Treatment for anxiety

Anxiety disorders affect more than 40 million American adults, making anxiety the most common mental health problem in the U.S. More than 40% of American adults have experienced an anxiety disorder at some point, but only one-third receive treatment. An estimated 25% of teens ages 13-18 have anxiety, but only one out of five receive treatment. 

People with anxiety disorders are often told to "stop worrying" or to "forget about it." This does not work and makes people with anxiety feel even more alone and misunderstood. Anxiety should be thought of as a physical illness, deserving treatment like any other illness. Many features of anxiety are tied to biological explanations, such as altered brain chemistry. 

Medications used to treat anxiety

Medications are often used in tandem with psychotherapy to treat anxiety. These medications can include antidepressants, buspirone, benzodiazepines, and beta blockers.

Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs), can be used to treat anxiety symptoms. SSRIs include escitalopram (Lexapro) and paroxetine (Paxil, Pexeva). SNRIs used to treat anxiety may include duloxetine (Cymbalta) and venlafaxine (Effexor XR).

Buspirone has been shown to be highly effective in the treatment of anxiety, especially the cognitive and interpersonal problems associated with generalized anxiety disorder. It can also relieve the free-floating fear and tension of anxiety. It does not have a sedative effect, unlike benzodiazepines, and usually has minimal side effects. Brand names include BuSpar and Vanspar. Buspirone can interact with MAO inhibitors and grapefruit or grapefruit juice.

Benzodiazepines are a class of sedatives used to treat anxiety, epilepsy, and alcohol withdrawal. They can help with sleep problems and relieve acute symptoms of anxiety. Because they can be habit-forming, they are usually prescribed as a short-term measure. Their sedative or numbing effective can also interfere with psychotherapy. Brand names include Xanax, Librium, Ativan, Valium, and Klonopin.

Beta blockers, or beta-adrenergic blocking agents, block the neurotransmitter epinephrine (adrenaline) and slow down the heart. They are sometimes used to treat heart "flutters" associated with panic attacks, but they are not very effective at treating generalized anxiety and phobias. Common beta blockers include Lopressor and Inderal.

Using TMS to treat anxiety

Anxiety involves abnormal patterns of electrical activity in the brain. Clinical research has begun to look at brain stimulation as a method of treatment. Repetitive transcranial magnetic stimulation (rTMS)  selectively targets brain regions that are about 5 centimeters deep into the brain. Deep transcranial magnetic stimulation (dTMS) targets deeper regions and has shown effectiveness in the treatment of OCD.

Medical marijuana and the treatment of anxiety

There have only been a few clinical trials on the use of medical marijuana to treat anxiety. Generally, the plant form of marijuana (cannabis) has shown the potential to worsen symptoms. However, cannabidiol (a component of cannabis) has been effective in the treatment of social anxiety disorder and tetrahydrocannabinol (THC, another cannabis component) has helped some PTSD patients.

Psychotherapy and the treatment of anxiety

Evidence-based forms of therapy, like cognitive behavioral therapy (CBT), prolonged exposure therapy (PE) and dialectical behavioral therapy (DBT) are the most effective at treating anxiety. All of these are long-term therapies that aim to produce fundamental changes in how the client manages stress, regulates their emotions, and views their reality and their relationships.

Cognitive behavioral therapy (CBT) is the most short-term therapy and helps the client identify inaccurate perceptions that can trigger anxiety. CBT can also help clients with PTSD reframe the traumatic experience that is at the root of their symptoms.  

Prolonged exposure therapy (PE) is a specific form of CBT used to treat phobias and PTSD. The client is given coping mechanisms that help defuse the power of traumatic memories or phobias. The client eventually realizes memories and or certain phobic thoughts do not have the ability to cause present harm and do not need to be feared.

Dialectical behavioral therapy (DBT) is useful in clients with borderline personality disorder, anxiety disorders, or PTSD. This therapy helps clients develop better coping and stress-management skills. It deals with deep-seated issues and usually requires a year or more of treatment.

Eye movement desensitization reprocessing therapy (EMDR) is used to alleviate the distress connected to memories of traumatic events. It is mainly used in the treatment of PTSD and is similar to prolonged exposure therapy. This therapy helps clients process the traumatic event so they can move forward to healing.

Helpful practices

Clients with anxiety disorders can do a lot to further their own recovery. Eating well and maintaining a healthy sleep schedules are two basic practices to help heal the brain. Clients can also take advantage of complementary therapies that improve the overall quality of life and are a useful adjunct to professional care.

Meditation and the practice of mindfulness has been shown to be useful in reducing the symptoms of psychological stress in people with anxiety.

Yoga combines the practice of mindfulness with breathing exercises and physical poses. It can reduce some symptoms of anxiety by calming the mind and reducing the stress response. 

Relaxation strategies include deep breathing and guided imagery. Both can reduce overwhelming anxiety and make it more manageable. Deep breathing from the diaphragm encourages the body to enter a relaxed stated. Guided imagery allows the mind to focus on more positive thoughts and feelings.

Awareness of negative thinking patterns that give rise to anxiety can help derail anxiety before it starts. If you are overwhelming by the new role of parenting, taking some "me time" may help you avoid a bout of crushing anxiety. Journaling is another tool that can be used to identify and deconstruct anxious thoughts and behaviors.

Types of anxiety

Occasional anxiety is a normal part of life. But anxiety that is persistent, overwhelming, or irrational may signal the presence of an anxiety disorder. Anxiety disorders are medical conditions that interfere with daily life. They include generalized anxiety disorder (GAD), panic disorder and panic attacks, agoraphobia, social anxiety disorder, separation anxiety, specific phobias. and selective mutism.

Obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are closely related to anxiety disorders and may also involve depression. Anxiety can also be related to irritable bowel syndrome (IBS), which manifests as abdominal pain, cramping, constipation, and diarrhea.

Generalized anxiety disorder (GAD)

Generalized anxiety disorder (GAD) is characterized by chronic anxiety and worry, even when there is nothing to justify it. People with GAD are excessively anxious and worried most of the time. They may feel restless and on-edge, have difficulty concentrating or will lose their train of thought easily, can be irritable, may have problems falling asleep or staying asleep. People with GAD feel significant free-floating anxiety and fear around work, relationships, and other areas of life. Their anxiety is such that it interferes with normal functioning. 

Social anxiety disorder (Social phobia)

People with social anxiety disorder have an intense fear of being judged by others in social situations. They often avoid social situations because they are concerned about the negative opinions of others. Social anxiety disorder can make it difficult to function at school and in the workplace. It can affect people of all ages. Children may have a very limited understanding of their social anxiety, even though it is pervasive. Social anxiety can be generalized, or present across any social situation. It can also be specific, or limited to certain circumstances such as eating in public, talking to authority figures, or using public restrooms.

Specific phobias

Many people have specific phobias, such as a fear of spiders or of seeing blood. Adults with specific phobias usually understand their fear is ill-founded but they avoid the feared stimulus anyway. Phobias are treated when they interfere with an individual's daily life. For example, a businessperson with a fear of flying may need to overcome that particular phobia in order to do her job.

Separation anxiety disorder

Separation anxiety can occur in adults, teens, and children but is most common in children. The anxiety level at being separated from a person or environment is much greater is normal. Children with separation anxiety may refuse to go to school or may worry obsessively about something happening to a loved one. They may have trouble sleeping alone or may have repeated headaches or stomachaches without a physical cause. Children with separation anxiety may not be able to verbalize their fears so it is important to obtain a diagnosis from a qualified psychiatrist.

Selective mutism

Selective mutism is a relatively rare anxiety disorder in which an individual refuses to speak in certain situations, such as in class or with friends. Selective mutism is diagnosed only if there are no other explanations, such as embarrassment at a speech impediment or a lack of fluency in the language. 

Panic disorder

People with panic disorder have inexplicable attacks of severe anxiety that can create symptoms resembling a heart attack. Individuals with panic disorder may experience heart palpitations, sweating, trembling and shaking, shortness of breath, and a feeling of impending doom. Sometimes, panic attacks are preceded by stressors or triggers. People with panic disorder may try to avoid triggers, which can lead to the development of agoraphobia.


Agoraphobia is the fear of being in a situation where panic attacks might occur. People with agoraphobia display at least two of the following fears: a fear of driving or using public transport, a fear of being in open spaces like parking lots or on bridges, a fear of crowded places, a fear of enclosed spaces such as a store; a fear of being outside the home alone.

Substance-induced anxiety disorder

Drugs (both prescribed and street) can be related to panic-like symptoms either during use or up to one month after cessation of use. 

Related disorders

Obsessive-compulsive disorder (OCD)

OCD is characterized by obsessive thoughts that trigger compulsive behaviors. For example, worrying about staying clean can trigger repeated hand-washing or bathing. These behaviors temporarily relieve the anxiety associated with the obsessive thoughts. Having a few idiosyncrasies does not warrant a diagnosis of OCD. Instead, OCD is a debilitating condition that interferes with normal life.

Post-traumatic stress disorder (PTSD)

Exposure to a traumatic event can trigger recurrent memories, distressing dreams, flashbacks, and negative physiological responses or psychological stress displayed as anger, guilt, or shame. The traumatic event can be experienced directly or it can be an event that happened to a loved one. PTSD is a complex disorder but it almost always involves feelings of anxiety in response to re-experiencing memories or emotions connected to the trauma. 



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