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Anxiety
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Anxiety and Mental Health Treatment

Anxiety disorders can be treated with a combination of pharmacological therapy and psychotherapy. Studies have shown that when used in combination versus alone, both of these treatments can have faster clinical outcomes with longer lasting effects. The two classes of pharmacological therapy used to treat these kind of disorders are antidepressants and benzodiazepines. Psychotherapy used to treat these disorders include cognitive behavioral therapy, cognitive therapy, and applied relaxation are well-known first-line therapy approaches.

Psychotherapy treatment approaches for anxiety

Cognitive behavioral therapy (CBT) is one of the most commonly used and widely accepted psychotherapy treatments for anxiety. This treatment modality uses a combination of interventions such as worry exposure, applied-relaxation, psychoeducation, cognitive re-structuring and problem-solving skills to educate the individual about their triggers and symptoms and then uses behavioral modifications in order to release their irrational thoughts and anxiety triggers.

Exposure therapy is a type of cognitive behavioral therapy in which the individual is exposed to the trigger or threat for a repeated number of times until the feared stimulus or response is eliminated. Exposing an individual to images of crowded malls or train stations who becomes anxious in congested spaces is an example of imaginal exposure therapy. Overtime this individual will become more comfortable with the image and will be able to venture into crowded spaces without having this unrealistic fear. Another type of cognitive behavioral therapy (CBT) is cognitive therapy, which targets distorted, and inappropriate thoughts and perceptions and using approaches to restructure these thoughts into positive and constructive thoughts. Applied-relaxation is a technique used to teach patient coping skills to relax immediately in an anxiety-provoking environment. Newer forms of cognitive behavioral therapy (CBT) to treat this that have been shown to be effective but are in still early stages of study are mindfulness and acceptance and commitment therapy (ACT).

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What is Anxiety?

Anxiety disorders consist of generalized anxiety disorder, social anxiety disorder, specific phobias, panic disorder and agoraphobia and are characterized by an intense state of worry and fear resulting from a threatening event or life stressor. It can be normal in cases of everyday stress or serious life stressors and individuals usually overcome this worry once the stressor dissipates however in individuals with this disorder, their state of worry becomes more intensified over time.

Pharmacological treatment for anxiety

An antidepressant medication is the first-line pharmacological agent used to treat anxiety. Selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) are the most widely used antidepressant agents to treat it. These medications work by increasing either serotonin or norepinephrine levels in the brain. These are neuronal hormones, formally called neurotransmitters that play a role in mood and anxiety. The following are a list of specific medications to treat theses disorders that fall into these medications classes:

  • Paroxetine (Paxil)-SSRI
  • Escitalopram (Lexapro)-SSRI
  • Sertraline (Zoloft)-SSRI
  • Fluoxetine (Prozac)-SSRI
  • Venlafaxine (Effexor)-SNRI
  • Duloxetine (Cymbalta)-SNRI
  • Paroxetine (Paxil)-SSRI
  • Escitalopram (Lexapro)-SSRI
  • Sertraline (Zoloft)-SSRI
  • Fluoxetine (Prozac)-SSRI
  • Venlafaxine (Effexor)-SNRI
  • Duloxetine (Cymablta)-SNRI

Other pharmacological agents used as second-line treatment for anxiety include benzodiazepines and buspirone, which is an agent used specifically for generalized anxiety disorder that falls into its own class. Benzodiazepines are commonly known as “nerve pills” or “anxiety pills” and are generally prescribed for short-term use in acute episodes because they are known to have a strong addiction potential. Benzodiazepines work on the same receptor in the brain as alcohol and therefore this class of medication should never be taken in combination with alcohol. The following are benzodiazepines that are used to treat it when antidepressants are not effective or are contraindicated:

  • Alprazolam (Xanax)
  • Diazepam (Valium)
  • Lorazepam (Ativan)
  • Clonazepam (Klonapin)
  • Alprazolam (Xanax)
  • Diazepam (Valium)
  • Lorazepam (Ativan)
  • Clonazepam (Klonapin)

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Psychotherapy treatment approaches for depression

Cognitive behavioral therapy targets the negative thoughts associated with the traumatic experience and the associated negative feelings in order to desensitize the individual to the traumatic related triggers. This technique begins by educating the individual about their symptoms and teaching them to recognize the rationale behind these symptoms. This initial cognitive process allows the individual to acknowledge the events and their symptoms and through behavioral modifications, they can work to release their irrational feelings regarding the traumatic event and replace them with more accurate and less negative thoughts. Through a series of multiple sessions, the individual is asked to imagine and describe the traumatic event and its consequences and to focus on the negative associations until they subside overtime. Relaxation techniques are taught during the sessions and homework is assigned so the individual so they can practice confronting their triggers of anxiety outside their therapy sessions. Common elements of cognitive behavioral therapy include:

  • Exposure therapy, a technique where the individual is exposed to the fearful traumatic trigger without any danger in order to overcome their distress
  • Role playing
  • Teaching individuals how to breathe in order to manage anxiety and stress
  • Educating individuals on normal reactions to trauma
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