Effective Therapy For Severe Anxiety Disorders
Severe anxiety disorders have never been more treatable. Physicians are routinely prescribing several anti-depressant medications that can make it easier for phobics, panic-disordered clients, and obsessive-compulsives to overcome disorders that had drastically restricted their lives for years. Cognitive behavior therapists are also finding more success than ever in working with these problems, as they refine a variety of useful methods.
These more effective treatments are arising from our increasing understanding of the origins of anxiety disorders. While we have always perceived anxious clients as emotionally or interpersonally over-sensitive, we are now realizing that some of those with panic and obsessive-compulsive disorders may be physiologically over-sensitive. They seem to have neurotransmitter system imbalances that predispose them to react to stress in an extreme manner. Anti-depressant medications may act to correct these imbalances.
We are also understanding more about how children may learn to play roles in their families that lead to anxiety disorders in their adult years. Overprotected children come to see themselves as fragile. They won't feel confident of their ability to handle intense emotion or anxiety, and may fear that a psychotic break, a heart attack, or a fainting spell will result from having these feelings. In dysfunctional families with alcoholic, physically ill, or emotionally unstable parents, children will understandably worry a great deal about their safety, but will try to avoid showing this anxiety for fear of further alienating their caretakers. This style of hiding your anxiety can produce a panic disorder in which you fear and avoid any situation that might lead you to be noticed as anxious. Compulsive washers may have been raised in shame-inducing families that left them feeling dirty, and compulsive checkers can sometimes recall growing up with a fear of making mistakes.
Seen from a broader perspective, anxiety disorders tell us that our traditional stereotypical gender roles can be unhealthy. The housebound agoraphobic woman can be understood as on strike, remaining safe at home (a woman's place), while refusing to venture out into the man's world outside. Panic-prone men often fear showing any emotion or sign of anxiety that would not fit with the traditional strong and silent male role.
While behavior therapy has achieved a reputation for effectiveness in treating anxiety disorders, most practical therapists have learned to combine behavioral techniques with other approaches. Systematic desensitization, the standard behavioral treatment for phobias, involves applying relaxation skills to feared situations. The client learns to relax, and then tries to maintain a relaxed state while imagining anxiety-provoking situations. Influenced by hypnosis, many therapists are finding that images of competence or of being loved by kind caretakers may be more effective than a relaxed state in countering anxiety for some phobics.
Another effective imagery technique is imaginal exposure, in which anxious clients are guided to vividly face intense feelings or situations that have triggered their fear of losing control. An obsessive-compulsive might be led through a prolonged session imagining being harshly criticized for making a mistake. Surviving this type of session can lead clients to gain comfort with feelings (such as anger) that they have feared. Adding elements of gestalt therapy and psychodrama, an imaginal exposure session can flow naturally into an opportunity for anxious clients to express long-denied or avoided emotions.
To be completely successful, any treatment of an anxiety disorder must include in vivo exposure. Agoraphobics who have feared highway driving must drive previously avoided roads before they'll feel sure that they have overcome their problem. For the obsessive-compulsive who has had to shower for hours before feeling clean enough to go out, treatment must include brief showers followed by normal socializing and activity. Therapists have discovered that in vivo behavioral techniques may lead previously "resistant" clients to develop greater insight into the psychological roots of their problems. An example is the agoraphobic client who after being pushed to drive outside her neighborhood for the first time in years, can sit in the car and clearly recall how she learned in childhood to stay home and protect her mother from an abusive father.
Clients presenting severe anxiety disorders have often lived restricted lives for years before coming to a therapist. While behavioral or experiential techniques may dislodge the phobia or compulsive habit relatively quickly, the client may still be left with lingering problems such as depression or the need for families to reorganize to fit the client's new competence. These problems can require a great deal of patience and time for therapist and client.
These more effective treatments are arising from our increasing understanding of the origins of anxiety disorders. While we have always perceived anxious clients as emotionally or interpersonally over-sensitive, we are now realizing that some of those with panic and obsessive-compulsive disorders may be physiologically over-sensitive. They seem to have neurotransmitter system imbalances that predispose them to react to stress in an extreme manner. Anti-depressant medications may act to correct these imbalances.
We are also understanding more about how children may learn to play roles in their families that lead to anxiety disorders in their adult years. Overprotected children come to see themselves as fragile. They won't feel confident of their ability to handle intense emotion or anxiety, and may fear that a psychotic break, a heart attack, or a fainting spell will result from having these feelings. In dysfunctional families with alcoholic, physically ill, or emotionally unstable parents, children will understandably worry a great deal about their safety, but will try to avoid showing this anxiety for fear of further alienating their caretakers. This style of hiding your anxiety can produce a panic disorder in which you fear and avoid any situation that might lead you to be noticed as anxious. Compulsive washers may have been raised in shame-inducing families that left them feeling dirty, and compulsive checkers can sometimes recall growing up with a fear of making mistakes.
Seen from a broader perspective, anxiety disorders tell us that our traditional stereotypical gender roles can be unhealthy. The housebound agoraphobic woman can be understood as on strike, remaining safe at home (a woman's place), while refusing to venture out into the man's world outside. Panic-prone men often fear showing any emotion or sign of anxiety that would not fit with the traditional strong and silent male role.
While behavior therapy has achieved a reputation for effectiveness in treating anxiety disorders, most practical therapists have learned to combine behavioral techniques with other approaches. Systematic desensitization, the standard behavioral treatment for phobias, involves applying relaxation skills to feared situations. The client learns to relax, and then tries to maintain a relaxed state while imagining anxiety-provoking situations. Influenced by hypnosis, many therapists are finding that images of competence or of being loved by kind caretakers may be more effective than a relaxed state in countering anxiety for some phobics.
Another effective imagery technique is imaginal exposure, in which anxious clients are guided to vividly face intense feelings or situations that have triggered their fear of losing control. An obsessive-compulsive might be led through a prolonged session imagining being harshly criticized for making a mistake. Surviving this type of session can lead clients to gain comfort with feelings (such as anger) that they have feared. Adding elements of gestalt therapy and psychodrama, an imaginal exposure session can flow naturally into an opportunity for anxious clients to express long-denied or avoided emotions.
To be completely successful, any treatment of an anxiety disorder must include in vivo exposure. Agoraphobics who have feared highway driving must drive previously avoided roads before they'll feel sure that they have overcome their problem. For the obsessive-compulsive who has had to shower for hours before feeling clean enough to go out, treatment must include brief showers followed by normal socializing and activity. Therapists have discovered that in vivo behavioral techniques may lead previously "resistant" clients to develop greater insight into the psychological roots of their problems. An example is the agoraphobic client who after being pushed to drive outside her neighborhood for the first time in years, can sit in the car and clearly recall how she learned in childhood to stay home and protect her mother from an abusive father.
Clients presenting severe anxiety disorders have often lived restricted lives for years before coming to a therapist. While behavioral or experiential techniques may dislodge the phobia or compulsive habit relatively quickly, the client may still be left with lingering problems such as depression or the need for families to reorganize to fit the client's new competence. These problems can require a great deal of patience and time for therapist and client.