There are many different types of treatments that are used with anxiety disorders. Slightly different techniques may be used for each anxiety disorder, however, the treatments tend to fall into one of the following categories:
Cognitive behavioral therapy (CBT)
Cognitive behavioral therapy (CBT) is a type of treatment that has been shown to be extremely effective with children, adolescents, and adults with anxiety and mood disorders. CBT is typically a brief therapy (usually 10-16 sessions) in which a therapist teaches the client techniques that address anxiety and mood symptoms. The techniques target cognitive symptoms (negative or anxiety-provoking thoughts), behaviors (avoidance of anxiety-provoking situations, repetitive behaviors such as compulsions), and the associated emotions (anxiety and sad mood). Some common techniques include:
- Graded exposure: facing your fears in a gradual manner starting with the least anxiety-provoking and eventually reaching the most anxiety-provoking situations
- Cognitive-restructuring: evaluating the accuracy of negative thoughts by identifying evidence for and against the thoughts
- Relaxation techniques: breathing, imagery, or muscle-relaxation based techniques designed to reduce daily anxiety and anxiety in specific situations
- Response prevention: preventing a person from engaging in a behavior that maintains the anxiety, for example, a compulsion or avoidance
- Behavioral activation: engaging in active and pleasurable activities in order to improve a person’s mood
CBT may be conducted with parent or family involvement or on an individual basis. Group CBT is also common.
Mindfulness and meditation-based approaches
Mindfulness strategies are used to teach patients to decrease avoidance of anxious thoughts, to disconnect their thoughts from their actions, and to behave according to their broader life values. Acceptance of one’s experience, rather than change, control, or suppression of symptoms, is emphasized. By stressing acceptance one’s experience, mindfulness techniques help individuals act more effectively and in accordance with personal values, even when faced with negative experiences such as worrisome thoughts or uncomfortable situations.
Mindfulness techniques also emphasize awareness of one’s surroundings and living in the moment instead of thinking about what just happened or what is about to happen. Individuals are taught to focus on experiences they tend to overlook on a daily bases. For instance, individuals focus on the flow of their breath, the way their feet feel as they touch the floor while walking, or the various sounds surrounding them. Practicing mindfulness can be done either informally through short exercises where one practices being aware of present thoughts or sensations (e.g., the experience of eating a single raisin), or through formal meditation where one sits for an extended period of time, focuses on whatever arises, and practices accepting and not reacting to whatever arises (be it pleasant or unpleasant).
Emotion-regulation based approaches
Emotion-regulation based approaches teach skills in the regulation of various emotions, including anxiety, depression, and anger. Emotion regulation consists of changing the strength of an emotion and the way in which the emotion is impacting one’s behaviors. People with anxiety disorders often report experiencing stronger emotions than others and that they do not know how to regulate their emotions. This can lead many people to feel as though their emotions are out of their control. By teaching anxious individuals how to turn down the volume on their emotions, it helps them to feel as though they can cope with negative emotions and that emotions are not threatening.
Family therapy is often used for anxiety disorders, especially in children and adolescents. In family therapy the client is the family, not the individual. Family therapy is based on the notion that psychological disorders are experienced within the context of the family and often family members are impacted by the anxiety disorder. For example, often family members of individuals with Obsessive Compulsive Disorder (OCD) participate in OCD rituals. This can maintain the OCD symptoms. However, if family members do not participate in these rituals, there is often family discord, leading to family members feeling trapped. In family therapy the goal is for the entire family to work together to reduce anxiety disorder symptoms. This often means many family members making changes in their own behaviors and approaches.
Interpersonal therapy targets the interplay between relationships and symptoms of psychological disorders. Individuals with anxiety disorders often report difficulties in relationships and anxiety symptoms and interpersonal problems have been show to be influence one another. For example, if you are a worrier, you might worry a lot about the safety of your spouse. You may want your spouse to call you when they arrive at work to reassure you that he/she made it there safely. Although this may seem like a little thing, this can lead your spouse to feel that you are constantly checking up on him/her. This may lead your spouse to withdraw from you, which may increase your worries more as you wonder why your spouse is being distant and worry that perhaps your spouse is unhappy in your relationship. In this manner, anxiety and interpersonal problems are often intertwined. Interpersonal therapy targets problems within your relationships and the way that you relate with others with the goal of reducing your anxiety.
Selective Serotonin Reuptake Inhibitors
SSRI’s are prescription drugs typically used to treat depression. These drugs are thought to increase serotonin in the brain. Serotonin is a neurotransmitter known to be related to mood, appetite and sleep. SSRI’s have been shown effective in the treatment of severe depression and anxiety but there is some controversy in their effectiveness in moderate and mild cases of these disorders. Common SSRI drugs proscribed for depression are Prozac, Zoloft, Lexapro and Paxil. SSRI’s can be prescribed by any medical doctor but it is recommended that these drugs be supervised by a psychiatrist whose expertise lies in psychopharmacology. It should also be noted that while these drugs can be effective, there can be side effects which include nausea, headache, insomnia, weight gain, and thoughts of suicide. It is because of these side effects and others that the use of SSRI’s in children is controversial, and should be considered carefully with a professional.
Finding a therapist
Finding a therapist is one of the most important (and many times difficult) aspects of pursuing treatment. It is important that you find a therapist who you like and to whom you feel connected. Each therapist has their own style and approach to seeing clients. The client’s sense of humor, interpersonal style, and ability to understand your point of view are essential components of their therapy. It is also important to find a therapist who is trained in the types of therapies that are used for anxiety disorder.
In the Cleveland area:
Amy Przeworski and members of the SOAR Institute see clients through the Case Western Psychology Department Clinic. Members of the SOAR Institute specialize in anxiety disorder assessment and treatment and can help clients to reduce their anxiety symptoms.
Norah Feeny and members of the PTSD Treatment Program at Case Western work with clients who have experienced traumatic events and related psychological symptoms.
For links to clinics, treatment providers, and other information please click here