If anxiety symptoms interfere with your daily life for two weeks or more, then see your doctor. If you feel suicidal, call your doctor or go to an emergency room right away.
Some people experience anxiety along with another condition, such as alcoholism or depression. This makes prompt treatment even more important. Treatments for anxiety might be more effective after the other conditions are under control.
Effective treatments for anxiety disorders are available today, and research will bring more of them in the future. Some people with anxiety disorders have reduced their symptoms so much that the condition no longer interferes with their daily life.1
The two main treatments for anxiety are medication and psychotherapy. Both depend on a thorough diagnosis. It will really help if you know whether anxiety is the primary problem or if anxiety results from a more basic issue (such as an overactive thyroid or side effect of medication).
Many treatments for anxiety disorders call on you to face your fears and practice new ways of responding to them. Remember that you will get to do these things at your own pace. And you will get plenty of support along the way.
The bottom line: No matter how long you’ve lived with anxiety, you always have options for reducing symptoms and creating the life you want to live.
Medication will not cure anxiety disorders, but it sure can ease the symptoms. Your brain chemistry has a lot to do with why you feel anxious, and medication targets this source of anxiety directly.
Getting relief from symptoms can free up a lot of energy. This allows people with anxiety disorders to get actively involved in psychotherapy. In fact, a combination of medication, psychotherapy, and a personalized self-help program works best for many people.
In most states, medication must be prescribed by physicians, usually psychiatrists. These professionals will offer psychotherapy themselves, or they work as a team with psychologists, social workers, or counselors.
It takes time to create an effective plan for medication. There are several factors to consider. One is the time it takes to find a dosage that works well for you. If you recently underwent detoxification for dependence on alcohol or another drug, this can also affect the timing and dosage of your medication.
The principal medications used for anxiety disorders are the following:
Keep in mind that all medications have side effects, so ask your doctor about these. Sometimes it’s possible to reduce side effects by adjusting the amount of a drug that you take and how often you take it.
Also inform your doctor of any other drugs you’re using—including prescription medications for other conditions, over-the-counter drugs, herbal remedies, and illegal substances. Your doctor will want to make sure that anxiety medications do not combine with these drugs to create unwanted side effects.
Tell your doctor about your consumption of coffee, soda drinks, wine, beer, and mixed drinks. Some people find that caffeine and alcohol make their anxiety worse.
Be sure to take medications exactly as prescribed. Don’t stop taking them abruptly, and don’t reduce the dosage on your own. Talk to your doctor first. Your doctor might recommend that you stay on medications even after you’re feeling better. This is a maintenance dose that can help to prevent a relapse to full-blown anxiety symptoms.
As you begin to take medications, keep your expectations realistic. Janice Gabe offers this perspective:
There are many different types of anxiety medications. If the first medication does not work, be patient. Usually medical doctors are able to find some type of medication that will work for you, but this process may take awhile. Most medications will begin to work in a few days to a few weeks. However, it will take four to six weeks of consistently taking the medication before the dose’s full potential is felt. This may sound like a long time to wait to start feeling better, but remember that you have probably been feeling bad for a lot longer than that.2
Remember that medication will probably not cure or reduce all your symptoms. Nor will medication automatically create changes in your behavior. For this you may need psychotherapy. This form of treatment can help you gain insight into your current ways of coping with anxiety and help you develop new skills.
Several kinds of professionals offer psychotherapy—psychiatrists, psychologists, social workers, and other trained counselors. You can refer to them all as therapists.
Many therapists rely on a treatment known as cognitive-behavioral therapy (CBT). Cognitive refers to what we think, and behavioral refers to what we do. Studies indicate that this approach to therapy can be effective for a wide range of problems, including depression, unhealthy anger, anxiety, and shame. According to the National Institute of Mental Health, “CBT or behavioral therapy often lasts about 12 weeks. It may be conducted individually or with a group of people who have similar problems. Group therapy is particularly effective for social phobia.”3
Cognitive treatments. The cognitive part of CBT helps people learn to discover, challenge, and change automatic thoughts. For example, CBT helps people with panic disorder to challenge the belief that their panic attacks are heart attacks. It also helps people with social phobia to dispute the belief that other people are always looking at them. Cognitive techniques are so powerful that even people who are not in therapy can benefit from them.
Behavioral treatments. The other major element of CBT is behavior change. To set the stage for this work, many therapists begin by teaching their clients to use deep breathing and other relaxation techniques. After developing these skills, people with anxiety disorders can move on to exposure therapy. This involves exactly what the name implies—deliberately exposing yourself to the very thing that triggers anxiety.
For instance, people with OCD who fear dirt and germs are encouraged to get their hands dirty and wait a little while before washing them.
People with PTSD may be asked to recall traumatic events in the safety of the therapist’s office.
People with social phobia might be directed to go to a party and resist the temptation to flee the room. They might even get a “homework” assignment to make a small blunder in a social situation and then observe how people actually respond.
The theory is that repeated exposure to the very thing you fear will—over time—make you less sensitive to anxiety triggers. You learn through your own direct experience that the consequences of facing your fear are less than you anticipated.
Does the idea of exposure therapy sound impossible? It’s not. This treatment has helped people with severe anxiety disorders to make positive, long-term changes in their behavior.
Keep in mind that the process is gradual. For example, a therapist might start with a visualization exercise that guides the person with OCD to merely imagine getting her hands dirty and delaying hand washing. The next stage of treatment might be for the client to actually get a little dirt on her hands and then wait for one full minute to wash them. During progressive stages, she may gradually increase the amount of dirt on her hands and the number of minutes that she delays hand washing.
Here’s another description of exposure therapy from the Understanding Major Anxiety Disorders and Addiction workbook, in the Co-occurring Disorders Series, by Dennis C. Daley and Ihsan M. Salloum:
An intense fear of driving on a major highway might be dealt with in these gradual steps: (1) you ride as a passenger in a car and drive by a major highway; (2) you ride as a passenger a short distance (for example, one exit) on a major highway; (3) you ride as a passenger a longer distance on a major highway; (4) you repeat each of these steps with a support person sitting next to you while you drive; (5) you repeat each of these steps alone. As part of the hierarchy, these trips on a major highway might be done first in light traffic, then in moderate traffic, and finally graduating to heavy traffic. The point is to expose yourself slowly to the fear through a step-by-step approach.4
There are several variations on this approach to therapy. One is for therapists to accompany their clients during exposure to a feared situation. Another is flooding, where clients walk into that situation with no gradual exposure beforehand. This technique calls for careful preparation.
In any case, the goal of exposure therapy is something that psychologists call habituation—facing your anxiety triggers so many times that you eventually get used to them.
To find a therapist, ask for referrals from friends, family members, and health care providers whom you trust—for example, your family doctor. Your priest, rabbi, or minister may also be able to help.
Perhaps you have health insurance and an employee assistance program through work. If so, ask about coverage for mental health services. Remember that your insurance might provide better reimbursement for mental health services within a preferred network of providers.
If you live near a college or university, check to see if it has a medical school or department of psychology. These might offer mental health services on a sliding-fee scale. Also check your local phone directory under mental health, health, social services, and crisis intervention services.
If you’re in crisis, go to a local emergency room. The staff can direct you to further help.
Many studies indicate that personal rapport with a therapist is the most important factor in successful mental health treatment.5 Once you have a list of potential therapists, develop a list of questions to ask them. The goal is to find someone who’s a good fit for you. Therapists will respect your right to be a smart consumer and get answers to these questions before starting therapy.
Some questions you can ask are the following:
Also, consider whether you prefer a male or female therapist.
If your current problems with anxiety are leading to harmful consequences, then remember to get treatment that focuses on immediate behavior change. Don’t settle for therapy that devotes months to exploring events from your childhood or issues not directly related to anxiety.
While the personal “chemistry” between you and a therapist is important, there are other ways for you to get the maximum benefit from therapy. For example, respond openly and honestly to your therapist’s questions. Be willing to consider new ideas. Keep your appointments, and do any assigned “homework” between sessions.
Don’t expect immediate relief from therapy, but do look for signs that you’re moving through stages of change. A respected body of research indicates that these stages include the following:6
Your treatment for anxiety can involve a whole team of professionals—doctors, therapists, pharmacists, and other specialists. Be sure that one of them keeps the big picture of your overall health and coordinates the medications and other treatments you’re receiving. Many people turn to their family doctor for this purpose.
Sometimes people with anxiety disorders judge themselves harshly for “failing” at therapy. If you’re showing up for therapy sessions, actively engaging with your therapist during the sessions, and completing your “homework” assignments between sessions, then there’s no way for you to fail.
Sometimes people take part in anxiety treatment for several months and report that they are still not feeling better. If this happens to you, then consider the possible reasons. Perhaps you could benefit from a new medication, an adjustment in your current medication, a new approach to therapy, or a new therapist. Sometimes it takes several different treatments or combinations of treatments to produce a therapeutic change.
Finally, remember that overall progress in treating anxiety can include occasional relapses to old habits of thinking and acting. View these events as opportunities to learn—and additional incentives to change.