Types of Anxiety Disorders
There are three types of anxiety disorders:
- Generalized Anxiety Disorder (GAD)
Signs and Symptoms
Unlike the relatively mild, brief anxiety caused by a specific event (such as speaking in public or a first date), severe anxiety that lasts at least six months is generally considered to be problem that might benefit from evaluation and treatment. Each anxiety disorder has different symptoms, but all the symptoms cluster around excessive, irrational fear and dread.
Anxiety disorders commonly occur along with other mental or physical illnesses, including alcohol or substance abuse, which may mask anxiety symptoms or make them worse. In some cases, these other problems need to be treated before a person can respond well to treatment for anxiety.
Diagnosis and Treatment
Anxiety disorders are treatable. If you think you have an anxiety disorder, talk to your doctor.
Sometimes a physical evaluation is advisable to determine whether a person’s anxiety is associated with a physical illness. If anxiety is diagnosed, the pattern of co-occurring symptoms should be identified, as well as any coexisting conditions, such as depression or substance abuse. Sometimes alcoholism, depression, or other coexisting conditions have such a strong effect on the individual that treating the anxiety should wait until the coexisting conditions are brought under control.
With proper treatment, many people with anxiety disorders can lead normal, fulfilling lives. If your doctor thinks you may have an anxiety disorder, the next step is usually seeing a mental health professional. It is advisable to seek help from professionals who have particular expertise in diagnosing and treating anxiety. Certain kinds of cognitive and behavioral therapy and certain medications have been found to be especially helpful for anxiety.
You should feel comfortable talking with the mental health professional you choose. If you do not, you should seek help elsewhere. Once you find a clinician with whom you are comfortable, the two of you should work as a team and make a plan to treat your anxiety disorder together.
In general, anxiety disorders are treated with medication, specific types of psychotherapy, or both. Treatment choices depend on the type of disorder, the person’s preference, and the expertise of the clinician.
People with anxiety disorders who have already received treatment should tell their clinician about that treatment in detail. If they received medication, they should tell their doctor what medication was used, what the dosage was at the beginning of treatment, whether the dosage was increased or decreased while they were under treatment, what side effects occurred, and whether the treatment helped them become less anxious. If they received psychotherapy, they should describe the type of therapy, how often they attended sessions, and whether the therapy was useful.
Often people believe that they have “failed” at treatment or that the treatment didn’t work for them when, in fact, it was not given for an adequate length of time or was administered incorrectly. Sometimes people must try different treatments or combinations of treatment before they find the one that works for them.
Most insurance plans, including health maintenance organizations (HMOs), will cover treatment for anxiety disorders. Check with your insurance company and find out. If you don’t have insurance, the Health and Human Services division of your county government may offer mental health care at a public mental health center that charges people according to how much they are able to pay. If you are on public assistance, you may be able to get care through your state Medicaid plan.
For additional resources for getting information and assistance, please visit Beyond Blue, a great webpage on a variety of mental health topics.
Medication does not necessarily cure anxiety disorders, but it often reduces the symptoms. Medication typically must be prescribed by a doctor. A psychiatrist is a doctor who specializes in mental disorders. Many psychiatrists offer psychotherapy themselves or work as a team with psychologists, social workers, or counselors who provide psychotherapy. The principal medications used for anxiety disorders are antidepressants, anti-anxiety drugs, and beta-blockers. Be aware that some medications are effective only if they are taken regularly and that symptoms may recur if the medication is stopped.
Choosing the right medication, medication dose, and treatment plan should be based on a person’s individual needs and medical situation, and done under an expert’s care. Only an expert clinician can help you decide whether the medicine’s ability to help is worth the risk of a side effect. Your doctor may try several medicines before finding the right one.
You and your doctor should discuss:
- How well medicines are working or might work to improve your symptoms.
- Benefits and side effects of each medicine.
- Risk for a serious side effects based on your medical history.
- How likely the medicines will require lifestyle changes.
- Costs of each medicine.
- Other alternative therapies, medicines, vitamins, and supplements you are taking and how these may affect your treatment.
- How the medication should be stopped. Some drugs can’t be stopped abruptly but must be tapered off slowly under a doctor’s supervision.
Psychotherapy (sometimes called “talk therapy”) involves talking with a trained clinician, such as a psychiatrist, psychologist, social worker, or counselor, to understand what caused an anxiety disorder and how to deal with it.
Cognitive Behavioral Therapy (CBT)
CBT can be useful in treating anxiety disorders. It can help people change the thinking patterns that support their fears and change the way they react to anxiety-provoking situations.
For example, CBT can help people with panic disorder learn that their panic attacks are not really heart attacks and help people with social phobia learn how to overcome the belief that others are always watching and judging them. When people are ready to confront their fears, they are shown how to use exposure techniques to desensitize themselves to situations that trigger their anxieties.
Exposure-based treatment has been used for many years to treat specific phobias. The person gradually encounters the object or situation that is feared, perhaps at first only through pictures or tapes, then later face-to-face. Sometimes the therapist will accompany the person to a feared situation to provide support and guidance. Exposure exercises are undertaken once the patient decides he is ready for it and with his cooperation.
To be effective, therapy must be directed at the person’s specific anxieties and must be tailored to his or her needs. A typical “side effect” is temporary discomfort involved with thinking about confronting feared situations.
CBT may be conducted individually or with a group of people who have similar problems. Group therapy is particularly effective for social phobia. Often “homework” is assigned for participants to complete between sessions. If a disorder recurs at a later date, the same therapy can be used to treat it successfully a second time.
Medication can be combined with psychotherapy for specific anxiety disorders, and combination treatment has been found to be the best approach for many people.
Some people with anxiety disorders might benefit from joining a self-help or support group and sharing their problems and achievements with others. Internet chat rooms might also be useful in this regard, but any advice received over the Internet should be used with caution, as Internet acquaintances have usually never seen each other and false identities are common. Talking with a trusted friend or member of the clergy can also provide support, but it is not necessarily a sufficient alternative to care from an expert clinician.
Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of therapy. There is preliminary evidence that aerobic exercise may have a calming effect. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, avoiding them should be considered. Check with your physician or pharmacist before taking any additional medications.
The family can be important in the recovery of a person with an anxiety disorder. Ideally, the family should be supportive but not help perpetuate their loved one’s symptoms. Family members should not trivialize the disorder or demand improvement without treatment.