Anxiety Disorders: Other Treatments

It should be noted that nonpharmacologic methods of treating anxiety are being intensively developed. A whole range of such methods is suggested, including hypnotherapy, psychotherapy, kinesiotherapy. In most clinical studies devoted to this problem, the effectiveness of various types of psychotherapy, including supportive psychodynamic and cognitive-behavioral psychotherapy, was evaluated. At present it is difficult to say how effective these methods are. Anxiety disorders often have a wavy course, so randomized clinical trials are needed to evaluate the effectiveness of any method. There are many obstacles that make it difficult to evaluate the effectiveness of psychotherapy. First of all, it concerns the difficulties in standardizing therapy and the choice of adequate control methods of treatment. Among the various methods of psychotherapy used to treat anxiety disorders, the most tested method is cognitive-behavioral psychotherapy.

Cognitive-behavioral therapy involves influencing cognitive attitudes (beliefs, beliefs, prejudices, etc.) associated with specific symptoms in this particular patient. Patients are trained to recognize pathological cognitive settings accompanying anxiety: for example, patients with panic disorder should realize that they overreact to normal visceral afferentation. Similarly, patients with social phobia should realize that they have a distorted reaction to situations in which they can be the focus of attention. Then the patients are trained in techniques that reduce anxiety (for example, breathing or relaxing exercises). Finally, patients are advised to imagine a situation that is troubling, or really be in such a situation and in practice to apply the mastered techniques to combat anxiety. And the degree of stress during such a functional training should gradually increase. For example, patients with a panic disorder with agoraphobia first show movies or lecture in a large audience, then gradually increase the psychogenic load, and finally, the patient tries to visit places that cause him particularly worried: for example, he goes into the subway or elevator. A patient with a social phobia is first asked as a training to ask the unknown person's way or to have dinner at a restaurant, and then try to give a lecture before a small group of people.

Such techniques often lead to a reduction in anxiety in patients with social phobia, panic disorder and obsessive-compulsive disorder. The effectiveness of psychotherapeutic methods in PTSD and generalized anxiety disorder has been poorly studied, but there are reports that these disorders also respond to psychotherapy. The fact of reducing symptoms should be interpreted with caution, since the improvement is not necessarily caused by psychotherapeutic interference. For example, in a controlled randomized trial, it is shown that in panic disorder, cognitive-behavioral therapy is no more effective than the patient's free listening method. In this connection, the question arises - which aspects of psychotherapy determine success? Thus, although cognitive-behavioral therapy has been successfully used to treat anxiety, its mechanisms of action remain unclear.

[1], [2], [3]