GETTING HELP

Many anxiety disorders if left untreated become chronic mental health conditions. Anxiety disorders is usually treated with medications, psychotherapy or a combination of the two. Research has found that a combination of the two is the most effective way to treat anxiety disorders. Independently, psychotherapy and medication can cause changes in the brain to improve symptoms of anxiety. In addition, psychotherapy helps people develop more helpful thinking styles which prevent or cope with feelings of anxiety.

Psychotherapy

Psychotherapy is a form of treatment that involves talking to a therapist about your thoughts and feelings. Unlike other medical treatments, psychotherapy is based on the collaborative relationship between an individual and a psychologist.

Several forms of psychotherapy have been shown to be effective in treating anxiety.

1. Specific phobias

The main treatment for specific phobias is Exposure Therapies. There is strong support that exposure therapy is an effective treatment for specific phobias. Exposure therapy is usually used together with relaxation exercises and/or imagery. It consists of gradually exposes patients to what frightens them and helps them cope with their fears.

2. Social Anxiety Disorder (SAD)

The main treatment for SAD is Cognitive Behavioural Therapy (CBT). There is strong support that CBT is an effective treatment for SAD. It consists of focusing on modifying the catastrophic thinking patterns and beliefs that social failure and rejection are likely; exposure therapies are designed to gradually encourage the individual to enter feared social situations and try to remain in those situations.

3. Panic Disorder

The main treatment for Panic Disorder is Cognitive Behavioural Therapy (CBT). There is strong support that CBT is an effective treatment for Panic Disorder. Cognitive therapy aims to help the person identify, challenge, and modify dysfunctional ideas related to panic symptoms (e.g., catastrophic consequences of bodily sensations). Avoidance of panic and panic-cues is targeted through exposure exercises, including both in vivo (e.g., going to crowded places or driving in traffic) and interoceptive (e.g., bodily sensations) exposures.

4. Generalised Anxiety Disorder (GAD)

The main treatment for GAD is Cognitive Behavioural Therapy (CBT). The cognitive therapy techniques focus on modifying the catastrophic thinking patterns and beliefs that worrying is serving a useful function (termed cognitive restructuring). The behavioural techniques include relaxation training, scheduling specific ‘worry time’ as well as planning pleasurable activities, and controlled exposure to thoughts and situations that are being avoided. The purpose of these exposures is to help the person learn that their feared outcomes do not come true and to experience a reduction in anxiety over time.

Medication

Medication does not cure anxiety disorders but often relieves symptoms.

Medications are sometimes used as the initial treatment of an anxiety disorder or are used only if there is an insufficient response to a course of psychotherapy. In research studies, it is common for patients treated with a combination of psychotherapy and medication to have better outcomes than those treated with only one or the other.

The most common classes of medications used to combat anxiety disorders are antidepressants and anti-anxiety drugs. Occasionally benzodiazepines and beta-blockers are prescribed. Be aware that some medications are effective only if they are taken regularly and that symptoms may recur if the medication is stopped.

  1. Antidepressants
  2. Anti-anxiety
  3. Benzodiazepines

Specific Phobia

Medications alone are of little benefit in specific phobia, except in cases where there have been substantial reductions in quality of life.

Benzodiazepines may be used on a short-term basis for temporary anxiety relief in specific phobia, pending resolution of symptoms with other forms of treatment.

Benzodiazepines enhance the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABAA receptor.

Examples include:

  • Alprazolam (Niravam, Xanax)
  • Chlordiazepoxide (Librium)
  • Diazepam (Valium)
  • Lorazepam (Ativan)

Benzodiazepines are generally used only for relieving acute anxiety on a short-term basis. Because they can be habit-forming, there is a potential for abuse and the development of physical dependence on these medications. It is not a good choice if you've had problems with alcohol or drug abuse.

Social Anxiety Disorder, Panic Disorder and Generalised Anxiety Disorder

Antidepressants in the class of the SSRIs and SNRIs are recommended medication for Social Anxiety Disorder, Panic Disorder and Generalised Anxiety Disorder.

SSRIs increases the amount of serotonin, a neurotransmitter in your brain (chemicals that relay signals between the brain cells).

Examples of SSRIs are:

  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil, Pexeva)
  • Sertraline (Zoloft)
  • Vilazodone (Viibryd)

Antidepressant treatment has been associated with an increased risk of suicidal thoughts and acts, particularly in adolescents and young adults. However, the absolute risk remains small and the risk of suicide in untreated depression is greater than the increased risk of suicidal thoughts and acts due to antidepressant medication.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs). SNRIs increase the amount of two neurotransmitters (serotonin and norepinephrine) in your brain. Venlafaxine (Effexor XR) in particular has been shown to be an effective medication for Social Anxiety Disorder.

Alternative Treatments

Beta-blockers can help with the physical symptoms of anxiety such as rapid heartbeat, shaking, and trembling in anxious situations. They will not help with the psychological symptoms (worry and fear).

Examples of beta-blockers include:

  • Atenolol (Tenormin)
  • Propranolol (Hemangeol, Inderal)

Stress management techniques and meditation can be helpful. Support groups (in-person or online) can provide an opportunity to share experiences and coping strategies. Exercise has also been found to help decrease symptoms of anxiety.

References
  • Ministry of Health Singapore. (2015). MOH Clinical Practice Guidelines 1/2015 Anxiety Disorders.
  • Ministry of Health UK. (2016). Start active, stay active: report on physical activity in the UK.
    https://www.gov.uk/government/publications/start-active-stay-active-a-report-on-physical-activity-from-the-four-home-countries-chief-medical-officers
  • National Institute for Health and Care Excellence. (2014). Physical activity: exercise referral schemes.
  • http://www.apa.org/monitor/2011/12/exercise.aspx
  • https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml
  • http://www.rxlist.com/benzodiazepines-page5/drugs-condition.htm#addiction
  • http://www.health.harvard.edu/mind-and-mood/overcoming-anxiety

RELATE