Treatment of anxiety
disorders
For you convenience, additional information can be found by
following the various links, as you may be more interested in anxiety disorders
which you are treating in your practice.
FOR
YOUR CLIENTS
How to Get Help for Anxiety DisordersIf
you, or someone you know, have symptoms of anxiety, a visit to the family
physician is usually the best place to start. A physician can help determine
whether the symptoms are due to an anxiety disorder, some other medical
condition, or both. Frequently, the next step in getting treatment for an
anxiety disorder is referral to a mental health professional. Among
the professionals who can help are psychiatrists, psychologists, social
workers, and counselors. However, it's best to look for a professional who
has specialized training in cognitive-behavioral therapy and/or
behavioral therapy, as appropriate, and who is open to the use of
medications, should they be needed. As
stated earlier, psychologists, social workers, and counselors sometimes work
closely with a psychiatrist or other physician, who will prescribe
medications when they are required. For some people, group therapy is a
helpful part of treatment. It's
important that you feel comfortable with the therapy that the mental health
professional suggests. If this is not the case, seek help elsewhere. However,
if you've been taking medication, it's important not to discontinue it
abruptly, as stated before. Certain drugs have to be tapered off under the
supervision of your physician. Remember,
though, that when you find a health care professional that you're satisfied
with, the two of you are working together as a team. Together you will be
able to develop a plan to treat your anxiety disorder that may involve medications,
cognitive-behavioral or other talk therapy, or both, as appropriate. You
may be concerned about paying for treatment for an anxiety disorder. If you
belong to a Health Maintenance Organization (HMO) or have some other kind of
health insurance, the costs of your treatment may be fully or partially
covered. There are also public mental health centers that charge people
according to how much they are able to pay. If you are on public assistance,
you may be able to get care through your state Medicaid plan. Strategies to Make Treatment More EffectiveMany
people with anxiety disorders benefit from joining a self-help group and
sharing their problems and achievements with others. Talking with trusted
friends or a trusted member of the clergy can also be very helpful, although
not a substitute for mental health care. Participating in an Internet chat
room may also be of value in sharing concerns and decreasing a sense of
isolation, but any advice received should be viewed with caution. The
family is of great importance in the recovery of a person with an anxiety
disorder. Ideally, the family should be supportive without helping to
perpetuate the person's symptoms. If the family tends to trivialize the
disorder or demand improvement without treatment, the affected person will
suffer. You may wish to show this booklet to your family and enlist their
help as educated allies in your fight against your anxiety disorder. Stress
management techniques and meditation may help you to calm yourself and
enhance the effects of therapy, although there is as yet no scientific
evidence to support the value of these "wellness" approaches to
recovery from anxiety disorders. There is preliminary evidence that aerobic
exercise may be of value, and it is known that caffeine, illicit drugs, and
even some over-the-counter cold medications can aggravate the symptoms of an
anxiety disorder. Check with your physician or pharmacist before taking any
additional medicines. References
1Narrow WE,
Rae DS, Regier DA. NIMH epidemiology note: prevalence of anxiety disorders.
One-year prevalence best estimates calculated from ECA and NCS data.
Population estimates based on U.S. Census estimated residential population
age 18 to 54 on July 1, 1998. Unpublished. 2Robins LN,
Regier DA, eds. Psychiatric disorders in America: the Epidemiologic
Catchment Area Study. New York: The Free Press, 1991. 3The NIMH
Genetics Workgroup. Genetics and mental disorders. NIH Publication No.
98-4268. Rockville, MD: National Institute of Mental Health, 1998. 4Regier DA,
Rae DS, Narrow WE, et al. Prevalence of anxiety disorders and their
comorbidity with mood and addictive disorders. British Journal of
Psychiatry Supplement, 1998; (34): 24-8. 5Kushner MG,
Sher KJ, Beitman BD. The relation between alcohol problems and the anxiety
disorders. American Journal of Psychiatry, 1990; 147(6): 685-95. 6Wonderlich
SA, Mitchell JE. Eating disorders and comorbidity: empirical, conceptual, and
clinical implications. Psychopharmacology Bulletin, 1997; 33(3):
381-90. 7Davidson JR.
Trauma: the impact of post-traumatic stress disorder. Journal of
Psychopharmacology, 2000; 14(2 Suppl 1): S5-S12. 8Margolin G,
Gordis EB. The effects of family and community violence on children. Annual
Review of Psychology, 2000; 51: 445-79. 9Yehuda R.
Biological factors associated with susceptibility to posttraumatic stress
disorder. Canadian Journal of Psychiatry, 1999; 44(1): 34-9. 10Bourdon KH,
Boyd JH, Rae DS, et al. Gender differences in phobias: results of the ECA
community survey. Journal of Anxiety Disorders, 1988; 2: 227-41. 11Kendler KS,
Walters EE, Truett KR, et al. A twin-family study of self-report symptoms of
panic-phobia and somatization. Behavior Genetics, 1995; 25(6):
499-515. 12Boyd JH, Rae
DS, Thompson JW, et al. Phobia: prevalence and risk factors. Social
Psychiatry and Psychiatric Epidemiology, 1990; 25(6): 314-23. 13Kendler KS,
Neale MC, Kessler RC, et al. Generalized anxiety disorder in women. A
population-based twin study. Archives of General Psychiatry, 1992;
49(4): 267-72. 14LeDoux J.
Fear and the brain: where have we been, and where are we going? Biological
Psychiatry, 1998; 44(12): 1229-38. 15Bremner JD,
Randall P, Scott TM, et al. MRI-based measurement of hippocampal volume in
combat-related posttraumatic stress disorder. American Journal of
Psychiatry, 1995; 152: 973-81. 16Stein MB,
Hanna C, Koverola C, et al. Structural brain changes in PTSD: does trauma
alter neuroanatomy? In: Yehuda R, McFarlane AC, eds. Psychobiology of
posttraumatic stress disorder. Annals of the New York Academy of Sciences,
821. New York: The New York Academy of Sciences, 1997. 17Rauch SL,
Savage CR. Neuroimaging and neuropsychology of the striatum. Bridging basic
science and clinical practice. Psychiatric Clinics of North America,
1997; 20(4): 741-68. 18Gould E,
Reeves AJ, Fallah M, et al. Hippocampal neurogenesis in adult Old World
primates. Proceedings of the National Academy of Sciences USA, 1999,
96(9): 5263-7. 19Hyman SE, Rudorfer MV. Anxiety disorders. In: Dale DC,
Federman DD, eds. Scientific American® Medicine.
Volume 3.
New York: Healtheon/WebMD Corp., 2000, Sect. 13, Subsect. VIII. This brochure is a revision by Mary Lynn Hendrix of an earlier version written by Marilyn Dickey. Scientific information and/or review for this revision were provided by Steven E. Hyman, M.D., Richard Nakamura, Ph.D., Matthew Rudorfer, M.D., Linda Street, Ph.D., and Elaine Baldwin, all of NIMH, and Una McCann, M.D., now of The Johns Hopkins University. Editorial assistance was provided by Clarissa Wittenberg, Margaret Strock, and Melissa Spearing of NIMH. All material in this publication is in the public domain and may be copied or reproduced without permission of the Institute. Citation of the source is appreciated. |
Updated:
June 22, 2001
From The Surgeon
General’s Report Chapter 4 Treatment of Anxiety Disorders
The anxiety disorders are treated with
some form of counseling or psychotherapy or pharmacotherapy, either singly or
in combination (Barlow & Lehman, 1996; March et al., 1997; American
Psychiatric Association, 1998; Kent et al., 1998).
Counseling and
Psychotherapy
Anxiety disorders are
responsive to counseling and to a wide variety of psychotherapies. More severe
and persistent symptoms also may require pharmacotherapy (American Psychiatric
Association, 1998).
During the past several decades, there
has been increasing enthusiasm for more focused, time-limited therapies that
address ways of coping with anxiety symptoms more directly rather than
exploring unconscious conflicts or other personal vulnerabilities (Barlow &
Lehman, 1996). These therapies typically emphasize cognitive and behavioral
assessment and interventions.
The hallmarks of
cognitive-behavioral therapies are evaluating apparent cause and effect
relationships between thoughts, feelings, and behaviors, as well as
implementing relatively straightforward strategies to lessen symptoms and
reduce avoidant behavior (Barlow,
1988). A critical element of therapy is to increase exposure to the stimuli or
situations that provoke anxiety. Without such therapeutic assistance, the
sufferer typically withdraws from anxiety-inducing situations, inadvertently
reinforcing avoidant or escape behavior.
The therapist provides
reassurance that the feared situation is not deadly and introduces a plan to
enhance mastery. This plan
may include approaching the feared situation in a graduated or stepwise
hierarchy or teaching the patient to use responses that dampen anxiety, such as
deep muscle relaxation or coping. One fundamental principle is that prolonged
exposure to a feared stimulus reliably decreases cognitive and physiologic
symptoms of anxiety (Marks, 1969; Barlow, 1988). With such experience generally
comes greater self-efficacy and a greater willingness to encounter other feared
stimuli. For panic disorder, interoceptive training (a type of conditioning
technique) and breathing exercises are often employed to help the sufferer
become more capable of recognizing and coping with the social cues,
antecedents, or early signs of a panic attack. Cognitive interventions are used
to counteract the exaggerated or catastrophic thoughts that characterize
anxiety. For treatment of obsessive-compulsive disorder, the strategy of
response prevention must be added to exposure to ensure that compulsions are not
performed (Barlow, 1988).
There is now extensive
evidence that cognitive-behavioral therapies are useful treatments for a
majority of patients with anxiety disorders
(Chambless et al., 1998). Poorer outcomes are observed, however, in more
complicated patient groups. With obsessive-compulsive disorder, approximately
20 to 25 percent of patients are unwilling to participate in therapy (March et
al., 1997). Another major limitation of cognitive-behavioral therapies is not
their effectiveness but, rather, the limited availability of skilled
practitioners (Ballenger et al., 1998).
It is possible that more traditional
forms of therapy based on psychodynamic or interpersonal theories of anxiety
also may prove to be effective treatments (Shear, 1995). However, these
therapies have not yet received extensive empirical support. As a result, more
traditional therapies are generally de-emphasized in evidence-based treatment
guidelines for anxiety disorders.
Pharmacotherapy
The medications
typically used to treat patients with anxiety disorders are benzodiazepines,
antidepressants, and the novel compound buspirone (Lydiard et al., 1996). In
light of increasing awareness of numerous neurochemical alterations in anxiety
disorders, many new classes of drugs are likely to be developed, expressly
targeting CRH and other neuroactive agents (Nemeroff, 1998).
Benzodiazepines
The benzodiazepines are a large
class of relatively safe and widely prescribed medications that have rapid and
profound antianxiety and sedative-hypnotic effects. The benzodiazepines are
thought to exert their therapeutic effects by enhancing the inhibitory
neurotransmitter systems utilizing GABA. Benzodiazepines bind to a site on the
GABA receptor and act as receptor agonists (Perry et al., 1997). Benzodiazepines
differ in terms of potency, pharmacokinetics (i.e., elimination half-life), and
lipid solubility.
The four benzodiazepines currently
widely prescribed for treatment of anxiety disorders are diazepam, lorazepam,
clonazepam, and alprazolam. Each is now available in generic formulations
(Davidson, 1998). Among these agents, alprazolam and lorazepam have shorter
elimination half-lives—that is, are removed from the body more quickly—while
diazepam and clonazepam have a long period of action (i.e., up to 24 hours).
Diazepam also has multiple active metabolites, which increase the risk of
“carryover” effects such as sedation and “hangover.” Benzodiazepines that
undergo conjugation appear to have longer elimination time in women, and oral
contraceptive can decrease clearance (Dawlans, 1995). Since Asians are more
likely to metabolize diazepam more slowly, they may require lower doses to
achieve the same blood concentrations as Caucasians (Lin et al., 1997).
Benzodiazepines have the
potential for producing drug dependence
(i.e., physiological or behavioral symptoms after discontinuation of use).
Shorter acting compounds have somewhat greater liability because of more rapid
and abrupt onset of withdrawal symptoms.
Because the benzodiazepines
do not have strong antiobsessional effects, their use in obsessive-compulsive
disorder and post-traumatic stress disorder is generally viewed as palliative
(i.e., relieving, but not eliminating symptoms). Rather, obsessive-compulsive
disorder and post-traumatic stress disorder are more effectively treated by
antidepressants, especially the SSRIs (as discussed below). When effective, benzodiazepines should be tapered after
several months of use, although there is a substantial risk of relapse. Many
clinicians favor a combined treatment approach for panic disorder and
generalized anxiety disorder, in which benzodiazepines are used acutely in
tandem with an antidepressant. The benzodiazepines are subsequently tapered as
the antidepressant’s therapeutic effects begin to emerge (American Psychiatric
Association, 1998).
Antidepressants
Most antidepressant
medications have substantial antianxiety and antipanic effects in addition to
their antidepressant action (Kent et al., 1998). Moreover, a large number of
antidepressants have antiobsessional effects
(Perry et al., 1997). The observation that the tricyclic antidepressant
imipramine had a different anxiolytic profile than diazepam helped to
differentiate panic disorder from generalized anxiety disorder and,
subsequently, social phobia.
Clomipramine, a tricyclic
antidepressant (TCA) with relatively potent reuptake inhibitory effects on
serotonin (5-HT) neurons, subsequently was found to be the only TCA to have
specific antiobsessional effects (March et al., 1997). The importance of this
effect on 5-HT was highlighted when the SSRIs became available. By the late
1990s, it became clear that all of the SSRIs have antiobsessional effects
(Greist et al., 1995; Kent et al., 1998).
Current practice
guidelines rank the TCAs below the SSRIs for treatment of anxiety disorders
because of the SSRIs’ more favorable tolerability and safety profiles (March et al., 1997; American Psychiatric Association,
1998; Ballenger et al., 1998). Nevertheless, there are patients who respond to
the TCAs after failing to respond to one or more of the newer agents.
Similarly, although relatively rarely used, the monoamine oxidate inhibitors
(MAOIs) have significant antiobsessional, antipanic, and anxiolytic effects
(Sheehan et al., 1980; American Psychiatric Association, 1998). In the United
States, the MAOIs phenelzine, tranylcypromine, and isocarboxazid (which has not
been consistently marketed this decade) are seldom used unless simpler
medication strategies have failed (American Psychiatric Association, 1998).
The five drugs within the SSRI
class—fluoxetine, sertraline, paroxetine, fluvoxamine, and citalopram—have
emerged as the preferred type of antidepressant for treatment of anxiety
disorders (Westenberg, 1996; Kent et al., 1998). In addition to
well-established efficacy in obsessive-compulsive disorder, there is convincing
and growing evidence of antipanic and broader anxiolytic effects (American
Psychiatric Association, 1998; Kent et al., 1998). Treatment of panic disorder
often requires lower initial doses and slower upward titration. By contrast,
treatment for obsessive-compulsive disorder ultimately may entail higher doses
(for example, 60 or 80 mg/day of fluoxetine or 200 mg per day of sertraline)
and longer durations to achieve desired outcomes (March et al., 1997). As all
of the SSRIs are currently protected by patents, there are no generic forms yet
available. This adds to the direct costs of treatment. Cost may be offset
indirectly, however, by virtue of need for fewer treatment visits and fewer
concomitant medications, and cost likely will abate when these agents begin to
lose patent protection in a few years.
Other newer antidepressants, including
venlafaxine, nefazodone, and mirtazapine, also may have significant antianxiety
effects, for which clinical trials are under way (March et al., 1997; American
Psychiatric Association, 1998). Paroxetine has been approved by the Food and
Drug Administration (FDA) for social phobia, and sertraline is being developed
for post-traumatic stress disorder. Nefazodone, which also is being studied in
post-traumatic stress disorder, and mirtazapine may possess lower levels of
sexual side effects, a problem that complicates longer term treatment with
SSRIs, venlafaxine, TCAs, and MAOIs (Baldwin & Birtwistle, 1998).
When effective in treating anxiety,
antidepressants should be maintained for at least 4 to 6 months, then tapered
slowly to avoid discontinuation-emergent activation of anxiety symptoms (March
et al., 1997; American Psychiatric Association, 1998; Ballenger et al., 1998).
Although less extensively researched than depression, it is likely that many
patients with anxiety disorders may warrant longer term, indefinite treatment
to prevent relapse or chronicity.
Buspirone
This azopyrine compound is a
relatively selective 5- HT1A partial agonist (Stahl, 1996). It was
approved by the FDA in the mid-1980s as an anxiolytic. However, unlike the
benzodiazepines, buspirone is not habit forming and has no abuse potential.
Buspirone also has a safety profile comparable to the SSRIs, and it is
significantly better tolerated than the TCAs.
Buspirone does not block panic attacks,
and it is not efficacious as a primary treatment of obsessive-compulsive disorder
or post-traumatic stress disorder (Stahl, 1996). Buspirone is most useful for
treatment of generalized anxiety disorder, and it is now frequently used as an
adjunct to SSRIs (Lydiard et al., 1996). Buspirone takes 4 to 6 weeks to exert
therapeutic effects, like antidepressants, and it has little value for patients
when taken on an “as needed” basis.
Combinations of
Psychotherapy and Pharmacotherapy
Some patients with
anxiety disorders may benefit from both psychotherapy and pharmacotherapy
treatment modalities, either combined or used in sequence (March et al., 1997;
American Psychiatric Association, 1998). Drawing from the experiences of
depression researchers, it seems likely that such combinations are not
uniformly necessary and are probably more cost-effective when reserved for
patients with more complex, complicated, severe, or comorbid disorders. The
benefits of multimodal therapies for anxiety need further study.
2 Anxiety is one of the few mental disorders for which animal
models have been developed. Researchers can reproduce some
of the symptoms of human anxiety in animals by introducing different types of
stressors, either physical or psychosocial.
3 Hypothalamus and the pituitary gland, and then the cortex,
or outer layer, of the adrenal gland. Upon stimulation by the pituitary hormone
ACTH, the adrenal cortex releases glucocorticoids into the circulation.
4 Also known as coriocotropin-releasing factor.
5 CRH may act as a neuromodulator, a neurotransmitter, or a
neurohormone, depending on the pathway.
Treating Specific Anxiety Disorders and Specific Treatment
Modalities.
NIMH ON PANIC DISORDERS
|
Posted:
June 01, 1999
Treatment Interventions for PTSD
Coping
with Traumatic Stress and PTSD Symptoms NIMH Fact Sheets
Positive
Coping Actions are those which help to reduce anxiety, lessen other distressing
reactions, and improve the situation in a way that does not harm the survivor
further and which improves things not only today, but tomorrow and later.
Positive coping methods can include:
Using
natural supports and to talk with those one is comfortable with - friends,
family, co-workers - at your own pace. Following
one's own natural inclination with regard to how much and to whom you talk is
usually best for the majority of people.
Learning about trauma and PTSD. It is useful
to for trauma
survivors to learn more about trauma and PTSD
and how it may affect them. For those with
PTSD, by learning just how common PTSD is, and finding that their problems are
shared by hundreds of thousands of survivors of trauma, they can better
recognize that they're not alone, not weak, and not "crazy." When a
survivor seeks treatment and learns to recognize and understand what is
triggering him or her, he or she is in a better position to cope with the
symptoms of PTSD. If the survivor wishes, he or she can tackle the source of
the problem or tell another person specifically what is happening.
Talking to other trauma survivors for support.
When survivors are able to talk about their
problems with others, something helpful often results. Seeking out support from
other trauma survivors, the survivor of trauma may feel less alone, feel
supported or understood, or receive concrete help with a problem situation. One
of the best places to find support is in a specially-designed "support
group." Being in a group with other survivors of trauma with PTSD may help
a trauma survivor reduce sense of isolation, rebuild trust in others, and
provide an important opportunity to contribute to the recovery of other
survivors of trauma.
Talking
to a doctor about trauma and PTSD. Part of
taking care of oneself means mobilizing the helping resources around one. A
doctor can take care of physical health better if he or she knows about PTSD
symptoms, and doctors can often refer trauma survivors for more specialized and
expert help.
Practicing
relaxation methods. These can include
muscular relaxation exercises, breathing exercises, meditation, swimming,
stretching, yoga, prayer, listening to quiet music, spending time in nature,
and so on. While relaxation techniques can be helpful, they can sometimes
increase distress by focusing attention on disturbing physical sensations or
reducing contact with the external environment. Be aware that while physical
sensations may become more apparent when a person is relaxed, continuing with
relaxation in a way that is tolerable (i.e., interspersed with music, walking,
or other activities) is, in the long run, helpful in reducing negative
reactions to internal thoughts, feelings, or perceptions.
Increasing
positive distracting activities. Positive
recreational or work activities help distract a person from his or her memories
and reactions. Artistic endeavors have also been a way for many trauma
survivors to express inner feelings in a positive, creative way. This can be
helpful as a means of improving mood, limiting the harm caused by PTSD, and
rebuilding a life. It is important to emphasize that distraction alone is
unlikely to facilitate recovery; active direct coping with traumatic events and
their impact is also important.
Calling
a counselor for help. Sometimes PTSD symptoms
worsen and ordinary efforts at coping don't seem to work too well. The survivor
of trauma may feel fearful or depressed. At these times, it is important to reach
out and telephone a counselor, who can help the survivor of trauma turn things
around
Taking
prescribed medications to tackle PTSD. One
tool that many survivors of trauma with PTSD have found helpful is medication
treatment in partnership with their doctor. By taking medications, some
survivors of trauma are able to improve their sleep, anxiety, irritability and
anger, or urges to drink or use.
Starting
an exercise program. It's important to see a
doctor before starting to exercise, but after getting the OK, exercise in
moderation has a number of possible benefits for those with PTSD. Walking,
jogging, swimming, weight lifting, and other forms of exercise may reduce
physical tension. They may help distract the person from painful memories or
worries, and thus give them a break from difficult emotions. Perhaps most
important, they can improve self-esteem and create feelings of personal
control.
Starting
to volunteer in the community. It’s important to
feel like you’ve got something to offer to others, that you’re making a
contribution. When you’re not working, it can be hard to get this feeling. One
way that many survivors of trauma have reconnected with their communities and
regained a feeling of contribution is to volunteer – to help with youth programs,
medical services, literacy programs, community sporting activities, and so on.
Negative
Coping Actions help to perpetuate problems. They may reduce distress
immediately, but short-circuit more permanent change. Actions that may be
immediately effective but cause later problems can be addictive, like smoking
or drug use. These habits can become
difficult to change. Negative coping methods can include isolation, use of
drugs or alcohol, "workaholism," violent behavior, angry intimidation
of others, eating, and different types of self-destructive behavior (e.g.,
attempting suicide). Before learning more effective and healthy coping, most
people with PTSD may try to cope with their distress and other reactions in
ways that lead to more problems.
Practice
lifestyle balance
This will include
attention to die, stress management, exercise and rest.
OBSESSIVE COMPULSIVE DISORDER
Simone was having
trouble getting out the door in the morning.
What had started with rewashing her teacup before drinking out of it had
developed into a complex ritual of washing rewashing checking and
double-checking all her doors and windows and dishes she might use for
dinner. She had been under increasing
stress at work and her significant relationship had recently ended. The therapist she was working with suggested
that she consult a psychiatrist for a medication evaluation. The therapist then consulted with the
psychiatrist a local expert with OCD regarding the development of these repetitive
behaviors. There was a history of
“eccentricity” in Simone’s family,
which revolved around compulsive behaviors.
With medication and a cognitive behavioral approach the therapists and
Simone were able to manage the anxiety and decrease the compulsive behaviors.
Many
people develop small ritual actions that help them ground themselves, stay
centered and focused and make the day feel like it is getting off to a good
start. For the individual with
Obsessive Compulsive Disorder these rituals dominate their existence and they
often can’t move beyond these rituals or participate fully in their lives.
For a thorough
discussion the treatment of OCD please read
http://www.psychguides.com/oche.html
For a screening tool
for OCD please visit
http://www.ocfoundation.org/ocf1070a.htm
For support,
information and professional training opportunities in working with OCD please
visit
For a summary of what
has been covered and future directions in the treatment of anxiety disorders,
please read from the following article
Anxiety Disorders:
Future Directions for Research and Treatment
A Discussion Paper
Prepared by:
Martin M. Antony, Ph.D., C.Psych.
and Richard P. Swinson, MD, FRCP(C)
Anxiety Disorders Clinic, Clarke Institute of Psychiatry
and Department of Psychiatry, University of Toronto
For:
Health Canada
1996
Chapter 2
Overview of the Anxiety Disorders
1.
What are the Anxiety Disorders?
a. Panic Disorder with (PDA) and
without (PD) Agoraphobia
b. Obsessive-Compulsive Disorder (OCD)
c. Social Phobia
d. Generalized Anxiety Disorder (GAD)
e. Specific Phobia
f. Posttraumatic Stress Disorder (PTSD)
2.
Prevalence of the Anxiety Disorders
5.
Health Care Utilization and Economic Costs
Chapter 3
Treatment of Anxiety Disorders
2. Pharmacological
vs. Psychological Treatments
a. Possible Side Effects of
Medications
b. Appropriateness of Treatment
4.
Research Findings: Effective Treatments for the Anxiety Disorders
a. Panic Disorder with (PDA) and
without (PD) Agoraphobia
b. Obsessive-Compulsive Disorder (OCD)
c. Social Phobia
d. Generalized Anxiety Disorder (GAD)
e. Specific Phobia
f. Posttraumatic Stress Disorder (PTSD)
1.
Gaps in the Research Literature
i. Adequacy of Treatment Delivery
ii. Outcome and Other Measurement Issues
iii. Assessment Instruments
2.
Methodological Limitations of Treatment Studies of Specific Anxiety Disorders
i. Obsessive-Compulsive Disorder
ii. Specific Phobia
iii. Generalized Anxiety Disorder
iv. Social Phobia
v. Posttraumatic Stress Disorder
3.
Potential Directions for Future Research
4.
Other Implications flowing from the Review of the Evidence-Based Anxiety
Treatment Literature
Appendix
1
Lifetime Prevalence of the Anxiety Disorders (%)
Appendix
2
Glossary of Medications
Glossary of Abbreviations
Glossary of Technical Terms
Appendix
3
Useful References Relating to the Assessment of Anxiety
Disorders
Our
mission is to help the people of Canada
maintain and improve their health.
Health Canada
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The
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represent those of Health Canada.
Également
disponible en français sous le titre
Les troubles anxieux : Orientations futures de la recherche et du traitement
- Document de travail
©
Minister of Supply and Services Canada 1996
ISBN
0-662-24980-1
Cat. No. H39-388/2-1996E
Canadian
Cataloguing in Publication Data
Antony,
Martin M. (Martin Mitchell)
Main
entry under title:
Anxiety Disorders: Future Directions for Research and Treatment: A Discussion
Paper.
Issued
also in French under title:
Les troubles anxieux : Orientations futures de la recherche et du traitement
- Document de travail.
Includes
bibliographical references.
ISBN
0-662-24980-1
Cat. No. H39-388/2-1996E
1.
Anxiety.
2. Anxiety — Treatment.
3. Anxiety — Canada.
I. Swinson, Richard.
II. Canada. Health Promotion and Programs Branch
III. Title.
RC531.A57 1996 616.85’2206 C96-980342-7
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For More Information
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Institute of Mental Health (NIMH)
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General inquiries: (301) 443-4513
TTY: (301) 443-8431
E-mail: nimhinfo@nih.gov
Web site: www.nimh.nih.gov
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(301) 231-9350
www.adaa.org
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www.apa.org
Association
for Advancement of Behavior Therapy
305 7th Avenue
New York, NY 10001
(212) 647-1890
www.aabt.org
National
Alliance for the Mentally Ill
Colonial Place Three
2107 Wilson Blvd., Suite 300
Arlington, VA 22201
1-800-950-NAMI (-6264)
www.nami.org
National
Mental Health Association
1021 Prince Street
Alexandria, VA 22314-2971
1-800-969-NMHA (-6642)
www.nmha.org
National
Center for PTSD
U.S. Department of Veterans Affairs
116D VA Medical and Regional Office Center
215 N. Main St.
White River Junction, VT 05009
(802) 296-5132
E-mail: ptsd@dartmouth.edu
Web site: www.ncptsd.org
|
For Information About Clinical Trials
NIMH
Clinical Trials Web Page
www.nimh.nih.gov/studies/index.cfm
National
Library of Medicine
Clinical Trials Database
www.clinicaltrials.gov
Thank you for joining us in this course. We hope it was helpful for you and your
clients. We thank you for all your work
with all of those coping with these challenges.
Return to school system to "Take an
Exam"
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