The Role of Therapy and Medication in Treating Anxiety

Introduction

Anxiety is one of the most common mental health disorders. It is estimated that up to 8 million people in the UK are affected by anxiety. It can affect people of any age or gender, although, according to the NHS, more women than men are affected by the condition and it is most common in people aged 35 to 55.

Research published by the Mental Health Foundation during Mental Health Awareness Week found that 60% of the 6,000 adult respondents reported suffering from anxiety that interfered with their daily lives in the previous two weeks. Of the respondents, 1 in 5 of them reported feeling anxious most or all of the time. 

Despite the clear prevalence of anxiety in the general population, stigma and misunderstanding of mental health continue to be a barrier to accessing help, with up to 45% of adults with anxiety failing to reach out for help or support. 

Anxiety manifests itself in a number of ways and can have both mental and physical symptoms; however, with the correct interventions the condition can usually be managed. Therapy, lifestyle changes and medication can all be used to manage the symptoms of anxiety and reduce the impact it has on our day-to-day activities.

Understanding Anxiety

Feeling anxious or nervous at times is perfectly normal. We may get worried before taking an exam, starting a new job or during major changes in our lives, such as becoming a new parent.

Anxiety is sometimes the body’s default reaction to a stressful situation; however, feeling anxious and having an anxiety disorder is not the same. An anxiety disorder is often debilitating and can have a significant impact on our quality of life. 

Anxiety is a common symptom of various conditions, including:

• Panic disorder
• Post-traumatic stress disorder (PTSD)
• Phobias including agoraphobia (fear of open spaces), claustrophobia (fear of enclosed spaces), acrophobia (fear of heights)
• Post-natal or postpartum anxiety
• Social anxiety disorder (social phobia)
• General anxiety disorder (GAD)

Many people who suffer from anxiety will be diagnosed with generalised anxiety disorder (GAD). This is where people suffer from anxious thoughts and feelings about their general life, rather than about a specific phenomenon or event.

GAD affects people’s day-to-day lives and can leave them having regular feelings of being worried and nervous. People with generalised anxiety disorder may find it very hard to relax and suffer from constant intrusive thoughts.

Some of the emotional and psychological symptoms of anxiety include:

• Restlessness or struggling to relax
• A constant sense of worry or dread that something bad is going to happen
• Feeling on edge
• Trouble concentrating
• Being moody or irritable

Some people with anxiety also suffer from physical symptoms, such as:

• Tiredness or fatigue
• Increased heart rate or palpitations
• Shaking or trembling
• Nausea or stomach pain
• Headaches or general aches and pains
• Muscle tension
• Sweating or feeling hot
• Problems sleeping (nausea)

The symptoms of anxiety can interfere with our day-to-day activities and cause problems at school or work, as well as family or relationship tension. 

We may feel anxious in response to a stressor such as financial trouble or moving house. However, usually once the stressor is over, our feelings and emotions calm down. An anxiety disorder may begin in response to a stressful situation (although this is not always the case); however, the symptoms will continue once the situation is resolved.

• Anxiety symptoms are often disproportionate to the situation
• Children and young people with anxiety may have worries that are not age appropriate
• Anxiety disorder impairs our ability to function normally

Experts do not fully understand the reason that people develop generalised anxiety disorder and sometimes it is impossible to link the onset of symptoms to a specific cause. Research suggests that anxiety may be caused by a combination of different factors, for example:

• Genetics or family history
• Stressful or traumatic events (such as sexual abuse, childhood trauma, domestic violence or bullying)
• Chronic health conditions (especially painful conditions such as arthritis or fibromyalgia)
• A history of alcohol or substance misuse

Anxiety can cause intrusive thoughts, disruptive thinking and catastrophising. It can cause a feeling of constant panic, with the sufferer being unable to pinpoint the specifics of what they are worrying about.

Depression differs from anxiety in that people with depression often feel low and start to stop caring about themselves and lose interest in daily activities, whereas people with anxiety may begin to care too much about everything, to the point that it becomes compulsive. People with anxiety disorders will often become withdrawn and may start to avoid social situations, which can lead to isolation and depression. 

If you feel that symptoms of anxiety, or any mental health condition, are having a significant effect on you, it is vital to reach out for help sooner rather than later. We know that early intervention is key to positive outcomes for people with poor mental health.

Treatment options for anxiety include a combination of medicine, therapy and self-help techniques.

Medication for Anxiety

People with anxiety will usually be advised to try therapy or self-help and lifestyle changes before resorting to medication. If you have additional issues alongside anxiety such as alcoholism or depression, it is vital that you also receive treatment for these problems as well. 

Some common medications for anxiety (listed from most commonly prescribed to least) include:

• Antidepressants called selective serotonin reuptake inhibitors (SSRIs) such as sertraline, escitalopram or paroxetine
• Antidepressants called serotonin and noradrenaline reuptake inhibitors (SNRI) such as venlafaxine or duloxetine
• Pregabalin which is an anticonvulsant traditionally used to treat epilepsy that has been found to also help treat symptoms of anxiety
• Benzodiazepines which are a type of sedative that can be used short term to treat serious symptoms of anxiety

Anxiety medication comes with a range of side effects including dizziness, digestive problems, nausea and insomnia. Benzodiazepines also come with a risk of addiction and should only be taken for up to 4 weeks at a time.

You may need to try several different medications in order to find the right one for you. You may also want to explore therapy options to treat your anxiety. Therapy can be used alone or in conjunction with medicine to keep the symptoms of GAD under control.

Therapy for Anxiety

Psychotherapy or talking therapy has been shown to work well in people who suffer from anxiety. A popular option is cognitive behavioural therapy (CBT). CBT also works well for other conditions that have anxiety as a common factor such as phobias.

Cognitive Behavioural Therapy (CBT) is a type of talking therapy that aims to change and reframe the way we think and approach our problems. CBT targets our negative thought cycles and helps us find new and positive ways to disrupt them in our minds. 

CBT is routinely used to treat common mental health conditions such as anxiety and depression.

The aim of CBT is to reframe the way we think and approach problems, often trying to break them down into smaller, more manageable parts:

1. Situation 
2. Thoughts
3. Emotions 
4. Physical feelings 
5. Actions

At the core of CBT teachings is the idea that the above five areas are interconnected and that they influence one another. This means that the thoughts you have will affect the way you feel (emotionally and physically). It also acknowledges that your thoughts affect your behaviour and actions. Simply put, when we feel bad, we can get caught in a cycle of negative thoughts and negative emotions and then we behave badly, by being unkind to ourselves or others, or by making poor choices in order to cope. 

The core aim of CBT is to change how we view our problems and thus how we feel about them and react to them. Anxiety specific CBT focuses on reframing identified anxious thoughts and dealing with them such as:

• Avoidance – avoidant behaviour is used to provide short-term relief for anxiety symptoms but can make people feel worse in the long term. CBT may use exposure therapy or may set you goals to get you out of your comfort zone and slowly face your triggers, in order to learn ways to deal with them in a controlled and safe way.
• Comparisons – rather than comparing yourself to others, CBT techniques aim to empower you with better self-esteem to replace these thoughts with something more useful and realistic.
• Emotional reasoning – CBT therapists may advise you to monitor and track emotionally charged and distorted thoughts as part of your regular journaling. Together you can then start to dissect and address them to make you feel less anxious and more empowered to cope in emotional situations.
• Filtering – people with anxiety often filter out or ignore certain information that doesn’t support their disproportionate thoughts. CBT will try to empower users to look at the whole picture and focus on ‘evidence’ that something is real rather than listening to their inner thoughts.
• Magnification – rather than focusing and obsessing over one small problem or mistake, zoom out and view the bigger picture and try to find the positives.
• Magical thinking – CBT helps users to challenge and rationalise their thoughts rather than getting caught up in compulsive fortune telling or mind reading behaviour.

People with anxiety often resort to thinking of worst-case scenarios. They may mentally list everything that may go wrong if they try out a certain activity and therefore they avoid it. Cognitive behavioural therapy can help participants to identify these anxious thoughts and replace them with something more realistic and positive.

Why choose CBT:

• Goal oriented
• Can be used in combination with other therapies or medicine
• Non-invasive
• Can be effective in addition to medication or when medication is not working or is not an option
• Helpful for people who get stuck in negative thought cycles or feel that they lack agency
• Teaches skills that can be used long term even after sessions are concluded

Sessions can be delivered one-on-one or in a group setting, either in person or online. Online therapy, or e-therapy, can be especially beneficial to people with social anxiety or GAD, especially in the early stages of treatment. Online therapy allows people to receive therapy from the comfort of their own homes, without the need to travel and expose themselves to extra stressors. 

Cognitive behavioural therapy does require significant engagement from patients. You will be expected to complete homework assignments, practise techniques outside of your sessions and provide honest feedback to your therapist. These unique features of CBT can be really helpful for people with anxiety because they provide something concrete and structured to focus on at home, which can help you to tune out negative thoughts and feelings. 

CBT may not work for everyone; however, it has been shown to be a highly effective treatment for a variety of mental health issues. Many people with anxiety disorders who try cognitive behavioural therapy find that they benefit from the techniques and skills that they learn.

Complementary Approaches

People with anxiety will benefit from finding ways to limit and manage stress. Lifestyle changes can also help to boost our mental health and happiness and improve our overall wellbeing.

We can try to feel happier and healthier by:

• Maintaining a healthy weight
• Eating a healthy balanced diet
• Staying hydrated
• Practising a good sleep routine
• Reducing alcohol consumption
• Making plans and having things to look forward to
• Trying new activities and hobbies and building resilience
• Being kinder to ourselves

Some people also find alternative treatments help with their mental health. Alternative therapies may promote relaxation and help us to make a calm space where we can be ourselves. 

Alternative treatments for anxiety may include:

• Mindfulness and meditation
• Yoga
• Aromatherapy
• Progressive Muscle Relaxation (PMR)

Complementary therapies work best in combination with other treatments for anxiety, such as therapy or medication. However, consult with your doctor before making any significant changes to your routine treatment plan.

Finding the Right Balance

Many people with mental health problems find a combination of medication, therapy and lifestyle changes works best for them.

Antidepressants take time to work and you may suffer side effects whilst your body gets used to them. Therapy is also not an instant fix and will require commitment and participation from you as well your therapist. If you opt to choose a therapy route it is important to find a qualified and experienced therapist that you gel with. This will help you get the most out of your sessions. 

If you have tried a number of treatments and coping mechanisms but are still suffering badly with GAD, your GP may refer you to a mental health specialist for further exploration and treatment. Community teams of specialists often include a range of different professionals that each bring their own unique training and perspective, such as:

• Psychiatrists
• Mental health nurses
• Clinical psychologists
• Occupational therapists
• Social workers

A specialist from your local mental health team will be appointed to assess you. They will want to discuss details about the interventions you have already tried and how effective they were. They may also want to know details about your life that may be affecting your recovery such as:

• Whether or not you have an appropriate support network
• Your work situation
• Any factors in your personal life that are affecting your GAD

Together, you will be able to create a new plan to tackle your anxiety. This may include trying new therapies or a combination of medication and therapy. On occasion, you may also be advised to try taking two different medications together.

Conclusion

Anxiety is a common condition that affects up to 1 in 10 adults in the UK at any one time. Anxiety disorders can cause debilitating symptoms of fear and worry which make us withdraw into ourselves, avoid social situations and affect our output at school or work. 

Early intervention is key in treating mental health disorders and many people with anxiety will benefit from a combination approach that includes therapy sessions and self-help. Some people may also find relief by taking antidepressants or other medication; however, it is important to identify and address the symptoms of your anxiety and learn some long-term coping mechanisms in order to provide the greatest relief.