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| Psychotherapy
involves talking with a trained mental health professional,
such as a psychiatrist, psychologist, social worker, or counselor
to learn how to deal with problems like anxiety disorders. |
| Cognitive-Behavioral
and Behavioral Therapy |
Research
has shown that a form of psychotherapy that is effective for
several anxiety disorders, particularly panic disorder and social
phobia, is cognitive-behavioral therapy (CBT). It has two components.
The cognitive component helps people change thinking patterns
that keep them from overcoming their fears. For example, a person
with panic disorder might be helped to see that his or her panic
attacks are not really heart attacks as previously feared; the
tendency to put the worst possible interpretation on physical
symptoms can be overcome. Similarly, a person with social phobia
might be helped to overcome the belief that others are continually
watching and harshly judging him or her.
The behavioral component of CBT seeks to change people's reactions
to anxiety-provoking situations. A key element of this component
is exposure, in which people confront the things they fear.
An example would be a treatment approach called exposure and
response prevention for people with OCD. If the person has a
fear of dirt and germs, the therapist may encourage them to
dirty their hands, then go a certain period of time without
washing.
The therapist helps the patient to cope with the resultant anxiety.
Eventually, after this exercise has been repeated a number of
times, anxiety will diminish. In another sort of exposure exercise,
a person with social phobia may be encouraged to spend time
in feared social situations without giving in to the temptation
to flee. In some cases the individual with social phobia will
be asked to deliberately make what appear to be slight social
blunders and observe other people's reactions; if they are not
as harsh as expected, the person's social anxiety may begin
to fade.
For a person with PTSD, exposure might consist of recalling
the traumatic event in detail, as if in slow motion, and in
effect re-experiencing it in a safe situation. If this is done
carefully, with support from the therapist, it may be possible
to defuse the anxiety associated with the memories. Another
behavioral technique is to teach the patient deep breathing
as an aid to relaxation and anxiety management.
Behavioral therapy alone, without a strong cognitive component,
has long been used effectively to treat specific phobias. Here
also, therapy involves exposure. The person is gradually exposed
to the object or situation that is feared. At first, the exposure
may be only through pictures or audiotapes. Later, if possible,
the person actually confronts the feared object or situation.
Often the therapist will accompany him or her to provide support
and guidance.
If you undergo CBT or behavioral therapy, exposure will be carried
out only when you are ready; it will be done gradually and only
with your permission. You will work with the therapist to determine
how much you can handle and at what pace you can proceed. A
major aim of CBT and behavioral therapy is to reduce anxiety
by eliminating beliefs or behaviors that help to maintain the
anxiety disorder. For example, avoidance of a feared object
or situation prevents a person from learning that it is harmless.
Similarly, performance of compulsive rituals in OCD gives some
relief from anxiety and prevents the person from testing rational
thoughts about danger, contamination, etc.
To be effective, CBT or behavioral therapy must be directed
at the person's specific anxieties. An approach that is effective
for a person with a specific phobia about dogs is not going
to help a person with OCD who has intrusive thoughts of harming
loved ones. Even for a single disorder, such as OCD, it is necessary
to tailor the therapy to the person's particular concerns. CBT
and behavioral therapy have no adverse side effects other than
the temporary discomfort of increased anxiety, but the therapist
must be well trained in the techniques of the treatment in order
for it to work as desired. During treatment, the therapist probably
will assign "homework"-specific problems that the
patient will need to work on between sessions.
CBT or behavioral therapy generally lasts about 12 weeks. It
may be conducted in a group, provided the people in the group
have sufficiently similar problems. Group therapy is particularly
effective for people with social phobia. There is some evidence
that, after treatment is terminated, the beneficial effects
of CBT last longer than those of medications for people with
panic disorder; the same may be true for OCD, PTSD, and social
phobia. Medication may be combined with psychotherapy, and for
many people this is the best approach to treatment. As stated
earlier, it is important to give any treatment a fair trial.
And if one approach doesn't work, the odds are that another
one will, so don't give up.
If you have recovered from an anxiety disorder, and at a later
date it recurs, don't consider yourself a "treatment failure."
Recurrences can be treated effectively, just like an initial
episode. In fact, the skills you learned in dealing with the
initial episode can be helpful in coping with a setback.
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