Treatment for anxiety disorders

In general, the three anxiety disorders that I most commonly see in my practice have the same options for treatment.

As with the majority of disorders, most people experience the greatest benefit from a combination of psychotherapy and medication. The pharmacological component may not be necessary for those who are experiencing mild anxiety or situational anxiety that can be linked to a specific event. However, when anxiety is moderate or severe or recurrent, it is possible that “talk therapy” alone will not be as effective.

Medication

Medication by itself is not likely to cure an anxiety disorder, but it can help minimize the symptoms. There are three classes of medications typically used to combat anxiety: antidepressants (SSRIs and SNRIs), antianxiety drugs (benzodiazepines and buspirone), and beta-blockers. These medications have been widely studied and proven to help. As with any medication, they are likely to cause side effects. In the case of antidepressants—just as when they are used for depression—it is important to note that they may pose serious risks to children, teens, and young adults (including suicidal ideation and suicide attempts).

Caution is particularly advised when taking benzodiazepines. Although they take effect more quickly than antidepressants, people can build up tolerance and even become dependent on them. Therefore, doctors usually prescribe benzodiazepines for short periods of time and as an “as-needed” (PRN) treatment.

Ideally, any psychotropic drug should be prescribed after a complete evaluation by a psychiatrist, since medical doctors with a specialization in psychiatry are the most knowledgeable professionals when it comes to this type of medication. To find the latest information about medication for anxiety, talk to your medical doctor and visit www.fda.gov.

Note: There is no “one-size-fits-all” medication for anxiety. You may need to try more than one medication before you and your doctor find the one that works best with your symptoms and causes you the fewest and least bothersome side effects.

Does Dr Maxwell prescribe medication? We get this question a number of times every year, so let’s clarify. In the state of Georgia (and most other states in the U.S.), the only professionals with the title of “doctor” who are allowed to prescribe any type of medication are medical doctors/physicians. The clinicians in the mental health field who have a PhD or a PsyD have the prefix of “Dr” because they hold academic doctoral degrees, not medical licenses.

Psychotherapy

Scientifically proven approaches for anxiety include cognitive-behavioral therapy, psychodynamic therapy, and EMDR, all of which are offered at my practice. Regardless of the approach, I first determine which pathway to anxiety is predominant (cortex- or amygdala-based).

Congitive-Behavioral Therapy (CBT)

CBT is known for its emphasis on practical, step-by-step tools and psychoeducation. It addresses both the cortex and the amygdala pathways to anxiety, teaching clients healthy, adaptive ways of thinking about and reacting to anxiety-inducing situations. CBT includes psychoeducational handouts, weekly action plans, weekly logs, and worksheets—all with the goal of helping you unlearn dysfunctional responses and learn new ways of reacting through repeated practice.

Relaxation training is a component of CBT that specifically addresses the amygdala pathway to anxiety. It is used to reduce the activation in the amygdala and the subsequent sympathetic nervous system response of fight-flight-freeze. The methods include various types of breathing techniques, muscle-focused relaxation techniques, mindfulness, and grounding skills. Also found to facilitate relaxation are meditative movement therapies (e.g., yoga and tai chi) and light-to-moderate aerobic exercise (with significant research-proven benefits for the brain and the body in general), both of which I typically suggest to clients. For those who wish to incorporate them into their new routines, we work together on devising an action plan and schedule that may help with motivation and accountability.

Psychodynamic Therapy

This approach recognizes the complexity of mental life and therefore addresses underlying psychological forces that may affect who you are. An approach that addresses the cortex pathway to anxiety, it considers the relationship between past and present and helps you understand the why behind your thoughts, emotions, and behaviors, including the root of self-defeating patterns. This enhanced self-awareness is thought to be behind the fact that clients who receive psychodynamic therapy continue to improve after treatment ends.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR therapy is an integrative psychotherapeutic approach that was originally developed for the treatment of PTSD (which used to be categorized as an anxiety disorder). Since then, it has been proven effective for a number of other conditions. EMDR combines a specialized technique (bilateral dual stimulation) with components of CBT and psychodynamic therapy. Click here to go to the EMDR page on this website.

Duration of psychotherapy

Typically, psychotherapy for anxiety begins with more frequent sessions and then tapers in order to gradually end treatment. It may also be helpful to schedule monthly booster sessions for a couple of months (or for as long as you’d like) after your treatment is over.

Complementary medicine

So far, research into the effectiveness of botanical products for the treatment of anxiety disorders has been inconclusive. Examples are chamomile, kava, lavender, melatonin, passionflower, and valerian, whether they are taken orally, applied topically, or as part of aromatherapy.

To get information on supplements, other complementary approaches, and research, visit the website for the National Center for Complementary and Integrative Health at https://nccih.nih.gov/health/anxiety.

Content based in part on the following two public domain sources:

• American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013
• National Institute of Mental Health publications