Anxiety Disorders: Treatment

Anxiety disorders are generally treated with psychotherapy, medication or both.

Psychotherapy

Psychotherapy or "talk therapy" can help people with anxiety disorders. To be effective, psychotherapy must be directed at the person's specific anxieties and tailored to his or her needs. A typical "side effect" of psychotherapy is temporary discomfort involved with thinking about confronting feared situations.

Cognitive Behavioral Therapy (CBT)

CBT is a type of psychotherapy that can help people with anxiety disorders. It teaches a person different ways of thinking, behaving and reacting to anxiety-producing and fearful situations. CBT can also help people learn and practice social skills, which is vital for treating social anxiety disorder.

Two specific stand-alone components of CBT used to treat social anxiety disorder are cognitive therapy and exposure therapy. Cognitive therapy focuses on identifying, challenging and then neutralizing unhelpful thoughts underlying anxiety disorders.

Exposure therapy focuses on confronting the fears underlying an anxiety disorder in order to help people engage in activities they have been avoiding. Exposure therapy is used along with relaxation exercises and imagery. One study, called a meta-analysis because it pulls together all of the previous studies and calculates the statistical magnitude of the combined effects, found that cognitive therapy was superior to exposure therapy for treating social anxiety disorder.

CBT may be conducted individually or with a group of people who have similar problems. Group therapy is particularly effective for social anxiety disorder. Often "homework" is assigned for participants to complete between sessions.

Self-Help or Support Groups

Some people with anxiety disorders might benefit from joining a self-help or support group and sharing their problems and achievements with others. Internet chat rooms might also be useful, but any advice received over the internet should be used with caution, as internet acquaintances have usually never seen each other and false identities are common. Talking with a trusted friend or member of your religious or spiritual organization can also provide support, but it is not necessarily a sufficient alternative to care from an expert clinician.

Stress-Management Techniques

Stress-management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of therapy. While there is evidence that aerobic exercise has a calming effect, the quality of the studies is not strong enough to support its use as treatment. Since caffeine, certain illicit drugs and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, avoiding them should be considered. Check with your physician or pharmacist before taking any additional medications.

The family can be important in the recovery of a person with an anxiety disorder. Ideally, the family should be supportive but not help perpetuate their loved one's symptoms.

Medication

Medication does not cure anxiety disorders but often relieves symptoms. Medication can usually be prescribed only by a medical doctor (such as a psychiatrist or a primary care provider), but a few states allow psychologists to prescribe psychiatric medications.

Medications are sometimes used as the initial treatment of an anxiety disorder, or are used only if there is insufficient response to a course of psychotherapy. In research studies, it is common for patients treated with a combination of psychotherapy and medication to have better outcomes than those treated with only one or the other.

The most common classes of medications used to combat anxiety disorders are antidepressants, anti-anxiety drugs and beta-blockers. Be aware that some medications are effective only if they are taken regularly and that symptoms may recur if the medication is stopped.

Antidepressants

Antidepressants are used to treat depression, but they also are helpful for treating anxiety disorders. They take several weeks to start working and may cause side effects such as headache, nausea or difficulty sleeping. The side effects are usually not a problem for most people, especially if the dose starts off low and is increased slowly over time.

Please note: Although antidepressants are safe and effective for many people, they may be risky for children, teens and young adults. A "black box" warning — the most serious type of warning that a prescription can carry — has been added to the labels of antidepressants. The labels now warn that antidepressants may cause some people to have suicidal thoughts or make suicide attempts. For this reason, those taking an antidepressant should be monitored closely, especially when they first start taking the medication.

Anti-Anxiety Medications

Anti-anxiety medications help reduce the symptoms of anxiety, panic attacks, or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines. Benzodiazepines are first-line treatments for generalized anxiety disorder. With panic disorder or social phobia (social anxiety disorder), benzodiazepines are usually second-line treatments, behind antidepressants.

Beta-Blockers

Beta-blockers, such as propranolol and atenolol, are also helpful in the treatment of the physical symptoms of anxiety, especially social anxiety. Physicians prescribe them to control rapid heartbeat, shaking, trembling and blushing in anxious situations.

Choosing the Right One

Choosing the right medication, medication dose and treatment plan should be based on a person's needs and medical situation, and done under an expert's care. Only an expert clinician can help you decide whether the medication's ability to help is worth the risk of a side effect. Your doctor may try several medicines before finding the right one. You and your doctor should discuss:

• How well medications are working or might work to improve your symptoms.
• Benefits and side effects of each medication.
• Risk for serious side effects based on your medical history.
• The likelihood of the medications requiring lifestyle changes.
• Costs of each medication.
• Other alternative therapies, medications, vitamins and supplements you are taking and how these may affect your treatment.
• How the medication should be stopped. Some drugs can't be stopped abruptly but must be tapered off slowly under a doctor's supervision.

For more information, please visit the Medications Health Topic webpage developed by the National Institute of Mental Health (NIMH): https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml. Please note that any information regarding medications is provided for educational purposes only and may be outdated. Information about medications changes frequently. Please visit the U.S. Food and Drug Administration (FDA) website (https://www.fda.gov/) for the latest information on warnings, patient medication guides or newly approved medications.

Join a study.

Clinical trials are research studies that look at new ways to prevent, detect or treat diseases and conditions, including anxiety disorders. During clinical trials, treatments might be new drugs or new combinations of drugs, new surgical procedures or devices, or new ways to use existing treatments. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individual participants may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Please note: Decisions about whether to apply for a clinical trial and which ones are best suited for a given individual are best made in collaboration with your licensed health professional.

Clinical Trials at NIMH/NIH

Scientists at the NIMH campus conduct research on numerous areas of study, including cognition, genetics, epidemiology and psychiatry. The studies take place at the NIH Clinical Center in Bethesda, Maryland, and require regular visits. After the initial phone interview, you will come to an appointment at the clinic and meet with a clinician. Visit NIMH Clinical Trials — Participants (https://www.nimh.nih.gov/health/trials/index.shtml) or Join a Study (https://www.nimh.nih.gov/labs-at-nimh/join-a-study/index.shtml).

How do I find a clinical trial near me?

To find a clinical trial near you, you can visit https://clinicaltrials.gov/. This is a searchable registry and results database of federally and privately supported clinical trials conducted in the United States and around the world. ClinicalTrials.gov gives you information about a trial's purpose, who may participate, locations and contact information for more details. This information should be used in conjunction with advice from health professionals.