Treatment Interventions

Welcome back to module three anxiety

disorders, this is Lecture four. In this lecture we will discuss

major treatment interventions. As we learned in module to the development

of treatment interventions for psychological disorders is very much

driven by the main models and use for understanding them. Recall that in our last lecture we

discussed the dominant models for understanding anxiety disorders,

the biological model and the cognitive behavioral model. Unsurprisingly, the leading treatments for

anxiety disorders rely on both biological and

cognitive behavioral research findings. First, let's consider biological

treatments, in the 1950s, a class of drugs called

the Benzodiazepines was discovered. These medications,

which include Valium, Xanax and Ativan were found to calm people's

anxiety when taken in lower doses and to help people sleep when

taken in higher doses. Investigation into the impact of

benzodiazepines on the brain found that these drugs increase the ability

of GABA to act on the amygdala and other structures in the fear circuit. Recall from the last lecture that GABA's

role appears to be the inhibition of activity in the fear circuit and that low GABA levels result in

over activity of this circuit. Benzodiazepines allow GABA to

be more active in the brain, which leads to lower activity

levels in the fear circuit. Benzodiazepines have been prescribed

to people who experience both the acute anxiety associated with panic disorder

as well as the more moderate yet chronic anxiety of GAD. While this class of drugs can be effective

in alleviating these symptoms of anxiety, there are very serious concerns

associated with its use. The impact of these drugs on the body

is short lived once their effect diminishes the anxiety

returns in full force. Additionally, taking a benzodiazepine for a long period of time leads to

physical dependence or addiction. Finally, these medications

produce unwanted and sometimes serious side effects,

especially when combined with alcohol. These side effects include drowsiness,

poor coordination, memory loss, depression, aggression and

dangerously slowed breathing. Taken together the concerns associated

with benzodiazepines prevent them from being a standalone intervention for

anxiety disorders. However, they are occasionally used

very carefully in a time limited way and in very low doses to help people manage

episodes of overwhelming anxiety until they're able to

become involved in therapy. In Module two, we discussed a class of

antidepressants called the series SSRIs. Have been found to be effective in

alleviating the symptoms of anxiety when they're prescribed in higher doses than

when they are prescribed for depression, as you may recall. SSRIs have the benefit of not

producing physical dependence and while they may cause

uncomfortable side effects, they are considered safe drugs

that are not lethal in overdose. The preponderance of research evidence

supports the efficacy of therapy for treatment of anxiety disorders,

specifically cognitive behavioral therapy. Some forms of cognitive behavioral therapy

involved helping the client identify the rigid maladaptive thought patterns

that are contributing to their anxiety and avoidance behavior. And assisting the client

in developing new adaptive, healthy thought patterns in their place. A fundamental component of this

therapeutic method involves helping the client become more aware or

mindful of their thought processes. And the impact they have on their

emotions and behavior, Acceptance and Commitment Therapy, or ACT. Is a newer form of cognitive behavioral

therapy that does not seek to help people with anxiety disorders, replace irrational

thoughts with rational healthy ones. Rather, ACT seeks to help people

accept their irrational thoughts as simply a part of their internal experience

of themselves the world in the future. ACT is predicated upon the belief that

if we accept our irrational thoughts, the thoughts have less power to

make us acutely distressed and lead to anxiety disorders. Another form of cognitive behavioral

treatment known as Exposure, with Response Prevention, or ERP. Has met with considerable success in

the treatment of a variety of anxiety disorders. This treatment modality involves exposing

the person to the very situation or object that triggers the anxiety. As well as preventing the person from

engaging in their preferred behavioral response to neutralize the anxiety, which

is most commonly a form of avoidance. An ERP treatment, a person with

an anxiety disorder is exposed to the anxiety producing stimulus and does not withdraw from it when panic or

acute anxiety occurs. When this treatment method is used in

a gradual systematic way by a therapist who is trained in its implementation. It is very successful in the treatment

of anxiety disorders such as phobias, panic disorder,

social anxiety disorder and OCD. The process of slowly exposing

a person to a feared stimulus while preventing an avoidance response is

called systematic desensitization. And it is often used in combination with

teaching people relaxation techniques that they used during

the exposure sessions. Most cognitive behavioral therapists use a

combination of techniques to assist their clients who are struggling

with anxiety disorders. At times, medications are used to

supplement the therapeutic techniques. But there is a great deal of research

evidence indicating that medication can decrease the effectiveness of CBT in

the treatment of anxiety disorders. In the next lecture,

we will consider socio-cultural and multi-cultural aspects of anxiety.