Anxiety Treatment

Effective treatments exist to improve the condition and quality of life of those who deal with anxiety. Intervention through psychotherapy, especially cognitive-behavioral therapy, can help learn new ways to cope with anxiety or with situations and events that provoke anxiety. Treatment can be individual or in a group, face-to-face, online or through therapeutic technologies. In cases where necessary, pharmacological treatment can be combined, given preventively every day, or a targeted calming treatment for situations such as an anxiety attack.

In situations of high-intensity anxiety, the combination of pharmacological-maintenance treatment alongside emotional-talk therapy has been found to be effective and has high success rates in reducing anxiety, promoting recovery and returning to function.

Cognitive-behavioral therapy (CBT): This is the most common and effective treatment for anxiety disorders. It focuses on the "here and now" and on a specific goal, and is usually a relatively short treatment (usually between 12 and 15 sessions). The treatment is based on the assumption that our thoughts and emotions influence behavior, so that negative thought patterns or thought distortions provoke an emotion that is anxiety, and hence lead to behavioral change, for example shutting-off or avoidance.

The treatment initially focuses on examining thought contents that accompany events identified as anxiety provoking. From these contents, recurring thought patterns and distortions are derived, which we would like to process and change. By working on thought patterns, identifying and regulating emotions and reducing the consequences of negative behaviors on psychological, daily, social and occupational functioning. In addition, the treatment will focus on early identification of factors and triggers for the appearance of anxiety and providing tools and skills for its regulation. Often, this will take place within the framework of a gradual exposure program to situations or objects that trigger anxiety.

Dynamic therapy or psychoanalytic therapy: In this therapeutic approach, the source of anxiety lies in fundamental and early mental processes, a significant part of which is not conscious. For example, anxiety can appear following an unresolved conflict, complexity in early object relationships (significant figures, usually parents), use of maladaptive defense mechanisms (for example: Displacement, projection, repression), and more. Since dynamic therapy works on the deep layers of the psyche, the therapeutic work is often based on a "therapeutic alliance" between the patient and the therapist, which includes the boundaries of the relationship and sessions (place, time, role, lack of reciprocity in the relationship, and more), alongside encouraging and promoting a relationship of trust that allows for openness, exposure, and sharing, sometimes to the point of projecting feelings and thoughts from relationships outside the room, into the room. The therapeutic techniques usually include listening and encouraging the patient to reveal their inner world, non-judgmental inclusion of their experiences, reflection, validation and echoing that help process the contents and find the best way for them to cope.

Traditional dynamic therapy is a long-term treatment and can last months or even years. However, in recent years, several approaches to focused and short-term dynamic therapy have been developed, based on psychodynamic principles, but with an emphasis on one central focus.

Pharmacological treatment: Treatment is usually given in situations where the intensity and frequency of anxiety symptoms are high and the impairment in daily functioning is significant. The treatment can be given as a single therapeutic response, but the recommendation is to combine it with emotional-talk therapy.

There are two levels of pharmacological treatment for anxiety –

1. The first level: Maintenance-preventive treatment, taken daily with the aim of reducing anxiety symptoms and enabling mental well-being and normal functioning. Treatment for anxiety usually includes medications from the antidepressant family, such as selective serotonin reuptake inhibitors (SSRIs), which are the first line of treatment, or serotonin-norepinephrine reuptake inhibitors (SNRIs). In other cases, other antidepressants will be given. Drug treatment is usually given for a long-term period.

• It is important to familiarize yourself with and consult with your doctor about the side effects profile of the medication.
• Some medications may actually increase anxiety during the initial period of their use, so you should consult with your doctor and consider a gradual and slower increase in dosage, in order to alleviate the phenomenon.
• It takes between 3 and 4 weeks to feel the effect of the medications and the change.
• You must not stop medication without medical advice and guidance, and all at once, as this may cause a "rebound reaction" – since brain cells have adapted to a certain amount of serotonin, a sudden stop of the medication does not allow them to adjust to the natural amount of serotonin in the body (without the medication). A gradual decrease allows the body to adjust itself.

2. The second level: Sedative treatment that can be given on a case-by-case basis around certain events, for example when symptoms are identified early, or as a preventative measure in places where an anxiety attack is likely to occur – for example, in cases of phobia of flying or in cases of high-intensity anxiety throughout the day, which cannot be reduced only through maintenance treatment. Sometimes the doctor will consider adding sedative treatment several times a day, or at bedtime, in cases of sleep disorders and difficulties due to anxiety. These medications include medications from the benzodiazepine family, but they are less recommended for the treatment of anxiety disorders due to their high potential for creating dependence and their limited effectiveness in the long term. Today, the recommendation is to prioritize, if possible, sedative and hypnotic medications from other families, for example, low-dose antipsychotics.