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- What are anxiety disorders?
- Symptoms of anxiety disorders
- Causes of anxiety disorders
- Prevention of anxiety disorders
- Risk factors for anxiety disorders
- Complications of anxiety disorders
- When to see a doctor about an anxiety disorder
- Diagnosis of anxiety disorders
- Conventional treatment of anxiety disorders
- Alternative/complementary treatment
- Living with an anxiety disorders
- Caring for someone with an anxiety disorder
Conventional treatment of anxiety disorders
Conventional treatment uses a combination of a number of different types of therapy (including psychotherapy and medication):
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is a form of psychotherapy, which teaches the person with the anxiety disorder to re-train their thoughts and behaviour when they face a situation that brings out their intense anxiety symptoms and fears.
CBT often lasts about 12 weeks and it may be conducted individually or with a group of people who have similar problems. Group therapy is particularly effective for social phobia.
A combination of cognitive therapy and medications is usually the approach that is often used very successfully for people with anxiety disorders as it combines both treatments together.
Mindfulness acceptance
This therapy is a relatively new one, which is beginning to gain popularity with conventional medicine and alternative medicine alike.
Mindfulness acceptance therapy is about being present in the moment and relishing it for what it is without stressing about the past or worrying about the future. Mindfulness is about allowing yourself to experience a situation and to observe how it makes you feel without judgement, without worry and without stress. It is one way to help accept yourself and be less anxious.
General guidelines for mindfulness acceptance therapy are:
- Try to be kind to yourself and view yourself with compassion. Let go of any pre-conceived notions and approach this with an open mind. Don't be too hard on yourself
- Try to direct your full awareness or attention to one aspect of the present
- Observe and describe the present moment. Try to see it for what it is, but do not evaluate or analyse it. Allow your senses to take in the reality of the situation and your internal processes
- Try not to judge yourself for whatever you are thinking, feeling or experiencing. If you start to judge yourself (should, should not, good, bad, nice, annoying) just move your mind back to just experiencing the situation and observing and describing it to yourself
- Observe your experience (your thoughts, emotions and physical sensations) without necessarily reacting to it it
Adapted from University of Melbourne's mindfulness program guidelines.
Kabat- Zinn (1998), a pioneer of mindfulness based therapeutic approaches in the West, describes mindfulness as “paying attention, without judgement, to the experience of the present moment”.
Systematic de-sensitisation
This is a technique that tries to break the link between the stimulus that causes the anxiety and the anxiety response. This technique requires the patient to gradually confront the object of fear. There are three main objectives in the process of this technique:
- A list of anxiety producing situation in order of worst to least fearful
- The de-sensistisation procedure for each item on the list (above) starting from the least anxiety-producing item to the most
- Relaxation training strategy
Systematic de-sensitisation is especially useful for treating people with simple phobias, social phobias, agoraphobia and post-traumatic stress syndrome.
Meditation
Studies show that any type of meditation is beneficial for reducing anxiety symptoms. Meditation induces a more relaxed state of mind, which helps people with anxiety disorders to reduce the amount of fear, anxiousness and negative internal chatter to relax and feel calmer. One caution should be noted: meditation may not be so beneficial for some people with any type of psychosis as the meditation may trigger their psychosis.
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Medication
There are a number of different types of medications that are used to treat anxiety disorders. Most medications will take anywhere from 2-12 weeks to start working and reach maximum effectiveness (this is also how long side effects should also take to be present):
- Atypical anti-psychotics - these medications are used to treat anxiety disorders which have associated psychoses, in which the person suffers hallucinations, delusion or just very confused thinking. Some research shows that atypical anti-psychotic medications may have a place in treating very severe anxiety. The new class of these drugs work on normalising the two neurotransmitters in the brain, serotonin and dopamine and have less side effects than the older class of atypical anti-psychotic medications and have been shown to be able to treat a number of anxiety disorders. Sometimes the atypical anti-psychotics are used in combination with SSRIs, at very low dosage. Most commonly atypical anti-psychotics are used to treat severe cases of post-traumatic stress disorder and also to treat some cases of obsessive-compulsive disorder. Some recent research also suggests that these drugs may be useful in treating people with other anxiety disorders, such as generalised anxiety disorder, agoraphobia and panic disorder which have not responded well to other treatments, or are severe. The atypical anti-psychotic medications have a number of side effects, which should be closely monitored (weight gain, reduce sex drive, muscle stiffness and restlessness). Examples of atypical anti-psychotics are: Risperidone (Risperdal®), Olanzapine (Zyprexa®), Quetiapine (Seroquel®)
- Benzodiazepines - these are an anti-anxiety medication, which also have a mild tranquilising effect. Benzodiazepines quickly reduce anxiety within 15-20 minutes of taking them and can be used only when required (they do not need to be taken every day). Benzodiazepines are prescribed at a low and regular dose, but only for a short period (as they can be addictive). This class of drugs have relatively few side effects (compared with some other types of medications), but if taken long term, they can become addictive. People who become addicted to benzodiazepines become dependent on them just to feel normal and without taking this drug, they often feel worse than they did prior to starting to take it. Examples of benzodiazepines: Lorazepan (Ativan®), Chlordiazepoxide (Librium®), Oxazepam (Oxazepam®), Diazepam (Valium®), Alprazolam (Xanax®),
- Beta blockers - these class of medication are used to lower blood pressure in people with anxiety disorders whose blood pressure may be raised higher than normal. Beta blockers work to reduce the effects of noradrenaline and norepinephrine, which may be raised higher than normal in people with anxiety disorders. Beta blockers may be used to reduce the symptoms associated with anxiety disorders, such as shaking, trembling, fast heartbeat, blushing. Beta blockers are primarily used to treat specific phobias such as social anxiety and performance anxiety. Examples of beta blockers are: Propranolol hydrochloride (Inderal®), Atenolol (Tenormin®)
- Monoamine oxidase inhibitors (MAOI) - these are the oldest class of anti-depressant medications and they should not be taken in combination with any type of SSRI drugs or St John's Wort as the combination can produce serious (and fatal) side effects. MAOIs can produce serious side effects and their use must be strictly monitored to prevent this from occurring. People are often prescribed MAOIs when other types of anti-depressants have not worked to reduce symptoms. MAOI are the least often prescribed anti-depressants as they have such a large range of side effects and a restrictive diet needs to be followed when taking them. Examples of MAOIs are: Phenelzine (Nardil®), Tranylcypromine (Parnate®), Isocarboxazid (Marplan®),
People taking MAOIs should avoid the following food (to reduce possible adverse effects):- Alcohol
- Avocados
- Broad beans
- Cheese (any type)
- Fermented soy extract
- Salami
- Meat or yeast extract
- Pickled herring
- Food that is stale or going off, especially meat, fish, offal, poultry or game
- Mood stabilisers - these medications are normally prescribed for people with bipolar disorder, but when standard treatments for anxiety disorders do not work (other medications), doctors can prescribe these to try to help reduce symptoms. Examples of mood stabilisers are: Valproate (Epilim®), Valproate Semisodium (Depakote®), Carbamazepine (Tegretrol®)
- Selective serotonin re-uptake inhibitors (SSRI) - these are a newer class of anti-depressant medications which alter the levels of serotonin in the brain (they increase the levels of serotonin to control mood) and to reduce anxiety symptoms. SSRIs were a recent anti-depressant medication development, only available from around 30 years ago. SSRIs are prescribed to help people who have the following anxiety disorders: agoraphobia, generalised anxiety disorder, obsessive-compulsive disorder, panic attacks, panic disorder, post-traumatic stress disorder, social phobias. These drugs can also produce side effects but these are usually milder in comparison to older antidepressants (MAOI) and side effects normally decrease after some time, for most people. Examples of SSRIs are: Citalopram (Cipramil®), Fluvoxamine (Faverin®), Paroxetine (Seroxat®), Fluoxetine (Prozac®), Sertraline (Lustral®).
SSRI should not be taken in combination with St John's Wort, other anti-depressants, MAOI as they can cause a fatal reaction - Tranquilisers - there are other classes of tranquilisers that can be prescribed (which are different to benzodiazepines) that can reduce anxiety symptoms very quickly. Some of these different types of tranquilisers may also have fever side effects than benzodiazepines. These tranquilisers are best when used over a short-term, should not be used with MAOIs and should not be used with alcohol. Examples of other tranquilisers are: Buspirone (Buspar®), Hydroxyzine
- Tricyclics - these are an older type of anti-depressant medication which work as well as SSRIs for anxiety disorders, but they are not used for obsessive-compulsive disorder (OCD). Tricyclics help to increase levels of serotonin and norepinephrine which help to reduce anxiety symptoms. These drugs have some side effects which can usually be reduced by lowering the dose or changing to another type of tricyclic medication, but even despite this, a great number of people abandon this medication due to the side effects that they produce. Examples of tricyclics: Amitriptyline (Triptafen®), Clomipramine (Anafranil®), Dosulepin/Dothiepin (Prothiaden®), Doxepin (Sinequan®), Imipramine (Tofranil®), Nortriptyline (Motival®)
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