How the drug D-cycloserine (DCS) can enhance Cognitive Behavioral Therapy

Posted on August 27, 2016 by JmaC
Exposure therapy is a well-known treatment for phobias and anxiety disorders, and recent research seeks to make exposure therapy even more effective through DCS, a drug that boosts learning in order to strengthen and speed up the effects of the therapy.
PUBLISHED: 02/10/2016


from Boston University


from Boston University

If you are familiar with Cognitive Behavioral Therapy (CBT) used to treat anxiety disorders, you might also be familiar with exposure therapy, a CBT technique that confronts the cause of anxiety in order to re-evaluate the actual danger present, and learn healthy ways to deal with the resulting fear. For example, if you are afraid of heights, exposure therapy might gradually expose you to different height levels, while teaching you better strategies to manage the stress it creates. Exposure therapy can be very effective – in a successful exposure, fear could begin with a high distress measurement of 80% to 90% and end significantly lower, at 10 to 20%. Ideally, this learning process should continue to lead patients to report a lowered distress rating whenever confronted by the feared object or event.

While effective, using exposure therapy to learn that a feared event or object is not dangerous takes time, as a patient will typically need to successfully confront the feared stimuli repeatedly to see lowered distress ratings. However, recent research has uncovered that there may be a way to speed up the benefits of exposure therapy, or even enhance the results.

This Drug Can Boost Learning and Reduce Anxiety Symptoms Faster

D-cycloserine (DCS), a memory enhancing drug that acts on specific nerve-cell receptors in the brain, can be used to improve the learning that takes place during exposure practices. DCS can help your cells respond to the neurotransmitter glutamate, which is important in a process integral to anxiety treatment called extinction learning. Extinction learning is the basis for exposure therapy: it allows anxious patients to learn that feared outcomes are unlikely to occur. After a patient with a phobia of spiders is exposed repeatedly to spiders without any negative consequences, the patient learns that the feared stimulus does not result in the feared outcome, and is able to overcome his or her fear.

The use of DCS can also lead to a faster reduction in anxiety symptoms over the course of treatment, and can even decrease the number of treatment sessions needed overall. The same holds true for symptoms of other anxiety-related problems, such as Social Anxiety Disorder, panic disorder, Obsessive-Compulsive Disorder, and Post-Traumatic Stress Disorder.

Because DCS is a memory enhancer and not an anxiolytic drug (a drug that reduces anxiety), taking DCS alone will not reduce anxiety. DCS only works to reduce anxiety symptoms in conjunction with exposure procedures, as it works to enhance the learning that takes place during therapy (i.e., by acting to boost the memory).

DCS Side Effects are Minimal, but Dose Timing Remains Uncertain

When used as a cognitive enhancer in conjunction with exposure therapy, doses of 50 and 250 milligrams of DCS are used, usually just for a few weeks. At this dose, DCS side effects are comparable to that of a placebo, with no known or recorded side effects.

However, scientists don’t yet fully understand the optimal dosing and dose timing (before or after fear subsides). As a recent study suggests, DCS’s effectiveness may depend on the success of the exposure itself. In other words, only patients who react with anxiety during the exposure therapy and then experience a significant decrease in anxiety by the end of the exposure may benefit from the medication. The study suggests that in an unsuccessful exposure (i.e., when the patient’s anxiety does not peak and then decrease), DCS may instead reinforce the anxious response.1

Next Steps in Using DCS to Enhance Exposure Therapy

Given that DCS has not yet been approved by the FDA as a drug used to enhance CBT for anxiety, it is currently unavailable to the public. However, a new research study examining DCS’s role in exposure therapy is being conducted at three universities: Boston University, University of Texas at Austin, and Rush University. The study will examine the effectiveness of giving DCS to patients only when fear subsides after an exposure.

If you feel anxious in social situations and live near one of the universities, please reach out to the appropriate contact for more information regarding possible participation in the clinical trial.

  • Boston University: nofear@bu.edu
  • University of Texas at Austin: s.witcraft@utexas.edu
  • Rush University: elizabeth_kaiser@rush.edu
Date of original publication: June 22, 2015
Updated on: February 10, 2016
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10 Truths About Panic Attacks

Posted on August 27, 2016 by JmaC
Your mind starts to race, your heart begins to pound, and you feel dizzy, shaky, and numb all at once. Panic attacks can be a horrifying experience – check out what Anxiety.org readers have to say about panic attacks and how to get through them.

Whether you’re alone in your room, surrounded by a crowd, or just going through your typical day, it can hit you like a sudden storm. Your mind starts to race, your heart begins to pound, and you feel dizzy, shaky, and numb all at once. You struggle through the fear, fighting away the dread as you try to keep your thoughts together. And all you want, all you long for, is to just… breathe.

What you’ve just gone through is a panic attack, and we here at Anxiety.org want to make sure that our visitors avoid, or at least are prepared for, debilitating situations like the one described above. We do this in several ways. First, we strive to deliver the most beneficial insights from renowned experts and specialists in the field of anxiety and mental health. Second, our staff works diligently to bring you information by combing the most up-to-date research materials and sharing their findings on noteworthy topics meant to aid you in finding your cure for anxiety. Lastly, we provide an outlet for our Anxiety.org community, meaning readers like you, to share their personal stories and offer their support. It’s from this last resource that we offer some personal perspectives into understanding panic attacks and how to get through them.

The Basics of a Panic Attack

Let’s start by getting to the very core of panic attacks: what do panic attacks feel like? We asked our Facebook followers that very question, and the majority described emotions similar to the description at the start of the article:

  • “You lose complete control of your mind and body. Heart pounding, hands shaking, heart beating out of your chest. Scared! But, because most people do not understand. You have to continue to function. While you are in a fog, you function.”

Others, however, experienced more dire and emotional events:

  • “Instant fear of dying! Like you wanna run. Everything you are looking at looks like it’s running together. Heart racing, short of breath. Feels like your in a bubble, you can see out but can’t be seen.”

There were also a few readers who couldn’t put the experience into words, but wanted to offer their own viewpoint:

  • “Hard to explain. Everyone’s different. But I will tell you something truthfully. They cannot harm you and you are stronger than them!”

No matter how panic attacks were described though, there was one thing the majority of our community had in common: the belief that no matter what happens or how they felt, they eventually came to the realization that they would always get through it:

  • “For me, not understanding what was happening created a more desperate panic in me. I really did research and did talk to a therapist and realized the more I learned about them, the less the servarity… When I feel one coming on I just dont panic, I just go with it and stay calm and it goes away.”

The Effects of a Panic Attack

Experiencing such complex emotions so frequently had us wondering what kind of impact panic attacks had on the average person. With this in mind, we next asked our followers how panic attacks affected them. Their answers ranged in severity, but many mentioned how damaging it was to their personal, everyday lives:

  • “Ummmm I don’t have a social life. It’s kind of hard to hang out with people when I never know how I’m going to feel from day to day and then feel incredibly awkward once I am around people”

For some, the fear of a possible attack coming on with no possible warning even had them avoiding normal activities:

  • “Just the thought of going out in public gets me going sometimes. I wouldn’t wish these feelings upon anyone. I have panic attacks out of no where, sitting at home reading a book or watching TV, “bam” it rears it’s ugly face!”

To add to that, the emotional and mental impact panic attacks caused could be just as devastating:

  • “I’m pretty much a hermit. I’m fine most of the time but on those days where I could really use a friend, it hurts deeply to be so alone.”

Tips for Surviving a Panic Attack

After reading about the emotional rollercoaster panic attacks can cause, and learning about the significant effects they have on everyday life, we at Anxiety.org wondered how we could possibly help our readers through these difficult experiences. Although we knew extensive research on your behalf, or asking a knowledgeable expert for guidance, would offer a valuable amount of information, we felt that the best source for advice would come from first-hand experience. So, we again turned to the Anxiety.org community to share their stories and advice about what they do when experiencing a panic attack.

For the most part, many people believed that deep breaths and talking yourself through the attack really helps:

  • “Isolate yourself from distracting surroundings/people and find a nice, quiet place to shut your eyes and focus on your breathing. I find this difficult to do right away after it begins, so I usually pace or go for a walk until I’ve tired myself out and then do this. Keep repeating to yourself that you’ve been through this before, survived and can do it again. And make yourself BELIEVE IT. Once you believe it, you start to realize that you can get through it like any other time. That you will survive. Other tips include shutting the lights off, lighting some candles and taking a warm bath once you feel yourself getting anxious. Drink lots of water and chamomile tea. And practice yoga regularly to help with the controlled breathing!”

There were also those who shared their experience and success with alternativetreatments, like relaxation and medication:

  • “I learned relaxation techniques from a CD given to me by a psychologist. I fortunately “grew out” of them after high school. By adulthood I found the right perscription for me for GAD. Xanax (.5mg) is great for anxious triggers like traveling.”

Although there was some debate on whether certain treatments and therapies worked over others, the consensus was that the best thing to do for those who suffer panic attacks is to find a method that works for them. One reader gave a simple yet helpful way to look at it:

  • “Once you know it won’t kill you it makes it easier to deal with.”

Help Us Help You

Hopefully these insights have given you a better understanding of the gravity of panic attacks and the methods that can be used to deal with them. If you are interested in learning more about what readers like you have to say, please follow us on Facebook orTwitter.

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A less traditional class of drugs could offer effective treatment for PTSD

Posted on August 27, 2016 by JmaC

Post-traumatic Stress Disorder (PTSD) is a serious anxiety disorder that results from exposure to a traumatic experience or from witnessing a life-threatening event such as violence, abuse, accident, war, disaster, or any situation that seriously threatens the integrity of a person. PTSD is known to be common among veterans, but is also highly prevalent in women. The affliction is currently a very serious burden in the U.S., with high associated mortality rates and healthcare costs.

A spate of treatments are available for those with PTSD, ranging from mental psychotherapy to antidepressants. There’s also exciting news in the area of PTSD treatment: the healthcare community has its eye on a different class of drugs that offers the potential to be highly effective at treating PTSD symptoms.

A Possible New Treatment Method for PTSD Sufferers

Research on PTSD is steadily increasing year by year, which has drawn me to investigate current and potential treatments for the affliction. The first line of treatment for the disorder generally consists of psychotherapy, such as cognitive therapy, exposure therapy, stress inoculation training, and pharmacotherapy with antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs) such as Sertraline and Paroxetine.

Atypical antipsychotics (AAs), which have traditionally been used to treat schizophrenia, are in a different class of drugs from antidepressants, the common standard for PTSD medication. AAs can affect several neurotransmitter systems which have been proven to be involved with the psychophysiology of PTSD. AAs have gotten a lot of attention from the scientific community, but current data proving its efficacy for PTSD is still insufficient. Thus, my team and I set out to conduct a meta-analysis in order to further clarify the effectiveness of AA therapies on PTSD.

Atypical Antipsychotics Reduce PTSD Symptoms

Our meta-analysis included the findings from 455 patients in eight studies: 231 were allocated to AA groups that received medication, and 224 were allocated to placebo groups. The results indicated that AAs were more effective than a placebo in treating PTSD patients. When the effects of pharmacotherapy were compared with placebo treatment, we found significant decreases in PTSD symptoms.

The Side Effects of AAs are Comparable to a Placebo

People with PTSD frequently have to be concerned about how to manage the side effects of their medication, which can often include muscle spasms and other movement disorders. In addition, the metabolic side-effects of AAs, which can lead to weight gain and diabetes, are also a critical concern for long-term use.

In order to analyze these possible drawbacks, we conducted a meta-analysis on dropout rates. Surprisingly, the results showed no statistical difference between AAs and placebo on acceptability and side effects. This finding may be explained by the low doses of AAs used to treat PTSD: somewhere between one-third and one-half of the dosage used to treat schizophrenia is given to people with PTSD.

Pharmacotherapy Shows Strong Potential in PTSD Treatment

AAs could be an effective new choice for treating PTSD, offering the benefits of reduced side effects when compared to other current mediations. We hope that our research and the search for better treatments will allow more people who suffer from PTSD to find greater peace of mind.

Date of original publication: June 18, 2015
Updated on: February 10, 2016
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How To Treat Anxiety in 6 Steps Using Mindfulness Meditation

Posted on August 27, 2016 by JmaC

Mindfulness meditation, a holistic mind-body treatment based in Buddhist psychology, is a powerful tool clinically proven to treat anxiety. This technique works by stopping the cycle of negative thoughts and helping you manage your feelings. The process of mindfulness meditation can be boiled down using these six essential steps:

  1. Stop yourself from obsessive thinking. Obsessing can make it difficult to let go of negative thoughts. Escaping this mental cycle is the goal of mindfulness meditation.
  2. Use an anchor to still the mind. Focusing on a single point can trigger physical relaxation, which will help you through the meditation process.
  3. Calm the body using the breath. A simple breathing exercise described below will help you relax and get in touch with your emotions.
  4. Focus on the sensations in the body. Every emotion has a sensation signal in the body. Find one sensation signal in the present moment and focus on it.
  5. Explore the qualities of the sensation signal you chose.
  6. Build up your ability to meditate for longer periods of time. Like any ability, meditation is a skill that takes practice. The longer you are able to meditate, the more benefit you will get from this exercise in mental control and emotional tolerance.

Read on to learn more about the process of mindfulness meditation – by fully understanding and utilizing these six steps, you can be on your way to practicing mindfulness meditation, and achieving all the mental health benefits that accompany it.

Mindfulness meditation has become nearly as recognizable and popular in mainstream Western culture as yoga. From ancient origins in the contemplative science of India and Tibet1, to the research laboratories of Ivy League medical schools, and from the conference rooms of elite corporations like Google2 to the VA hospitals of the US military3, there seems to be no discipline or sphere of life that isn’t taking an interest in mindfulness.

The healthcare community agrees that research outcomes support its efficacy – so how can you begin to utilize mindfulness meditation in your own life? You still need clear instructions and competent mentors to guide your experience. What follows are some easy steps to get a basic mindfulness practice started, with specific attention given to managing difficult or overwhelming emotions such as anxiety. While mindfulness meditation is very safe, please consult your therapist when starting any new regime and do not try the following instructions when you are having a panic attack.

1. Get out of the spin cycle of your thinking mind.

You may already be aware that the intensity and duration of negative emotions is driven or exacerbated by excessive rumination. That is – you can’t seem to let go of negative thoughts and instead , to your own detriment, obsess over and indulge worst-case scenarios that only compound shame, sadness, fear or anger. Quick hint, trying to suppress negative thoughts does not solve ruminations. When you’re caught in the grips of a spin cycle, use the following mindfulness technique.

2. Use an anchor to stabilize the turbulent mind.

The mind needs an anchor, or a single point of focus, to direct it away from ruminations and elicit the body’s natural relaxation response. Dr. Herbert Benson, a Harvard Medical School cardiologist who specializes in mind-body medicine, coined the term “the relaxation response” to describe the physical state of deep rest that changes the body’s response to stress. Many objects or anchors of attention are useful in stabilizing the mind and achieving this relaxation response. These anchors could include attending to sounds in the present moment, focusing on your breath passing in and out of the nostrils, repeating a prayer or affirmation, or any of the four foundations used in traditional Buddhist training.1

For those who struggle with anxiety, I often recommend using the second foundation, mindfulness of sensations, as the primary focus. The second foundation not only provides a solid, real-time anchor for attention, but also serves as an exposure or desensitization exercise that short-circuits habituated stimulus-response patterns.

After finding an anchor, the next mindfulness step is physically based – the following breathing exercise will help you attain the body’s natural relaxation response.

3. Come into your body where your emotions reside.

Find a comfortable and relaxed position, whether seated or lying down. Try to keep your spine straight and stay physically relaxed as much as you can. Begin by taking ten natural, gentle breaths, focusing your mental attention on your nostrils as you inhale, pause, and then exhale. At the tail end of your exhale, count a number aloud or to yourself, designating the completion of a cycle. Then, repeat that number during the next inhalation until you’ve completed ten full breath cycles.

If you get distracted by external sounds, passing thoughts, or physical discomfort, that’s totally normal. Don’t give up, get frustrated, or treat the breathing exercise like a race. Simply recognize your distraction as part of the exercise and calmly choose to return your focus to the breath, beginning again at the number one. After ten continuous breaths, expand your awareness to include your entire body.

Drop down into the body and feel the sensations arising, fully devoting your attention in the same manner that you were attending to the breath passing in and out of your nostrils. Yes, this body is where you always live, and yet, perhaps, you hardly notice it. If your entire body is too broad or vast a terrain to attend to, break it up into parts or regions in your mind, and go through a complete body scan, segment by segment, from the crown of your head to the tips of your toes and back again.

Do not judge what you notice about your body, desire something different, secretly hope for something to change, or expect a continuous, pleasant ride. Meet every physical sensation with utter acceptance. The goal of this practice is to ground yourself in the present moment of lived experience, here and now, rather than dwelling on the mental abstractions of past and future. This practice also helps you reconnect with the body, close to where the emotions truly reside, rather than occupying yourself with the stories or perceptions of emotions. Once you’ve completed a body scan, continue on the next step…

4. Befriend one emotion to undercut the reactivity circuit.

Imagining your body is a terrain and your awareness like a radar scanner, tracking the most intense or pervasive signal. Gravitate towards that signal, wherever it is, and make it the new object or anchor of attention. Every emotion has two parts: the sensation signal in the body, and the story fabricated in the mind. You are only interested in the first. Perhaps your sadness is like a hollow sensation in the gut. Your anxiety might be a constriction in the chest. Your anger may present as a burning sensation in the jaw. As you experience pain, tension, tightness, gripping, bluntness or dullness in any particular region, let those physical sensations become your signal and resist the urge to push them away.

Explore the signal like a child exploring a new territory, or a scientist using a microscope. You are observing energy patterns at play in the present moment. Meanwhile, avoid indulging the story line about what the signal seems to mean – allow those thoughts to pass on their own in the background of your awareness. If, at the time of your practice, your signal is pleasant, relaxing, and enjoyable, follow the same instructions of attending moment by moment with acceptance and without attaching to the story. If there is no pervasive sensation or signal, keep your attention openly scanning the body from head to toe and back, resist the urge to become disinterested, and stay attuned until something prominent emerges. Once you’re locked into a pervasive emotional signal, continue to the next phase of the exercise.

5. Go deeper by inquiring into the qualities of the sensation.

During this phase of the meditation practice, I often encourage my clients to inquire about the specific nuances of their signal by prompting them with the following questions: Where is the signal located in the body? What is its shape? What is its texture? Does it have a color? Is it dense or dispersed? Static or moving? This inquiry helps bring one’s attention closer to the signal, thereby deconditioning the habituated stimulus-avoidance-response circuit. When focusing on the sensation without the story line, my clients are often amazed to find that they are able to sit with and accept their distressing emotions for longer periods of time. However, one session of mindfulness meditation is not enough to escape the cycle of negative thoughts and emotional reactivity. You’ll need to continue to practice accordingly as follows.

6. Work your edge, systematically staying present for longer periods of time.

Just like physical strength, endurance and flexibility, emotional tolerance and resilience are skills that can by systematically developed. Treat meditation like a mental workout – you wouldn’t expect physical results in one session, but you would expect slight to moderate discomfort as you stretch and tone new muscles. Befriending distressing emotions through mindfulness requires a systematic increase in the intensity and duration of exposure to the signal. When you lift weights, run on the treadmill or do yoga postures, you are often asked to “work your edge” in a safe, responsible and consistent manner. You go right up to the threshold of your perceived capacity, breathe, and stay a little longer than you think you can. If you back off and avoid the edge of your comfort zone, you won’t grow new neural pathways and your emotional flexibility atrophies.

Conversely, if you go through the process of exposure in meditation too deeply, too quickly, or too recklessly, you risk getting overwhelmed or experiencing re-traumatization, the mental equivalent of physical injury, and can actually strengthen the negative avoidance response. Finding the right balance is key, and I often use a rating scale to help orient clients to the optimal ranges for new learning: the numbers 1-4 mean you’re not in the ball game, while 8-10 mean you’re risking injury. A number within the range of 5-7 is considered the sweet spot for change.

By mindfully attending to emotions with care, patience, and diligence, and by following these instructions over time, you’ll find that it is possible to turn an enemy into an ally, befriend anxiety, and reclaim your life. Though it can be very beneficial to find a mentor, therapist, or group that can help you understand and practice mindfulness meditation, by following these steps you can begin to experience the benefits of mindfulness through day-to-day efforts.

Date of original publication: July 20, 2015
Updated on: March 23, 2016
Posted in MindFulness | Leave a comment

Understanding Traumatic Stress

Posted on August 27, 2016 by JmaC

Stress is something we all face. It comes in many forms and differs across contexts, from work-related or financial stress, to social problems, to new life changes, to internal experiences. Some stressors are minor or short term, while others may be chronic. Because stress varies in intensity, length, and type across individuals, it can be difficult to pinpoint what “stress” is without looking to the body for answers.

The three I’s for traumatic stress on the body are:

    • Impact
    • Intensity
    • Intervention

What occurs in the body during times of stress?

Although what causes stress is different for each person, the “stress response” – theimpact – is universal. In the face of a major stressor (internal or external), the body goes into a “fight or flight” mode. During this “fight or flight” mode, the sympathetic nervous system and a specialized stress-response system called the hypothalamic pituitary adrenal (HPA) axis are activated. This activation results in the release of stress hormones and changes in the body to deal with the threat. When the threat is resolved, another system, called the parasympathetic nervous system, is activated to help the body return to homeostasis, a healthy balance of both systems. Although this stress response system works very well for acute stressors, activating this stress response over and over or being unable to return to homeostasis due to chronic stress can be very harmful to one’s physical and mental health, with research showing links between stress and many conditions, including depression and cardiovascular disease1.

What is traumatic stress?

Trauma is a specific type of stress that reflects exposure to terrible events generally outside the range of daily human experience that are emotionally painful, intense, and distressing. According to the Diagnostic and Statistical Manual of Mental Disorders, 5thedition2, there are specific criteria for what qualifies as a traumatic event:

“Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

• Directly experiencing the traumatic event

• Witnessing, in person, the traumatic event

• Learning that the traumatic event occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event must have been violent or accidental

• Experiencing repeated or extreme exposure to aversive details of the traumatic event (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse)” (pg. 271)2.

The reason for this narrow definition of trauma, and its distinction from stress more generally, is in part because traumatic events can result in particularly problematic trauma responses that are unique from general stress responses. In addition to that initial stress response in the body discussed earlier, long term psychological consequences are seen in many individuals that are exposed to traumas. A psychiatric condition commonly associated with trauma exposure is posttraumatic stress disorder (PTSD) which includes a variety of symptoms:

• Re-experiencing the trauma in distressing ways

• Avoidance of trauma-related cues

• Negative beliefs about oneself or others as a result of trauma

• Mood alterations following the trauma

• Hypervigilance

Many of the symptoms of PTSD are normal reactions in the first few weeks after the trauma but can become PTSD if they persist past the first month and cause problems with family, friends, work, or other important areas of one’s life.

Keep in mind that trauma responses are different across people and many will see no lasting negative effects of trauma. For example, rates of PTSD in the general population are approximately 8%, despite 50-60% of individuals reporting exposure to a traumatic event3. For those that do have negative psychological outcomes as a result of trauma, the development of PTSD is not the only potential response. Depression, substance use problems, and other anxiety disorders are also common trauma-related conditions that can emerge as a result of trauma exposure.

How will trauma affect you?

It is hard to know exactly how trauma will affect you. We know that there are many things that can influence the likelihood of developing PTSD or other psychological problems after exposure to trauma:

  • Type of trauma
  • Age that the trauma occurred
  • Severity of traumatic event or exposure to multiple traumas
  • Presence of other risk factors such as negative family environment or co-occurring psychological problems
  • Biological factors

Biological and environmental factors interact to create greater risk for or resilience against negative outcomes following trauma4. But, there is still so much we do not know about why some develop PTSD and some do not. The best thing to do if you are exposed to a traumatic event is to reach out to a professional for intervention and help. Exciting new research suggests that early intervention in emergency departmentsfollowing trauma might prevent PTSD and depression symptoms from developing5, so reaching out sooner rather than later may be particularly important. One example of this in action is how schools now respond to traumatic events, like shootings, by bringing in counselors and making mental health services readily available. If these professionals were trained in trauma-focused treatment, it might be particularly effective at reducing risk for developing PTSD following such traumas.

And for people who have struggled for a long time with PTSD or other trauma-related problems, it is never too late to get help. Common treatments, which can include counseling and/or medication, help people at all ages and stages of recovery. For PTSD in particular, research supports the use of exposure therapy and cognitive processing therapy, as well as selective serotonin-reuptake inhibitors (SSRIs) either alone or in combination with therapy6-8. It is important to find a clinician that is licensed and trained in working with people who have PTSD. For the therapy to work best, you want to find someone with expertise in what you are going through. Don’t be afraid to ask the clinician if they have been trained in cognitive behavioral therapy and have worked with traumatized people before. Remember, this is not something that you have to survive or face alone!

Date of original publication: October 22, 2015
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What OCD Treatment Is Best?

Posted on August 27, 2016 by JmaC

Do You Know Which Of These Treatments Works Best For OCD Sufferers?

    • SSRIs, like fluxotine or other antidepressants
    • Exposure therapy
    • Ritual prevention
    • Atypical antipsychotics, like risperidone

Obsessive-compulsive disorder (OCD) is an anxiety disorder that affects over 6 million Americans each year. The symptoms of OCD typically begin in childhood and strengthen moving into adulthood. These symptoms include intrusive thoughts, images or urges (obsessions) as well as repetitive behaviors or mental acts (compulsions). For some suffers, these symptoms can become debilitating. Fortunately, effective evidence-based treatments exist for OCD, and those afflicted can find help and recover.

Choosing which treatment is best for each individual patient, however, can be a complicated decision for clinicians to make. The case study illustration below describes an OCD case in which a patient showed little reduction in symptoms with a certain course of treatment, and required the addition of an alternative treatment. Thankfully, recently released research examines which OCD treatments present the best course of action for patients, findings that provide important new guidance for clinicians and families.

A Case Study In OCD Treatment

Jim (pseudonym) is a 36-year-old man with OCD who is preoccupied with the idea of contracting H.I.V., even in situations in which transmission is impossible or extremely unlikely. For example, Jim fears that he might come in contact with H.I.V by touching door handles, using public toilets, or shaking hands with someone who could be infected. In these situations Jim is beset by near constant thoughts of H.I.V., as well as lingering doubts such as What if I had a scrape on my finger that could have let H.I.V get into my bloodstream? These intrusive thoughts, which are known clinically as obsessions, provoke intense distress and anxiety.

To find relief, Jim ends up washing his hands over and over again in a ritualistic fashion, up to 100 times per day. He also asks his family members to reassure him that he has not become infected, in order to quell his obsessive doubts. These repetitive behaviors (compulsions), which accompany obsessions, are the other cardinal feature of OCD. Compulsions aim to relieve the anxiety provoked by obsessions, but their effect is only short lived. Jim reports that his fears always return, and no matter how hard he tries he cannot overcome his doubts. While many people have fears of contracting an illness such as H.I.V., Jim’s problem is well beyond typical. On a given day his obsessions and compulsions dominate his waking life. They make it difficult for Jim socialize with others, do his job, and even leave his house. As a result he feels depressed and hopeless about the future.

Certain OCD Treatments May Cause Only A Slight Improvement In Symptoms

Jim has been seeing his psychiatrist for the past six months. Dr. “Smith” prescribed fluoxetine, a selective serotonin reuptake inhibitor (SSRI), which the Food and Drug Administration (FDA) has approved as a first-line treatment for OCD. Dr. Smith tapered the medication to a maximally tolerated dose, but Jim reported only slight improvement in his symptoms. Dr. Smith then switched to a second SSRI, which had similar effects. With two SSRI trials that still left Jim with significant OCD symptoms, Dr. Smith has to determine: Well, what to do now?

The Options for OCD Treatment

Unfortunately this situation is relatively common in OCD treatment. Although research supports the use of SRIs for OCD (i.e., clomipramine and the SSRIs), most patients experience only a partial reduction in symptoms, and some do not respond at all. When patients do not fully respond to an SSRI alone, the next step is to add an additional treatment, which is known as augmentation. Two common SSRI augmentation strategies are the addition of atypical antipsychotic medications (such as risperidone) orcognitive-behavioral therapy (CBT), consisting of exposure and ritual prevention (EX/RP). Recent evidence described here suggests that EX/RP is a far more effective augmentation strategy than atypical antipsychotic medications like risperidone. However, if some individuals are not helped by EX/RP, risperidone might be an option worth trying for them. Being able to match treatments to individual patients in this way is the goal of personalized medicine, but it requires clinicians to make accurate predictions about who will benefit from one treatment over another.

Which Treatment Option is Best in This Situation?

Jim’s symptoms are on the higher end of the continuum of severity – even with his SSRI, Jim is spending over five hours per day on his obsessions and compulsions. He finds his compulsions almost impossible to resist once triggered, and his symptoms are causing substantial impairment in his day-to-day functioning. On the Yale-Brown Obsessive Compulsive Scale (YBOCS), considered the gold standard measure of OCD severity, Jim scores a 28 out of a maximum of 40 points, putting him in the severe OCD range. Dr. Smith may think, perhaps Jim’s symptoms are too severe for EX/RP, a common statement or perception among psychiatrists. In addition, Jim is also moderately depressed and Dr. Smith may wonder if Jim’s depression would interfere with EX/RP treatment. These sorts of thoughts might lead Dr. Smith to instead begin prescribing risperidone – but would this course of action be warranted and effective?

Analyzing Treatment Options For SRI-Resistant Individuals

My colleagues and I recently undertook a study to examine this question, the results of which were recently published in the Journal of Consulting and Clinical Psychology. In this study, we conducted a secondary analysis of data from an SRI augmentation trial conducted by Dr. Blair Simpson and Dr. Edna Foa. One hundred individuals who continued to have significant OCD symptoms despite an adequate trial of an SRI were randomized into groups to receive two months of treatment with either risperidone, pill placebo, or 17 sessions of EX/RP.

Exposure Therapy and Ritual Prevention Show High Levels of Effectiveness

As described here, their study found that EX/RP was superior to risperidone as an augmentation strategy, meaning that, on average, patients experienced more relief in their OCD symptoms with EX/RP. This finding reported on the overall trend (i.e., on average patients do better with EX/RP). Our secondary analysis aimed to identifymoderators, or characteristics that either increase or decrease differences between treatments. Moderator analyses can be used to identify factors that would help treating clinicians choose one treatment over another for an individual patient. We evaluated a wide range of potential moderator variables, including OCD severity, types of OCD symptoms, duration of illness, severity of co-occurring depression, and overall level of functioning.

What we found was surprising: OCD severity was in fact a moderator, but in the oppositedirection from clinical intuition that may suggest that severe OCD requires an antipsychotic in lieu of EX/RP. Instead, we found that the more severe the OCD, the greater the difference in outcome between EX/RP and risperidone. In other words, EX/RP’s superiority over risperidone increased with increasing OCD severity. In addition, depression was not related to worse outcome with EX/RP at the levels of depression studied (mild to moderate). These results suggest that EX/RP should be the recommended SRI augmentation strategy for most patients, even for severe OCD. Returning to the example of Jim, our results suggest that Dr. Smith should recommend EX/RP, even though Jim’s symptoms are severe and he is experiencing moderate depression. Our data indicates that adding EX/RP to Jim’s SRI may be the most effective way for him to become well.

Continuing Research On Choosing The Right OCD Treatment

Now, Dr. Simpson (at Columbia University in NYC) and Dr.Foa (at the University of Pennsylvania in Philadelphia) are examining whether those who achieve wellness through SRI augmentation with EX/RP can then safely discontinue their SRI medication without experiencing a relapse. More information for this ongoing trial, which is funded by the National Institutes of Mental Health, can be found here.

Hopefully, with clinical studies like the one examined here, both clinicians and those suffering from OCD can find the most effective treatment available. If you are suffering from OCD, you can discuss the benefits of different treatment options with your doctor or psychiatrist.

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Walking On Eggshells May Be The Best Strategy For A Chronically Anxious Partner

Posted on August 27, 2016 by JmaC

Editor’s Note: This article is based on studies conducted by the author, as Principal Investigator, and funded by a research award (#1360530) from the National Science Foundation’s Division of Behavioral and Cognitive Sciences. “… implications for how to help people have happier relationships … when one has a chronically insecure partner” was one of the hopefully anticipated outcomes of the program. -wnt

Dealing with chronic anxiety can be challenging. But anxiety, like almost everything else in life, is usually not managed in isolation. Close relationship partners, such as close friends and romantic partners, often play a role in managing one’s anxiety. My research has examined how people cope with having a chronically anxious friend or romantic partner. Typically, the examination is of a specific type of anxiety that psychologists refer to as “attachment anxiety,” which involves chronic worries about being unloved, rejected or abandoned by others. Attachment anxiety is similar to social anxiety and separation anxiety disorder . All of these anxieties deal with inter-related relationship concerns of being negatively evaluated, rejected, and abandoned by others.

” …anxiety is not just managed on one’s own; rather, one’s important relationship partners also change their own thinking, motivations, and behaviors to manage anxiety.”

The research suggests that attachment anxiety is detected by other people. Anxious people are perceived as anxious by others, especially friends and romantic partners, who have had plenty of opportunities to observe their behavior. There are many behavioral cues that may help friends and romantic partners learn about the anxiety. For example, chronically anxious people may often express anxiety to their relationship partners by:

  • Openly talking about their anxiety
  • Through displays of negative emotions (such as crying, pouting, or yelling)
  • Overreacting to negative events (such as reading too much into others’ behaviors and making small problems out to be more important than they are)

The Research Studies

All of these behaviors may help friends and romantic partners learn that someone is anxious. The studies examine whether friends and romantic partners detect each other’s attachment anxiety. Both members of friendship or romantic relationship pairs (called “dyads”) are asked to participate in a study. Typically, between 100 and 200 dyads per study are assessed. Each person completes a well-validated self-report measure of attachment anxiety. An example item on one of these measures is, “I often worry that other people don’t really love me.” Participants indicate their level of agreement to several of these statements to assess their own anxiety. In addition, participants complete a similar self-report measure of their perceptions of their friend’s or romantic partner’s attachment anxiety (e.g., “My partner often worries that other people don’t really love him/her”).

Given that both members of the dyads participate in the studies, I can examine the correlation between one person’s perceptions of their relationship partner’s attachment anxiety and their relationship partner’s self-reports of their own attachment anxiety. Across several studies, this correlation was found to be positive and statistically significant, indicating that people who report that they are more anxious tend to be perceived as more anxious by their friends and romantic partners. In other words, anxiety is often accurately detected.

” … if a sensitive topic of conversation comes up, they might tell the anxious partner what they want to hear rather than being honest … “

According to the findings, once people observe these behaviors and learn that their friend or romantic partner is anxious and easily upset, they become highly motivated to avoid doing things that might upset the anxious individual, and they change their behaviors accordingly. For example, if a sensitive topic of conversation comes up, they might tell the anxious partner what they want to hear rather than being honest about their opinions. Or they might change the topic of conversation altogether. They may also give excessive amounts of praise, more than they would ordinarily, to keep the anxious person feeling loved and valued. They may also feel pressure to agree to requests made by the anxious person so that the anxious person doesn’t feel hurt.

Walking On Eggshells

Colloquially, we often refer to this pattern of behavior as “walking on eggshells” – people tiptoe around anxious people to avoid upsetting them. Several studies have been conducted suggesting that people behave in this way around anxious relationship partners.

In one study, participants brought a friend or romantic partner to the laboratory. They were placed into separate rooms and asked to rate their friend or romantic partner on several traits and abilities (e.g., physically attractive, intelligent, socially skilled, interesting to talk to). Then they completed several other measures related to a different investigation so they would forget what they said on these ratings. At the end of the one-hour appointment, they were asked to rate their friend or romantic partner again on the same traits and abilities, but this time some participants were told that their friend or romantic partner waiting in the other room would get to see their ratings.

Participants who had detected that their friend or romantic partner was highly anxious tended to inflate their ratings during this second assessment, changing some of their lower ratings to more positive ratings, if they believed their anxious friend or romantic partner would be viewing their ratings. Participants who had non-anxious friends or romantic partners did not do this – they were more likely to express their negative evaluations, if they had them, to their non-anxious friend or romantic partner.

Study Findings

These results provide direct evidence that people are sometimes extra careful around anxious partners. In addition, in several other studies, participants were asked to complete self-report measures of their tendencies to “walk on eggshells.” These measures assessed whether one hides complaints, exaggerates their positive thoughts and feelings, and is reluctant to turn down the partner’s requests (e.g., ” I never say “no” when he/she asks me for help”; “When I am feeling negative emotions about him/her, I am careful not to express them”). I have repeatedly found positive and statistically significant associations between perceptions of a partner’s anxiety and these self-reported behaviors, suggesting that people who detect their relationship partners’ high anxiety tend to report “walking on eggshells” around those anxious partners. This is the case for both friends and romantic partners.

People who have heard about this research often ask, is this “good” or “bad” for relationships? Well, just like almost everything, the answer is not that simple because there are both costs and benefits. On the one hand, having to “walk on eggshells” to help an anxious person manage their feelings can be burdensome. It is unpleasant to regularly be in a state of waiting for the other shoe to drop, worrying that one could accidentally say or do the wrong thing and incite the negative emotions of an easily upset partner. My work suggests that this can take a toll on one’s happiness in the relationship – people were less satisfied with their romantic relationships on days they reported “walking on eggshells” around their romantic partners.

” … walking-on-eggshells behavior seemed to make highly anxious people feel just as loved and valued as non-anxious people.”

On the other hand, “walking on eggshells” around anxious partners can help those anxious partners feel more valued and loved, which could reduce conflict and improve the relationship for both people. The research also suggests that this does occur. People who were high in attachment anxiety did not feel more insecure about their romantic relationships than people who were low in anxiety on days following their partner’s “walking on eggshells.” In other words, this walking-on-eggshells behavior seemed to make highly anxious people feel just as loved and valued as non-anxious people. So, as with most things in life, there is a trade-off here.

Is This Dysfunctional Behavior?

“Walking on eggshells” around anxious partners may appear to be dysfunctional from some perspectives, and it’s important to consider these perspectives. For instance, one could argue that it is dysfunctional to be in relationships in which we have to mask our thoughts and feelings; that we should seek friends and romantic partners who allow us to feel comfortable enough to express whatever is on our mind; and be our “true selves,” unfettered by concerns about upsetting them. Such a high level of comfort would certainly be ideal. However, this level of comfort may be unrealistic. Most people do tailor their behavior in one way or another to accommodate the personality characteristics and feelings of their relationship partners. Indeed, changing one’s behavior to accommodate a relationship partner is thought to serve as proof that a close relationship exists, as is being concerned for a partner’s emotional welfare and behaving in ways that enhance the partner’s welfare.

“Most people do tailor their behavior in one way or another to accommodate the personality characteristics and feelings of their relationship partners.”

So most of us actually don’t live up to this ideal – we don’t express whatever is on our mind without consideration of others’ feelings, because that’s not how most close relationships work. Some may also characterize this “walking on eggshells” pattern as a “co-dependent relationship” – a relationship in which one person is dependent on the other for self-worth, approval, or identity. Although this dependence seems to be evident for anxious people in my studies, this type of dependence is not all that uncommon or pathological. Most of us depend, to some degree, on receiving approval, validation, and care from our close relationships.

Happiest When We Receive Approval and Love

Although some of us like to think of ourselves as unconcerned and uninfluenced by social approval, this is a denial of our social nature. A large body of research suggests that receiving approval, acceptance, and love matters to most of us, and that we’re happiest and healthiest when we receive it. So we all exhibit aspects of this “co-dependence,” although anxious people seem to display it in stronger form, which is what sets the stage for the “walking on eggshells” process. We could think of it as taking normal dependence and sacrifice to overdrive in the service of managing anxiety.

What Does It All Mean?

This work has many practical implications. For example, clinicians may want to consider interventions that help close relationship partners manage the challenges of maintaining a relationship with an anxious person and become more supportive and supported in those relationships. People who suffer from anxiety may want to consider whether their relationship partners have become cautious or stressed, and have open discussions with their partners regarding anxiety and the best way to manage it in their relationship. Partners of anxious people should realize that the urge to walk on eggshells around anxious people is common, and should consider the costs and benefits of this strategy. Intervening on interpersonal relationships may be a useful component of a comprehensive approach to anxiety treatment.

Now, of course, this pattern doesn’t describe everyone. It is based on statistical analysis that averages across responses made by hundreds of participants. Not every person and relationship may function in this way. Nevertheless, this research demonstrates that, for many anxious people, anxiety is not just managed on one’s own; rather, one’s important relationship partners also change their own thinking, motivations, and behaviors to manage anxiety.

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Alleviating Worry with Positive Thoughts

Posted on August 27, 2016 by JmaC

Worries are a normal feature of human existence. Whether it is an upcoming presentation or a romantic date, we all have our concerns about the future, and in many cases, this type of worry is actually helpful1. For instance, worrying about that upcoming date may encourage you to buy a new outfit or clean your place of residence, both of which may help you impress your potential partner. In anxiety disorders, though, worrying can be taken to a pathological extreme2. For these individuals, worries are often intrusive and uncontrollable and can produce a significant amount of distress. Consequently, research scientists and clinicians alike are always on the hunt for easily implemented forms of treatment that can help alleviate such worries.

Focusing on the Negative

One aspect of pathological worry that is particularly distressing for sufferers is that these individuals tend to imagine only negative outcomes to future scenarios3. Returning to the romantic date example, an individual with healthy amounts of worry might imagine that their date will think their new outfit is ugly, but they will also imagine that their date might find it attractive and fashionable. In this way, their fear is balanced by a positive possibility. However, an individual with pathological worry will imagine only the negative outcome. In this scenario, the individual can become fixated on the imagined negative outcome and fail to realize that there are positive possibilities as well.

Positive Thoughts as Way to Treat Worry?

Recently, a team of researchers led by Dr. Claire Eagleson of King’s College London wanted to know whether pathological worriers could be trained to imagine positive outcomes to their worries rather than fixate on negative possibilities4. To investigate this question, the researchers recruited individuals with Generalized Anxiety Disorder (GAD) and trained them to respond to worries by imagining positive outcomes to the situations that spurred their fears. Participants were asked to identify a situation they were currently worried about, imagine how that event could have a positive outcome, and record this positive outcome in a journal. A separate group of participants were asked to simply imagine something positive that was completely unrelated to the initial worry and record this positive imagery in their journal. The researchers then sent participants home with these journals so that they could record themselves practicing.

After four weeks, the participants came back into the lab, and they were evaluated to see if their anxiety had improved. The results revealed that, on average, participants reported a significant decrease in their worry and experience of anxiety-related symptoms over the course of the study. They also reported an increase in their feelings of optimism. Intriguingly, the participants who imagined unrelated positive events reported the same improvements in worries and anxiety as well as the same increase in optimism. Thus, this intervention seemed to help even after a very short period of time.

What this Means for Treatment

This study is encouraging in that the simple act of imagining positive events, either related to the initial fear or not, served to counteract the negative effects of worry. These findings suggest that simply redirecting worried thoughts to positive imagery of any kind can lead to improvements in the overall experience of anxiety. Crucially, given that even individuals imagining unrelated positive events saw improvements, this work suggests that it might not be necessary to challenge or change the worries themselves. Instead, the simple act of distracting the mind with a positive image may be sufficient. Though further research is needed, this work opens the door to new avenues of treatments that are easy for individuals to implement in any number of situations.

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Cognitive Behavioral Therapy (CBT): Effective Anxiety Treatment

Posted on August 27, 2016 by JmaC
PUBLISHED: 08/03/2016


from Emory University

Cognitive Behavioral Therapy (CBT) refers to a broad range of psychological treatments for anxiety disorders. Generally speaking, these clinical approaches seek to alleviate both negative cognitions (i.e., thoughts, beliefs) and maladaptive behaviors associated with mental disorders1.

CBT seeks to blend the best parts of behavior and cognitive therapies2. From the perspective of CBT, one must address both the maladaptive behaviors and the cognitions associated with mental disorders to provide adequate treatment3. For instance, imagine a man named Fred. Fred suffers from severe social anxiety. Consequently, when at parties, he finds himself constantly thinking, “I am so awkward. Everyone thinks I’m weird.” To cope with these distressing thoughts, he drinks too much, which makes him feel substantially worse the next day. To help Fred, a therapist using CBT will encourage him to challenge his negative thoughts and develop a more positive appraisal of his actions. In addition, the therapist will also help him develop coping mechanisms that do not rely on alcohol. In this way, CBT can help reduce both sources of stress for Fred and hopefully help him experience significantly less anxiety in social situations.

What makes CBT unique?

If a friend, therapist, or medical professional has suggested you investigate CBT to help with anxiety or an anxiety-related disorder, there is a reason. Namely, it works. Early behavior therapists demanded empirical evidence for any proposed new therapy4. In other words, they needed scientific evidence that a therapy helped patients or clients before applying it clinically. Most therapies under the umbrella of CBT have maintained this strict scientific rigor, and consequently, we know that they actually help people cope with their disorders. In particular, over the past 10 years, there have been two large scale meta-analyses5-6, examining the effectiveness of CBT across numerous studies. Whereas a typical study may examine only 100 participants, meta-analyses combine data from upwards of hundreds of studies, sometimes including thousands of individual participants, into a single analysis. This approach gives researchers tremendous power to see whether a given clinical approach is truly effective across circumstances. In regards to CBT for anxiety, both of these papers concluded that CBT was “highly effective” at treating anxiety disorders5-6, including generalized anxiety disorder (GAD),panic disorder, social anxiety disorder, and post-traumatic stress disorder (PTSD).

What does CBT look like?

CBT can take many forms and is often tailored to the needs of individual clients. However there are some consistent approaches that therapists use. Listed below are a few common types of therapy and techniques that an individual might encounter while participating in CBT.

Interpersonal Therapy

Interpersonal Psychotherapy (IPT) is a “time-limited” form of psychotherapy that, within a few sessions, seeks to identify interpersonal problems which are causing psychological distress and develop a plan of action to address the source of these problems7. This model specifically holds that interpersonal problems (e.g., difficulties with a boss, fight with a family member) can be connected to psychological symptoms. Consequently, therapists using IPT seek to alleviate problematic symptoms, give clients interpersonal skills to aid their current situation, and boost the client’s sources of social support. In this way, IPT improves the client’s experience of their disorder while giving them real-world skills to help them address the problems at hand.

Thought Diaries/Thought Records

Thought diaries or thought records are a straightforward approach to addressing the negative cognitions often associated with anxiety disorders8. In this technique, clients are asked to write down their negative thoughts (e.g., “I will fail this upcoming exam.”), the situation in which they had the thought (e.g., talking with a family member about school), the emotions associated with the thought (e.g., fear, anxiety), how they attempted to cope (e.g., breathing exercises), and the eventual outcome of the event (e.g., “I initially felt really scared, but after doing breathing exercises, I was less worried about the exam.”). This technique can be incredibly useful for helping clients identify the specific situations that cause them anxiety and which techniques work to help them calm their worries.

Modern Exposure Therapies

Exposure therapies were pioneered by Joseph Wolpe, a South African behavior therapist9. Exposure therapy was originally designed to treat clients with phobic fears and makes use of a therapeutic approach known as systematic desensitization. In this model, therapists slowly expose clients to the target of their fear in increasing degrees. For example, for an individual with spider phobia, a therapist will begin by simply showing them pictures of spiders, then proceed to showing them fake spiders, then present them with a real, living spider, and, finally, the therapist will ask them to directly approach and touch the spider. During this process, the therapist leads clients through techniques such as progressive muscle relaxation until they feel calm and no longer experience fear in response to the feared target. Though originally developed strictly as a behavior therapy, modern variants include cognitive techniques to help clients reduce their mental experience of fear.

History of CBT

Though it came to fruition in the 1970’s and 1980’s, CBT has roots in the work of behavior therapists in the early 20th century. Behavior therapy grew out of the behaviorist school of thought, which argued that psychologists should focus only on “observable” behaviors rather than speculate regarding the content of a person’s thoughts10. Following this vein, behavior therapy approached mental disorders by addressing specifically the negative behaviors associated with those disorders. For instance, Mary Cover Jones, the “mother of behavior therapy,” developed a technique to reduce a fear of bunnies in a child by rewarding that child with candy in the presence of a bunny11-12. In essence, she simply replaced negative fear-related behaviors with positive behaviors associated with eating candy.

Behavior therapists made crucial advancements in the treatment of mental disorders. However, many clinicians during the 1970’s began to feel that the behaviorist perspective did not adequately describe their clients’ experiences. One such professional, a psychiatrist by the name of Aaron Beck, noted that his depressed patients experienced unrealistically negative and self-defeating “automatic thoughts”13-16. Whereas a non-depressed individual might brush-off a minor failure, Beck found that his depressed patients interpreted their negative experiences more globally, using categorical statements such as, “I never do anything right.” Previously, behavior therapists ignored such thoughts. Beck, though, saw them as a crucial feature of the disorder and sought to engage with clients, challenging these extreme thoughts to reduce the distress they caused. Based on this work, Beck founded Cognitive Therapy, which serves as the basis of many of the most influential therapies present today.

New Approaches to CBT

Over the past 40 years, a growing number of CBT-based approaches have emerged, using a diverse range of techniques. Perhaps the two most popular variants in recent years have been Acceptance and Commitment Therapy (ACT), and Dialectical Behavior Therapy (DBT). Though these therapies differ in many ways, they share the core goal of addressing problematic thoughts and behaviors by helping individuals restructure their responses to negative thoughts and events, while redirecting their energies to more positive behaviors. In particular, both approaches utilize mindfulness techniques, such as meditation, to help individuals focus their thoughts on the moment17-18. Though the efficacy of both of these approaches are still being examined4, a growing literature suggests that they are extremely effective in reducing the experience of anxiety among their clients19-20.

Date of original publication: August 03, 2016
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Advances in anxiety research shed light on new challenges

Posted on August 27, 2016 by JmaC
PUBLISHED: 01/03/2016

Anxiety is the most prevalent mental illness in the United States. It affects nearly 14% of the population yearly. While new information on anxiety disorders has flourished over the last decade, little is being done to improve treatment options and enhance the care of patients with anxiety.

Although anxiety disorders are lesser known than other psychiatric conditions like schizophrenia, depression, and bipolar, they can be just as crippling. In a study conducted by Alexander Bystristky, Sahib. S. Lhalsa, Michael E. Cameron and Jason Schiffman, titled Current Diagnosis and Treatment of Anxiety Disorders, the roadblocks of anxiety found in 2013 was simply more mounting evidence of this mental health care issue’s complexity.

2013 Research Findings

1. Problems With Diagnosis

  • Co-morbidities
  • Overlapping Symptoms

According to the National Co-morbidity Survey, there are extensive co-morbidities in patients with anxiety. Simply put, anxiety disorders frequently co-occur with other mental and physical health problems. It is not unusual for one person to have multiple diagnosable conditions. It’s possible a single person might have multiple different disorders emerge at different times in their lifetime.

Additionally, anxiety disorders and other mental health problems have many overlapping symptoms that make them difficult to distinguish. For example, if a patient experiences panic-like symptoms, it may be a symptom of panic disorder, or may be agoraphobia or social phobia. As a result, determining a diagnosis for a specific anxiety disorder can be a challenge.

2. Biology of Anxiety

In recent years, biological research in anxiety disorders has shifted to neurochemical and neuroimaging technology. Although there are new insights on the role genetics play in anxiety disorders, the exact interplay between genetic, biological, and stress factors is not well understood. However, a basic understanding of the brain regions reveals a close association between the following areas and the ABC’s of anxiety:

  • (A) Amygdala: a quick response to threat and immediate alarm reaction is related to a disturbance of these circuits.
  • (B) Basal Ganglia: these regions are associated with information processing during alarming situations.
  • (C) Coping Cortex: coping mechanisms are related to a distribution of these difficult to distinguish circuitry systems.

Neurochemicals such as Serotonin, GABA, Dopamine, Neuroepinephrin, and many others have also recently been linked to anxiety disorders. Each chemical plays a very different, but equally important, role in anxiety regulation. Manipulating one or more of these chemicals with medication can combat specific aspects of anxiety.

3. Medication & Psychotherapy

The two most frequently used treatments for anxiety disorders arepsychopharmaceuticals and psychotherapy. Each case of anxiety is different, but most often the first line of treatment for a patient with anxiety is either medication, sessions of therapy with a trained professional, or a combination of both those methods. The most popular and effective form of therapy for anxiety is Cognitive Behavioral Therapy (CBT), as common medications for anxiety disorders include:

  • Selective Serotonin Reuptake Inhibitor (SSRI): Usually the first medication prescribed to patients with anxiety disorders. Regulating serotonin is correlated with a reduction in anxiety.
  • Serotonin Neuroepinephrin Reuptake Inhibitor (SNRI): Usually taken after an inadequate response to SSRIs. Combats effects to some symptoms of anxiety in some people but may exacerbate symptoms of anxiety in others.
  • Benzodiazepine: Produces an immediate, effective anxiolytic response but has a high potential for overdose, dependence, withdrawal, and impaired cognition.
  • Anti-seizure Medication: Has anxiety reducing properties similar to that of SSRI’s.
  • Tricyclic Antidepressant: Is proven to be effective for anxiety reduction but has a number of associated adverse effects.

What’s Left?

Anxiety research has provided a lot of useful information about the role of genetics and environmental influences. Although the available treatment options are numerous, they target very different symptoms of anxiety. In the future, more effective and perhaps hybrid treatments of several options need to be explored in order to increase the success and duration of anxiety relief.

Date of original publication: September 26, 2013
Updated on: January 03, 2016
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