Anxiety disorders are among the most treatable of psychological problems. Most individuals who receive appropriate treatment experience a significant reduction in symptoms. For Substance-Induced Anxiety Disorders and Anxiety Disorders Due to a General Medical Condition, the focus is generally on reducing the substance use or on treating the medical condition that is causing the problem. However, for the other anxiety disorders, evidence-based treatments include medications, cognitive-behavioral therapy (CBT), or a combination of these approaches.
The selective serotonin reuptake inhibitors (SSRIs), such as paroxetine, fluoxetine, and sertraline, have been shown to be useful for treating most of the anxiety disorders. Other antidepressants (e.g., venlavaxine, imipramine)
are also useful for particular anxiety disorders. Anxiolytic medications (especially the benzodiazepines, such as alprazolam and diazepam) are also effective for reducing anxiety, although they are usually prescribed with caution due to the potential for abuse and the difficulty that some people have discontinuing these drugs. All of the anxiety disorders, except perhaps specific phobias, have been shown to improve following treatment with medications.
CBT includes a number of components. First, patients are encouraged to expose themselves to the situations they fear until their fear subsides. For example, individuals with Social Anxiety Disorder may practice meeting new people, engaging in conversations, or purposely making minor mistakes in social situations. Individuals with Panic Disorder are encouraged to expose themselves to the physical feelings they fear (e.g., running in place until their fear of a racing heart decreases), in addition to the feared agoraphobic situations. In the case of OCD, the exposure is combined with prevention of the compulsive rituals (e.g., touching "contaminated" objects without washing one's hands).
Second, cognitive therapy is often used to help individuals to replace their anxious thoughts with more balanced, realistic perspectives. For example, an individual with Generalized Anxiety Disorder (GAD) who worries whenever his or her spouse is late would be encouraged to consider all of the possible factors that may contribute to the lateness, rather than assuming the worst.
Third, treatment may include teaching the individual other relevant skills. For example, people with GAD often benefit from relaxation or meditation-based treatments. Individuals with Social Anxiety Disorder may benefit from learning to communicate more effectively.
Finally, treatment often includes a combination of medication and CBT. Generally, CBT, medications, and combined treatments are equally effective on average, although some individuals respond better to one approach than another. In the long term, after treatment has been discontinued, symptoms are more likely to return following treatment with medications than they are following treatment with CBT.
Martin M. Antony
Anxiety Treatment and Research Centre, St. Joseph's Hospital
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