Psychotherapy treatment for anxiety

Anxiety disorders - Diagnosis and treatment

Diagnosis

You may start by seeing your primary care provider to find out if your anxiety could be related to your physical health. He or she can check for signs of an underlying medical condition that may need treatment.

However, you may need to see a mental health specialist if you have severe anxiety. A psychiatrist is a medical doctor who specializes in diagnosing and treating mental health conditions. A psychologist and certain other mental health professionals can diagnose anxiety and provide counseling (psychotherapy).

To help diagnose an anxiety disorder, your mental health provider may:

Give you a psychological evaluation. This involves discussing your thoughts, feelings and behavior to help pinpoint a diagnosis and check for related complications. Anxiety disorders often occur along with other mental health problems — such as depression or substance misuse — which can make diagnosis more challenging.
Compare your symptoms to the criteria in the DSM-5. Many doctors use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to diagnose an anxiety disorder.

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Treatment

The two main treatments for anxiety disorders are psychotherapy and medications. You may benefit most from a combination of the two. It may take some trial and error to discover which treatments work best for you.

Psychotherapy

Also known as talk therapy or psychological counseling, psychotherapy involves working with a therapist to reduce your anxiety symptoms. It can be an effective treatment for anxiety.

Cognitive behavioral therapy (CBT) is the most effective form of psychotherapy for anxiety disorders. Generally a short-term treatment, CBT focuses on teaching you specific skills to improve your symptoms and gradually return to the activities you've avoided because of anxiety.

CBT includes exposure therapy, in which you gradually encounter the object or situation that triggers your anxiety so you build confidence that you can manage the situation and anxiety symptoms.

Medications

Several types of medications are used to help relieve symptoms, depending on the type of anxiety disorder you have and whether you also have other mental or physical health issues. For example:

Certain antidepressants are also used to treat anxiety disorders.
An anti-anxiety medication called buspirone may be prescribed.
In limited circumstances, your doctor may prescribe other types of medications, such as sedatives, also called benzodiazepines, or beta blockers. These medications are for short-term relief of anxiety symptoms and are not intended to be used long term.

Talk with your doctor about benefits, risks and possible side effects of medications.

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Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

While most people with anxiety disorders need psychotherapy or medications to get anxiety under control, lifestyle changes also can make a difference. Here's what you can do:

Keep physically active. Develop a routine so that you're physically active most days of the week. Exercise is a powerful stress reducer. It may improve your mood and help you stay healthy. Start out slowly and gradually increase the amount and intensity of your activities.
Avoid alcohol and recreational drugs. These substances can cause or worsen anxiety. If you can't quit on your own, see your doctor or find a support group to help you.
Quit smoking and cut back or quit drinking caffeinated beverages. Both nicotine and caffeine can worsen anxiety.
Use stress management and relaxation techniques. Visualization techniques, meditation and yoga are examples of relaxation techniques that can ease anxiety.

Make sleep a priority. Do what you can to make sure you're getting enough sleep to feel rested. If you aren't sleeping well, see your doctor.
Eat healthy. Healthy eating — such as focusing on vegetables, fruits, whole grains and fish — may be linked to reduced anxiety, but more research is needed.

Alternative medicine

Several herbal remedies have been studied as a treatment for anxiety, but more research is needed to understand the risks and benefits. Herbal and dietary supplements aren't monitored by the Food and Drug Administration (FDA) the same way medications are. You can't always be certain of what you're getting and whether it's safe. Some of these supplements can interfere with prescription medications or cause dangerous interactions.

Before taking herbal remedies or dietary supplements, talk to your doctor to make sure they're safe for you and won't interact with any medications you take.

Coping and support

To cope with an anxiety disorder, here's what you can do:

Learn about your disorder. Talk to your doctor or mental health provider. Find out what might be causing your specific condition and what treatments might be best for you. Involve your family and friends and ask for their support.
Stick to your treatment plan. Take medications as directed. Keep therapy appointments and complete any assignments your therapist may give you. Consistency can make a big difference, especially when it comes to taking your medication.
Take action. Learn what triggers your anxiety or causes you stress. Practice the strategies you developed with your mental health provider so you're ready to deal with anxious feelings in these situations.
Keep a journal. Keeping track of your personal life can help you and your mental health provider identify what's causing you stress and what seems to help you feel better.
Join an anxiety support group. Remember that you aren't alone. Support groups offer compassion, understanding and shared experiences. The National Alliance on Mental Illness and the Anxiety and Depression Association of America provide information on finding support.
Learn time management techniques. You can reduce anxiety by learning how to carefully manage your time and energy.
Socialize. Don't let worries isolate you from loved ones or activities.
Break the cycle. When you feel anxious, take a brisk walk or delve into a hobby to refocus your mind away from your worries.

Preparing for your appointment

You may start by seeing your primary care provider. He or she may refer you to a mental health professional.

What you can do

Before your appointment, make a list of:

Your anxiety symptoms. Note when they occur, whether anything seems to make them better or worse, and how much they affect your day-to-day activities and interactions.
What causes you stress. Include any major life changes or stressful events you've dealt with recently. Also note any traumatic experiences you've had in the past or as a child.
Any family history of mental health problems. Note if your parents, grandparents, siblings or children have struggled with any mental health problems.
Any other health problems you have. Include both physical conditions and mental health issues.
All medications you're taking. Include any medications, vitamins, herbs or other supplements, and the doses.
Questions to ask your doctor to make the most of your appointment.

Some basic questions to ask your doctor include:

What's the most likely cause of my anxiety?
Are there other possible situations, psychological issues or physical health problems that could be causing or worsening my anxiety?
Do I need any tests?
Should I see a psychiatrist, psychologist or other mental health provider?
What type of therapy might help me?
Would medication help? If so, is there a generic alternative to the medicine you're prescribing?
In addition to treatment, are there any steps I can take at home that might help?
Do you have any educational materials that I can have? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor will likely ask you several questions, such as:

What are your symptoms, and how severe are they? How do they impact your ability to function?
Have you ever had a panic attack?
Do you avoid certain things or situations because they make you anxious?
Have your feelings of anxiety been occasional or continuous?
When did you first begin noticing your feelings of anxiety?
Does anything in particular seem to trigger your anxiety or make it worse?
What, if anything, seems to improve your feelings of anxiety?
What traumatic experiences have you had recently or in the past?
What, if any, physical or mental health conditions do you have?
Do you take any prescription drugs?
Do you regularly drink alcohol or use recreational drugs?
Do you have any blood relatives who have anxiety or other mental health conditions, such as depression?

Preparing and anticipating questions will help you make the most of your time.

By Mayo Clinic Staff

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Treatment of anxiety and panic attacks in group psychotherapy

Anxiety is a common cause of a decrease in the quality of life, the development of psychosomatic diseases. Anxiety disorders can reach varying degrees of severity (from mild anxiety to panic attacks). Anxiety can arise as an emotional reaction in response to some real threat, as well as be seemingly unreasonable or exaggerated. There are two different approaches to treating anxiety disorders and panic attacks.

Drug therapy and a whole range of psychological techniques are aimed only at suppressing the symptoms of anxiety. The psychodynamic approach in psychology is aimed at researching and treating the causes of an anxiety disorder.

The fact that these two approaches to the treatment of anxiety disorders have different vectors of influence does not mean that they are not compatible at the initial stage of therapy. One form of psychodynamic approach is group psychotherapy. For many psychologists, psychotherapists, and even more so for patients, the question of the possible effectiveness of group psychotherapy in the treatment of anxiety disorders remains open.

Group therapy is a widely known form of therapy and is becoming more and more in demand in today's world. The idea of group therapy is formed under the influence of films, popular articles and books.

People who are thinking about participating in a psychological group often have questions about what happens during group meetings, how the group can help, whether the group is useful for healthy people or is only needed for people with symptoms of neurosis. And in particular, can group therapy help with anxiety disorders.

Classes in the group, which is described below, are conducted in the format of group psychoanalysis. People come, sit in a circle and talk to each other. These meetings take place once a week. In the process of communication in a psychotherapeutic group, people build relationships, different feelings arise, memories emerge. The psychologist acts as the conductor of this "orchestra". It is widely believed that group therapy primarily helps participants develop social skills. It certainly is. Although the most important therapeutic effect of the group is that each member of the group can see their emotional difficulties and limitations and deal with them.

In this article, we will touch on some aspects of group psychotherapy for anxiety disorders, using a fragment of the description of one group meeting.

In a group session, one of the participants, I'll call her Marina, shares her discovery. She was able to connect the panic attacks that occur on the subway and in some other situations with a childhood memory of bathing. As a child, the process of bathing was a terrible procedure for Marina. To wash her hair, her grandmother kept her in the bathroom by force, and her mother poured water on her from the shower. Marina could not breathe, choked on water and screamed terribly, as she felt that she was about to choke and die. Sometimes, hearing her screams, neighbors would come. Mom explained to them that her daughter just had such a fear of washing, and they left, taking with them the last childish hope for salvation.

Parents, most likely, perceived such a fear of swimming as a whim, an unfortunate misunderstanding. The child needed to be bathed, and no one was going to kill Marina. For a little girl, things looked different. We can only guess why bathing scared her so the first time. Maybe she saw some movie scene, or water got into her nose and her breath caught. But every time she realized that she was going to bathe, she was terrified, she was sure that she would choke and die. And it is her grandmother and mother who want her to suffocate. This nightmare recurred with her for some time each week.

As an adult, the girl experienced a lot of anxiety in situations where something held her back. For example, in transport, when she could not get out of the subway car, train or plane at any time. Or in situations where it was embarrassing to leave suddenly.

In all these cases, anxiety increased, and a feeling of lack of air associated with the childhood impression that if something holds you down, you can suffocate and die.

The group members start a lively discussion, commenting on Marinin's story and the events at the previous group session that helped to revive these childhood memories.

Suddenly, one member of the group turns pale, begins to breathe heavily. With tears, she says that she suddenly became ill. She wants to get up but can't. The whole body, limbs and face became numb. The legs do not obey, the hands are cramped, the fingers are together and they cannot be separated. The band members are very frightened by her condition. They offer to call an ambulance, open a window, bring water.

I ask her how such a “state” began and ask her to speak all the thoughts and memories that come to mind. Alla says that after Marina's story, she had the idea that this situation is the most terrible of all the stories she heard about Marina's childhood and from what she had ever heard. Then she began to think that in fact she was not the most terrible, and there was some kind of vague feeling that she was somehow connected with herself. Then she felt bad, wanted to get up and go out, but could not.

When I asked how this story could be connected with her, Alla said that when she was three years old, she turned a kettle of boiling water over herself and burned her leg. She remembers how the skin on her leg turned into "strings". He no longer remembers anything. Her mother told her that she spent a long time in the burns department of the hospital. She was bandaged there. They held her and poured peroxide on her leg to soak and remove the bandages. Mom said that she screamed terribly during these dressings. Members of the group speculate about what Alla could feel at these dressings as a small child. A three-year-old child does not understand the need for medical manipulations, and feels that he is being subjected to senseless violence every time. The child is taken away from the mother, forcibly held, causing a lot of pain. In the course of the conversation, it becomes clear that Marina's story about how she was held while bathing allowed Alla to recall childhood feelings associated with dressings. As a result of the analysis of the situation, Alla's condition returns to normal, the numbness in the body disappears.

Consciously, Alla did not remember the dressings and her stay in the burn center, but this repressed feeling that was remembered in the group was an integral part of her whole life. Childhood trauma found a "way out" in obsessive anxieties. For example, she often imagined how someone would suddenly break into the house, grab her and kill her. Or suddenly she will accelerate in a car and crash into a wall. Her fantasies always contained an element of senseless violence against her, caused anxiety and were repeated over and over again.

By the way, before Alla did not suspect that such obsessive fantasies are not inherent in all people. However, this anxiety, although unpleasant, did not greatly affect her life. She was quite successful and happy. She had no obvious symptoms of neurosis. Alla came to the group out of interest, a desire to learn something new about herself and other people.

We now knew that her disturbing fantasies were a compulsive repetition of childhood burn trauma. Thus, the experience of reconstructing repressed experiences in a group session allowed her to completely get rid of unpleasant obsessive fantasies in life.

The mechanism of formation of the symptoms described above (panic attacks and obsessive anxious fantasies) is identical to the mechanism of development of post-traumatic stress syndrome (PTSD). For the first time, anxiety arises in a situation of helplessness and a sense of threat to life. Then the feelings experienced in a state of stress are repeated again and again, wedged into ordinary life. As a rule, the primary traumatic situation is repressed and an unconscious repetition of the experienced feelings occurs. Outwardly, it looks like a too strong reaction to external events.

Getting rid of such conditions occurs due to the intellectual and emotional understanding of the source of their occurrence. As soon as the unconscious process becomes conscious, the excessively strong reaction to external stimuli disappears.

In theory, everything looks pretty simple, you just need to understand what, for example, panic attacks in the subway are connected with. In reality, it happens that one symptom contains several traumatic experiences. So it was with Marina. After the group session described, her fear of enclosed spaces did not completely disappear. It took more time and work before Marina and I managed to reconstruct all the traumatic events in her life that led to panic attacks.

The format of this article does not imply a description of the entire process of group therapy. This is just one of the small episodes of the group's work. Group meetings are different. One group is not like the other. Of course, not every group session has such strong feelings. But always group therapy and group dynamics is a very interesting process that can reveal different facets of personality, allowing a person to free himself, in particular, from unnecessary anxiety, cure panic attacks and live in a state of much greater inner comfort.

Tatiana Yakovenko

Anxiety and anxiety treatment in St. Petersburg

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Anxiety and restlessness

The experience of anxiety and restlessness can be a normal condition caused by objective reasons. Such a natural emotional state for a person has a biological meaning: it allows you to adapt in stressful situations, mobilize the body's resources and maintain self-control in extreme situations. Moreover, it is an explicable and transient state.

Anxiety and restlessness, which interferes with the enjoyment and enjoyment of normal life, is a pathological condition. It can be steady, repetitive or severe, incessant for a long time. As a rule, over a long distance, anxiety and anxiety become the causes of some mental disorders and somatic diseases.

Left untreated, pathological anxiety and restlessness can lead to the development of neuroendocrine disorders, diseases of the gastrointestinal tract, nervous, cardiovascular, urogenital and respiratory systems.

In our clinic, depending on the case, the treatment of anxiety is carried out by psychotherapists or psychiatrists. As a rule, outpatient psychotherapy sessions are sufficient to treat feelings of anxiety and restlessness. In the presence of pronounced symptoms of a pathological condition, drugs can be prescribed that restore healthy sleep and normalize mood.

Quiz: Spielberger Anxiety Scale

Read each of the following sentences carefully and choose an answer based on how you usually feel.

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Symptoms of a pathological state of the psyche

Psychotherapeutic treatment of anxiety and anxiety

Diagnosis of anxiety is a certain difficulty in people with somatic and mental illnesses, since anxiety may not be a symptom in itself, a mental disorder. Therefore, in addition to examination and examination (neuro- and psychological testing), the doctor can refer you to a cardiologist, gastroenterologist, neurologist or psychoneurologist for examination.

It is also rather difficult to differentiate anxiety and anxiety from a depressive episode, which, in turn, is often a companion of this pathological emotional state. Such a psychopathological state may be based on a violation of neurochemical processes with symptoms common to them (anxiety and depression): excessive anxiety, fear, insomnia, fatigue, decreased concentration, weakness, stomach pain and other unpleasant sensations from the gastrointestinal tract.

Treatment of feelings of anxiety and anxiety

Given the above features of the pathological emotional state, treatment of feelings of anxiety and anxiety must be started in advance in order to avoid chronicity of the disease, the development of depression and some somatic diseases.

With a timely visit to a doctor, a series of psychotherapy sessions is enough to treat anxiety. Treatment of increased anxiety may include drug supportive therapy, which allows you to normalize the psycho-emotional state in the shortest possible time and quickly get involved in work with the doctor.

We also offer hypnosis treatment for anxiety. Our hypnotherapists specialize in the treatment of a variety of borderline mental disorders, successfully using Ericksonian and classical hypnosis in their work, as well as effective authorial suggestive techniques.

In some cases the treatment of anxiety in adults is carried out in our clinic. Indications for inpatient treatment of anxiety may be the chronicity of a mental disorder or a depressive episode, or the need to select medication under the supervision of a physician.

Drug treatment of anxiety

Sources

Exercise as treatment for anxiety: systematic review and analysis — https://pubmed.ncbi.nlm.nih.gov

Psychopharmacotherapy of anxiety disorders in elderly patients — https:// psychiatr.

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