Understanding Anxiety and its Treatment

Anxiety is probably the most common symptom of distress that intrudes in “normal life.” Though far from anything like a “mental disorder,” most people can relate to times of excess worry, perhaps fear of the dark, or of having the isolated panic attack. Maybe it is because these low-level experiences of anxiety are so common that many people underestimate the problem of clinical anxiety in the field of psychopathology.

Anxiety disorders are more common than all others psychological disorders combined: 18% of the U.S. population, over any given 12 month period,will have a diagnosable anxiety disorder. Compare this to only 8% for all other disorders combined.

Though often thought to be less serious than other mental problems, anxiety disorders are remarkably persistent throughout the lifespan. This is surprising, since anxiety is usually thought to be highly treatable. The fact that fewer than 30% of sufferers seek treatment no doubt contributes to this problem. One obvious conclusion to be drawn here is that if untreated, anxiety disorders are less likely to “just go away” than many other disorders.

One reason so few people seek treatment is the early age of onset–typically adolescence or even younger. With so many turbulent changes taking place at this time of life, many youths don’t realize their anxiety is “abnormal,” and that it should be singled out for treatment. What’s more, even if they think about getting help, younger people are more likely to encounter barriers such as financial limitations, uncertainty about how to obtain help, and shame or embarrassment about even asking.

The problems with early onset are compounded by the fact that it predicts not just the failure to get immediate help, it also puts them at risk for chronic, often incapacitating mental health problems later in life that are not limited to anxiety. Later substance abuse is a particular risk for those who develop an anxiety disorder early on.

If anxiety is so treatable, then it is obviously important to help more people get treatment earlier on in order to reduce misery now, and prevent long-term problems later.

Anxiety Treatment 

Before giving a brief overview of the effectiveness of anxiety treatments, I should note the information I will provide is distilled from my read of current literature review articles and meta-analyses in the refereed professional journals. From this background research, a number of interesting facts and patterns became clear. The medications currently in use for treating anxiety have well-established effectiveness across the variety of anxiety disorders, although the degree of this “effectiveness” is characterized as only “moderate.”Somewhat more than half of patients treated with medications for anxiety disorders report their level of improvement to be “inadequate.”

Reports of the relative effectiveness of psychotherapy for anxiety are somewhat inconsistent.Some sources report medication is just as effective as therapy, while the better indications find psychotherapy more effective than medication. One point of difference that is crystal clear is that anxiety medications tend to work only while being taken, with high relapse rates when stopped. Because psychotherapy actually changes the individual, rather than just masking the symptom, there is much less of a problem with relapse after therapy is completed.

One often reads in the popular media, on the internet, and in the professional journals that the best approach to treatment is one that combines medication and psychotherapy. I also hear this treatment recommendation quite often in clinical settings where I work. What truly surprised me was to learn that the evidence for this position, especially in the case of anxiety, is very weak.

The evidence from well-designed studies is that medicine adds no further benefit over psychotherapy alone.When psychotherapy is added to medication alone,therapy often adds more benefit. The finding that was most interesting is that the long-term recovery from both anxiety and depression was worse when medication is combined with psychotherapy, compared with psychotherapy alone.

As H.L. Menken observed in 1917, “There is always an easy solution to every human problem—neat, plausible, and wrong.”Medication is convenient and easy, but “wrong” if it is ineffective or, at best, only masks the problem while the patient is taking it. The research literature reviewed here supports a shift away from pushing medication in favor of more emphasis on psychotherapy.What’s more, the common mantra about the merits of “combined medication with psychotherapy” needs re-thinking.Since combining medication with therapy adds no benefit in the short-run, and undermines treatment gains in the long-run, it violates the tradition of the Hippocratic Oath that states “first, do no wrong.”

One position in favor of medication argues that it can help settle an anxious patient who is in so much turmoil that they cannot meaningfully participate in therapy. Though this is hypothetically possible, I suppose, I must remark that in more than twenty years seeing patients, I’ve never heard of a single such case. I have, however, heard about many more alien abductions.Would it be putting too fine a point on the matter to add that I don’t really believe alien abductions occur?

For those suffering from anxiety disorders, it is recommend you seek therapy first and foremost. Physicians, in many cases, will doubtless continue to recommend medical solutions, since that is how they are trained, even when evidence from their own professional journals favors therapy over medication. If seeking resources from a physician, you will likely have to be especially forthright in advocating for your needs. If circumstances (e.g., finances, limited resources in your community) dictate, medication should be considered as an option of last, not first resort. The evidence is that it stands a reasonable chance of being at least somewhat helpful.

Dr.Crowhurststherapy approach is among leading Calgary psychologists and psychotherapists. He offers Counseling Services in Calgary, AB to help people through their personal troubles so they can begin to live a life that is fulfilling and enjoyable. His unique approach helps people overcome a broad range of symptom disorders, personal problems and interpersonal difficulties. Dr. Crowhurst holds a Bachelor’s degree from Simon Fraser University, a Master’s degree in Clinical Psychology from St. Mary’s University in Halifax and a Doctorate in Clinical Psychology from the University of Calgary.

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