Psychodynamic Therapy
Psychodynamic therapy focuses on the evolution of your symptoms from a developmental perspective and explores unconscious conflict and fantasy. For example, some people who experience anxiety grew up in families where critical evaluation and judgment prevailed and perfectionism was valued, or where expressing feelings was discouraged. Anxiety symptoms are seen as a breakdown of adaptive defense mechanisms, which usually serve to keep unacceptable unconscious conflicts and fantasies out of conscious awareness. Through a psychodynamic lens, anxiety symptoms are seen a “compromise”, a less distressing alternative than having to confront these unconscious conflicts.
Cognitive Behavioral Therapy
CBT is very often the therapy of choice for anxiety disorders. As David Clark, PhD, and Aaron Beck, MD discuss in their 2007 Cognitive Therapy of Anxiety Disorders, the cognitive model of anxiety examines the persistence of anxiety in absence of real threat. Primarily, cognitive approaches stress that thought processes, which center on exaggerated threat appraisals and vulnerability are at the root of anxiety responses. They rest on the premise that these cognitive processes begin a cascade of heightened selective attention to personal risk, high autonomic nervous system arousal, inability to recognize safety cues, a heightened sense of helplessness, and avoidance behavior, all of which reinforce the anxiety response. Cognitive therapies work to focus clients’ attention away from the perceived threat to engage in cognitive restructuring, to examine how they “automatically” think about and appraise threat, challenge and modify these thought processes, and reduce overestimations of threat. Behavioral interventions that follow may include forms of exposure therapy and self-monitoring of progress.
Exposure
Exposure can be imagined or real, works very well for phobias, and can be helpful for social anxiety and OCD. It involves systematic, repeated and eventually, prolonged exposure to feared situations or things. As Dr. Bourne states, phobias develop from sensitization, where a fear of a specific situation or thing becomes paired in our minds with strong anxiety. Through a process of slow and careful desensitization, phobic clients would face the feared situation in very small amounts to start, with a “safe” person with them, and spend enough time in or near the feared situation to experience a bearable level of anxiety until more time and proximity can be tolerated. Using specific breathing and relaxation techniques can make exposure easier. Usually goals are set between client and therapist about what they want to master, at what intensity, and by when. Imagining the feared situation first through “imagery desensitization” is also helpful.
Deep physical relaxation
Anxiety manifests in our physical selves in the form of shallow breathing, tense muscles and jitteriness, with even stronger and more disturbing symptoms occurring during panic attacks. Use of the breath to expand chest-level breathing patterns and progressive relaxation to calm tense muscles and meditation to calm the nervous system can help reduce physical anxiety and perceived stress. These techniques can and should be used between sessions.
Psychoeducation
A combination of specific education about anxiety as part of psychotherapy, can be helpful for people with anxiety disorders. You may feel better from gaining a concrete understanding of anxiety symptoms and the kinds of treatment that usually help.
Medication
Generally, all classes of medication used for depression –the older tricyclic antidepressants, the MAO inhibitors, and the newer SSRIs and SNRIs are helpful for panic, OCD, social phobia. The SSRIs, and an SNRI, Effexor, can be helpful for generalized anxiety disorders. Medications which are specific for anxiety include:
Benzodiazepines (e.g., Ativan, Klonopin, Xanax, and Valium: Relatively fast-acting medications that work to relieve anxiety by slowing down the central nervous system. The draw-backs include dependency and side effects, mainly oversedation (e.g., such as drowsiness, confusion, memory loss, and low mood).
Beta Blockers (Inderal, or propranolol): are used to treat high blood pressure and heart problems, but can block the physical effect of anxiety by inhibiting adrenaline. It is often used to combat types of social anxiety (e.g., performance anxiety, meeting new people).
Buspar (Buspirone): Slower acting and increases serotonin, like an SSRI, over time
Resources and Information
For a comprehensive look at types of therapy for anxiety, see the following link:
http://www.helpguide.org/mental/anxiety_therapy.htm
The following websites provide comprehensive overviews of medication choices.
http://www.nimh.nih.gov/health/publications/anxiety-disorders/index.shtml#pub8