Psychotherapy for Anxiety Disorders

Written By: Stephanie Boone

In recent years, various pharmaceuticals such as anti-depressants and tranquilizers have been utilized to treat a wide range of anxiety disorders. This trend, while often immediately beneficial to the patient, has publicly overshadowed the therapeutic treatments which are arguably the most effective in the long run.

According to the National Institute of Mental Health (NIMH), each year roughly nineteen million adults within the United States experience anxiety disorders—which include obsessive-compulsive disorder (OCD), panic disorder (PD), post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), social anxiety disorder/social phobia, and specific phobias, such as fear of the outdoors (agoraphobia) or confined spaces (claustrophobia), among many others.

Although prescription medications are the fastest method of treating anxiety disorders, they can have numerous side effects and consequences. Patients can easily become dependent on tranquilizers and sedatives, such as the benzodiazepines Atavin and Xanax, because of the (usually quite welcome, for anxiety sufferers) sense of calm they produce. Anti-depressants like Prozac and Zoloft, while not habit-forming, may cause a variety of physical side effects such as weight gain, insomnia, upset stomach, and diminished sexual appetite. These drugs can, when taken correctly, help sufferers of anxiety disorders to feel better—but most experts agree that for long-term improvement, patients should combine use of pharmaceuticals with psychotherapy.

Two common forms of psychotherapy utilized for treatment of anxiety disorders are behavioral and cognitive therapy: in cognitive therapy, the therapist helps the patient to adapt his or her problematic thought patterns into those which are healthier. For example, the therapist might help someone with panic disorder to prevent panic attacks—and make those that do occur less intense—by teaching him or her how to mentally re-approach anxiety-inducing situations. In behavioral therapy, the therapist will help the patient to combat undesirable behaviors which often come hand in hand with anxiety; for example, the patient will learn relaxation and deep breathing exercises to use when experiencing hyperventilation as a result of panic attacks (American Psychological Association).

Since these methods of treatment are such close cousins—both involving, in a sense, active re-education of the mind by the patient—therapists often use them together, in a broader classification of treatment called cognitive-behavioral therapy (CBT). CBT is used to treat all six forms of anxiety disorders listed above.

The National Association of Cognitive-Behavioral Therapists (NACBT) lists on their website several different specific forms of CBT which have developed in the past half-century or so. These include:

Rational Emotive Therapy (RET)/Rational Emotive Behavior Therapy

Psychologist Albert Ellis, in the 1950s, believed that then-trendy psychoanalysis was an inefficient form of treatment because the patient was not directed to change his or her way of thinking; he originated RET, which was later developed further by neo-Freudian psychotherapist Alfred Adler. RET has roots in Stoic philosophy, such as in the writing of Marcus Aurelius and Epictetus; behaviorists Joseph Wolpe and Neil Miller seem also to have influenced Albert Ellis. Ellis continued working on his therapeutic approach, and in the 1990s—nearly forty years after first developing the treatment—he renamed it Rational Emotive Behavior Therapy, in order to make the treatment’s moniker more accurate.

Rational Behavior Therapy

One of Ellis’s students, physician Maxie C. Maultsby, Jr., developed this slight variation about ten years after Ellis first developed his. Rational Behavior Therapy is distinctive in that the therapist assigns “therapeutic homework” to the client, and places “emphasis on client rational self-counseling skills”. Clients are urged to take added initiative in their own recoveries, even beyond that encouraged by many other forms of CBT.

Some other specialized forms of CBT are Schema Focused Therapy, Dialectical Behavior Therapy, and Rational Living Therapy. Many who are acquainted with CBT know of the therapy due to Feeling Good: The New Mood Therapy, the best-selling self-help book David Burns wrote in the 1980s.

Finally, one form of behavioral psychotherapy which differs from CBT is Exposure with Response Prevention; usually used to treat specific phobias, Exposure with Response Prevention involves gradually making the patient familiar with the object or action causing anxiety—a sort of step-by-step “face your fears” treatment. In one successful case, a man who’d had a specific phobia of insecticides (after an incident of being poisoned himself while working in the fields of East Asia) for ten years became asymptomatic after ninety days of nearly consecutive treatment. His treatment included exposing himself to situations in which people were working with insecticides—sometimes the exposures were overseen by therapists, sometimes by his family members, and, eventually, by he alone. According to the authors of the study, the patient “was able to return to work at the farm and tolerate insecticides without much difficulty. Currently he is continuing with self-exposure sessions and maintaining well” (Narayana, Chakrabarti, & Grover, 12).

As with almost any illness, anxiety disorder patients must take some initiative in their treatment and recovery—whether it be by seeking help from a physician, taking medications properly and punctually, or attending and actively engaging in therapy sessions. CBT and other forms of psychotherapy, like Exposure with Response Prevention, are alternate forms of treatment for those who do not wish to take anti-depressants or other pharmaceuticals (or to only take those medications), but still wish to work towards recovery; the benefit of such therapies, which take them a step beyond pharmaceuticals, are thus: anti-depressants and other drugs seem to act as analgesics or, at best, vitamins; however, given the potential side effects, most patients might not wish to take them for their entire lives. With the aid of therapies—especially therapies in which they can most actively work towards recovery—patients can make the changes which will allow them to live with less anxiety for years to come.