In recent years,
various pharmaceuticals such as anti-depressants and tranquilizers have been utilized to treat a wide range of anxiety disorders. This trend, while often immediately beneficial to the patient, has publicly overshadowed the therapeutic treatments
which are arguably the most effective in the long run.
According to
the National Institute of Mental Health (NIMH), each year roughly nineteen million adults within the United States experience
anxiety disorders—which include obsessive-compulsive disorder (OCD), panic disorder (PD), post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), social anxiety disorder/social phobia, and specific phobias, such as fear of the
outdoors (agoraphobia) or confined spaces (claustrophobia), among many others (http://www.nimh.nih.gov/publicat/anxiety.cfm).
Although prescription medications are the fastest method of treating
anxiety disorders, they can have numerous side effects and consequences. Patients can easily become dependent on tranquilizers
and sedatives, such as the benzodiazepines Atavin and Xanax, because of the (usually quite welcome, for anxiety sufferers)
sense of calm they produce. Anti-depressants like Prozac and Zoloft, while not habit-forming, may cause a variety of physical
side effects such as weight gain, insomnia, upset stomach, and diminished sexual appetite. These drugs can, when taken
correctly, help sufferers of anxiety disorders to feel better—but most experts agree that for long-term improvement,
patients should combine use of pharmaceuticals with psychotherapy.
Two
common forms of psychotherapy utilized for treatment of anxiety disorders are behavioral and cognitive therapy: in cognitive
therapy, the therapist helps the patient to adapt his or her problematic thought patterns into those which are healthier.
For example, the therapist might help someone with panic disorder to prevent panic attacks—and make those that do
occur less intense—by teaching him or her how to mentally re-approach anxiety-inducing situations. In behavioral therapy,
the therapist will help the patient to combat undesirable behaviors which often come hand in hand with anxiety; for example,
the patient will learn relaxation and deep breathing exercises to use when experiencing hyperventilation as a result of
panic attacks (American Psychological Association).
Since these methods
of treatment are such close cousins—both involving, in a sense, active re-education of the mind by the patient—therapists
often use them together, in a broader classification of treatment called cognitive-behavioral therapy (CBT). CBT is used
to treat all six forms of anxiety disorders listed above (CBT info).
The National Association of Cognitive-Behavioral Therapists (NACBT)
lists on their website several different specific forms of CBT which have developed in the past half-century or so. These
include:
Rational Emotive Therapy (RET)/Rational Emotive Behavior
Therapy
Psychologist Albert Ellis, in the 1950s, believed that
then-trendy psychoanalysis was an inefficient form of treatment because the patient was not directed to change his or her
way of thinking; he originated RET, which was later developed further by neo-Freudian psychotherapist Alfred Adler. RET
has roots in Stoic philosophy, such as in the writing of Marcus Aurelius and Epictetus; behaviorists Joseph Wolpe and Neil
Miller seem also to have influenced Albert Ellis. Ellis continued working on his therapeutic approach, and in the 1990s—nearly
forty years after first developing the treatment—he renamed it Rational Emotive Behavior Therapy, in order to make
the treatment’s moniker more accurate.
Rational Behavior
Therapy
One of Ellis’s students, physician Maxie C. Maultsby,
Jr., developed this slight variation about ten years after Ellis first developed his. Rational Behavior Therapy is distinctive
in that the therapist assigns “therapeutic homework” to the client, and places “emphasis on client rational
self-counseling skills” (http://www.nacbt.org/historyofcbt.htm). Clients are urged to take added initiative in their own recoveries, even beyond that encouraged by many other forms of
CBT.
Some other specialized forms of CBT are Schema Focused Therapy, Dialectical
Behavior Therapy, and Rational Living Therapy. Many who are acquainted with CBT know of the therapy due to Feeling Good:
The New Mood Therapy, the best-selling self-help book David Burns wrote in the 1980s (http://www.nacbt.org/historyofcbt.htm).
Finally, one form of behavioral psychotherapy which differs from CBT
is Exposure with Response Prevention; usually used to treat specific phobias, Exposure with Response Prevention involves
gradually making the patient familiar with the object or action causing anxiety—a sort of step-by-step “face
your fears” treatment. In one successful case, a man who’d had a specific phobia of insecticides (after an incident
of being poisoned himself while working in the fields of East Asia) for ten years became asymptomatic after ninety days
of nearly consecutive treatment. His treatment included exposing himself to situations in which people were working with
insecticides—sometimes the exposures were overseen by therapists, sometimes by his family members, and, eventually,
by he alone. According to the authors of the study, the patient “was able to return to work at the farm and tolerate
insecticides without much difficulty. Currently he is continuing with self-exposure sessions and maintaining well”
(Narayana, Chakrabarti, & Grover, 12).
As with almost any illness,
anxiety disorder patients must take some initiative in their treatment and recovery—whether it be by seeking help
from a physician, taking medications properly and punctually, or attending and actively engaging in therapy sessions. CBT
and other forms of psychotherapy, like Exposure with Response Prevention, are alternate forms of treatment for those who
do not wish to take anti-depressants or other pharmaceuticals (or to only take those medications), but still wish to work
towards recovery; the benefit of such therapies, which take them a step beyond pharmaceuticals, are thus: anti-depressants
and other drugs seem to act as analgesics or, at best, vitamins; however, given the potential side effects, most patients
might not wish to take them for their entire lives. With the aid of therapies—especially therapies in which they
can most actively work towards recovery—patients can make the changes which will allow them to live with less anxiety
for years to come.
References
American Psychological Association. (2004). Anxiety Disorders: The Role of
Psychotherapy in Effective Treatment.
Retrieved December 14, 2005, from http://www.apahelpcenter.org/articles/article.php?id=46.
Narayana, K. C., Chakrabarti, S., & Grover, S. (2004). Insecticide
Phobia Treated With Exposure and Response-Prevention: A Case Report. German Journal of Psychiatry, 7(2): 12-13.
