Treatments for anxiety disorders come in two major forms: (1) psychotherapy; or (2) medication. A person can choose to use one of them, but most research indicate that some combination of the two approaches does lead to more positive recovery results.
In this article, we will briefly run through the two major approaches of treatments for anxiety disorders.
Therapy addresses the underlying causes of an individual’s fears and anxieties, going past the symptoms and fixing the root of the problem. Once we uncover the source of our anxieties, therapy can then provide us with new perspectives. Through therapy, we can learn learn relaxation methods, and even equip ourselves with problem solving skills.
However, one should note that there are different forms of anxiety disorders. As a result, we should tailor our treatment according to each individual case. We can conduct therapy either in group settings or in private one-on-one sessions. Below are several of the most popular and widely accepted forms of therapy:
1. Cognitive Behavioral Therapy (CBT)
This is one of the most widely used therapies when it comes to mental illnesses in general, not just in anxiety disorders, or major depression. It has a very high efficacy, and studies have shown it to be very effective with almost all anxiety disorders (i.e. panic disorder, phobias, GAD, or SAD etc.).
CBT addresses the erroneous way we depict the world surrounding us, how we see the world through a distorted and negative perspective, and how this biased viewpoint affect our behaviors in a normal situation, leading to anxiety.
In short, the premise of CBT is that our thoughts and perceptions affect the way we feel. If we change our thought processes, adjust our expectations, attitudes and beliefs, then we can change how we feel and how we react to situations.
CBT process: Thought challenging (or cognitive restructuring)
This involves three steps:
- Identifying negative thoughts: A person who has anxiety disorders will magnify the situation they are in, perceiving each scenario as more threatening than they actually are. It is very difficult for such an individual to identify their irrational thoughts, even though they might know that they are irrational. As such, the therapist will ask you what you were thinking when the anxiety emerged.
- Challenging negative thoughts: Once you identify the source of anxiety and the main negative thoughts underlying the anxieties, the therapist will teach you to evaluate this thought/perception. The therapist will lead you to question the evidence for negative thoughts, analyzing unhelpful beliefs, and testing out the reality of negative predictions. Strategies for challenging negative thoughts include conducting experiments, weighing the pros and cons of worrying or avoiding the thing you fear, and determining the realistic chances that what you’re anxious about will actually happen.
- Replacing negative thoughts: After the identification process, then you can replace them with more accurate and positive thoughts, either by coming up with realistic calming statements to say to yourself during anxious situations, or anticipating a situation that usually triggers your anxiety levels.
2. Exposure Therapy
One of the most common reaction towards our anxieties, whether for those who are only mildly anxious, or those who are clinically so, is to try and avoid said circumstance that invite anxiety. But one of the problem with this habit of avoidance is that we never get a chance to face our anxiety and assess the validity of our anxiousness, an old (and cliched) saying is that we fear what we do not understand, and avoiding our fears may exacerbate it. Exposure therapy came from the idea that once we expose ourselves to our object of anxiety, and through repeated exposure, the fear that originates from said object will diminish as a sense of control slowly builds up through the process. This therapy can be done in two ways: either through imagining the object of fear or scary situations, or confronting it in real life. Exposure therapy can also be incorporated into CBT sessions.
A component of exposure therapy is called systematic desensitization, and this posits that rather than facing the object of fear straightaway in a traumatic fashion, we should approach mild versions of our fears, and slowly work our way up through a sequence that can slowly build up our confidence, it works in three parts:
- Relaxation skills: Progressive muscle relaxation or deep breathing techniques can be taught during therapy sessions and practiced as a homework. These techniques and skills are used in conjunction with the gradual exposure we conduct with our fears, in order to encourage relaxation.
- Step-by-step list: This is where we create a list, demonstrating the steps that we need to take in order to come face to face with the object of fear, in a gradual manner. For example, if you are scared of heights, the first item on the list will consist of looking at pictures displaying points of view from a tall building or mountain etc., then you will gradually move on to videos, and then finally climb a high object yourself. Each step will need to be very specific, and contain clear and measurable objectives.
- Working through it: During this step, which is conducted under the therapist’s guidance, you will work through each step and stay in one particular stage until you can finally overcome that fear, so that you can learn the harmlessness of the object of fear. Once the anxiety intensifies during any such stage, you will employ the relaxation techniques that you have learned.
P.S. Relaxation techniques are a frequently taught and utilized skill set in anxiety therapies, because these techniques emphasize the importance of how tension in our physical body can have an influence on our mental state, and thus by addressing these muscle tensions and releasing them, we can also counter the stress and anxiety in our mind. Commonly used techniques are progressive muscle relaxation, deep breathing, visualization, or meditation, and we have featured them in this month’s A-Project, providing a basic guideline on how to perform them on your own, though it is also advisable to have a professional by your side while performing them so as not to under-utilize or make any missteps.
Medication for anxiety disorders are generally SSRIs (Selective serotonin reuptake inhibitors). Occasionally benzodiazepines are used when the aforementioned drugs do not work, but are generally avoided due to the heavier side effects from consumption. To provide the most basic introduction as to how these drugs work and affect our mood, I will risk the chance of getting flak from the “biologists” in the ranks of our audience. Neurotransmitters (chemicals in our nervous system) play an important role in regulating our moods and mental states. They are released at one end of each nerve tissue, and between each nerve there is a small gap called the synapse. So if one particular neurotransmitter stayed in the synapse for a longer period of time before being “sucked” back into their respective neuron (a process termed reuptake), the more potent its effects. Serotonin is usually linked with an uplifted mood, so what the class of drug called SSRIs did is actually very literal; it inhibits the reuptake of serotonin, and as cause the serotonin in our nervous system to stay longer in the synapse, thus uplifting our mood.
Though there are certain side effects resulting from consumption of these drugs, they can be reduced if one follows the psychiatrist’s advice on what food to avoid while taking them, or what time to not consume them.
Though the purpose of this article is to provide a clear cut (an extremely dry) outline on what treatments of anxiety disorders generally consists of, I should add as a reminder at the end that there is no such thing as a miracle cure, and anyone promising such a thing at the start of any therapy is lying.
Treatments, be it medical or psychological, is a process, one that consists of hard work, commitment, and it may or may not include a relapse of behavior or mind state. To use a cliched phrase that is so worn through by now that it may seem like an empty platitude, but is nonetheless true in this case, sometimes things does get worse before it starts turning for the better.
There are no quick fixes or antibiotics. It is a process of learning, not just about curing the problem, but also understanding the problem, and in this process, understand more about ourselves as well. It doesn’t just involve participating in treatments or sessions, but also making a change in our lifestyle and our habit in real life. As such, like any other thing in life, we can learn from it, maybe not from the fact that such and such a disorder is meaningful or anything like that, but that we can make a change if we decide so, and that is all there needs to be.
You can also read this article on why sometimes the mindset is more important than the treatments themselves.
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