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Anxiety Disorders: Treatment

Anxiety Disorders: Treatment. Chapter 4. Treatment: Biological Approaches. Beta-blockers (Propanolol) Prevent somatic symptoms of anxiety Effective only with performance anxiety Benzodiazepines (Xanax, Valium) Enhance GABA system, increases threshold for neural excitation

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Anxiety Disorders: Treatment

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  1. Anxiety Disorders: Treatment Chapter 4

  2. Treatment: Biological Approaches • Beta-blockers (Propanolol) • Prevent somatic symptoms of anxiety • Effective only with performance anxiety • Benzodiazepines (Xanax, Valium) • Enhance GABA system, increases threshold for neural excitation • Frequently prescribed for GAD, Social Phobia, and PD/A • Risk of developing dependence, abuse • Relapse rates high when medication is discontinued • Tri-cyclic Antidepressants (TCA; Imipramine) • Effective for GAD and PDA • Side effects make medication difficult for many to tolerate

  3. Treatment: Biological Approaches (cont.) • Selective Serotonin Reuptake Inhibitors (SSRI; Prozac, Paxil) • Effective for GAD, PD/A, Social Phobia • Fewer side effects, but still intolerable for some • Surgery • Cingulotomy rarely used, only in extreme cases as last resort • Only 30% respond to even this treatment

  4. Treatment: Psychological Approaches • Cognitive-behavioral Treatment (CBT) • Assessment and Self-monitoring • Relaxation Training (Breathing, Muscle Relaxation, Meditation) • Cognitive Restructuring • Exposure (Imaginal and/or In Vivo) • Skill training (assertiveness, social skills)

  5. Systematic Desensitization • First empirically-supported treatment approach for anxiety disorders • Based on experimental work of Wolpe and Salter • Involves relaxation training and gradual, systematic imaginal exposure to feared situations or objects • Effective only for specific phobias

  6. Systematic Desensitization: Procedure • Introduction of Subjective Units of Distress (SUDs) • Training in deep muscle relaxation • Construction of anxiety hierarchies • Systematic imaginal exposure to pair state of relaxation with anxiety-evoking stimuli • Sample hierarchy (test anxiety): • Not knowing the answer to the first question (100) • Instructor distributes the exam (90) • Walking to the exam (70) • Studying for the exam (50) • Reading about the exam on the syllabus (10)

  7. Panic Control Treatment • Assessment • Semistructured Diagnostic Interview • Functional Analysis (cognitive, behavioral, and physiological components) • Behavioral Assessment (symptom induction or BAT tests) • Self-report or clinician rating scales • Self-monitoring • Breathing Retraining • Cognitive Restructuring • Interoceptive Exposure to somatic cues • In Vivo Exposure to avoided contexts

  8. Panic Control Treatment • Assessment • Semistructured Diagnostic Interview • Functional Analysis (cognitive, behavioral, and physiological components) • Behavioral Assessment (symptom induction or BAT tests) • Self-report or clinician rating scales • Self-monitoring • Breathing Retraining • Cognitive Restructuring • Interoceptive Exposure to somatic cues • In Vivo Exposure to avoided contexts

  9. Effectiveness of PCT • About 70% of treatment completers are improved • As effective as medications • Highest retention of any known treatment • Low rate of relapse after end of treatment • Combination of medication and PCT enhances short-term effects, but over time PCT alone is superior

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