Effective Treatment for Anxiety Disorders

Dr. David L. Kupfer, Ph.D.

Anxiety disorders, even severe cases, can now be considered quite treatable. Physicians are routinely prescribing a variety of medications that can make it easier for people to overcome phobias, panic disorder, and obsessive-compulsive disorder. Cognitive-behavioral therapists are also finding success in helping people with these problems, sometimes with clients who have had to restrict their lifestyles for years due to anxiety.

These more effective therapies are arising from our increasing understanding of the origins of anxiety disorders. While we have always perceived anxious clients as emotionally or interpersonally over-sensitive, we are now realizing that some of those with panic and obsessive-compulsive disorders may be physiologically over-sensitive. They seem to have neurotransmitter system imbalances that predispose them to react to stress in an extreme manner. Anti-depressant medications may act to correct these imbalances.

We are also understanding more about how children may learn to play family roles that lead them to have anxiety disorders when they become adults. Overprotected children come to see themselves as fragile. They donít feel confident of their ability to handle stress, and may fear that a psychotic break, a heart attack, or a fainting spell will result from their encounters with intense emotions or stress. In families with alcoholic, physically ill, or emotionally unstable parents, children may worry about their safety, but will try to avoid showing this anxiety for fear of alienating or overwhelming their caretakers. This habit of hiding your anxiety can produce a panic disorder in which you fear and avoid any situation in which your anxiety might be noticed. Compulsive washers may been raised in shame-inducing families that left them feeling dirty, and compulsive checkers can sometimes recall growing up with a fear of making mistakes.

Seen from a gender-sensitive perspective, anxiety disorders tell us how our traditional gender roles might be confining. The housebound agoraphobic woman can be understood as being on strike, remaining safe at home (a womanís place), while refusing to venture out into the manís world outside. Panic-prone men often fear showing any emotion or sign of anxiety that would not fit with the traditional strong and silent male role.

Research has demonstrated the effectiveness of cognitive-behavioral therapy in the treatment of anxiety disorders. Behavioral techniques help clients face and cope with their fears through exposure and anxiety management techniques. For phobics, systematic desensitization is a standard behavioral treatment. Clients learn how to relax or simply accept anxiety, and then are coached in using these skills while imagining anxiety-producing situations. This gives them the confidence to go into situations (driving, flying, enclosed spaces) that they have previously feared and avoided.

Another effective behavioral technique is imaginal exposure, in which anxious clients are guided to vividly imagine intense feelings or situations that have triggered their fear. An obsessive-compulsive, for example, might be led through a prolonged session imagining being harshly criticized for making a mistake. Facing a fear in imagery can lead clients to gain comfort with feelings that they have previously feared.

To be completely successful, any treatment of an anxiety disorder must include in vivo exposure. Agoraphobics who have feared highway driving must drive previously avoided roads before they can feel sure that they have overcome their problem. For the obsessive-compulsive who has had to shower for hours before feeling clean enough to go out, treatment must include brief showers followed by normal socializing.

Behavior therapy may also include response prevention, in which a client learns how to deal with anxiety without the use of maladaptive responses such as avoidance, escape, or compulsive checking or washing.

Cognitive therapy addresses specific beliefs and broad patterns of thinking that can contribute to anxiety. If you place excessive emphasis on succeeding or being accepted, anxiety may result. A cognitive therapy approach to anxiety disorders carefully examines the attitudes clients have about anxiety itself. Panic-prone clients may fear that even minimal levels of anxiety can escalate into psychological catastrophe (panic attacks or psychotic episodes) or physical catastrophe (heart attack, sudden death). They may have zero tolerance for anxiety, fearing that any anxiety is dangerous and must be avoided. Anxiety makes such people feel a loss of control. For these clients, learning how to reduce anxiety through relaxation may not be the key to therapy; it might be more important for them to learn that anxiety can be tolerated. Therapy produces real growth when the client emerges thinking of anxiety as a valuable teacher.