Treatment of Anxiety Disorders
The information provided below is not comprehensive, but rather provides a general overview of the most common associated features.
Anxiety is very prevalent in our society and it can be hard to manage d/t all the stressors we face on a daily basis. Taking the initial steps for treatment can be crucial to recovery. There are many different ways to manage anxiety, such as therapy, medication, complimentary/alternative therapy (CAM) and treatment of underlying medical cause.
Therapy
Generalized Anxiety Disorder (GAD): CBT
Obsessive-Compulsive Disorder (OCD): CBT, Exposure Therapy, Imaginal Exposure, Habit Reversal Training.
Post-Traumatic Stress Disorder (PTSD): CBT, Cognitive Therapy, Cognitive Processing Therapy, Eye Movement Desensitization and Reprocessing (EMDR) Therapy, Prolonged Exposure, Narrative Exposure Therapy
Panic Attacks: CBT, Cognitive Behavioral Modification, Panic-Focused Psychodynamic Therapy (PFPP), Rational Emotive Behavior Therapy (REBT).
Exposure and Response Therapy (ERP)-In ERP therapy, people who have OCD are placed in situations where they are gradually exposed to their obsessions and asked not to perform the compulsions that usually ease their anxiety and distress. Your therapist will design a task for you that exposes you to that fear and then asks you to wait before performing your compulsion (ritual). Each time your will be asked to wait longer and longer until the gradual exposure and delayed response help extinguish the fear. Your brain learns that nothing bad happens when you stop performing compulsive rituals.
Imaginal Exposure-If ERP is too intense to start with, imaginal exposure (visualization) may be the first step. The therapist creates a scenario that elicits a personal fear and then asked the individual to imagine themselves deviated from their normal routine/response. Over time, they are gradually desensitized to the feared situation, making them more willing to move the process to real life, and engage in the next step, ERP.
Habit Reversal Training-This intervention includes awareness training and then the introduction of a competing response.
Cognitive Processing Therapy (CPT) is a specific type of cognitive behavioral therapy that helps patients learn how to modify and challenge unhelpful beliefs related to the trauma.
Prolonged Exposure teaches individuals to gradually approach trauma-related memories, feelings and situations. By facing what has been avoided, a person presumably learns that the trauma-related memories and cues are not dangerous and do not need to be avoided.
Eye Movement Desensitization and Reprocessing (EMDR) Therapy-encourages the patient to briefly focus on the trauma memory while simultaneously experiencing bilateral stimulation (typically eye movements), which is associated with a reduction in the vividness and emotion associated with the trauma memories.
Narrative Exposure Therapy (NET) helps individuals establish a coherent life narrative in which to contextualize traumatic experiences.
Cognitive-Behavioral (or CBT): This is a very common form of therapy to treat anxiety. It combines both cognitive and behavioral approaches. Homework is often integral part of the process.
Cognitive Therapy: Is based on the notion that our thoughts control our feelings. If we change the narrative that we tell ourselves (from negative to positive) it elevates the anxiety. The therapy is often short-term and goal-oriented. Homework is a key component to this modality.
Behavioral Therapy: The idea is that our behaviors impact our emotions. Therefore, therapy is focused on engaging in behaviors that foster wellbeing and avoid behaviors that enhance the anxiety.
Cognitive Behavior Modification focuses on identifying dysfunctional self-talk and narratives in order to change unwanted behaviors.
Rational emotive behavior therapy (REBT) is a technique to teach patients to detect and dispute “irrational beliefs” or negative thoughts that are believed to be causing their psychological problems.
Panic-Focused Psychodynamic Therapy (PFPP) is a form of treatment based on certain psychoanalytic concepts. These concepts assume that people are shaped by early relationship experiences and that unconscious motives and psychological conflicts are at the core of symptoms. The unconscious is a hiding place for painful emotions, but if these painful emotions can be brought in to the conscious mind, they can be dealt with.
Pharmacologically
Pharmacology is a medicine-based approach for treatment. The medications typically focus on either neurotransmitters (chemicals in the brain) or regulating our body’s physiological reaction to stress. Anxiety is very hard to treat strictly with pharmacological interventions. Without intensive therapy, medications can only mask symptoms for a short period of time.
Anxiety usually occurs in two ways. 1. There is an external event (stimulus) and your brain initiates a physiological reaction that is disproportionate to the threat of the stimulus. 2. You experience physiological symptoms (rapid heart rate, increased blood pressure, difficulty breathing, tingling in hands and/or feet, nausea, disorientation, dizziness and sweating) that your brain interprets as anxiety or stress due to the absence of an identifiable stimulus (like running a marathon).
Medications (and therapy) that treat anxiety interrupt one of these two cycles.
Complimentary or Alternative Medicine
Complimentary Medicine is a term that refers to medical interventions that do not fall within the scope of scientific medicine. These therapies are often used in conjunction with scientific (or traditional) medicine. Some examples include:
Treatment of Underlying Medical Cause
Sometimes there is an underlying medical condition that is causing the anxiety. Typically, the following conditions increases heart rate, blood pressure and shortness of breath. Anything that limits the amount of oxygen in the body can also increase these processes. These physiological responses are the same that occur with anxiety so if the underlying disease is unknown, the symptoms may be misinterpreted as anxiety. Although there are many different conditions that can either cause or amplify anxiety, here are a few of the most common:
Therapy
Generalized Anxiety Disorder (GAD): CBT
Obsessive-Compulsive Disorder (OCD): CBT, Exposure Therapy, Imaginal Exposure, Habit Reversal Training.
Post-Traumatic Stress Disorder (PTSD): CBT, Cognitive Therapy, Cognitive Processing Therapy, Eye Movement Desensitization and Reprocessing (EMDR) Therapy, Prolonged Exposure, Narrative Exposure Therapy
Panic Attacks: CBT, Cognitive Behavioral Modification, Panic-Focused Psychodynamic Therapy (PFPP), Rational Emotive Behavior Therapy (REBT).
Exposure and Response Therapy (ERP)-In ERP therapy, people who have OCD are placed in situations where they are gradually exposed to their obsessions and asked not to perform the compulsions that usually ease their anxiety and distress. Your therapist will design a task for you that exposes you to that fear and then asks you to wait before performing your compulsion (ritual). Each time your will be asked to wait longer and longer until the gradual exposure and delayed response help extinguish the fear. Your brain learns that nothing bad happens when you stop performing compulsive rituals.
Imaginal Exposure-If ERP is too intense to start with, imaginal exposure (visualization) may be the first step. The therapist creates a scenario that elicits a personal fear and then asked the individual to imagine themselves deviated from their normal routine/response. Over time, they are gradually desensitized to the feared situation, making them more willing to move the process to real life, and engage in the next step, ERP.
Habit Reversal Training-This intervention includes awareness training and then the introduction of a competing response.
- Awareness training may be practicing the habit or tic in front of a mirror, focusing on the sensations of the body and specific muscles before and while engaging in the behavior, and identifying and recording when the habit or tic occurs. These techniques increase awareness of how and when the urges develop, making it more likely that an individual will be able to intervene and make a change.
- Next the individual develops a competing response, in other words they learn to replace the habit or tic with something similar to the movement that is not noticeable to others.
Cognitive Processing Therapy (CPT) is a specific type of cognitive behavioral therapy that helps patients learn how to modify and challenge unhelpful beliefs related to the trauma.
Prolonged Exposure teaches individuals to gradually approach trauma-related memories, feelings and situations. By facing what has been avoided, a person presumably learns that the trauma-related memories and cues are not dangerous and do not need to be avoided.
Eye Movement Desensitization and Reprocessing (EMDR) Therapy-encourages the patient to briefly focus on the trauma memory while simultaneously experiencing bilateral stimulation (typically eye movements), which is associated with a reduction in the vividness and emotion associated with the trauma memories.
Narrative Exposure Therapy (NET) helps individuals establish a coherent life narrative in which to contextualize traumatic experiences.
Cognitive-Behavioral (or CBT): This is a very common form of therapy to treat anxiety. It combines both cognitive and behavioral approaches. Homework is often integral part of the process.
Cognitive Therapy: Is based on the notion that our thoughts control our feelings. If we change the narrative that we tell ourselves (from negative to positive) it elevates the anxiety. The therapy is often short-term and goal-oriented. Homework is a key component to this modality.
Behavioral Therapy: The idea is that our behaviors impact our emotions. Therefore, therapy is focused on engaging in behaviors that foster wellbeing and avoid behaviors that enhance the anxiety.
Cognitive Behavior Modification focuses on identifying dysfunctional self-talk and narratives in order to change unwanted behaviors.
Rational emotive behavior therapy (REBT) is a technique to teach patients to detect and dispute “irrational beliefs” or negative thoughts that are believed to be causing their psychological problems.
Panic-Focused Psychodynamic Therapy (PFPP) is a form of treatment based on certain psychoanalytic concepts. These concepts assume that people are shaped by early relationship experiences and that unconscious motives and psychological conflicts are at the core of symptoms. The unconscious is a hiding place for painful emotions, but if these painful emotions can be brought in to the conscious mind, they can be dealt with.
Pharmacologically
Pharmacology is a medicine-based approach for treatment. The medications typically focus on either neurotransmitters (chemicals in the brain) or regulating our body’s physiological reaction to stress. Anxiety is very hard to treat strictly with pharmacological interventions. Without intensive therapy, medications can only mask symptoms for a short period of time.
Anxiety usually occurs in two ways. 1. There is an external event (stimulus) and your brain initiates a physiological reaction that is disproportionate to the threat of the stimulus. 2. You experience physiological symptoms (rapid heart rate, increased blood pressure, difficulty breathing, tingling in hands and/or feet, nausea, disorientation, dizziness and sweating) that your brain interprets as anxiety or stress due to the absence of an identifiable stimulus (like running a marathon).
Medications (and therapy) that treat anxiety interrupt one of these two cycles.
Complimentary or Alternative Medicine
Complimentary Medicine is a term that refers to medical interventions that do not fall within the scope of scientific medicine. These therapies are often used in conjunction with scientific (or traditional) medicine. Some examples include:
- Cranial Electrical Stimulation: anxiety
- Inositol: panic disorder
- Meditation: for all forms of stress
- Rhodiola (Rhodiola rosea): stress
- Yoga: anxiety and PTSD
Treatment of Underlying Medical Cause
Sometimes there is an underlying medical condition that is causing the anxiety. Typically, the following conditions increases heart rate, blood pressure and shortness of breath. Anything that limits the amount of oxygen in the body can also increase these processes. These physiological responses are the same that occur with anxiety so if the underlying disease is unknown, the symptoms may be misinterpreted as anxiety. Although there are many different conditions that can either cause or amplify anxiety, here are a few of the most common:
- Heart disease
- Diabetes
- Hyperthyroidism
- Respiratory disorders, such as chronic obstructive pulmonary disease (COPD) and asthma.
- Altitude Sickness.
- Drug misuse or withdrawal
- Withdrawal from alcohol, anti-anxiety medications (benzodiazepines) or other medications
- Chronic pain or irritable bowel syndrome
- Rare tumors that produce certain fight-or-flight hormones
- Sometimes anxiety can be a side effect of certain medications.
If you would like to be evaluated for an Anxiety Disorder or seek pharmacological treatment.