How to Treat Anxiety

Psychotherapy and medications are the two principal ways to treat anxiety.  Moderate to severe anxiety is typically best treated with both medication and cognitive behavioral therapy (CBT).  In the corresponding article, I will discuss an overview of both treatments.

CBT

CBT is considered the gold standard of the treatment of anxiety disorders such as generalized anxiety, panic disorder, obsessive compulsive disorder and phobias. CBT is an evidence based practice that follows a particular format and has been shown to benefit most patients.  The basic principles are as follows:

  • Restructuring of automatic thought processes that are counterproductive such as catastrophizing and interpreting ambiguous situations in a threatening manner.  
  • Addressing avoidance behaviors such as excessive preparation and checking behaviors
  • Addressing avoidance behaviors: such as avoiding ordering in a restaurant or avoiding eye contact with a stranger.
  • Teaching problem-solving skills when confronted with anxiety provoking situations
  • Addressing fixed negative beliefs such as “the world is unsafe” or “disease is inevitable”

The treatment teaches skills using weekly sessions and reinforces them with homework or in home exposures to anxiety producing events.  Relaxation techniques such as progressive muscular relaxation and deep breathing help people lower their physical level of stress.  CBT works best in people who are highly motivated and have the time and money to invest in the treatment.

Medications

Medications may help reduce anxiety to a manageable level so that people can begin to engage in learning CBT techniques.  Prefered medications have few side effects and low potential for addiction or abuse. Serotonin reuptake inhibitors (SSRIs) are the most safe and effective medications for most anxiety disorders.  Other medications such as benzodiazepines, antihistamines, and atypical antidepressants also play a role. I have summarized some take away points about each class of medication.

SSRI

  • Benefits: low side effect burden, no addiction potential, effective in 60-70% of cases
  • Negatives:  sexual dysfunction, withdrawal syndrome, take 2-4 weeks to see initial results  potential to cause suicidal thinking (rare)

Benzodiazepines

  • Benefits:  Work very quickly, few side effects
  • Negatives: Addictive, sedating, require seeing a physician face-to-face to prescribe

 

Antihistimines (hydroxyzine)

  • Benefits: work relatively quickly, good side effect profile, no withdrawal syndrome
  • Negatives: can cause dry mouth and dry eyes, can be sedating.

Click here for a link to the FDA medication guides

Leave a Reply