If you have received treatment for your anxiety or depression in the past and achieved only limited results don't be disheartened. Not all treatments or therapists are the same and some are more effective than others. Recent developments in anxiety and depression treatment has brought essential new understandings which until recently went largely unrecognised. For example a problem known as 'relaxation induced anxiety' (see below for more) can make it virtually impossible for relaxation techniques to assist in the long term alleviation of anxiety disorders. In fact attempting relaxation techniques in these cases tends to make anxiety worse, only relieving symptoms temporarily at best by distracting your mind. By contrast a treatment which has been well evidenced to provide lasting relief from anxiety and depression is known as cognitive behaviour therapy (CBT). CBT is the principal mode of treatment used by professional staff at NSWADTC.
Cognitive Behaviour Therapy: CBT is the best evidenced treatment for overcoming anxiety disorders and depression. CBT is not just counselling or talking about yourself or your problems with your therapist. It is an approach which teaches cognitive (thought) and behavioural (action) techniques for overcoming a range of psychological problems including anxiety disorders and depression. CBT practitioners teach strategies to overcome anxious physiology, thoughts and behaviours. The approach incorporates techniques which are tailored to suit your individual symptom presentation and the type of disorder you are experiencing. Treatment is typically brief (8-16 sessions) and highly structured, including home practice exercises which are to be repeated between consults. The aim of CBT is to eliminate unnecessary anxiety and depression altogether. When conducted well CBT programs are relatively simple and comfortable to complete. The approach teaches you all you need to know to completely understand your anxiety, including how it started and why it has grown to become a significant problem for you. CBT is evidence based, meaning the methods used are founded in clinical research results. It is highly effective, typically producing a permanent significant improvement and often complete elimination of symptoms. In the case of panic disorder, for example, CBT programs which include a technique called interoceptive exposure (desensitisation to physical anxiety sensations via simple behavioural exercises) have been shown to achieve a long term elimination of panic attacks in up to 93% cases.
Other Anxiety Treatments
Cognitive Therapy: Cognitive therapy (CT) is the forerunner therapy to CBT and is often what therapists are doing when they say they use CBT. Essentially, CT focuses on changing feelings by showing you how to change aspects of your thinking. It is based in the understanding that beliefs determine the automatic thoughts that occur in response to an event and that these thoughts determine how you feel and behave when you respond to an event. CT techniques are used as a component of CBT programs and are quite useful in enhancing the outcomes of CBT programs. CT alone is, however, not as effective as CBT in overcoming anxiety disorders or depression.
Distraction Techniques: Many well meaning therapists and self help books recommend using distraction techniques such as keeping busy, counting backwards from 100, snapping a rubber band on your wrist, reading a book or doing puzzles etc as methods to alleviate anxiety. These techniques often bring temporary relief from anxiety symptoms (whilst you are distracted) but can cause the anxiety to return stronger than before once you stop being distracted. These days anxiety specialists recommend against the use of distraction techniques except maybe for short term use in overcoming a brief anxiety inducing situation (such as being forced to drive over a bridge as a passenger when you have a phobia of bridges). Moreover, it is generally recognised that distraction techniques do not provide a cure for anxiety disorders and the use of them often makes symptoms worse.
Relaxation Techniques: A range of relaxation techniques have been employed for the treatment of anxiety disorders, although anxiety specialists often avoid their use as they are typically ineffective and can at times make anxiety symptoms worse (see relaxation induced anxiety below). The types of relaxation techniques which have in the past been used to treat anxiety disorders include progressive muscle relaxation PMR (which can still be useful as part of a CBT program for generalised anxiety disorder), guided imagery exercises/audio tapes etc (eg imagine you are on a tropical island - similar in effect to distraction techniques), meditation and hypnosis. It is important to remember that relaxation techniques although typically not offering a cure for anxiety disorders can be very useful for people in general. Becoming practiced at a relaxation technique can provide a mini mental and physical holiday from stress which can be can be used by all. Moreover, if applied appropriately relaxation techniques can be useful for maintenance of general well being (for all including anxiety sufferers) once CBT has been completed.
What is Relaxation Induced Anxiety? Most sufferers of anxiety disorders have at some point attempted relaxation techniques such as meditation, guided imagery, hypnosis, deep breathing or listening to relaxation tapes or soundscapes. For many experiencing anxiety disorders, relaxation training at best brings temporary relief from anxiety symptoms. Often the use of relaxation tapes or techniques only work while the techniques are novel enough to distract you from your fearful thoughts. Once you remember that you might again have a panic attack, for example, the fear returns. It has been theorised that this is because if you try to relax to get away from anxiety sensations the primitive centres in your brain that control the only get the message that you are trying to get away from something (via relaxation). It doesn't realise that you are trying to get away from your own anxiety and assumes instead that you are trying to escape a dangerous predator (subsequently increasing your heart rate etc to assist you to escape). In essence doing anything to try and push away anxiety sensations typically makes you more anxious by triggering the so if you try to relax when becoming anxious you may end up feeling more anxious.
If therefore a well meaning friend or therapist has given you relaxation tapes for your anxiety and they aren't working (or seem to be making the anxiety worse) don't blame yourself because it is probably the wrong approach that you have been advised to use. Instead find an anxiety disorder specialist who employs evidence based CBT.
What about CBT and Medication Together?
Mindfulness and ACT:
Diet and Exercise:
Other Therapies (eg psychoanalysis, narrative therapy alternative therapies):
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