Anxiety disorders encompass a wide range of potential causes and co-existing conditions, so there is no one size fits all approach. Effective anxiety treatment requires a personalised approach, as what works for one person may not work for another. To make the most of your options, it is advisable to work with your doctor or therapist to determine the most appropriate course of action for your particular circumstances.
Professional therapy
The following treatment alternatives require the involvement of mental health or medical professionals with the necessary qualifications.
- Cognitive Behavioural Therapy (CBT): In CBT, a licensed therapist trained in CBT helps clients identify, understand, and modify their anxiety-related thought and behaviour patterns through regular sessions. Therapists who specialise in CBT may incorporate interpersonal therapy (IPT) to cultivate coping skills, encourage documentation of thoughts as they arise throughout the week, and possibly use exposure therapy if appropriate to the individual’s disorder.
- Dialectical behaviour therapy (DBT): DBT, a specific variant of CBT, incorporates the philosophical practice of dialectics, in which multiple or even contradictory ideas are examined, combining acceptance and change at the same time. For example, patients may accept their current life circumstances while feeling motivated to improve them. DBT places a strong emphasis on mindfulness, enabling individuals to acknowledge and understand their thoughts as they occur.
- Exposure therapy: This form ofa therpy involves gradually exposing the individual to feared situations in a safe and controlled environment, with the ultimate aim of reducing the associated anxiety. Practitioners begin by having patients repeatedly visualise the feared situation or object and possible reactions to it. Frequently used in the treatment of OCD, phobias and PTSD, exposure therapy can incorporate virtual reality or computer simulation to create a realistic yet completely safe exposure method.
- Group therapy: Group therapy refers to therapeutic settings that involve multiple participants in addition to a single healthcare provider. In addition to normalising an individual’s experience by fostering connections with others, group therapy can serve as an alternative for those who cannot afford individual therapy. Peer support groups provide a platform for sharing experiences and offering guidance. In addition, by participating in a support group, people with common anxiety problems can find validation for their experiences. Process groups, particularly suitable for people with social anxiety or generalised anxiety disorder (GAD), aim to uncover and address the sources of anxiety as friendships develop within the group.
- Hypnosis: Hypnotherapy can be administered by doctors, therapists, psychologists, social workers, nurses or other licensed professionals. Hypnosis induces a deeply relaxed state through techniques such as controlled breathing, guided imagery or muscle relaxation, making the individual more receptive to suggestions. Hypnotherapists may use imagery or simple verbal cues to reduce the severity of anxiety symptoms. Positive results can be seen after just a few sessions. If hypnosis shows promise, hypnotherapists may also teach self-hypnosis techniques for ongoing practice.
Prescription Medications
The following medications are available on prescription and are usually prescribed by general practitioners for anxiety. In severe cases or if treatment resistance is observed, consultation with a psychiatrist may be recommended.
What is the most common type of prescription for anxiety?
- SSRIs and SNRIs: Originally developed as antidepressants, these classes of drugs have been shown to be effective in treating anxiety. SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) act on neurotransmitters in the brain. SSRIs, including fluoxetine, fluvoxamine, sertraline, citalopram, paroxetine and escitalopram (known by brand names such as Paxil, Prozac and Zoloft), inhibit the reuptake of serotonin, which helps regulate mood. SNRIs such as venlafaxine, milnacipran, desvenlafaxine, levomilnacipran and duloxetine (e.g. Cymbalta and Effexor) increase levels of serotonin and norepinephrine. These drugs are prescribed for several anxiety disorders, including PTSD, GAD, panic disorder, SAD and OCD.
- Benzodiazepines: Benzodiazepines target the GABA neurotransmitter and have multiple effects on sleep, relaxation, anxiety, mood and memory. However, due to their habit-forming potential, doctors usually explore other medication options first, especially for patients with a history of addiction. Examples of benzodiazepines prescribed for anxiety include lorazepam, clonazepam and diazepam (brand names Xanax, Librium, Valium and Ativan). They may be part of the treatment plan for panic disorder, SAD or GAD.
- Beta-blockers: Used primarily to treat heart conditions, beta-blockers such as atenolol and propranolol inhibit the binding of epinephrine and norepinephrine to nerve receptors. In the context of anxiety, beta blockers are often prescribed specifically for social anxiety disorder in performance situations such as public speaking, rather than as a long-term treatment. Brand names for beta blockers include Inderal, Tenormin and Lopressor. They are usually used for infrequent, performance-related episodes of social anxiety.
- Off-label and other medications: In some cases, doctors may prescribe alternative medications for anxiety. These may include tricyclic antidepressants such as imipramine, monoamine oxidase (MAO) inhibitors, anxiolytics such as buspirone, or drugs with different mechanisms of action such as mirtazapine. Ketamine has attracted increasing scientific interest as a potential treatment for depression and anxiety, and has been granted priority review status by the FDA for the treatment of depression. Although not FDA-approved for anxiety, some physicians may use ketamine off-label for the treatment of anxiety.
In addition, physicians may consider off-label use of medications approved by the FDA for conditions other than anxiety or approved outside the United States.
Brain stimulation therapies
The following treatments focus on specific regions of the brain that affect stress, anxiety, mood and fear responses.
How can anxiety be treated without the use of medication?
- Deep brain stimulation (DBS): DBS is an invasive procedure in which an electrode is implanted in the brain. Similar to a pacemaker that regulates heart function, the electrode helps to stabilise the patient’s mood. DBS has traditionally been reserved for severe cases of treatment-resistant obsessive-compulsive disorder (OCD), but ongoing research suggests its potential effectiveness in treating post-traumatic stress disorder (PTSD).
- Repetitive Transcranial Magnetic Stimulation (rTMS): rTMS involves delivering pulses of magnetic fields to the brain via a scalp electrode. Although extensively studied for OCD, rTMS is now being explored as a treatment option for other anxiety disorders such as panic disorder, PTSD and social anxiety disorder.
- Vagus nerve stimulation: This technique uses the extensive connections of the vagus nerve to indirectly stimulate deeper areas of the brain, offering a less invasive alternative to surgery. Although still in the early stages of research, vagus nerve stimulation shows promise for refractory cases of PTSD, panic disorder and obsessive-compulsive disorder.
- Other brain stimulation therapies: Other approaches include transcranial direct current stimulation (tDCS), transcranial electrical stimulation (tES), and electroconvulsive therapy (ECT). Although research specifically targeting anxiety disorders is limited, ongoing studies suggest potential benefits for generalised anxiety disorder, obsessive-compulsive disorder, PTSD and social anxiety disorder.
Self-help
Self-help strategies and complementary and alternative medicine (CAM) may be beneficial for people seeking alternative or complementary methods to conventional medicine.
Natural ways to treat anxiety
- Self-help: Consider reputable self-help books, DVDs, or CDs recommended by mental health professionals, trusted sources, or recommendations from trusted people in your network.
- Exercise: Physical activity releases endorphins, which improve mood and focus. Exercise can also help replace negative thoughts with positive ones, boost confidence and provide a sense of accomplishment.
- Diet and nutrition: Research suggests that certain nutrient deficiencies may be associated with different manifestations of anxiety. For example, zinc deficiency has been linked to panic disorder and obsessive-compulsive disorder, while deficiencies in magnesium and vitamins D, B6 and B12 may also contribute to anxiety.If a deficiency is suspected, your doctor may order a blood test to assess your nutrient levels. Certain nutrients, such as L-theanine and tryptophan, have been shown to potentially reduce anxiety when included in the diet. Ongoing research is investigating the potential anti-anxiety benefits of vitamin E, omega-3 polyunsaturated fatty acids, glycine and inositol supplements.When managing anxiety through diet, it may be necessary to moderate or avoid certain foods and drinks.
A 2005 study found that the preservative sodium benzoate, commonly found in jelly, soda and other products, may contribute to anxiety. There is also some evidence that age and high cholesterol may be linked to anxiety. Moderation is advised when consuming stimulants such as sugar and caffeine, as these can potentially increase anxiety. It’s important to note that as well as increasing anxiety, alcohol also acts as a diuretic, which can lead to the loss of valuable nutrients.
- Meditation and mindfulness: Practices such as meditation and mindfulness can help manage anxiety by focusing thoughts and maintaining present-moment awareness. Meditation involves directing thoughts in a specific direction, while mindfulness involves acknowledging experiences without judgement.
- Relaxation techniques: Guided imagery, breathing exercises, progressive muscle relaxation, massage, tai chi, yoga, reiki, music therapy and art therapy are examples of relaxation techniques that can promote relaxation and reduce stress.
- Herbal supplements: Some herbal supplements, such as chamomile and kava, have shown promise in reducing anxiety. However, it’s important to consult a doctor before taking any herbal supplement to minimise the risk of adverse interactions or side effects. Research into other herbal supplements is ongoing and caution should be exercised.
Remember that it may take time to see improvements and it is important to discuss any side effects with your healthcare provider. Never stop taking any medicine suddenly without medical advice.
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