Anxiety Treatment Program Options

Many factors related to symptoms are factored into anxiety disorder diagnoses. These include symptom severity, duration, triggers and associated behaviors. Each type of anxiety disorder has specific criteria that must be met for a diagnosis to be made. All types require that the anxiety must be causing: “… significant distress or impairment in social, academic, occupational or other important areas of functioning,” according to the DSM-5.

A thorough history and professional assessment is required to establish the presence of an anxiety disorder and the degree of impairment. Physical, social, mental, emotional and spiritual health are examined. Proper assessment and accurate diagnoses are necessary to direct appropriate care and treatment.

In addition to using the DSM-5 criteria for the diagnosis of anxiety disorders, other assessments are also done to assess all areas of health and functionality. Laboratory analyses traditionally have included toxicology screening for alcohol, drugs and medications. Stress hormone levels are not typically measured other than for research purposes. Brain mapping technology has recently been incorporated into the clinical setting as an adjunctive diagnostic tool, such as functional Magnetic resonance imaging (fMRI) and quantitative electroencephalogram (qEEG). Both fMRI or qEEG provide information as to how much each part of the brain is being used. Certain patterns have been associated with different psychiatric and medical diagnosis. Brain mapping data is currently being used in some select centers in the United States in combination with conventional evaluation methods.

Once an accurate diagnosis is made and discussed with the anxious individual and his/her family (when appropriate), care can be given and the healing process can begin.

Treatment for anxiety

In our current society, anxiety often goes untreated. Symptoms tend to worsen over time and unhealthy coping mechanisms can become habits that are hard to break. Too frequently, those experiencing symptoms of anxiety can compensate for long periods, then either gradually or rapidly decompensate. When thoughts and feelings of dread become excessive and coping behaviors become irrational or dysfunctional, it is time to seek help. It is far easier to admit that things are not all right rather than explain why things have fallen apart.

Medication

Medication may be needed in order to treat the symptoms of anxiety and keep the patient on track. They can be used to keep the patient calm or help reduce any other possible mental issues. Here are some medications that may be used:

  • Barbiturates (habit-forming): Often used to prevent seizures, like nembutal
  • Benzodiazepines (highly habit-forming), Used for acute anxiety, like panic attacks, e.g. diazepam (many end in “-am”)
  • Tranquilizers: Used to induce sleep, like chloral hydrate, imidazopyridines (may be habit-forming)
  • SSRI’s: selective serotonin re-uptake inhibitors, like fluoxetine
  • SNRI’s: serotonin and norepinephrine re-uptake inhibitors, like duloxetine
  • NDRI’s: norepinephrine and dopamine re-uptake inhibitors, like bupropion
  • TCA’s: tricyclics like nortriptyline
  • MAOI’s: monoamine oxidase inhibitors like selegiline
  • Atypical antidepressants: other mechanism of action like mirtazapine
  • Other medications: mood stabilizers, antipsychotics, atypical antipsychotics like quetiapine
  • Beta-blockers: Block “fight or flight” response/adrenaline surge, like propranolol (many end in “-ol)
  • Micro-ribonucleic acid: (micro-RNA)based therapies: Not yet developed, genetically-based
  • Herbal/natural remedies: Some herbs traditionally used to promote relaxation include chamomile, lavender, valerian, passion flower and many others. Vary culturally and geographically.

Neuromodulation

Although perceptions seem to form based on conscious thought, this is not entirely true. Past experiences form brain circuit pathways that bypass conscious thought when a threat re-presents itself. This is called neuromodulation. Neuromodulation can also be reversed or re-shaped with therapy. In fact, therapy is a form of neuromodulation. It is through the process of neuromodulation that new habits are formed, such as effective coping strategies and healthy lifestyle behaviors.

  • Psychotherapy: One-on-one therapy aimed at healing past traumas and disappointments
  • Group therapy: Group of persons overcoming anxiety with a professional facilitator
  • Support groups: Group of persons overcoming anxiety through mutual help and support
  • Cognitive behavioral therapy (CBT): Individual, group, videoconferenced, computer-based therapy designed to focus on emotional awareness and healthy decision-making
  • Acceptance-commitment therapy (ACT): Like CBT, with focus on person’s relationship to experiences rather than the content of the experience
  • Applied cognitive processing therapies (ACPT): There are 4 ACPT’s
    • Interpretation modification: Helps to avoid making falsely negative assumptions based on physical and mental cues
    • Imagery modification: Teaches persons how to conjure positive images during stressful interactions
    • Approach-avoidance training: Helps develop social skills
    • Eye Movement Desensitization and Reprocessing (EMDR): Alternates use of brain hemispheres (left to right to left, etc.) to process past negative experiences and enhance adaptive behaviors
  • Sequential intervention: Another cognitively-based form of therapy for anxiety
  • Supportive-expressive therapy: Aims to improve communication skills to improve social interactions
  • Music interventions: Few other forms of psychological therapy can lift mood faster than music
  • Art therapy: Creative expression can be an outlet for emotions and bring out feelings previously not expressed, particularly helpful with children
  • Equine therapy: Nonverbal communication between horses and humans
  • Mindfulness training: Separates thoughts of past and fears of future from present moment
  • Relaxation techniques: Warm baths, prayer, meditation, journaling, hobbies
  • Treatment of co-occurring disorders: Persons with underlying addictions to alcohol or drugs must undergo detoxification and re-assessment prior to beginning anxiety treatment

Barriers to treatment

Despite initiatives aimed at connecting people who are struggling with anxiety and providers who can help them, many are not receiving the care they need. Recent efforts have been made in public health awareness and education about anxiety disorders. Also, recruitment and education of more providers with competency in anxiety treatment. But barriers to care still exist. Two major barriers are social stigma (real or imagined) and health insurance problems. Stigma and insurance barriers can be overcome, but the biggest barrier remains. That is, individuals fail to realize that their symptoms really do warrant treatment and that it actually can help.

For family, friends and employers

Families, classmates, teachers, co-workers, employers and community members can all be adversely affected by a single person’s response to stress. Loved ones are often the first ones to address the problem and the affected person the last. There is never a valid reason to keep silent when someone is clearly struggling. Everyone needs help sometimes.

Taking the first step

Feeling trapped by your own feelings and thoughts can obstruct true happiness. Fear, anger, resentment, stress and anxiety may all be protective emotions, but without help, they can really get in the way. Sometimes such feelings leads to behavior patterns that include self-sabotage. Getting help with anxiety symptoms can reverse negative behavior patterns like self-sabotage, leading to a new freedom and a new happiness.