Anxiety is an emotion and is therefore experienced in varying degrees of intensity by different people. At one end of the spectrum it is normal and helps us to function; at another it can be extremely maladaptive and result in considerable distress for the sufferer. It is duration, intensity, and frequency that separate normal, functional anxiety from abnormal, pathological anxiety. Anxiety or stress in response to events that we need to react to is normal. However, this natural response can become a problem if it impairs your ability to live your life fully.
For example, anxiety may be problematic for you if:
- The anxiety feelings or sensation are very powerful or last a long time
- Fears or worries you are having seem disproportionate to the situation
- You change your behavior to avoid scenarios that might cause anxiety
- Worries that you experience are very distressing or difficult to manage
- Anxiety symptoms happen frequently or include overwhelming anxiety such as panic attacks
- Enjoyment of everyday life is affected
For those suffering from anxiety, medication can prove extremely helpful. Anxiety can be an insufferable condition. People often reach the point where they would do anything not to feel a constant sense of fear, agitation and anticipation. The physical side effects are draining and the intrusive thoughts and constant rumination exhausting.
However, anxiety disorders are complex problems that cannot be solved simply. Many people seek a fast and easy cure through medication but sadly there no “magic pill”. Medications need to be taken within this context. They can be beneficial in the short term and as an adjunct to psychological therapies but in themselves they are not the solution, even when very effective at temporarily removing discomfort.
Medication works at a superficial level by dampening down the physiological (or in some cases, depending on the medication, cognitive) symptoms of anxiety, but they don’t deal with the underlying emotional issue which needs to be addressed through psychological approaches.
Therefore, the recommended treatment for anxiety disorders is psychological therapy, and at present, the “gold-standard” is cognitive behavioral therapy. Whilst, people prefer a “quick-fix” in the form of a pill, it is only usually in acute cases of anxiety, in anxiety that hasn't responded to other treatments, or in severe forms that doctors prescribe medication.
Cognitive behavioral therapy (CBT)
CBT sets out to change negative patterns of behavior and address cognitive distortions in the way we view ourselves and the world around us. It has two key components:
- Cognitive therapy. This looks in depth at how negative thoughts or beliefs contribute to or reinforce anxiety. Cognitive restructuring or thought-challenging is a key component in treating anxiety and involves identifying, challenging and replacing negative thoughts that contribute to and maintain the cycle of anxiety.
- Behavioral therapy. This explores your behavior and reactions in situations that cause anxiety.
The basic notion of CBT is that our thoughts affect the way we feel and the way we behave, which in turn reinforces those thoughts and beliefs. External events do not cause us to feel a certain way but rather it is our perception of it that determines how we feel.
One of the key reinforcing behaviors in anxiety is avoidance. Human beings are pleasure-seeking and pain avoiding and it is normal to avoid unpleasant things, such as things that make you feel anxious. Exposure therapy is a behavioral approach known as classical conditioning which involves repeated contact with the thing that feeds your anxiety, and the rationale of treatment is that over time, repeated exposure to the situation reduces the associated anxiety. This is known as habituation.
Graded exposure or systematic desensitization is the approach that is usually used. It begins with learning relaxation techniques which will be employed in the anxiety-provoking scenario. Then the person will immerse themselves in situations that provoke fear and employ the relaxation to effectively reframe the situation and leave it not feeling anxious. Each situation will be increasing degrees of anxiety and the person will work through them stage-by-stage until they are able to confront their ultimate fear and “extinguish” it. The idea is that the fear can be unlearned by effectively separating the associated stimulus and response.
Acceptance and commitment therapy
Acceptance and commitment therapy (ACT) posits that the meaning and significance we give to thoughts reinforces emotional distress. It is very similar to cognitive-behavioral therapy (CBT) as it draws heavily on the basis of CBT, but it is different in that it accepts and embraces thoughts that CBT would hold as dysfunctional and in need of repair.
So rather than the focus being identifying, challenging and correcting thoughts that may be causing or reinforcing anxiety, ACT encourages people to view them without emotion and in a “matter of fact” way. This essentially encourages the person to put the thought into perspective and afford it less power – the only meaning that thoughts have are the ones we ascribe to them. Rather than fighting distress, people are encouraged to accept it and learn to follow a life based on values that are important to them rather than allowing their symptoms to dictate their life. Meditation and mindfulness are therefore a key part of this approach as the person moves towards acknowledging their thoughts without judgment or avoidance.
Dialectical behavioral therapy
Dialectical behavioral therapy was originally designed for use with those with personality disorders but has since been use widely in the treatment of many other disorders. DBT combines individual therapy with skills training group-work. The focus is upon helping people to manage intense emotions more effectively, better manage interpersonal relationships, and ability to cope with emotional crises. The focus is on managing those conflicts in life that are concerned with dialectics or polar opposites (usually to do with change and acceptance) and finding a balance in those situations, so avoiding the “all or nothing” script. The four components of therapy are mindfulness, tolerance of distress, emotional regulation, and interpersonal effectiveness.
Interpersonal therapy (IPT)
Interpersonal psychotherapy is a brief (attachment-focused) psychotherapy that draws both on psychodynamic and CBT traditions. IPT focuses upon interpersonal relationships as a cause of mental distress – so our psychological difficulties are a response to difficulties we experience when interacting with others. The aim of IPT is to enable the person to develop better interpersonal and intrapersonal communication skills in their relationships through identification of emotions, healthier expression of those emotions and exploring how past relationships affect your current interactions.
Solution-focusedd brief therapy
This is different to many therapeutic approaches as it is solution rather than problem-focused and is goal-directed. The future is a key focus of the approach and it encourages people to consider preferred futures and aims to help them uncover the changes they need to make to achieve those goals. It is less about the therapist as expert but posits that the individual has the answers or solutions to their own problems but just need the right questions asked to help them uncover them.