Psychological Therapy For Anxiety - Treating Anxiety: Mental Health

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Psychological therapy for anxiety

Certain types of psychotherapy, particularly cognitive behavioral therapy and exposure therapy, are beneficial in treating anxiety disorders. Both approaches involve working with a mental health professional, such as a psychiatrist, psychologist, or social worker, to understand the sources of anxiety and to learn how to control symptoms.

Cognitive behavioral therapy

Cognitive behavioral therapy, the leading form of therapy for anxiety, aims to correct ingrained patterns of negative thoughts and behaviors. As the name suggests, it has two parts. Cognitive therapy helps people change patterns of thinking that prevent them from overcoming their fears. Behavioral therapy works to change their reactions in situations that trigger anxiety. People with social phobia, for example, may assume that others will inevitably regard what they say as stupid. This is negative thinking. As a result, these people may avoid being with or talking to others. This is an example of negative behavior. The goal of cognitive behavioral therapy is to break this chain of thoughts and reactions.

Because negative thoughts and behaviors tend to come to the fore when people are under stress, the first step in cognitive behavioral therapy is to help you recognize when you're stressed. It's important to have an inner "thermostat" that can tell you just how stressed you really are and how to dial it down.

Behavioral therapists say there are three components to a stress reaction. These are commonly called the ABCs: affect, behavior, and cognition. Affect is how you feel; it refers to your emotional response to a particular situation. Behavior is what you do; for example, it can include tensing your jaw, tapping your foot, pacing, or overeating. Cognition is the thoughts you have when you are stressed; for example, thinking, "I'm going to miss my work deadline and get fired."

Research has shown that cognitive behavioral therapy is effective for panic disorder, generalized anxiety disorder, post-traumatic stress disorder, specific phobia, and social phobia. Cognitive behavioral therapy can be done individually or in a group. If the anxiety is the result of a traumatic event that affected more than one person, group therapy may be most effective.

Cognitive behavioral therapy usually takes place weekly for several weeks or months; once your condition stabilizes, you may see the doctor once or twice a month or only if symptoms start to worsen.

The therapist typically begins by asking you to record your thoughts and level of anxiety in certain situations. Then, you and the therapist discuss these thoughts, evaluate how realistic they are, and work together to substitute more productive thoughts. The therapist might also challenge you to consider what would happen if the fears came true, and whether that outcome would actually be so bad.

The behavioral component of cognitive behavioral therapy incorporates two main strategies. The first, called exposure or desensitization, involves having patients face their fears directly. This can be done in several ways. One is through role-playing. Another is by having an individual imagine frightening situations and describe them. Yet another strategy is to give patients "homework" in which they put themselves in real-life situations that spark anxiety. The reasoning is that avoiding anxiety-causing thoughts and situations reinforces the individual's fears or false beliefs. In real-life situations, patients can practice recognizing negative thoughts and substituting more realistic ones. With repeated exposure, people eventually become desensitized to fear-provoking situations.

The other main strategy is teaching patients practical skills to help them feel more in control in difficult situations. For people who become extremely anxious when they have a lot to do, this may mean offering tips on setting goals and managing time. Those who are uneasy in social situations can be coached in conversational techniques and other social skills.

Research has found that people with generalized anxiety disorder and panic disorder who choose both cognitive behavioral therapy and medication have fewer symptoms and a lower chance of relapse than those who use medication alone. Studies also show that in the long run these patients are able to stop taking medication or reduce their dose.

However, a study in the Journal of the American Medical Association found that people with panic disorder who received only cognitive behavioral therapy maintained their improvement longer once treatment was stopped than did those who received the tricyclic antidepressant imipramine (Tofranil) as well as therapy. It's possible that the medication may have undermined the cognitive behavioral therapy by reducing the intensity of people's fears. Thus, the process of facing their fears during the desensitization may have been less meaningful than it would have been otherwise. More research is needed to clarify which patients are better off with cognitive behavioral therapy alone and which ones might benefit from adding medication.

Exposure therapy

Sometimes exposure therapy is used alone. For example, a method called exposure and response prevention is effective for treating several anxiety disorders. Under the guidance of a therapist, the patient imagines or actually confronts his or her fears. Studies show that exposure therapy yields significant, long-lasting results: 60%–80% of patients improve, and the benefits last two to six years. Exposure therapy might be used in any of the following ways.

Obsessive-compulsive disorder. Individuals who fear contamination might be encouraged to touch some object that they imagine to be covered with germs. Then they must refrain from washing their hands for several hours. The goal is for them to lessen the anxieties that accompany obsessive thoughts about contamination and, in particular, to do so without compulsively washing their hands.

Post-traumatic stress disorder. During therapy, patients are asked to talk or write about the trauma that they experienced. At first, the process can induce tremendous fear and even terror, but as patients learn that they can "relive" the experience without being harmed, they are less affected by it, and their anxiety gradually diminishes.

Panic disorder. The therapist deliberately induces the symptoms that patients fear most by having them spin in a chair, hyperventilate, or run upstairs repeatedly. Patients can rate experiences as more or less anxiety-provoking, identify the sensations they have been misinterpreting, and understand why their fears are unrealistic. They also practice anxiety-provoking exercises in homework assignments until the fear of fear gradually recedes.

Last updated:	September 05, 2008