort they experience in panic attacks are not harmful and are under the individual’s control. Some of the exercises may include a) head shaking to produce dizziness or disorientation; b) quick head lifting to make one’s self lightheaded; c) breath holding to recreate the feeling of a tight chest or smothering sensation; d) spinning in a chair for one minute to produce dizziness; and e) hyperventilating to bring on the symptoms of unreality, shortness of breath, tingling, hot or cold, dizziness, etc.
The previously described two types of therapy are used for panic attacks and other anxiety disorders that may induce panic symptoms. They would not be appropriate for generalized anxiety disorder, PTSD, or obsessive-compulsive disorder. The following therapy techniques are universal to nearly all anxiety diagnoses:
Relaxation training: This is a widespread technique used to address anxiety, but the form of relaxation may vary considerably. Relaxation might include guided meditation or self-hypnosis. Therapists may suggest a yoga class. Biofeedback machines may be used to help clients achieve relaxed states, and virtual reality is sometimes used as well. The goal is to teach clients to achieve a relaxed state on their own, outside of the therapist’s office and without the use of external equipment.
Modeling and role-playing: This is the mentally or physically rehearsing a new thought or a new way of behaving. Individuals with social anxiety or obsessive-compulsive disorder may find this especially helpful, as it offers an arena to practice new opportunities for interacting.
Self-talk and affirmations: This is a universal technique to CBT and often includes coping statements. Clients are encouraged to adopt coping statements that appeal to them, memorize these statements and using them when under stress. An individual with panic disorder may adopt a coping statement that says, “Although my heart is beating a little faster right now, I’m completely healthy and in control. I can just breathe deeply and my heartbeat will slow down.”
Medication might be recommended in conjunction with therapy. Different types of anxiety benefit from different medications. Each has its own pros and cons and should be discussed with and monitored by a doctor.
Panic disorder prescription therapies frequently include the benzodiazepine class of sedatives, antidepressants selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs) and monoamine oxidase inhibitors (MAOIs).
Social phobia is usually a lifelong fear of being scrutinized, leading to humiliation and embarrassment, in either social or evaluative situations. Antidepressants, both SSRIs, and SNRIs, are recognized for treating social anxiety disorder. Benzodiazepine may also be used.
Specific phobias are excessive and unrealistic fears of specific, concrete objects or situations that by themselves may pose a only minor threat or no threat at all. The level of distress upon exposure to the feared object/ situation may reach that of a classic panic attack. Specific phobias are categorized as fear of a) animals and insects; b) natural environments; c) blood, disease, injections; d) situations such as flying, driving, or elevators, tunnels, and bridges; e) other situations or objects. Medications are not prescribed for social phobias, as exposure therapy is the preferred course of treatment.
Generalized anxiety disorder (GAD) describes a debilitating, constant and uncontrollable lifetime of worry. The worry is out of proportion and usually cannot be pinpointed to any actual threat. SNRI are used for GAD and antihistamines may provide sedation.
Post-traumatic stress disorder (PTSD) has a known origin in a traumatic event such as war, sexual assault, childhood abuse (physical or sexual), natural disasters, or auto or other accidents. SSRI medications Zoloft and Paxil are the only pharmaceuticals authorized for treatment, although other medications are sometimes prescribed.
Obsessive-compulsive disorder (OCD) describes a syndrome of persistent and recurring obsessions (ideas, thoughts and images) or compulsive behaviors (such as counting). SSRI antidepressants are effective in treating OCD.