Anxiety – a feeling of worry and nervousness associated with some physical symptoms of unease – is a normal response to a situation or an object that can cause a threat, and is experienced by all of us in our day-to-day lives. The feeling you get when you are nearing an exam for which you haven’t prepared well, or when you are running out of balance to pay your bills, or when you encounter a dog that is barking at you in a threatening manner – are all part of a normal response that actually allows you to prepare well to the anticipated situation.
But what happens when this experience becomes out of proportion to the real threat, or occurs when there is no threat at all, and this causes distress and difficulty in carrying out your daily activities?
Types of Anxiety & Symptoms
Anxiety disorders can be described as a group of mental conditions characterized by an excessive and persistent sense of apprehension; associated with physical symptoms such as palpitations, sweating, nausea etc.; interfering with daily activities such as job performance, school work, and relationships. This experience of irrational anxiety is not temporary as in the case of normal anxiety, but occurs continuously or repetitively.
Common types of anxiety disorders include generalized anxiety disorder, simple phobia, social phobia, agoraphobia, and panic disorder. Those with generalized anxiety disorder experience excessive anxiety and worry over everyday situations that is out of proportion to the actual threat of the situation, associated with physical symptoms such as restlessness, fatigue, irritability, muscle tension, insomnia, nausea, vomiting etc.; and this persists for a long time (usually more than six months). Those with phobias become inappropriately anxious in the presence of a particular object or situation, or under specific social circumstances; associated with physical symptoms such as tremors, difficulty breathing, sweating etc., inducing an intense urge to avoid the particular object or the situation. People with panic disorders experience recurrent episodes of panic attacks – spontaneous occurrence of periods of intense fear -- that is also associated with symptoms such as palpitations, sweating, difficulty breathing, dizziness, and fear of impending medical emergency.
Other psychiatric conditions such as obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and depression can also be associated with anxiety disorders.
The general treatment plan for anxiety disorders includes proper assessment and arriving at the diagnosis, general measures such as psychoeducation and improving problem solving skills, providing psychotherapy, and pharmacotherapy.
Psychotherapy is the form of healing that is carried out by trained therapists based on one-to-one communication with the patient, and relies on strong interpersonal relationship between the patient and the therapist. There are hundreds of methods of psychotherapy that are based on a diverse range of techniques and targeted at varied goals; and it is evident that psychotherapy is as equal as or sometimes better than pharmacotherapy (medication) options in treating mental conditions.
The main type of psychotherapy used to treat anxiety disorders is cognitive behavioral therapy (CBT), through which the therapist recognizes maladaptive thought processes and behavioral patterns underlying the condition and makes necessary interventions to rectify the thought processes and behavioral patterns in order to bring them back to normal, through a systematic approach.
Cognitive Behavioral Therapy (CBT)
The main techniques of CBT for anxiety disorders include relaxation training, psychoeducation, graded exposure, and distraction.
The therapist will teach the patients about some techniques of relaxation during bouts of anxiety, which includes techniques of muscle-relaxation, slow breathing, and imagining restful scenes. This may be accompanied by audio-recording relaxation programs so that the patients can train themselves at home. Then the therapist will take the patients through a step-wise process of graded exposure in which each patient will be exposed in a systematic manner to the object or situation that induces anxiety, while maintaining a record regarding the thoughts and symptoms experienced during each step, and thereby identify the maladaptive thought processes and behavioral patterns underlying the condition. These will be analyzed further, and the therapist will educate the patients with logical facts that could be used to develop more realistic thoughts and thereby reduce the level of anxiety faced during each step. The patient will also be equipped with skills to modulate his behavior during each of these sessions. This process will be facilitated by learning materials such as booklets, audiotapes, or CDs. The therapist will also employ distraction techniques needed to shift the focus of attention of the patient at situations where it is needed.
All these techniques will be devised in a tailor-made fashion that suits the requirements of each individual’s condition. Each session of CBT may take between 30-60 minutes, and patients may need to participate in few sessions a week, for a period that can vary from six weeks to six months. The sessions may take place either in an individual manner, or in groups, based on the patient’s requirements. Computer-based CBT programs are also currently being developed, thereby making it a further more comfortable and easy-to-use option to the patients.
There is substantial research evidence based on several meta-analyses that CBT is one of the most effective methods to treat anxiety disorders. It is evident that CBT is a method of instructive treatment that is rationally understood by the patient, and has a short-term treatment plan (average of sixteen sessions) while providing long-term benefits to the patient by addressing the root of the problem regarding our thought processes; and hence is a definite option as a main part of the treatment of anxiety disorders. Thus, psychotherapy along with proper pharmacotherapy remains as the mainstay of treatment of anxiety disorders worldwide.