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.