Complementary and Alternative Treatments for Anxiety

© 2020 Randi Fredricks, Ph.D. All rights reserved.

No part of this book may be reproduced, stored in a retrieval system, or transmitted by any means without the written permission of the author.

Published by AuthorHouse 08/18/2020

ISBN: 978-1-7283-6232-8 (sc)

ISBN: 978-1-7283-6230-4 (hc)

ISBN: 978-1-7283-6231-1 (e)

Library of Congress Control Number: 2020909353

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Contents

Introduction

1. The Anti-Anxiety Diet

2. Nutritional Supplements for Anxiety

3. Herbal Medicine for Anxiety

4. Reducing Anxiety with Bodywork

5. Exercise and Movement for Anxiety

6. Mind–Body Interventions and Anxiety

7. Psychedelics, Consciousness and Anxiety

8. Psychological Treatments for Anxiety Disorders

References

Disclaimer

The information in this book is intended to provide helpful information on the treatment of anxiety and does not constitute medical advice. The publisher and author are not responsible for any specific health needs that may require medical supervision and are not liable for any damages or negatives consequences from any treatment, action, or application to any person reading or using the information contained in this book. References are provided for informational purposes only and do not constitute an endorsement of the sources noted. In reference to any website cited, readers should be aware that the content of websites listed in this book may change. The content of this book is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical or mental health condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this book. If you think you may have a medical emergency, please call your doctor, go to the emergency department, or call 911 immediately.

Introduction

Fear is a natural reaction to moving closer to the truth.

— Pema Chodron (2002)

Anxiety disorders are one of the most common mental health problems in the world, affecting millions of people every year. While these disorders are highly treatable, only one-third of those suffering with them receive treatment. Research has shown that 1 in 13 people globally suffer from an anxiety disorder, the most common of which are specific phobia and social phobia (Remes, 2016).

For the acutely or chronically anxious patient, finding effective treatments can be challenging. While conventional anxiety treatments are beneficial for some, they don’t work for a large number of people. The efficacy of any given treatment depends on the type of anxiety disorder, the symptoms being treated and other variables unique to each person.

Anxiety disorders are often difficult to treat because symptoms differ greatly from person to person. To compound this, determining the factors that trigger an individual’s anxiety can be challenging. These factors have made establishing a universal anxiety treatment plan nearly impossible.

Conventional medicine has been directed at the goals of diagnosis, treatment, and when possible, cure, of disorders. Complementary and alternative medicine (CAM) practices focus on promotion of health and involvement of the patient in a process of healing that is aimed at addressing the underlying cause of illness.

This book discusses complementary and alternative therapies that people have found effective in helping anxiety. It’s important to understand the distinction between complementary and alternative. When a therapy or treatment is offered as complementary, it is being used alongside standard treatments. If that same therapy or treatment is used instead of conventional treatments, it is considered alternative.

Types of Anxiety Disorders and Their Symptoms

Everyone feels anxious now and then. It’s a normal emotion. For example, you may feel nervous when faced with a problem at home, before a job interview, or before making an important decision. Anxiety disorders are different than this sort of everyday anxiety. Because of this demarcation, anxiety disorders are considered a group of mental illnesses that prevent a person from carrying on with their normal life (Fredricks, 2008).

Excessive anxiety can manifest in one of five major anxiety disorders; 1) generalized anxiety disorder (GAD), 2) obsessive compulsive disorder (OCD), 3) panic disorder, 4) post traumatic stress disorder (PTSD), or 5) social anxiety disorder (SAD). Each disorder requires timely treatment in order to be manageable.

Epidemiological studies show that anxiety disorders are highly prevalent and a significant cause of functional impairment, constituting the most frequent mental health disorders. As mentioned, specific phobias and social phobia are the most common with the highest rates for simple phobia and agoraphobia. Panic disorder, GAD, PTSD, and OCD are less frequent but nevertheless debilitating (Martin, 2003; Narrow, 2002; Remes, 2016).

Each anxiety disorder has its own distinct features, but they are all characterized by the common theme of excessive, irrational fear and dread. The descriptions that follow help to differentiate the different types of anxiety disorders. This background information will be useful later when we discuss complementary and alternative treatments.

Specific Phobias

A specific phobia is an anxiety disorder that is characterized by an unreasonable or irrational fear related to exposure to specific objects or situations. As a result, the affected person tends to avoid contact with the objects or situations and, in severe cases, any mention or depiction of them. Specific phobia affects around 12% of people at some point in their life (Craske, 2016).

There are a number of types of phobias and it’s not unusual to experience a specific phobia about more than one object or situation. Specific phobias can also occur along with other types of anxiety disorders. The most common specific phobias include:

• Acrophobia: Fear of heights

• Aerophobia: Fear of flying

• Aquaphobia: Fear of water

• Arachnophobia: Fear of spiders

• Blood, injury, and injection (BII) phobia: Fear of injuries involving blood

• Claustrophobia: Fear of being in constricted, confined spaces

• Driving phobia: Fear of driving a car

• Emetophobia: Fear of vomiting

• Erythrophobia: Fear of blushing

• Escalaphobia: Fear of escalators

• Hypochondria: Fear of becoming ill

• Tunnel phobia: Fear of tunnels

• Zoophobia: Fear of animals (APA, 2013; Merikangas, 2010)

These are far from the only specific phobias. People can develop a phobia about almost anything. Also, as society changes, the list of potential phobias changes. For instance, nomophobia is the fear of being without a cell phone or computer (Bragazzi, 2014).

In someone with a specific phobia, the fear or anxiety may be triggered both by the presence and the anticipation of the specific object or situation. A person who encounters something they are phobic of will usually show signs of fear or express discomfort. In some cases, it results in a panic attack. In adults, the person may logically know the fear is unreasonable but still find it difficult to control the anxiety. This condition may significantly impair the person’s functioning and even physical health (Craske, 2016).

A person with a phobia can experience the following symptoms. No matter what specific phobia a person has, it’s likely to produce these types of reactions:

• An immediate feeling of intense fear, anxiety and panic when exposed to or even thinking about the source of the fear

• Awareness that the fear is unreasonable or exaggerated but feeling powerless to control it

• Difficulty functioning normally because of the fear

• Doing everything possible to avoid the object or situation or enduring it with intense anxiety or fear

• Feeling nauseated, dizzy or fainting around blood or injuries

• Physical reactions and sensations, including sweating, rapid heartbeat, tight chest or difficulty breathing

• Worsening anxiety as the situation or object gets closer in time or physical proximity

• In children, possibly tantrums, clinging, crying, or refusing to leave a parent’s side or approach their fear (Choy, 2007; Kessler, 2005).

Complex Phobias

These phobias mostly develop during adulthood and are associated with a deep-rooted fear about a certain situation or circumstance. Sometimes complex phobias continue for years.

A complex phobia is much more likely to affect a person’s wellbeing than a specific phobia. For example, those who experience agoraphobia may also have a number of other phobias that are connected. These can include monophobia (a fear of being left alone) and claustrophobia (a fear of feeling trapped in closed spaces). In severe cases, a person with agoraphobia will rarely leave their home. Complex phobias can be considerably more difficult to treat than simple phobias.

The Cause of Phobias

Much is unknown about the actual cause of specific phobias. They seem to develop as a result of having a negative experience or panic attack related to a specific object or situation. Moreover, there may be a link between a person’s specific phobia and the phobia or anxiety of their parents due to genetics or learned behavior. Research has suggested that changes in brain functioning may play a role in developing specific phobias. For example, a number of studies have found that the amygdala in the brain is associated with the development of a phobia (Choy, 2007; Kaczkurkin, 2015).

Social Anxiety Disorder

Social anxiety disorder (SAD), also referred to as social phobia, is characterized by an intense fear of public situations. It is the third most prevalent psychiatric disorder, following substance abuse and depression. Women and men are equally likely to develop SAD (Pollack, 2001).

SAD can be limited to only one type of situation, such as a fear of speaking in public, or it may be so broad that a person experiences symptoms almost any time they’re around other people. SAD can become so debilitating that it prevents people from going to work or school. In a survey of 191 women with SAD and an eating disorder, nearly one half were unable to complete high school (Hinrichsen, 2007).

People with this problem have a hard time making friends and even associating with family. The symptoms of SAD include an intense fear of the following activities:

• Asking questions in groups

• Attending social gatherings

• Being assertive

• Being introduced

• Being watched doing something (such as eating or writing)

• Indirect evaluation (such as test taking or a job review)

• Interacting with people deemed important

• Making small talk

• Meeting or talking with strangers

• Public speaking or performing

• Small group discussion

• Using public restrooms

• Using the telephone

• Spending time after a social situation analyzing your performance and identifying flaws in your interactions

• Expecting the worst possible consequences from a negative experience during a social situation

Physical symptoms often accompany the intense anxiety of SAD and include blushing, trembling, nausea, profuse sweating, and difficulty talking. People with SAD are generally aware that their feelings are irrational. However, even if they manage to confront what they fear, they usually feel extremely anxious beforehand and intensely uncomfortable throughout. Afterward, anxious feelings tend to linger as they worry about what people are thinking about them.

In a study of patients with SAD, about half reported that their disorder began in response to a specific embarrassing experience, while the others reported that it had been with them for as long as they could remember. SAD often co-occurs with other anxiety disorders as well as eating disorders, and increases a person’s risk of depression fourfold (Hinrichsen, 2007).

Substance-related disorders frequently develop in individuals who attempt to self-medicate their SAD by drinking or using drugs. Approximately one half of patients with SAD have comorbid mental, drug or alcohol problems. Studies have shown that at least 16% of patients who present with SAD have alcohol abuse problems. Longitudinal data indicates that SAD precedes approximately 70% of these comorbid conditions, suggesting that these conditions arise in response to the disorder (Kessler, 2005).

Panic Disorder

Panic disorder is characterized by unexpected and repeated panic attacks. Panic attacks are experienced as episodes of intense fear accompanied by physical symptoms that can include chest pain, heart palpitations, shortness of breath, dizziness, and abdominal distress.

Panic attacks sometimes lead to panic disorder, but not always. For example, people can have one attack then never have another. For those who have panic disorder or numerous panic attacks, it’s important to seek treatment as a preventative measure. Untreated, the disorder can become disabling.

If you’re having a panic attack, you may genuinely believe you’re having a heart attack, losing your mind, or on the verge of death. Panic attacks can occur at any time, even during sleep. An attack generally peaks within 10 minutes, but some can last much longer. Some symptoms of a panic attack can include:

• Chest pain or discomfort

• Chills or hot flushes

• Derealization (feelings of unreality)

• Depersonalization (being detached from oneself)

• Fear of dying

• Fear of losing control or going crazy

• Feeling dizzy, unsteady, lightheaded, or faint

• Feeling of choking

• Nausea or abdominal distress

• Palpitations, pounding heart, or accelerated heart rate

• Paresthesias (numbing or tingling sensations)

• Sensations of shortness of breath or smothering

• Sweating, trembling or shaking (APA, 2013)

Panic disorder is often accompanied by other serious conditions such as depression, drug abuse or alcoholism. About one-third of people with panic disorder develop agoraphobia. With early treatment, can co-occurring conditions can often be prevented (Goldstein-Piekarski, 2016).

Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is characterized by chronic anxiety, exaggerated worry and tension, even when there is little or nothing to provoke it. The condition is often accompanied by another anxiety disorder, depression or substance abuse (Regier, 1998).

GAD is diagnosed after someone spends 6 or more months worrying excessively about a number of everyday problems. People suffering from this disorder can’t stop worrying, even though they know that their worry is more intense than the situation warrants. They often experience physical symptoms, such as headaches, fatigue, muscle and joint pain, trembling, irritability, and sweating. The symptoms of GAD can also include the following:

• Being easily fatigued

• Difficulty concentrating or mind going blank

• Irritability

• Muscle tension

• Restlessness or feeling keyed up or on edge

• Sleep disturbances (difficulty falling or staying asleep, or restless unsatisfying sleep) (APA, 2013)

The potential causes of and risk factors for GAD have been well researched and are thought to include the following:

• A family history of anxiety

• Childhood abuse

• Excessive use of caffeine or tobacco

• Recent or prolonged exposure to stressful situations, such as personal or family illnesses

It is the robust association of GAD with psychological comorbidities that contributes to the complexity of the illness as well as the limited treatment success. More than 90% of patients with GAD present with an additional psychiatric diagnosis. In 48% of patients with GAD, the ancillary condition is major depressive disorder (MDD). GAD and MDD’s diagnostic criteria share four symptoms: difficulty sleeping, difficulty concentrating, being easily fatigued, and psychomotor agitation (Kessler, 2001; Rickels, 2002).

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) can occur at any age, including childhood, and there is some evidence that susceptibility to PTSD may run in families. Women are more likely than men to develop it. The disorder is often accompanied by depression, substance abuse, or one or more other anxiety disorders (Keane, 2006).

PTSD is commonly associated with war veterans. In fact, research has indicated that as many as 30% of veterans experience PTSD at some point after a war. The disorder also frequently occurs after violent personal assaults such as rape, mugging, or domestic violence, terrorism, natural or human-caused disasters, and accidents (Dohrenwend, 2006; Kulka, 1990).

Symptoms of PTSD often are grouped into four main categories:

1. Intrusive thoughts such as repeated, involuntary memories, distressing dreams, or flashbacks of the traumatic event. Flashbacks are sometimes so vivid that the person believes they are re-living the traumatic experience.

2. Avoiding reminders of the traumatic event may include avoiding people, places, objects, activities, and situations that trigger distressing memories. The person may try to avoid remembering or thinking about the traumatic event or resist talking about what happened or how they feel about it.

3. Negative thoughts and feelings can include ongoing and distorted beliefs about oneself or others, ongoing fear, horror, anger, guilt or shame, loss of interest in activities previously enjoyed, or feeling detached or estranged from others.

4. Arousal and reactive symptoms can include being irritable or having angry outbursts; behaving recklessly or in a self-destructive way, being easily startled, or having problems concentrating or sleeping (APA, 2013).

Whatever the original source of the trauma, some people with PTSD repeatedly relive the event in the form of nightmares and disturbing recollections during the day. Anniversaries of the traumatic event can be particularly difficult. Ordinary events sometimes serve as reminders of the trauma and trigger flashbacks or intrusive images that lead to high anxiety. A person having a flashback—triggered by images, sounds, smells, or feelings—may lose touch with reality and believe that the traumatic event is happening all over again (Koffel, 2016).

Fortunately, not every traumatized person gets full-blown PTSD, or experiences PTSD at all. PTSD is diagnosed only if the symptoms last more than a month. In those who do develop PTSD, symptoms generally begin within 3 months of the trauma. The course of the illness varies with some people recovering within 6 months, while others have symptoms that last much longer. If someone has the symptoms of PTSD for less than 30 days, they are considered to have acute stress disorder (Liu, 2017).

Acute stress disorder (ASD) is an anxiety disorder characterized by a cluster of dissociative and anxiety symptoms occurring within one month of a traumatic or stressful event. The dissociation that occurs is a psychological reaction to trauma in which the mind tries to cope by sealing off some features of the trauma from conscious awareness. For example, certain thoughts, emotions, sensations, and/or memories are compartmentalized because they are too overwhelming for the conscious mind to integrate.

The symptoms of ASD are similar to those of PTSD, but of shorter duration, lasting at least 2 days but less than a month after a traumatic event. For people with ASD, psychotherapy can be a useful intervention and help prevent the development of PTSD (Lin, 2018).

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) involves anxious thoughts or rituals that the person feels can’t be controlled. Those with OCD are plagued by persistent, unwelcome thoughts or images, or by the urgent need to engage in certain rituals. For example, people with OCD often become obsessed with germs or dirt, so they wash their hands over and over. People with OCD are usually filled with doubt and feel the need to check things repeatedly. Long periods of time can be spent engaging in rituals, like touching things or counting, pre-occupation with order or symmetry, or persistent thoughts of performing repugnant behaviors that are opposed to the person’s beliefs.

The disturbing thoughts or images associated with OCD are called obsessions, and the rituals that are performed in an attempt to prevent or get rid of them are called compulsions. The person finds no pleasure in carrying out the rituals, only temporary relief from the anxiety that grows if the rituals are not performed.

The symptoms of OCD include either obsessions or compulsions characterized by the following:

OCD with Obsessions:

• Recurrent and persistent thoughts, impulses, or images that are experienced at some time during the disturbance as intrusive and inappropriate and that cause marked anxiety or distress

• The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action

• The person recognizes that the obsessions, impulses, or images are a product of his or her own mind

• The thoughts, impulses, or images are not simply excessive worries about real-life problems

OCD with Compulsions:

• Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly

• The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive (APA, 2013)

Most adults with OCD recognize that what they’re doing is senseless, but they can’t control or stop it. However, some people with OCD—particularly children—may not realize that their behavior is out of the ordinary.

Depression and other anxiety disorders often accompany OCD and people with OCD also have a higher incidence of eating disorders. Similarly, people with OCD often try unsuccessfully to use alcohol or drugs to calm themselves. Roughly 25% of people with OCD meet the criteria for a substance use disorder (Mancebo, 2009).

When OCD gets bad enough, it prevents someone from holding down a job or from carrying out normal responsibilities at home. Getting appropriate help and sticking to a treatment plan are key to getting relief from OCD (Pallanti, 2011).

Obsessive-Compulsive Spectrum Disorders

There are a spectrum of disorders that don’t meet the diagnostic criteria for obsessive-compulsive disorder (OCD) as spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 has a whole chapter dedicated to the spectrum of similar disorders entitled Obsessive-Compulsive Related Disorders, also known as obsessive-compulsive spectrum disorders (OCSD) or the OCD spectrum (APA, 2013).

The OCD spectrum includes a cluster of symptoms that are similar to, but not exactly the same as, OCD symptoms. Sometimes the only difference between OCD and a given obsessive-compulsive spectrum disorder is the specific focus of the obsessions and/or compulsions (Allen, 2003). The following are the disorders the DSM-5 lists as obsessive-compulsive related disorders.

Body Dysmorphic Disorder

Body dysmorphic disorder is a form of mental illness in which the person is obsessed and/or preoccupied with an imagined defect or what they perceive as something abnormal in their appearance. It has to sufficiently impair the person’s quality of life or cause extreme distress in order to be diagnosed. It is similar to OCD because both illnesses involve repetitive checking; in this compulsive examination of body image (APA, 2013; Singh, 2019).

Skin Picking (Excoriation Disorder)

Pathologic skin picking, also called excoriation disorder, is one of several disorders classified as body-focused repetitive behaviors (BFRBs). It’s a mental illness in which the person compulsively picks or digs into the skin with fingers, pins, tweezers, or other items to remove small irregularities such as moles or freckles. Although classified as an impulse control disorder, skin picking is similar to OCD in that sufferers of both illnesses engage in repetitive behaviors, usually because they feel uncomfortable. However, it’s worth noting that many people with this disorder report that the behavior is often done unconsciously (APA, 2013; Harries, 2017).

Trichotillomania

Trichotillomania (TTM) is another BRFB in which the affected person repeatedly pulls out hair from any part of the body for non-cosmetic reasons, resulting in noticeable hair loss. Like skin picking, TTM is similar to OCD in its repetitive behaviors.

Although TTM has been grouped with OCD in the DSM-5, research suggests that TTM and OCD may have less in common than originally thought. In fact, approaches to treating TTM, which include habit reversal therapy and medication (n-acetyl cysteine or olanzapine), are quite different from those used to treat OCD. Additionally, some first-line treatments used for OCD appear ineffective for TTM (APA, 2013; Grant, 2016).

Hoarding Disorder

Compulsive hoarding, also known as hoarding disorder, is a behavioral pattern characterized by excessive acquisition of and an inability or unwillingness to discard large quantities of objects that cover the living areas of the home and cause significant distress or impairment.

In cases of pathological or compulsive hoarding, the items kept often have little or no value to others, eventually causing severe cluttering of the person’s home so that it is no longer able to function as a viable living space. While hoarding is no longer considered a subtype of OCD, it has similar characteristics, such as spending a large amount of time collecting, arranging, and putting items in order. The chief difference between hoarding and OCD is that hoarders typically don’t have insight into how serious their disorder really is (APA, 2013; Frank, 2012).

Treatment of OCD Spectrum Disorders

Although OCD spectrum disorders have a wide range of diagnostic categories that differ in significant ways, research suggests that, in addition to sharing some symptom patterns, these disorders have other similarities. It’s clear that the OCD spectrum disorders differ in systematic ways, particularly in terms of compulsivity and impulsivity.

The concept of OCD spectrum disorders is a powerful one that has helped clinicians develop a variety of treatment approaches. OCD has the most developed knowledge base of these disorders and serves as a guide for treatment (Allen, 2003).

Anxiety Disorders Not Otherwise Specified

The term anxiety disorders not otherwise specified was around for years to explain anxiety disorders that didn’t completely meet the diagnostic criteria of anxiety disorders listed in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV (APA, 2000). With the publication of the fifth edition, the American Psychiatric Association changed the term to other specified anxiety disorder and unspecified anxiety disorder in the DSM-5 (APA, 2013).

The term other specified anxiety disorder and unspecified anxiety disorder is important because a large number of people suffer from an anxiety disorder that does not quite meet the diagnostic criteria for a specific anxiety disorder. These people have significant anxiety or phobias that don’t fit the requirements for an anxiety disorder but are serious enough to be distressing and disruptive (Fletcher, 2019).

For a clinician to diagnosis someone with other specified anxiety disorder and unspecified anxiety disorder a number of things have to occur. For one, the clinician rule-outs other possible causes of anxiety symptoms before diagnosing a specific anxiety disorder. In order for a specific anxiety disorder to be diagnosed, the clinician must determine whether the anxiety symptoms are severe enough to result in significant distress, or impairment in functioning and those symptoms must meet the diagnostic criteria as spelled out in the DSM-5 for the anxiety disorder being considered.

If the client’s symptoms do not match any specific anxiety disorder, the clinician then determines if the anxiety symptoms are due to another psychiatric disorder, a medical disease or disorder, or the use of, or withdrawal from, alcohol and other drugs. The two most common of these are anxiety due to another medical condition; substance/medication induced anxiety disorder (drugs) and the catchall categories other specified and unspecified anxiety disorder. These two diagnoses are used when symptoms create significant distress and/or impaired functioning but do not meet the diagnostic criteria for any of the other anxiety disorders (APA, 2013; Brady, 2013).

Anxiety Disorder Due to Another Medical Condition

Certain medical disorders or diseases can cause psychiatric symptoms. To determine this, a medical evaluation is performed by a qualified health care professional to rule out a medical condition that may be causing the symptoms. For example, a person experiencing panic attacks may have cardiac, endocrine, GI-related, inflammatory, metabolic, neurological, or respiratory problems. When the fear and anxiety symptoms are the direct effect of a medical condition, this would be referred to as an anxiety disorder due to another medical condition. This diagnosis is not used if their anxiety is due to realistic concerns about having a medical condition. For instance, someone with appendicitis may be reasonably worried about pain. This is a normal and rational worry. Therefore, it would not be diagnosed as a mental disorder (Bystritsky, 2013; Niles, 2015).

Substance/Medication-Induced Anxiety Disorder

When anxiety symptoms are a direct result of a prescription drug, over-the-counter drug, or street drug, then the correct diagnosis is substance/medication-induced anxiety disorder.

The DSM-5 diagnostic criteria for substance/medication-induced anxiety disorder is the same as other anxiety disorders; primarily anxiety and panic. Obsessions and compulsions should not be present, as the obsessive-compulsive disorders—which may also be precipitated by drugs or medications—have their own category. Symptoms must develop during or within a month of use or intoxication, or within a month after withdrawal from a drug or substance known to cause anxiety. Additionally, the anxiety must not be ascribable to other anxiety disorders and must not be the result of delirium caused by the drug.

The responsible drug or drugs must be specified. The anxiety may be caused by either the proper or customary use of the drug. It may also occur because of misuse, intoxication or withdrawal from a substance (APA, 2013; Brady, 2013).

Prescription drugs that can cause anxiety as a side effect of the drug include medications containing amphetamines, certain high blood pressure (hypertensive) medications, steroidal drugs used to treat respiratory disorders, and various hormonal medications, including thyroid medications (von Moltke, 2003).

Non-prescription drugs can also cause anxiety symptoms. This would include drugs that contain caffeine, cold and flu medications, nicotine and alcohol. Similarly, withdrawal from these substances can precipitate anxiety symptoms. The use and withdrawal from several street drugs are also implicated in precipitating, or worsening, an anxiety disorder.

Other Specified or Unspecified Anxiety Disorder

As mentioned, it’s common for someone not to fully meet the diagnostic criteria for a particular anxiety disorder. For instance, unexpected panic attacks are a diagnostic criterion for panic disorder. A person might meet all the diagnostic criteria for panic disorder except one. Instead of unexpected panic attacks, they experience limited symptom panic attacks. Although they do not meet the full criteria, it is still worthwhile for the therapist to note these anxiety symptoms if they cause significant distress or impairment. In this case, they could receive a diagnosis of other specified anxiety disorder (Ipser, 2006).

The diagnosis other unspecified anxiety disorder is also used when there are anxiety-like symptoms that cause significant distress or impaired functioning. Sometimes there is insufficient information to determine what particular type of anxiety disorder may be present. This situation may occur in emergency room settings, where a complete history and full psychiatric evaluation are not always feasible.

Sleep Problems and Anxiety

Americans are notoriously sleep deprived, but those with psychiatric conditions are even more likely to be so. Chronic sleep problems affect 50 to 80% of patients with a psychiatric disorder, compared with 10 to 18% of adults in the general U.S. population (Kyle, 2010).

Sleep disturbances are highly prevalent in anxiety disorders. Because of this, this book will discuss CAM therapies that help with insomnia, particularly as it relates to anxiety disorders.

Sleep problems, such as insomnia or nightmares, have even been incorporated in anxiety disorder definitions, including generalized anxiety disorder (GAD) and posttraumatic stress disorder (PTSD). Studies have found that sleep problems affect more than 50% of adult patients with GAD and are common in those with PTSD, OCD, panic disorder, and phobias (Yazdi, 2014).

Insomnia is a risk factor for developing an anxiety disorder. For example, in a longitudinal study of teenagers sleep problems preceded anxiety disorders 27% of the time (Breslau, 1996).

Insomnia can worsen the symptoms of anxiety disorders and prevent recovery. Historically, doctors treating patients with psychiatric disorders viewed insomnia and other sleep disorders as symptoms. But research has suggested that sleep problems increase the risk of developing certain psychiatric disorders, such as anxiety. This research has clinical applications, because treating a sleep disorder—whether with CAM or conventional methods—may also help alleviate symptoms of co-occurring mental health problems including anxiety (Ford, 1989).

Conventional Treatments for Anxiety Disorders

Conventional treatment options for anxiety disorders include psychotherapy, group therapy and medication. The common protocol for anxiety disorders is psychotherapy combined with prescription medication. The most popular form of psychotherapy, cognitive-behavioral therapy (CBT), has been considered the gold standard. However, research has suggested that the benefits are not long lasting (Johnsen, 2015). When combined with other approaches to therapy—such as psychodynamic—results from CBT improve significantly. Sustained gains from CBT seem to occur when therapy is ongoing over a longer period of time and when multiple approaches are used (Glass, 2008; Leichsenring, 2008).

Historically, psychopharmacology has been a widely used conventional treatment for anxiety disorders. The most commonly prescribed drugs for anxiety are benzodiazepines, noradrenaline reuptake inhibitors (SNRIs), and serotonin-selective reuptake inhibitors (SSRIs) (Baldwin, 2012).

Benzodiazepines are usually prescribed for anxiety disorders on an as-needed basis, meaning they are not supposed to be taken regularly. Benzodiazepines used to treat anxiety disorders include Xanax, Klonopin, Valium, and Ativan (Watanabe, 2007).

SNRIs are considered the first-line pharmacological treatments for anxiety disorders, with the exception of specific phobias. SNRIs work by blocking the reuptake of serotonin and norepinephrine, ultimately producing long-term neurochemical changes in the brain. SNRIs include Pristiq, Cymbalta, Ultram, and