Anxiety Help: Psychological Treatments VPL Veritas Programming. Psychological Treatments for Anxiety Disorders Phobias ... Panic Attacks ... Obsessions and Compulsions ... Chronic Worrying Because most anxiety disorders do not respond quickly to psychological therapies that focus on a person's emotional past, they are generally thought of as difficult to overcome. For the most part, this reputation is not deserved. Psychological therapies that desensitize a person to feared situations or that teach a person how to recognize and cope with anxious thoughts and feelings have proven effective against most anxiety disorders. Many people find that their anxiety symptoms are significantly eased without extensive talk therapy. However, unlike the other anxiety disorders, post-traumatic stress disorder typically does require treatment focusing on a person's emotional past. This is not to say that therapies that simply desensitize a person or that teach a person how to defuse anxious thoughts have no place in the treatment of post-traumatic stress disorder. They do. In fact, they usually are important parts of such therapy. Learning to quell intense anxiety generally makes people with post-traumatic stress disorder better able to handle talking with their therapists about trauma in their pasts. Note: This booklet does not cover post-traumatic therapy in detail. Veritas Programming's UNSPEAKABLE TRUTHS AND HAPPY ENDINGS: HUMAN CRUELTY AND THE NEW TRAUMA THERAPY does. . BEHAVIOR THERAPY Behavior therapies help people modify their behavior. Whatever benefits accrue -- one example would be an overall easing of anxiety; another could be a new way of interpreting formerly anxiety-provoking situations -- are understood to be a direct or indirect result of the behavior modification. Today, the most commonly practiced behavior therapies are EXPOSURE THERAPY and RELAXATION TRAINING. In EXPOSURE THERAPY the person is exposed to the feared situations or objects until he becomes desensitized to them. The exposure can either be real -- that is, the therapist can actually take the person into the feared situation -- or imaginary. The kind of exposure therapy in which the therapist has the person simply imagine the feared situation is called "imaginal desensitization" or "imagery work." Because being actually exposed to the feared situation or object at least initially makes people very anxious, many exposure therapists also teach people simple ways to help them diminish their anxiety. Deep breathing and focusing thoughts away from the fear are examples of anxiety-reducing techniques. Many exposure therapists also use some techniques of cognitive therapy and relaxation training (see below). Exposure therapy is particularly effective in treating phobias and in treating obsessive compulsive disorder. For people with OCD, exposure therapy is most useful in treating those for whom obsessive thoughts provoke compulsive rituals; it is less useful in treating those who simply suffer obsessive or intrusive thoughts. When treating OCD an exposure therapist exposes the person to situations that provoke the obsessive thoughts. Prior to the exposure, the person agrees not to perform the compulsive ritual that typically relieves some of the anxiety. Eventually the person learns that the anxious thoughts and feelings disappear even without the rituals. Studies are indicating that exposure therapy can also be effective against panic disorder and, to a somewhat lesser extent, against post-traumatic stress disorder. RELAXATION TRAINING is another form of behavior therapy. One of the symptoms of having extreme anxiety is increased muscular tension, which itself results in shakiness and fatigue from the subtle but constant muscular exertion. Relaxation training involves becoming aware of the physical sensations of both muscular tension and muscular relaxation. It gives people some relief from symptoms. But because relaxation training requires that people monitor their own muscular tension, it has an additional benefit. Relaxation training quite effectively teaches people how to quickly recognize the physical cues that tell them they are becoming anxious. Consequently, they become skilled at identifying the situations and the thoughts and images that make them anxious. It is not surprising, then, that relaxation training works well in combination with cognitive therapy (see below) and imagery work. Experiments conducted at several centers have shown relaxation training to be effective against generalized anxiety disorder. COGNITIVE THERAPY The theory behind COGNITIVE THERAPY is that highly anxious people have cognitive habits that may be hidden to them but that are causing their pathological anxiety. An example would be an anxious person who constantly assumes that the worst is about to happen. This basic assumption can become so pervasive that it is accepted as normal by the person and not easily identified as the source of anxiety. In cognitive therapy, this person would be shown that constantly assuming that the worst is about to happen is unrealistic, unnecessary, and self-defeating. But more than just instilling their clients with a simplistic, "Pollyanna" approach to life, cognitive therapists teach them how to analyze their assumptions, how to separate realistic from unrealistic assumptions, and how to nip anxiety-provoking cognitive habits in the bud. People in the midst of an attack of extreme anxiety typically have difficulty thinking rationally. Since rational thinking is necessary for (and is, in fact, the hallmark of) cognitive therapy, people are sometimes encouraged to use simple techniques such as deep breathing and distraction to help calm themselves somewhat. Cognitive therapy has been shown to be helpful for people with phobias and generalized anxiety disorder. There is also evidence to indicate that cognitive therapy can be effective against panic disorder. Even if the person with panic disorder cannot identify a feared situation that triggered the panic attack, he or she can be helped to recall the automatic thoughts and negative assumptions that accompanied the intense panic (and that, perhaps, accelerated the terror). Many cognitive therapists believe that the person can eventually be taught to recall the automatic thoughts and negative assumptions that brought on the panic attack in the first place and, hence, to abort the attack. THESE TWO BASIC therapeutic approaches -- behavior therapy and cognitive therapy -- are both problem-oriented and highly structured. (In fact, some therapists even go so far as to hand their clients an agenda at the outset of each session, clearly stating the session's goals and the means that will be used to achieve them.) Another feature shared by both approaches is that, for all the anxiety disorders except post-traumatic stress disorder, they are extremely time-limited. At the very first session, people are usually given a good idea about how many weeks or months therapy will require. These two therapies are used by many therapists throughout the country to control the most painful and obvious symptoms of the anxiety disorders. Perhaps most typically, therapists mix and match between the two. In fact, the mixing and matching has become so common that the term "cognitive-behavioral therapy" has become almost standard. Debate still rages about whether, in most people, phobias, panic attacks, obsessions and compulsions, and chronic worrying are psychologically or biologically caused. Interestingly, many therapists who champion the biological point of view advocate behavior and cognitive therapy to help people cope with and control the symptoms of anxiety disorders. And many therapists who believe that anxiety disorders are essentially psychological problems recommend the use of drug therapy for people who need quick relief from intense anxiety at the beginning of behavior or cognitive therapy. Even therapists who are strong defenders of traditional psychoanalysis sometimes advocate the use of behavior and cognitive therapy (and, yes, even drug therapy) to help people with anxiety disorders get some relief from their symptoms. As a rule, these therapists suggest that once the person has recovered from the anxiety disorder, psychotherapy focusing on the possible emotional roots of the anxiety disorder is helpful. All contents Copyright 1995-1999, Veritas Programming. All Rights Reserved.