Anxiety Treatment Options

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MEDICATION

Medication can be very helpful for sufferers of anxiety as its decreases anxiety symptoms whilst you are taking it. HOWEVER, MEDICATION DOES NOT CURE ANXIETY DISORDERS. Some people may choose not to use medication, others will choose to combine cognitive behavioural therapy or some other type of therapy with medication, and some people may only utilize medication.

Benefits of Medication

  • Medication can decrease the distressing physical symptoms of anxiety.  e.g. heart palpitations, sweating, shaking, etc.
  • Medication can reduce the negative thoughts experienced by anxiety sufferers.
  • Anxiety sufferers, who also have depression, can find anti-depressant medication improves their mood as well as decreasing their anxiety

 Types of Medication

Selective Seratonin Reuptake Inhibitors (SSRI’s)

SSRI’s are anti-depressants and are currently the most popular anti-depression / anti-anxiety drugs as they have fewer side effects than MAOI’s. SSRI’s include drugs such as Prozac, Luvox and Aropax. SSRI’s must be taken on a daily basis for at least a few weeks before they are effective.

SSRI drugs can interact with other drugs so before taking any medication in addition to your SSRI you should check with your doctor that is safe to do so.

Side effects may include poor sleep, fatigue and increased sweating. There may also be an adverse impact on one’s sexual functioning.

Seratonin and Noradrenaline Reuptake Inhibitors (SNRI’s)

SNRI antidepressants influence the levels of serotonin and norepinephrine in the brain. Venlafaxine (Effexor) is an example of an SNRI.

Side effects may include nausea, sexual dysfunction, sweating, sleep disturbance and tremors, as well as an increase in blood pressure.

Monoamine Oxidase Inhibitors (MAOI’s)

MAOI’s are antidepressants that work by inhibiting the breakdown of seratonin and norepinephrine in the brain, thus causing a reduction in the symptoms of anxiety.

People taking MAO’s have to follow a strict diet. They must not eat certain foods which contain tyramine (e.g. most aged cheeses, most alcoholic beverages,  sausage products and Marmite) as these foods can interact with the medication to suddenly increase blood pressure and cause symptoms such as headaches and vomiting. Users of MAOI’s also have to be careful about drugs they take in addition to their MAOI. A severe high blood pressure reaction, in response to inappropriate food, beverages or medication, left untreated can lead to stroke or death.

Common side effects of MAOIS include insomnia, fatigue or drowsiness, sexual dysfunction, and weight gain.

Benzodiazepines

Benzodiazepines include drugs such as Valium, Ducene, Serepax, Xanax and Kalma. Benzodiazepines work very quickly to calm you but their effects do not last long.

Single doses can cause fatigue and drowsiness and therefore reduce your ability to think on your feet (e.g. in a job interview or oral exam).

Benzodiazepines have some significant drawbacks. Firstly, people who take benzodiazepines on a daily basis for more than a few weeks may become physically dependent upon them. Therefore, these drugs should not be ceased abruptly as there is the risk of rebound anxiety and withdrawal effects. Anyone planning to reduce and or cease their intake of benzodiazepines should do so in consultation with their doctor.

Secondly, these drugs may be abused; therefore people who have a history of substance abuse may be advised to avoid benzodiazepines.

Thirdly, alcohol should not be consumed when you are taking benzodiazepines as it increases the sedative effect of the medication.

Furthernore, people taking benzodiazpines need to exercise caution when driving or operating potentially dangerous machinery until they work out how they respond to the medication.

Side effects may include poor memory, fatigue, sleeping longer, impaired coordination, and loss of interest in sex. Benzodiazepines may also worsen a sufferer’s depression.

Beta Blockers

Beta blockers, such as Inderal, are used to treat anxiety.

Beta blockers can alleviate heart palpitations and stop one’s hands from trembling as they block adrenaline receptors in the heart and muscles. They may also be helpful for blushing and sweating. These drugs are taken about an hour before a feared event and their effects last a couple of hours.

Beta blockers appear to be best used for performance anxiety.  i.e. public speaking, exams, music recitals etc. Beta blockers may be less effective at reducing negative anxiety provoking thoughts than they are at reducing physical anxiety symptoms such as heart palpitations and tremor. One of the limitations of using beta blockers is that if a feared social event is sprung on you without warning you don’t have an hour for the drugs to take effect.

Beta blockers generally cannot be used by asthmatics, diabetics or people with some forms of heart disease,

Burns, D. D (1999). The Feeling Good Handbook. New York, New York. Plume.

The information provided here is only a summary and is NOT intended as a substitute for a medical consultation. Should you be interested in taking medication for your social anxiety, you should discuss the pros and cons of treatment, side effects and so forth with a doctor. A number of factors need to be taken into account when prescribing medication, including the nature of your social anxiety, your medical history and the other drugs you are taking.

RELAXATION TECHNIQUES TO REDUCE ANXIETY

Our bodies respond to anxiety provoking thoughts and feared situations with muscle tension. When an anxious person interprets a situation as threatening the fight or flight response is triggered , hormones are released and the involuntary nervous system gets the muscles tense ready to help the individual to respond to danger (Andrews, Crino, Hunt, Lampe & Page,1994).

Constant muscle tension can make people feel cranky, fatigued & apprehensive and develop muscle pain and soreness as well as headaches (Andrews et al, 1994)

People are more likely to have a panic attack when they are in a constant state of tension as they are already highly stressed so a minor  event could cause further tension which results in hyperventilation and panic (Andrews et al,1994).

Relaxation is the voluntary release of muscle tension or psychological tension (Andrews et al, 1994)

The benefits of relaxation include:

  • feeling calm
  • reduced muscle tension
  • lowered blood pressure
  • lowered heart rate
  • decreased output of hormones that increase the flight or fight response
  • reduced perspiration
  • breathing more slowly
  • sleeping better (Davis, Eshelman, & McKay, 1995)

There are a number of different relaxation techniques to choose from: e.g.

  • Slow breathing
  • progressive muscle relaxation
  • isometric relaxation
  • meditation
  • visualization
  • self hypnosis (Davis, Eshelman & Mc Kay, 1995)

Please note this list is not exhaustive and you may need to try a few different types of relaxation techniques until you find one that you feel is suitable for you.

Relaxation is a skill, and like other skills such as playing the piano or tennis, your ability to relax will improve with regular, repeated practice.

Stress management techniques,  such as those mentioned above, are most beneficial when practiced regularly or when  implemented as soon as you detect any increase in your tension or anxiety levels.

References:
Andrews, G., Crino, R., Hunt, C., Lampe, L. & Page, A. The Treatment of Anxiety Disorders. Cambridge University Press. Melbourne. Australia.

Davis, M., Robbins Ehselman, E. & Mc Kay, M. (1995) Fourth Edition. The Relaxation & Stress Reduction Workbook. New Harbinger Publications, Inc. California, USA.

SLOW BREATHING TO DECREASE ANXIETY AND PANIC

Many anxiety sufferers breathe too fast and shallow. When confronted with a feared scenario  they breathe rapidly which leads to increased shortness of breath and further hyperventilation.

Some Symptoms of Hyperventilation

  • dizziness
  • lightheadedness
  • lump in the throat
  • fatigue
  • poor concentration
  • choking sensation
  • difficulty swallowing
  • racng heart
  • shaking
  • blurred vision
  • shortness of breath
  • chest pain
  • disorientation
  • tingly sensations  or numbness in the hands, feet and mouth

People who chronically breathe too fast tend to: sigh often, take deep breaths and feel short of breath.

Slow breathing can relieve anxiety and prevent you from having a panic attack, if you do it as soon as you notice yourself overbreathing or becoming anxious. Socially phobic and panicky people are advised to slow their breathing before tackling a feared situation or at any time they feel anxious.

When you are first learning this breathing relaxation exercise you may find it easiest to practice  lying flat on your back, knees bent, feet flat on the floor and eight inches apart. Place one hand on your chest and one hand on your abdomen.

Hold your breath and count to 10
Then breathe out and think’ relax’ to yourself

Then inhale slowly through your nose for 3 seconds. The hand on your abdomen should rise whilst the hand on your chest should stay relatively still.

Then exhale through your mouth for three seconds, making a whooshing noise as you breathe out. Think “RELAX” as you exhale. The hand on your abdomen should fall as you exhale.

After a minute of breathing in and out in a six second cycle, hold your breath again for 10 seconds

Keep repeating this process for 5 minutes.

Once you feel you have mastered the technique lying down, then start practising slow breathing whilst sitting or standing. Then you will be able to do slow breathing to relax yourself wherever you are in public.

Do this deep breathing for 20 minutes a day and any time when you feel yourself becoming anxious. Depending upon your commitments you might need to break up your 20 minutes during the day into 4 x 5 minutes relaxation segments or 2 x 10 minute relaxation segments.

EXPOSURE THERAPY

Exposure therapy is often essential if you are to overcome your anxiety disorder.The cognitive behavioural treatment of  conditions such as: panic with agoraphobia, simple phobias, social anxiety, obsessive compulsive disorder and post traumatic stress usually entails an exposure component. That is, you must subject yourself in the situations you are worried about. Although this sounds frightening, your therapist will give you the tools to cope with confronting your fears (e.g. rational thinking, slow breathing and isometric relaxation).

The guidelines for exposure are that the sessions must be

  • graded
  • repeated and regular
  • prolonged

Graded:
Your therapist will work with you to determine what would be an appropriate first step; it should be difficult enough to provoke some anxiety but easy enough for you to be fairly confident you can do it. Once you can cope with Step 1 confidently, then you can move onto a more difficult situation and gradually work up your most feared scenarios.If someone was frightened of dogs they might consider that smaller dogs were less threatening tyhan large ones and particular breeds were less aggressive than others. Someone with a dog phobia might therefore start off exposure therapy by interacting with a Cavalier King Charles puppy and gradually work up to patting an adult rottweiler.

It is important not to confront a feared situation that is far too difficult for you, as if you tackle something too stressful, without sufficient preparation, you may become extremely anxious or even have a panic attack. Such a negative experience would only strengthen the association between fear and the setting.

Repeated:
You need to confront your feared situations frequently and regularly if you are going to overcome your anxiety. If your exposures are too far apart your fear will have risen again by the next time you do it.

Prolonged:
Generally, it is advised that you stay in the feared situation until your anxiety starts to decrease. Anxious people often approach or attempt a feared situation but then choose to escape from the feared social or performance situation. When you avoid or leave feared situations your fear of them increases because the decrease in anxiety which follows escape gives you the idea that avoidance was a helpful strategy. However, if you stayed in the feared situation your anxiety would eventually decrease and the next time you confronted the situation you would be less anxious.

Therefore, it is important to your recovery that you stay in the situation you are attempting. Try not to panic or flee if the anxiety becomes severe. If your anxiety is high, you may feel you temporarily need time out from your feared activity, e.g. if you were attending a house party you might go to the bathroom or sit outside in the garden, do some slow breathing, develop some rational thoughts and wait for the fear to decrease for going back into the party.

Remember exposure is necessary for your recovery.

Andrews, G., Crino,R., Hunt,C., Lampe, L., & Page, A. (1994). The Treatment of Anxiety Disorders Cambrdige, England. Cambridge University Press

COGNITIVE BEHAVIOURAL THERAPY FOR ANXIETY

What does cognitive behavioural therapy for anxiety involve?

Cognitive behavoural therapy posits that how you think affects how you feel, and that your emotions influence your behaviour. Therefore if you think realistic, helpful thoughts you anxiety will be less and you will function better.

The example below  — for someone who fears having a panic attack on a train — highlights the interaction between thoughts, physical symptoms and behaviour.

 

UNHELPFUL THOUGHT

“Im going to have a panic attack”. I always panic on trains”.
“I’ll sweat and shake, everyone will see I’m anxious and think I’m weird”

PHYSICAL SYMPTOMS

You start to sweat and shake

UNHELPFUL THOUGHT

“I feel so sick, I must look terribly anxious, I’ll pass out if this keeps up”

PHYSICAL SYMPTOMS

You sweat even more profusely and feel even more dizzy

UNHELPFUL THOUGHT

“I can’t stay on the train. I’ve got to get off at the next stop”

BEHAVIOUR

You get off the train and as you exit the carriage your anxiety decreases

UNHELPFUL THOUGHT

“I’m weird and stupid. Other people have no trouble travelling on trains”

A cognitive behavioural psychologist will ask what situations are anxiety provoking for you. The therapist will also elicit what you think and do in these situations.

The psychologist will help you to:

  • identify your unhelpful thoughts and beliefs
  • evaluate the evidence for and against your thoughts and beliefs
  • create more realistic statements you can say to yourself when anticipating or confronting feared situations as these will decrease the degree of anxiety you experience
  • devise a plan for gradually exposing yourself to your situations.

The CBT psychologist will also help you to identify your problematic behaviours and give you strategies to help you cope with your physical symptoms of anxiety. Your CBT psychologist may recommend books and handouts be read and completed as part of treatment.

Cognitive behavioural therapy encompasses:

  • Education about anxiety
  • Cognitive therapy
  • Exposure therapy (both imaginal and ‘real life’ situations)
  • Relaxation training
  • Slow breathing

EXERCISE

Regular physical exercise is a simple and effective means of reducing stress.

Physical exercise is the outlet for the body when it’s in the fight or flight state. Exercise releases the natural chemicals — such as adrenalin — that accumulate during stress. Exercise releives chronic muscle tension, reduces insomnia and decreases depression and anxiety.

Exercise also:

  • increases alertness and concentration
  • reduces skeletal muscle tension and helps people to feel more relaxed
  • leads to a more rapid metabolism of excess adrenaline and thyroxin in the bloodstream (i.e. it reduces the hormones which increase arousal)
  • allows people to discharge their frustrations (which can aggravate phobias or panic reactions)
  • helps you to feel good by stimulating the production of endorphins
  • increases your energy level

Be sure to consult with your doctor before beginning any exercise program.

NUTRITION & LIFESTYLE ISSUES

Anxiety sufferers are advised to pay attention to dietary and lifestyle factors which can aggravate anxiety (Andrews,Crino, Hunt, Lampe & Page, 1994).

Caffeine
Avoid or limit caffeine. Chocolate, some high energy drinks, hot chocolate beverages, coffee, tea & cola drinks all contain caffeine, a stimulant which accelerates the fight or flight response. Caffeine can interfere with your sleep and make you more nervous. Switch to decaffeinated coffee, herbal tea and/or decaffeinated cola drinks, or reduce the number of cups of coffee/cola you have.

Alcohol
Alcohol can aggravate anxiety. People with anxiety are often tempted to drink alcohol before and/or during social engagements as it initially decreases anxiety. However, after alcohol has been in your system for a few hours it acts as a stimulant, making you more likely to hyperventilate and putting you at increased risk of having a panic attack.

Smoking
Try to quit smoking or at least reduce the number of cigarettes you have. Nictotine, like caffeine, is a stimulant which accelerates the fight or flight response. Unfortunately, many anxious people smoke before or during social events and this will only increase your anxiety. A mental health practitioner can assist you to cease smoking and information on how to stop smoking is available from QUIT.

Sleep
Try to get a good night’s sleep. Being overly tired can make you more anxious and increase the likelihood of you having a panic attack.

Suppressing Anger
Endeavour to express your anger (1) in an assertive way and (2) as soon as possible after a negative event, as pent up anger increases your level of stress (Andrews et al,1994).

Rectreational Drugs
Cocaine, marijuana and amphetamines can increase anxiety levels and lead to users having panic attacks (Burns,1999).
Andrews, G., Crino,R., Hunt,C., Lampe, L., & Page, A. (1994). The Treatment of Anxiety Disorders Cambridge, England. Cambridge University Press

Burns,D.D. (1999). The Feeling Good Handbook. New York. New York. Plume.