Treatment of
Anxiety Disorders



By Harold L. Burke, Ph.D.

 

“Anxiety disorder,” “anxiety attack,” phobias, generalized anxiety disorder, fear, panic disorder, agoraphobia, post traumatic stress disorder / PTSD, and obsessive-compulsive disorder: Information, treatments, current research, resources, and helpful hints

All of us have experienced anxiety or fear at some time in our lives. We can usually get over such emotions within a reasonable amount of time. However, an individual may be suffering from an anxiety disorder if the anxiety is sufficiently severe as to cause significant distress or to interfere with occupational, social, or other functioning. Fortunately, on the Web and in libraries. there is much information about anxiety disorders, mood disorders, and mental disorders, including the treatment of such disorders. There are numerous treatments for anxiety disorders including alternative, holistic treatments. The Brain Therapy Center provides information, psychological/neuropsychological assessment, treatment, current research information, resources, and helpful tips.

What is a panic attack, and what does “agoraphobia” mean?

A panic attack refers to a discrete period of intense fear in which at least four of the following symptoms develop abruptly and peak within 10 minutes:

• Feeling your heart is beating hard (palpitations)
• Sweating
• Trembling
• Feeling short of breath or like you are being smothered
• Feeling as if you are being choked
• Feeling chest pain or discomfort
• Feeling nausea or abdominal discomfort
• Feeling dizzy or lightheaded
• Feeling that things are not real or that you are detached from yourself
• Feeling as though you are losing control or going crazy
• Fearing that you are dying
• Feeling numb or having tingling sensations
• Feeling chilled or having hot flashes

Agoraphobia is feeling anxious about being in places or situations from which escape may be difficult (or embarrassing) or in which help may not be available (e.g., being outside the home, being in a crowd, traveling in a vehicle). A person usually avoids such situations fearing intense distress or a panic attack.

What are some of the specific anxiety disorders, and what are some of the symptoms?

There are many different anxiety disorders. Three of them are based on whether an individual experiences panic attacks with or without agoraphobia or agoraphobia without a history of panic disorder.

• Panic Disorder Without Agoraphobia
• Panic Disorder With Agoraphobia
• Agoraphobia Without a History of Panic Disorder

Specific Phobia is a marked, persistent, and excessive fear of a specific object or situation. The individual recognizes the phobia as being excessive, and the phobia significantly interferes with the individual’s life. 

Social Phobia is a marked, persistent, and excessive fear of one or more social or performance situations in which the individual may be exposed to unfamiliar people or scrutiny by others.

Obsessive-Compulsive Disorder consists of obsessions (thoughts, impulses, or images) or compulsions (repetitive acts) that the person recognizes as excessive or unreasonable. The obsessions and compulsions cause marked distress, are time consuming, or significantly interfere with the person’s life. In the case of obsessions, the person attempts to ignore the obsessions. In the case of compulsions, the person feels driven to perform the act and to reduce distress or to prevent some dreaded event or situation. 

Posttraumatic Stress Disorder occurs after an individual has experienced a traumatic event that initially caused intense fear, horror, or helplessness. The person then persistently re-experiences the event through recurrent, distressing recollections or physiological reactions to various cues that symbolize the event. The person attempts to avoid stimuli associated with the original trauma. This can happen by (a) becoming generally numb, (b) avoiding anything that is associated with the trauma, (c) having difficulty remembering an important aspect of the trauma, (d) losing interest in significant activities, (e) feeling detached from others, (f) having a restricted range of emotional expression, or (g) having a sense of a foreshortened future. The individual also experiences persistent symptoms of increased arousal (e.g., insomnia, irritability, difficulty concentrating, hypervigilance, exaggerated startle response).
(See also: post tramatic stress disorder [sp.])

Generalized Anxiety Disorder occurs if a person experiences excessive anxiety and worry about several events or activities for at least six months. The person also may experience difficulty concentrating, restlessness, fatigue, irritability, muscle tension, or insomnia.

A person may also suffer from an anxiety disorder caused by medical conditions or by substances (e.g., alcohol) either due to intoxication by or withdrawal from the substance.

The causes of anxiety are multiple and not definitively known. However, much is being discovered about the relationships among neurobiological factors (e.g., genes, neurochemicals, firing patterns among neurons), the occurrence of specific traumatic events, and “psychological” factors (e.g., the way in which one thinks about oneself, the world, and the future).

Such discoveries offer much hope for individuals suffering from anxiety disorders, and there are several well-documented and clinically-proven methods for treating these disorders. These methods include psychotherapy (particularly cognitive-behavioral therapy), antidepressant medications, and various exercises/techniques that focus on relaxation. In addition, there are several alternative therapies with less efficacy research that have been used by many clinicians with reported success. EEG biofeedback (neurofeedback) is one such method that appears to be more holistic and not reliant on medications. (Please see special page on EEG Biofeedback on this website for an explanation of this exciting methodology.)   

Several Treatment Modalities for Anxiety

At the Brain Therapy Center, our staff specializes in several treatment modalities including individual psychotherapy, neurofeedback, and exercise/diet consultation. We use primarily five types of psychotherapy, depending upon the needs of each client and combined synergistically to optimize effect:

• Cognitive therapy helps individuals replace dysfunctional, inaccurate thoughts and images (causing anxiety) with thoughts and images that are more accurate and decrease anxiety.

 

• Behavioral therapy is the systematic application of scientific principles of learning theory to change behavior. By changing certain maladaptive behavioral patterns, anxiety can be decreased. One very good example of this approach is systematic desensitization in which exposure to a feared stimulus is gradually increased while the patient is relaxed. This usually occurs over several sessions and is very gradual and controlled so that a person does not continue to be “re-traumatized” by exposure to the stimulu

 

• Logotherapy assists the client in achieving more meaning in life. Sometimes a person experiences excessive anxiety, angst, or worry due to a lack of direction or purpose in life or to uncertainties about life. Logotherapy helps the individual address these issues and access those dimensions of his/her personality that can neutralize such anxiety.

 

• Existential therapy assists the client in examining the relationship between anxiety/angst and very basic life choices.

 

• Medical hypnosis assists the client in entering an extremely relaxed but focused state so that subconscious processes of healing can occur. Often during the course of formal hypnosis therapy, a client with panic attacks, for example, will learn self-hypnotic techniques that can be utilized to abort panic attacks.

EEG biofeedback (neurofeedback) uses operant conditioning to alter brain waves so that a client’s brain can achieve more flexibility and stability. This in turn can help decrease or prevent excessive anxiety.

We at the Brain Therapy Center also have the requisite knowledge to allow us to have a close working relationship with physicians who may be prescribing anti-anxiety medications. (Dr. Harold Burke, Director of the Brain Therapy Center, has earned an M.S. and a Ph.D., has completed two years of basic medical sciences, and is currently enrolled in a post-doctoral Master of Science program in Clinical Psychopharmacology.)

Some Helpful Hints

• Seek help from a mental health professional. For example, a licensed clinical psychologist has had extensive education and training in treating anxiety disorders. A psychiatrist should be considered if you are primarily interested in psychotropic medications. Your primary care physician is certainly licensed to prescribe anti-anxiety (anxiolytic) medications, but psychiatrists have had much more training and experience in treating anxiety disorders and usually have the latest information about the best anxiolytic medications (e.g., that SSRI’s such as Prozac are considered more efficacious and safer than benzodiazepines such as Ativan or Xanax for treating anxiety). In any case, do not procrastinate in seeking help especially if you have had previous episodes of anxiety. There is mounting evidence that repeated episodes get worse and increase the probability of future episodes. In addition, as anxiety gets worse, people often turn to substances such as alcohol. This can lead to serious substance abuse or dependence.  

 

• Exercise, particularly with aerobic exercise, can be very beneficial. This exercise does not have to be intense to benefit the patient. Even 10 minutes of walking will increase your energy for 60-120 minutes and improve your mood. If possible, do 10 minutes of gentle stretching, 20 minutes of aerobic exercise, and 5-10 minutes of stretching as a cool down. Do this at least three times per week, but remember that the level of intensity does not make that much difference. Research has found that such exercise increases deep sleep, decreases stress reactivity, increases self-esteem, and increases such chemicals as BDNF (brain-derived neurotropic factor) that actually “heals” the brain. Of course, consult with your physician if you have any questions or doubts whatsoever about the wisdom of your doing exercise.

 

• Decrease your stress levels as much as possible. Stress makes it more difficult to cope with anxiety and the events in life that can exacerbate anxiety. Psychotherapy, biofeedback, exercise (e.g., aerobic, yoga, Tai Chi) and meditation/prayer have been shown to be effective in decreasing stress.  

 

• Try to improve your sleep. Insomnia may be one of your symptoms, and you need to get adequate amounts of sleep. In addition, inadequate sleep makes coping with anxiety more difficult. Taking excessive over-the-counter sleep aids is not a good answer; they can make things worse. Taking benzodiazepines (such as Xanax^®) on a chronic basis is usually not the answer. They can make the insomnia and anxiety worse if you stop taking them; you may become dependent on them; and they can impair your cognition, memory, and reaction time. A published study has shown that even relatively low doses of alprazolam (Xanax^®) can impair driving, divided attention, and reaction time. The latest guidelines from the American Psychiatric Association state that the SSRI’s (e.g., Prozac^®) are more effective and more appropriate for treating anxiety disorders than the benzodiazepines (e.g., Ativan^®, Xanax^®). Seeking advice from a physician, improving sleep habits, and exercising regularly can improve your sleep and decrease your anxiety.

 

• Self-help books, such as Feeling Good: The New Mood Therapy by Dr. David Burns, may be helpful. However, please realize that there is no substitute for a mental health professional especially if your anxiety is severe.

 

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