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30 Jan 2020 by Heather S. Lonczak, Ph.D.
The lifetime prevalence rate for anxiety disorders is estimated at 33.7% of the
population—an estimate that has remained quite stable over the years (Bandelow &
Michaelis, 2015).
Overall, anxiety disorders represent the most common psychiatric disorders within the
general population (Öst, 2008), and the number one mental disorder among women
(Chambala, 2008).
While anxiety may serve a useful purpose (e.g., alerting us to dangers), too much
anxiety impairs functioning and performance in certain activities (Yerkes & Dodson,
1908).
If you are depressed you are living in the past. If you are anxious you are living in the
future. If you are at peace you are living in the present.
Lao Tzu
When anxiety reaches the clinical level, it interferes with the ability to live life to the
fullest, often causing significant social and occupational impairment. Anxiety
disorders cover a lot of territories:
On the positive side, there are several effective therapeutic approaches for anxiety
disorders, as well as a variety of techniques and worksheets individuals may apply
themselves.
This article will describe these approaches while also addressing the specific issues of
social and childhood anxiety disorders. By shedding light on anxiety disorders and
their treatment, the goal is to provide useful suggestions, tools, and above all, hope for
individuals negatively impacted by these conditions.
Before you continue, we thought you might like to download our three Positive
Psychology Exercises for free. These science-based exercises will explore
fundamental aspects of positive psychology including strengths, values, and self-
compassion, and will give you the tools to enhance the wellbeing of your clients,
students, or employees.
Despite the enormous stressors of modern society, there are ways to respond without
succumbing to serious anxiety problems. Anxiety has been described as “the absence
of the happy messengers that keep us tranquil” (Hart, 1999, p. 5).
Severe anxiety is generally more a reflection of worry about anxiety itself as opposed
to the problem underneath.
It is not fear of public speaking per se that is the real problem, but rather, the
anticipation of associated anxiety that causes distress. It is by confronting such
anxiety that individuals often experience relief.
1. Cognitive therapy
Cognitive therapy is the most common psychological treatment for anxiety disorders.
This approach involves working with therapists to identify the feelings, thoughts, and
beliefs that impact an individual’s ability to modify behaviors. For example, a person
with a phobia of dogs would work to uncover the irrational beliefs that surround this
phobia, such as the inherent danger in approaching all dogs.
Cognitive therapy is typically combined with behavior therapy to address beliefs and
cognitions in conjunction with working toward ways of changing behaviors.
For example, the patient with the dog phobia might try approaching docile dogs while
also working with a therapist on their irrational fears. This is an approach known as
exposure therapy.
2. Cognitive-Behavioral Therapy
In this way, the CBT approach is tailored to the individual needs of the client and
modified based on their progress (Hazlett-Stevens & Craske, 2004). CBT is grounded
in the assumption that “emotional [i.e., anxiety] disorders are maintained by cognitive
factors, and that psychological treatment leads to changes in these factors through
cognitive and behavioral techniques” (Hofmann & Smits, 2008, p. 621).
Exposure
Social skills training
Cognitive restructuring
Problem-solving training
Self-monitoring or journaling of symptoms
Homework
Relaxation training
Also, it may be implemented via brief therapy or over a longer duration depending
upon the client and their presenting problems.
Meta-analyses have determined that CBT is an effective approach for the treatment of
anxiety disorders (Butler, Chapman, Forman, & Beck, 2006; Deacon & Abramowitz,
2004; Hofmann & Smits, 2008; Stewart & Chambless, 2009).
Attention bias modification is a newly emerging approach that involves the use of
computer-based attention training with patients with anxiety to affect hyper-attention
to perceived threats in the environment (Bar-Haim, 2010).
Although studies investigating this approach are minimal, attention bias modification
represents a promising new approach for the treatment of anxiety disorders (Hakamata
et al., 2010).
4. Hypnosis
Hypnosis has also been found to benefit individuals dealing with anxiety.
Hypnosis is like meditation, but with added objectives based on the needs of the
individual. It may involve varying states of consciousness during which attention is
focused and distractions are tuned out (McNeal, 2019).
Importantly, hypnosis is not an out-of-control experience, as the patient has power
over and awareness of what’s going on. Additionally, its goals are achievable within a
minimal time commitment (Straub & Bowman, 2016).
Hypnosis (including self-hypnosis) has been widely used within the mental health
field (Valentine, Milling, Clark, & Moriarty, 2019). It has also been reported as a
useful tool for patients dealing with the following:
5. Psychodynamic therapy
Although treatment may be lengthy, short-term psychodynamic therapy also has been
reported as an effective approach for anxiety.
For example, one study reported that a 30-session psychodynamic treatment was
helpful for the treatment of generalized anxiety – although this approach was less
successful than CBT (Leichsenring et al., 2009).
Additionally, studies in which vagus nerve stimulation was used to treat epilepsy or
depression have reported significant reductions in anxiety symptoms (Chavel,
Westerveld, & Spencer, 2003; Rush et al., 2000).
With exposure therapy, the patient is exposed to their feared object or situation, such
as flying.
Such exposure is typically gradual, with the exposure beginning with less threatening
stimuli and gradually working its way toward increasingly feared stimuli (Wolpe,
1958).
Of course, the nature and duration of the arachnophobia exposure therapy will depend
upon the patient’s individual symptoms and needs.
Like CBT, there are different ways in which exposure therapy may be implemented
depending upon the client and diagnosis. For example, exposure therapy may be in
vivo, as is the case with the live spider. Simulated exposure is a similar technique in
which the patient experiences a proxy of the feared stimuli. For example, viewing a
film of spiders is a simulated exposure.
Recent technology has provided therapists with the tools to implement more realistic
simulations via virtual reality exposure therapy.
In such cases, patients wear headsets in which they experience a highly realistic
virtual space. This technique is useful for several anxiety disorders and phobias; for
example, military patients with PTSD can use virtual reality to simulate battlefield
experiences.
Another type of exposure therapy is flooding.’ With this technique, patients confront
their fears via simulated or in vivo exposure that is not gradual. Instead, patients are
rapidly exposed to fear-provoking stimuli until they feel less anxious. For example, a
patient with a bridge phobia is taken to a bridge and asked to stand on it until their
anxiety wanes.
Flooding is based on the idea that without engaging in avoidance, the patient’s fear
will become extinguished (Abramowitz, Deacon, & Whiteside, 2019). Therapists
generally prefer gradual exposure over flooding because the latter is intense and may
have negative repercussions for patients not prepared for such direct and immediate
exposure to feared stimuli.
Other forms of exposure therapy include prolonged exposure, which was designed for
the treatment of PTSD. With prolonged exposure, both repeated in vivo and imaginal
exposure are combined to enable the patient to experience trauma without the feared
outcomes.
This technique has been widely used for the treatment of PTSD and is considered by
many clinicians as the best option for this disorder (Van Minnen, Harned, Zoellner, &
Mills, 2012).
Along with CBT and other therapist-implemented approaches for anxiety, various
additional techniques may help to ease symptoms. Here is a list of ideas:
While mindfulness activities are often add-ons with CBT and other forms of therapy,
there is recent evidence supporting their unique benefit for the reduction of anxiety
(Blanck et al., 2018).
Exercise has also been associated with reduced anxiety symptoms among sedentary
patients with medical conditions (Baldwin et al., 2014).
Exercise is especially attractive because it’s cost-effective and may be performed in a
variety of ways. While exercise may not reap the same benefits for patients with
anxiety as CBT or other psychological approaches, it may enhance the impact of such
treatment.
Along with mindfulness techniques and aerobic exercise, here are a variety of things
that individuals can do to reduce anxiety:
Get involved in a hobby you love (e.g., baking, gardening, reading, painting,
etc.).
Listen to your favorite music.
Journal your feelings.
Take a warm bath.
Make sure to eat healthy, as junk food can have adverse effects on physical and
psychological health.
Get enough sleep.
Go out in nature.
Avoid emotional triggers (e.g., people and places that consistently increase
your anxiety).
Spend time with animals.
Organize your home or workspace, as clutter may exacerbate anxiety.
Watch caffeine and alcohol intake.
Spend time with family and friends whom you enjoy.
Social anxiety may take several forms, such as a fear of public speaking, social
situations, or meeting new people.
Social anxiety stems from an individual’s fear of adverse judgments or scrutiny from
others and the humiliation that follows. As such, social phobia may lead to significant
problems within occupational, educational, and social domains, which often result in
low self-esteem and loneliness.
The best treatment for social anxiety is CBT, with exposure therapy often
recommended.
For example, an individual with public speaking anxiety might work on speaking in
front of a few people and gradually work their way up to larger groups.
Socially anxious people may also benefit from social skills and relaxation training.
The authors found the psychological treatments to be highly effective for social
anxiety disorder, with no differences between treatment types (likely because so many
studies used combined treatments). Lower effectiveness was noted for patients with
more severe social anxiety disorder (Acarturk et al., 2008).
In another study, which was randomized with a one-year follow-up, Anderson et al.
(2013) compared in vivo exposure with virtual reality exposure for the treatment of
social anxiety.
In sum, while social anxiety disorder often results in severe impairment, there are
psychological treatments that have been found to diminish significantly associated
symptomatology and enhance the quality of life for many individuals.
Helpful Exercises
When experiencing anxiety, self-guided
mindfulness exercises may help individuals calm down.
Because such activities may be conducted as needed and for free, they represent
highly feasible ways to deal with anxiety issues.
Many therapists will prescribe self-guided mindfulness and meditation exercises for
clients to complete between in-person therapy sessions or as a tool to help during
moments of intense anxiety.
With the rise in digital technologies, such as smartphones and blended care e-therapy
platforms like Quenza (pictured here), the prescription of take-home interventions
such as these is becoming increasingly more common and convenient.
While the potential value of self-guided exercise has face validity, standalone
exercises performed outside of treatment intervention have rarely been researched.
Blanck et al.’s (2018) study shows that there are positive ways for individuals to deal
with their anxiety on their own, outside of a structured intervention.
If you are feeling anxious or stressed, you can search and apply various exercises
based on your unique interests and needs. Here are some examples:
Deep-breathing meditation
Sitting meditation
Body scan meditation
Loving-kindness meditation
Spiritual meditation
Vipassana meditation
Transcendental meditation
Mantra meditation
Walking meditation
Buddhist meditation
Yoga
For CBT group therapy to be effective, the group needs to be both cohesive and task
focused. Other key group therapy factors include altruism, imitative behaviors,
interpersonal learning, and installation of hope (Yalom, 1995).
While there is more research examining one-on-one CBT therapy for anxiety than
for group therapy (Whitefield, 2010), the latter approach has some advantages:
Cost-effectiveness
The ability to reach more people
May facilitate the normalization of behaviors (e.g., by seeing that others have
the same problems)
The acceptance of challenges that are elicited by peers versus the therapist
Positive reinforcement by multiple people
Exposure situations that are more easily recreated within a group setting
The ability to exercise problem-solving skills by making suggestions to other
group members (Whitefield, 2010)
While many individuals with anxiety disorders may benefit from group CBT, there
are some people for whom group therapy is likely to be less effective, such as those
with co-morbid psychological disorders, more severe and chronic presentation of
problems, negative core beliefs, communication problems, interpersonal issues, active
suicidal ideation, fear of group environments, extreme stress, or poor relationships
(Moorey, 1996).
Additionally, individuals who lack the motivation to change or fail to comply with
treatment are less likely to be a good match for group CBT (Moorey, 1996).
Group-based CBT as useful for the treatment of social anxiety disorders (Butler et al.,
2018; Hedman et al., 2011).
In terms of key ingredients for group CBT as a treatment for social anxiety,
researchers examined mechanisms for change for two group-based approaches: CBT,
and mindfulness and acceptance-based therapy.
Results indicated that mindfulness and acceptance were fundamental mechanisms of
change for both group approaches, whereas cognitive reappraisal was more important
for CBT (Kocovski, Fleming, Hawley, Ho, & Antony, 2015).
Respondents described their anxiety as a lack of security and noted that creating a
securing group environment involved the following themes:
Sharing with others (e.g., getting to know others with similar problems)
Knowledge given to participants (e.g., as related to the link between anxiety
and thoughts, behaviors, health, and lifestyle)
Structure (e.g., how instructors responded to participants’ needs and provided
acceptable structures for group members to practice on their own;
Abrahamsson et al., 2018)
Overall, if you are dealing with anxiety and feel that group therapy is a good fit for
you, there is likely a group that will meet your needs. Once you do some research and
find groups that interest you, it is also a good idea to try out several until you find the
best fit.
There is a certain magic in the act of creating; young children expressing themselves
through art appear not to have a care in the world.
Indeed, the therapeutic benefit in the creation of art transcends age and talent. There
are two important reasons that art therapy is a viable approach for anxious individuals:
Art therapy has also been described as creating a cathartic release of positive feelings
(Curl, 2008). Research supports this idea, as art therapy has been found effective for
the reduction of anxiety and other psychological symptoms across multiple
populations.
Engaging in art such as coloring mandalas, making collages, and modeling with
clay is associated with reduced anxiety among college students (Sandmire,
Gorham, Rankin, & Grimm, 2012).
Creating art such as ‘healthy image posters,’ greeting cards, and silk wall
hangings is related to reduced anxiety among family caregivers of cancer
patients (Walsh, Martin, & Schmidt, 2004).
Participation in group art therapy is related to the reduction of symptomatology
among adult psychiatric outpatients primarily diagnosed with depressive,
anxiety, and adjustment disorders (Chandraiah, Anand, & Avent, 2012).
Engaging in art therapy is related to the reduction of overall state anxiety
among adult cancer patients (Nainis et al., 2006).
Creating art is related to reduced levels of perceived stress among Canadian
college students (Abbott, Shanahan, & Neufeld, 2013).
Making pottery is related to reduced anxiety among elderly nursing home
residents (Doric-Henry, 1997).
Engaging in art-therapy-based supervision among end-of-life care workers is
associated with reduced anxiety and enhancement of emotional awareness and
regulation (Potash, Ho, Chan, Wang, & Cheng, 2014).
Art therapy incorporated into brief CBT among individuals with anxiety
disorders is associated with reduced frequency of panic attacks (Morris, 2014).
Simply being exposed to visual art has been shown to reduce anxiety symptoms
among psychiatric inpatients (Nanda, Eisen, Zadeh, & Owen, 2010), a finding
that attests to the powerful healing power of art.
Music does have a way of changing moods, whether this means sinking into the angst
of the blues or experiencing the upbeat feelings of disco. Because of its ability to
affect mood, music therapy has been used to help patients deal with a variety of
psychological problems.
Performing music may also foster positive feelings that promote healing. The efficacy
of music therapy for the reduction of anxiety is also supported by scientific literature.
For example, music has been found to reduce anxiety among cancer patients receiving
chemotherapy (Bulfone et al., 2009; Karagozoglu, Tekyasar, & Yilmaz, 2012),
physiological signs of anxiety among patients receiving mechanical ventilatory
support (Korhan, Khorshid, & Uyar, 2011), and anxiety among patients with
Alzheimer’s disease (Guétin et al., 2009).
There are many ways we can enhance our moods with the use of music; here are some
ideas:
Pick music that fits your mood or activity, such as upbeat music for exercise
and classical music for relaxation.
Try meditative music before sleeping.
Take dance lessons.
If you are anxious or angry while driving, pick music that will calm your
nerves.
Do not expose yourself to others’ music if it causes stress.
Use music while creating art as a way of adding inspiration.
Similarly, there are several ways you might engage in creative art as a way of
promoting positive wellbeing.
Here are a few ideas:
Pottery
Origami
Collage making
Painting or drawing
Building with Legos or Lincoln Logs
Beading
Making paper airplanes
Scrapbooking
Knitting
Stained glass making
Sewing or quilting
As with adults, childhood anxiety disorders cause significant impairment and are often
unrecognized (Walkup et al., 2008).
Rapee et al. (2009) note that childhood anxiety has a negative impact on peer
relationships, school functioning, and family processes. Childhood anxiety disorders
also commonly occur in conjunction with other psychological diagnoses and have
been linked to inhibited temperament (Rapee et al., 2009).
The most common childhood anxiety disorders include separation anxiety, phobias,
social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder,
and PTSD.
As with adults, childhood anxiety disorders are often successfully treated using CBT
or skill-focused treatment, both of which are sometimes combined with
pharmacological treatment.
In a randomized, controlled study of 488 children with anxiety disorders, CBT, both
alone and in combination with antidepressant therapy, was related to significant
reductions in anxiety severity as compared to a no-treatment comparison group
(Walkup et al., 2008).
In a study examining the long-term effects of CBT combined with parental anxiety
management, children who received the combined treatment were significantly less
likely to be diagnosed with an anxiety disorder three years later (Cobham, Dadds,
Spence, & McDermott, 2010).
Interestingly, the combined therapy was significantly more effective than the CBT
treatment alone, which makes sense given that psychological symptoms in parents are
related to treatment outcomes among children with anxiety (Berman, Weems,
Silverman, & Kurtines, 2000).
Along with parental influences, the quality of peer friendships has also been found to
predict better CBT treatment responses among kids with anxiety disorders (Baker &
Hudson, 2013).
While there is some evidence that children with particular anxiety disorders (e.g.,
obsessive-compulsive disorder) may benefit from pharmacological treatment
(especially selective serotonin re-uptake inhibitors), quality studies examining the
effects of psychotropic medication for the treatment of pediatric anxiety are scarce
(Reinblatt & Riddle, 2007).
There is, however, evidence that CBT is an effective treatment for children with
anxiety disorders, with long-term benefits often noted (Muris, Meesters, & van
Melick, 2002). Moreover, CBT is particularly effective for treating childhood anxiety
disorders when combined with family training (Muris et al., 2002).
For example, in a study examining a 10-week dose of iCBT among participants with
generalized anxiety, iCBT was associated with significant positive treatment effects
comparable to those found for in-person treatment (Robinson et al., 2010). Similarly,
CBT e-therapy has been reported as effective for the treatment of obsessive-
compulsive disorder, PTSD, social anxiety, and generalized anxiety (Klein, Meyer,
Austin, & Kyrios, 2011).
A Take-Home Message
Anxiety symptoms and clinical anxiety disorders are highly prevalent and often
debilitating.
The psychological treatment approach with the most scientific support for anxiety
disorders is CBT. Consequently, CBT is often the treatment of choice among
therapists specializing in anxiety issues.
CBT may take many forms, with exposure therapy often reported as highly successful
for the reduction of anxiety. Exposure therapy may be enhanced with other
therapeutic approaches, such as relaxation training and acceptance-based therapy.
There is also support for the efficacy of group CBT for the treatment of anxiety,
especially when groups are both cohesive and task focused.
Anxiety disorders are common among children, with the most frequent diagnoses
including separation anxiety, phobias, social anxiety, generalized anxiety, obsessive-
compulsive disorder, and PTSD. Research similarly indicates that CBT has long-term
benefits for kids, especially when combined with family therapy. Along with CBT, art
and music therapy also represent research-based approaches found to soothe an
anxious mind.
In addition, there are various things individuals can do on their own to relieve anxiety,
such as deep breathing, aerobic exercise, meditation, yoga, enjoying a hobby, listening
to music, etc.
We hope you enjoyed reading this article. Don’t forget to download our three Positive
Psychology Exercises for free.
REFERENCES