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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