Anxiety disorders - Other treatments

It should be noted that non-pharmacological methods of treating anxiety are also being intensively developed. A number of such methods have been proposed, including hypnotherapy, psychotherapy, and kinesiotherapy. Most clinical studies devoted to this problem have assessed the effectiveness of various types of psychotherapy, including supportive psychodynamic and cognitive-behavioral psychotherapy. At present, it is difficult to say how effective these methods are. Anxiety disorders often have a fluctuating course, so randomized clinical trials are needed to assess the effectiveness of any method. There are many obstacles that complicate the assessment of the effectiveness of psychotherapy. First of all, this concerns the difficulties in standardizing therapy and choosing adequate control treatment methods. Among the various psychotherapy methods used to treat anxiety disorders, the most tested method is cognitive-behavioral psychotherapy.

Cognitive behavioral therapy involves influencing the cognitive attitudes (ideas, beliefs, prejudices, etc.) associated with specific symptoms in a given patient. Patients are taught to recognize pathological cognitive attitudes that accompany anxiety: for example, patients with panic disorder must realize that they overreact to normal visceral afferentation. Similarly, patients with social phobia must realize that they have a distorted reaction to situations in which they may find themselves in the center of attention. Patients are then taught techniques to reduce anxiety (for example, breathing or relaxation exercises). Finally, patients are advised to imagine a situation that causes anxiety, or to actually find themselves in such a situation and to apply the learned techniques for combating anxiety in practice. Moreover, the degree of load during such functional training should gradually increase. For example, patients with panic disorder and agoraphobia are first shown films or lectures in a large audience, then the psychogenic load is gradually increased, and finally the patient tries to visit places that provoke especially pronounced anxiety in him: for example, enters the subway or an elevator. A patient with social phobia is first asked to ask a stranger for directions or have lunch in a restaurant as a training exercise, and then try to give a lecture in front of a small group of people.

Such techniques often reduce anxiety in patients with social phobia, panic disorder, and obsessive-compulsive disorder. The effectiveness of psychotherapeutic methods for PTSD and generalized anxiety disorder is poorly studied, but there are reports that these disorders also respond to psychotherapy. The fact that symptoms decrease should be interpreted with caution, since the improvement is not necessarily due to psychotherapeutic intervention. For example, in a controlled randomized trial, cognitive behavioral therapy was shown to be no more effective than free listening for panic disorder. This raises the question: what aspects of psychotherapy determine success? Thus, although cognitive behavioral therapy is successfully used to treat anxiety, the mechanisms of its action remain unclear.

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