Cognitive-Behavioural Therapy

People with generalized anxiety disorder (GAD) go through the day filled with exaggerated worry and tension, even though there is little or nothing to provoke it. They anticipate disaster and are overly concerned about health issues, money, family problems, or difficulties at work.
People with GAD cannot get rid of their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. They are unable relax, startle easily and have difficulty concentrating.
Physical symptoms that often accompany the anxiety include, but are not limited to, fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, lightheadedness, having to go to the bathroom frequently, feeling out of breath and hot flashes.
GAD affects about 6.8 million Americans and about twice as many women as men. It comes on gradually and can begin across the life cycle, though the risk is highest between childhood and middle age.
It is diagnosed when someone spends at least 6 months worrying excessively about a number of everyday problems. There is evidence that genes play a modest role in GAD.
Other anxiety disorders, depression, or substance abuse often accompany GAD, which rarely occurs alone. It is commonly treated with medication an/or cognitive-behavioral therapy.
Treatment of Anxiety Disorders
Anxiety disorders are typically treated with medication, specific types of psychotherapy, or both. Treatment choices depend on the problem and the persons preference.
Before treatment, a doctor must conduct a careful diagnostic evaluation to determine whether the symptoms are caused by an anxiety disorder or a physical problem. If an anxiety disorder is diagnosed, the type of disorder must be identified, as well as any coexisting conditions, such as depression or substance abuse.
Sometimes alcoholism, depression or other coexisting conditions have such a strong effect on the individual that treating the anxiety disorder must wait until the coexisting conditions are brought under control.
People with anxiety disorders who have already received treatment should tell their current doctor about that treatment.
If they received medication, they should tell their doctor what medication was used, what the dosage was at the beginning of treatment, whether it was ever increased or decreased, what side effects occurred and whether the treatment helped them significantly. If they received psychotherapy, they should describe the type of therapy, how often they attended sessions and how much the therapy helped.
Often people believe that they have failed at treatment or that the treatment did not work for them when, in fact, it was not given for an adequate length of time or was administered incorrectly. Sometimes people must try several different treatments or combinations before they find the one that works for them.
Medications
Medication will not cure anxiety disorders, but it can keep them under control while the person receives psychotherapy, often from a psychologist. The principal medications used to treat anxiety disorders are antidepressants, anti-anxiety drugs and beta-blockers which control some of the physical symptoms.
With proper treatment, many people with anxiety disorders can lead normal, fulfilling lives.
Antidepressants
Antidepressants were developed to treat depression but are also effective for anxiety disorders. Although these medications begin to alter brain chemistry after the very first dose, their full effect requires about 4 to 6 weeks before symptoms start to fade. It is important to continue taking these medications long enough to let them work.
SSRIs
Some of the newest antidepressants are called selective serotonin reuptake inhibitors, or SSRIs. SSRIs alter the levels of the neurotransmitter serotonin in the brain, which, like other neurotransmitters, helps brain cells communicate with one another.
Fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil) and citalopram (Celexa) are some of the SSRIs commonly prescribed for panic disorder, OCD, PTSD, and social phobia. These drugs are also used to treat panic disorder when it occurs in combination with OCD, social phobia or depression.
Venlafaxine (Effexor), a drug closely related to the SSRIs, is also used to treat GAD. These medications are started at low doses and gradually increased until they cause side effects or produce a beneficial effect.
SSRIs have fewer side effects than older antidepressants, but they sometimes produce slight nausea or jitters when people first start to take them. These symptoms fade with time, however.
Some people also experience sexual dysfunction with SSRIs, which may be helped by adjusting the dosage or switching to another medication.
Tricyclics
Tricyclics are older than SSRIs and work as well as SSRIs for anxiety disorders other than OCD. They are also started at low doses that are gradually increased.
They sometimes cause dizziness, drowsiness, dry mouth and weight gain, which can usually be corrected by changing the dosage or switching to another medication.
Tricyclics include imipramine (Tofranil), which is prescribed for panic disorder and GAD and clomipramine (Anafranil), which is the only tricyclic antidepressant useful for treating OCD.
MAOIs
Monoamine oxidase inhibitors (MAOIs) are the oldest class of antidepressant medications and the ones most commonly prescribed for anxiety are phenelzine (Nardil), followed by tranylcypromine (Parnate) and isocarboxazid (Marplan), which are useful in treating panic disorder and social phobia.
People who take MAOIs cannot eat a variety of foods and beverages (including cheese and red wine) that contain tyramine or take certain medications, including some types of birth control pills, pain relievers (such as Advil, Motrin and Tylenol, cold and allergy medications and herbal supplements; these substances can interact with MAOIs to cause dangerous increases in blood pressure.
MAOIs can also react with SSRIs to produce a serious condition called serotonin syndrome, which can cause confusion, hallucinations, increased sweating, muscle stiffness, seizures, changes in blood pressure or heart rhythm and other potentially life-threatening conditions.
Anti-Anxiety Drugs
High-potency benzodiazepines combat anxiety and have few side effects other than drowsiness. Because people can develop a tolerance to them and may need higher and higher doses to get the same effect, benzodiazepines are generally prescribed for short periods of time, especially for people who have abused drugs or alcohol or who become dependent on medication easily.
One exception to this rule, however, is people with panic disorder, who can take benzodiazepines for up to a year without harm. Clonazepam (Klonopin) is used for social phobia and GAD, lorazepam (Ativan) is helpful for panic disorder and alprazolam (Xanax) is useful for both panic disorder and GAD.
Some people experience withdrawal symptoms if they stop taking benzodiazepines abruptly instead of tapering off, and anxiety can return once the medication is stopped. These potential problems have led some physicians to shy away from using these drugs or to use them in inadequate doses.
Buspirone (Buspar), an azapirone, is a newer anti-anxiety medication used to treat GAD. Possible side effects include dizziness, headaches, and nausea. Unlike benzodiazepines, buspirone must be taken consistently for at least 2 weeks to achieve an anti-anxiety effect.
Psychotherapy
Psychotherapy involves talking with a trained mental health professional, such as a psychologist, social worker, or counselor, to discover what caused an anxiety disorder and how to deal with its symptoms.
Cognitive-Behavioral Therapy
Cognitive-Behavioral Therapy (CBT) is very useful in treating anxiety disorders. The cognitive part helps people change the thinking patterns that support their fears and the behavioral part helps people change the way they react to anxiety-provoking situations.
For example, CBT can help people with panic disorder learn that their panic attacks are not really heart attacks and help people with social phobia learn how to overcome the belief that others are always watching and judging them. When people are ready to confront their fears, they are shown how to use exposure techniques to desensitize themselves to situations that trigger their anxieties.
People with OCD who fear dirt and germs are encouraged to get their hands dirty and wait increasing amounts of time before washing them. The therapist helps the person cope with the anxiety that waiting produces; after the exercise has been repeated a number of times, the anxiety diminishes.
People with social phobia may be encouraged to spend time in feared social situations without giving in to the temptation to flee and to make small social blunders and observe how people respond to them. Since the response is usually far less harsh than the person fears, these anxieties are lessened.
People with PTSD may be supported through recalling their traumatic event in a safe situation, which helps reduce the fear it produces. CBT therapists also teach deep breathing and other types of exercises to relieve anxiety and encourage relaxation.
Exposure-based behavioral therapy has been used for many years to treat specific phobias. The person gradually encounters the object or situation that is feared, perhaps at first only through pictures or tapes, then later face-to-face.
Group therapy is particularly effective for social phobia. Often homework is assigned for participants to complete between sessions.
There is some evidence that the benefits of CBT last longer than those of medication for people with panic disorder, and the same may be true for OCD, PTSD, and social phobia. If a disorder recurs at a later date, the same therapy can be used to treat it successfully a second time.
Medication can be combined with psychotherapy for specific anxiety disorders, and this is the best treatment approach for many people.
Taking Medications
Before taking medication for an anxiety disorder:
1. Ask your doctor to tell you about the effects and side effects of the drug.
2. Tell your doctor about any alternative therapies or over-the-counter medications you are using.
3. Ask your doctor when and how the medication should be stopped. Some drugs cannot be stopped abruptly but must be tapered off slowly under a doctors supervision.
4. Work with your doctor to determine which medication is right for you and what dosage is best.
5. Be aware that some medications are effective only if they are taken regularly and that symptoms may recur if the medication is stopped.
How to Get Help for Anxiety Disorders
If you think you have an anxiety disorder, the first person you should see is a psychologist, psychiatrist or your family doctor. It must be determined whether the symptoms that alarm you are due to an anxiety disorder, another medical condition or both.
If an anxiety disorder is diagnosed, the next step is usually contracting with a mental health professional to provide treatment. The practitioners who are most helpful with anxiety disorders are psychologists and therapists who have training in cognitive-behavioral therapy and/or behavioral therapy and who are open to using medication if it is needed.
You should feel comfortable talking with the mental health professional you choose. If you do not, you should seek help elsewhere.
Once you find a mental health professional with whom you are comfortable, the two of you should work as a team and make a plan to treat your anxiety disorder.
Remember that once you start on medication, it is important not to stop taking it abruptly.
Certain drugs must be tapered off under the supervision of a doctor or bad reactions can occur. Make sure you talk to the doctor who prescribed your medication before you stop taking it.
If you are having trouble with side effects, it is possible that they can be eliminated by adjusting how much medication you take and when you take it.
Most insurance plans, including health maintenance organizations (HMOs), will cover treatment for anxiety disorders. Check with your insurance company and find out.
If you do not have insurance, the Health and Human Services division of your county government may offer mental health care at a public mental health center that charges people according to how much they are able to pay. If you are on public assistance, you may be able to get care through your state Medicaid plan.
Ways to Make Treatment More Effective
Many people with anxiety disorders benefit from joining a self-help or support group and sharing their problems and achievements with others. Internet chat rooms can also be useful in this regard, but any advice received over the Internet should be used with caution, as Internet acquaintances have usually never seen each other and false identities are common.
Talking with a trusted friend or member of the clergy can also provide support, but it is not a substitute for care from a psychologist or other mental health professional. Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of their therapy.
There is preliminary evidence that aerobic exercise may have a calming effect. Since caffeine, certain illicit drugs and even some over-the-counter cold medications can aggravate anxiety disorders, they should be avoided.
Check with your physician or pharmacist before taking any additional medications. Also, the family is very important in ones recovery. Ideally, the family should be supportive and should not trivialize the disorder or demand improvement without treatment.

What is an Anxiety Disorder?

“Anxiety disorder” is a term that covers many different types of nervous conditions that cause anxiousness, feelings of fear or other unwanted, counterproductive or irrational feelings. These feelings of anxiety can be due to a particular phobia, to a particular event or happening earlier in life, or may be due to pathological (medical) uneasiness. There may be no warning of the onset of your anxiety disorders. They can be sudden, or develop gradually over many years and such events are likely to cause profound disturbance of the sufferer’s normal daily routine. In the 21st Century, the occurrence of anxiety disorders is assuming alarming proportions. They afflict more than forty million American adults. Many adolescents, and even children, also develop these disorders. Most patients are seriously affected, with the disorder(s) affecting them for several months, or even years. You may suffer frequent bouts of fear, concern, or apprehension of some worrying event.

Why Do People Get Anxiety Disorders?

Many factors may contribute to the occurrence of anxiety disorders. There is not just one cause for all anxiety disorders. They may occur as the result of a combination of many different factors.

Those factors may include:

Childhood events: Disturbing and traumatic events in childhood, such as child abuse, loss of parents, separation from family, accident or illness, can leave a lasting effect on the mind. Even having been bullied, embarrassed, or made fun of at school can produce lasting anxieties that manifest into a serious anxiety disorder later in life.

Genetic: Parents with anxiety disorder can pass it on to, or cause their children to be more likely to suffer from this type of condition, because of genetic factors or the environment that they provide in the family home.

Stress and Trauma: Stressful, traumatic events can contribute to anxiety disorders. Domestic violence, rape (or other forms of sexual molestation), physical assault, death of a family member or loss due to natural disasters like floods or earthquakes, leaves a person feeling helpless. This feeling of powerlessness leads to fear and resultant anxiousness.

Substance abuse: Alcoholism and drug addiction may contribute to anxiety disorders in some people. And, not surprisingly, most alcoholics and drug addicts had some sort of disorder before they became addicted. The addictive substance was a coping mechanism for a time against the anxious, out of control feelings.

Medical ailments: Certain disorders, like eating or sleeping disorders, depression and other nervous ailments, may contribute to more anxiety disorders, and possible medical problems. These disorders do not allow the body to function normally. Without proper sleep or nutrition, anyone is likely to become very anxious.

Personality: Whether a person is born with low self-esteem or develops it in later life, they are likely to become anxious.

Social and Economic Issues: Believe it or not, the rich are not immune to anxiety, peer pressure and stress. Life is stressful at all levels of human society. Being poor gives you may put more pressure on you – just to survive and try to improve your situation for yourself and your family.

Brain abnormalities: Medications prescribed to alleviate symptoms of some ailments can sometimes affect the chemical balance in the brain and cause an anxiety disorder. Allergic reactions to certain medicines might also lead to an anxiety disorder.

Treatments

There are innumerable therapies and treatments available for anxiety disorders. Certain drugs may help to provide some relief or even the possibility of a complete cure in some cases. Some patients have had good results when the advice of their personal medical doctor was combined with various cognitive therapies (forms of psychotherapy that are based on the belief that the way we think may have a positive or negative effect on they way we feel and deal with our life experiences.) You can become a stronger and more effective person by developing an optimistic attitude and learning to accept the tragedies of life. Additional knowledge can be gathered from many different sources, like the Internet, books, magazines and journals. Increasing your knowledge about your condition can be a very important factor in keeping most anxiety disorders at bay.

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Panic attacks feel a lot like heart attacks. A panic attack might cause your heart to race, and it might cause you to become short of breath. You might find that you feel dizzy or light headed, and they are characterized with the feeling of life or death importance. It is not uncommon to believe that you are dying or about to die when you are having a panic attack. Fortunately for sufferers, they are usually not of a long duration, and will stop when they have run their course, usually a few minutes, or when the cause of the panic is removed.

If you are terrified that you might have another panic attack, you may just end up cutting yourself off from everything in order to avoid having another. You might hide from the world, or otherwise separate yourself from the friends and family who might otherwise be able to help you. If this sounds familiar to you, then you need to consider seeking professional help to empower you to dispel the threat of panic attacks that hangs over your head.

You may also be able to help yourself by avoiding the situations that cause you to have your panic attacks in the first place. One of the biggest causes of panic attacks is stress, and if you are constantly in stressful situation, then you will be at a much higher risk for panic attacks in the future. This stress is not necessarily the stress that comes over a few days over a particular event; panic attacks are triggered by constant stress over a period of months or sometimes even longer. This stress is often too much for people to bear, and even if we do not realize that, our bodies do, and they rebel.

Panic attacks can also be caused by certain situations. If you get a panic attack every time you are running late, or stuck in traffic, or going over a bridge, then you need to make sure to avoid those situations to prevent these same events from triggering more panic attacks in the future. You can take a different route to work, leave early, and avoid roads that you know will be snarled with traffic or even head to a local place for dinner after work before facing the drive home.

If you practice avoiding panic attacks and chart where you were, what you were doing, and how you felt immediately prior to each panic attack, then you can use this information to avoid the things that trigger you. You may be able to save yourself a lot of trouble with your mental and even your physical health later down the road.

Panic attacks do not just feel remarkably like heart attacks; recent studies have linked experiencing panic attacks with an increased likelihood of actually having a heart attack later. Keep your odds low and keep your stress levels down to avoid panic attacks and to remain as healthy as possible. No one likes to suffer, and panic attacks certainly fall into the category of suffering.

If you are at risk for panic attacks or you have had them in the past, then you should examine the past causes of your panic attacks so that you can help yourself to avoid similar situations in the future. You should also get in contact with your doctor to find out if you may need medication or therapy to help you take charge of your life and get away from the panic attacks. It can be difficult to determine exactly the best means of preventing panic attacks, but you may get better results when pairing the practice of avoiding triggers with medication to help you feel calmer. A therapist can also help you learn mental tricks to help you ride through the panic attacks without completely losing your cool the next time you feel one coming on.

This article was presented by Panic Defence, the UK’s leading name in combating panic and anxiety. If you would like a free download with easy and effective tips to end panic, visit www.panichandbook.com now.