What do I do if I think I may
have an anxiety disorder?
The first thing to do is to talk to your primary
care physician and have a complete physical examination
done in order to rule out the possibility that you
may have another non- anxiety based physical problem. Many
people with panic, for instance, have already visited
the Hospital Emergency Department and have been ‘sent
home’ because ‘nothing is wrong’. Once
your physician has determined that you have an anxiety
disorder, talk to him or her about treatment resources
available in your area. Psychiatrists, psychologists,
clinical social workers who have specialized training
in anxiety disorders are some of the mental health
professionals that can be of help to you. If
you have to wait to get an appointment- don’t
despair. Many cities and communities have organizations
that offer self-help and support groups for people
suffering with Anxiety Disorders. There are several
self- help books available on the market and there
are several websites which offer on-line support.
These can all be invaluable sources of help to you
in your recovery.
Currently, there are two main types of treatment
which have been shown to be effective with anxiety
disorders. Often the two treatments are used together;
however each is effective on its own. These include:
- Pharmacological treatment
- Cognitive Behaviour Therapy (CBT)
Pharmacological treatment
This type of treatment involves the use of prescribed
medications such as antidepressants which are designed
to reduce the symptoms associated with anxiety
and panic. These can be prescribed by your doctor
or by a psychiatrist. Every medication has
side effects but these usually begin to disappear
or are at least tolerated as your body gets used
to them. Once you have found one that is
tolerable and effective for you, you will need
to be on them for at the very least six months.
Many now believe that you will need them for up
to two years in order to repair some of the effects
of the anxiety disorder or its often accompanying
depression. Some people may need to be on
them for life. These medications are usually
well tolerated but to limit their side effects
they should be started at a very low dose with
the dose slowly raised. Similarly when tapering
them, they should be tapered very slowly.
Other medication prescribed for anxiety disorders,
include the benzodiazepines, (which should be prescribed
at a low and regular dose) avoiding the "as required"
approach. Because
of the risk of addiction, they are recommended to
be prescribed for a very short period of time.
Often people with associated bipolar illnesses and
people for whom one medication is not enough will
require the addition of an atypical antipsychotic. These
agents can be very helpful to get the sufferer to
complete recovery.
Psychological treatment
The main type of psychological treatment used to
treat Anxiety Disorders is called Cognitive- Behaviour
Therapy- otherwise known as CBT. Sometimes Behaviour
Therapy alone is used. CBT is done alone
or in small groups. The Cognitive portion consists
of identifying the thoughts and thought patterns
that make you anxious and keep you anxious and
then challenging them. An example of this
would be that as you begin to feel anxious you
say to yourself: “What if my dizziness
means that I’m having a stroke?” You
might then be asked to evaluate this thought by
finding out whether dizziness always implies a
stroke, what other explanations there are for dizziness
and what are the likely consequences of dizziness.
The Behavioural aspect involves challenging yourself
to face the situations and sensations and thoughts
that you may have come to avoid out of fear of feeling
anxious. This is done is small, manageable steps
called Exposure. Through exposing yourself in small
steps you learn that you can feel anxious in a particular
situation and you can still be ok. You learn that
the anxiety isn’t going to kill you or make
you go crazy. Eventually you learn to face the situations
and sensations that you have been avoiding out of
fear and you learn to gain control over the anxious
feelings rather than letting them control you.
Each anxiety disorder has a slightly different approach
to treatment using this tool.
Social Anxiety Disorder
Treatment includes Individual or Group Cognitive
Behaviour Therapy and/or medication. The
approach involves challenging the ideas that cause
one to self punish or be harsh with one self.
Post Traumatic Stress Disorder
Cognitive Behaviour Therapy (CBT) and medication
are the most commonly used treatments for Post
Traumatic Stress Disorder.
Obsessive Compulsive Disorder
Obsessive Compulsive Disorder reponds well
to Behaviour
Therapy (sometimes called Exposure and Response Prevention)
and Cognitive-Behaviour Therapy. In
addition, certain medications have also been shown
to be effective in the treatment of Obsessive Compulsive
Disorder.
Generalized Anxiety Disorder
Sometimes Generalized Anxiety Disorder is difficult to diagnose because it
doesn’t have some of the more dramatic symptoms
of, for example, Panic Disorder or Obsessive Compulsive
Disorder. It is therefore
very important to speak with your primary care
physician about your condition. Currently, Cognitive
Behaviour Therapy is used as a treatment method
and could include: learning problem solving skills,
learning to tolerate negative emotions and uncertainty,
relaxation techniques, evaluating your thoughts
and anxiety management tools. As well, medication
can be an effective tool for dealing with Generalized
Anxiety Disorder.
Specific Phobia
Specific Phobias respond very well to Behaviour Therapy
or Exposure Therapy. There is emerging evidence
that Cognitive- Behaviour Therapy is also very helpful
in the treatment of phobias. For most cases
of Specific Phobia, however, there is no requirement
for medication.
Panic Disorder
Panic Disorder responds well
to Cognitive-Behaviour Therapy. In addition,
specific medications have also been shown to be effective
in its treatment. In the case of agoraphobia, Cognitive-
Behaviour Therapy alone is recommended.
Children and Youth
Treatment for children can include Cognitive- Behaviour
Therapy as well as specific medications, although
caution is required. Treatments are, however, applied
differently with children than they are with adults
due to the differences in age and/ or developmental
stages of the children and youth in need.
We will have more detailed information about treatment
for children and youth who suffer from anxiety disorders
available in the coming months.
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