Weighed down by anxiety? Treatment can free you.
When you’re struggling with symptoms of generalized anxiety disorder, it can be tempting to try to tough things out, chalk them up too much stress, or hope they’ll go away on their own. Unfortunately, for people struggling with anxiety, this is often not the case.
“Most anxiety does not go away on its own,” says Jennifer Hartstein, PsyD, a psychologist in New York City. “Anxiety thoughts are sticky thoughts, and they just [keep] pulling more thoughts in there, so it can just get bigger, and bigger, and bigger.”
Treating anxiety disorders mainly focuses on disrupting these negative and unproductive thought patterns. “Generalized anxiety disorder is [often] treated through a combination of psychotherapy and medication,” says Ben Michaelis, PhD, a psychologist in New York City.
Therapy for Anxiety Disorders
The research-backed choice for addressing maladaptive thought patterns is cognitive behavioral therapy (CBT). “The clinician will sit with you and help to identify particular thoughts—or cognitions—that are negative, that you repeat to yourself, [or] that are worry-based,” says Gail Saltz, MD, psychiatrist at New York-Presbyterian Hospital, Weill Cornell Medicine.
Maladaptive thoughts and behaviors may stem from patients’ tendencies to obsess over fear-inducing details, according to a 2013 study in Pharmacy and Therapeutics. This makes it hard to make rational judgments and decisions, and they cope by assuming the worst-case scenario and then acting to protect themselves against that threat.
In CBT, a therapist can question a thought or specific word choice that might represent black-and-white thinking (like “hate” or “failure”). Then, the therapist will help you to figure out a more accurate view of the situation and a more positive or nuanced way of thinking about it, according to Dr. Saltz.
Another form of therapy used to treat generalized anxiety disorder is called psychodynamic therapy, in which the clinician guides you to explore the roots of deeply ingrained emotional issues and reflect on patterns in your life, according to the American Psychological Association. “Understanding and bringing to consciousness what those conflicts are can also help diminish anxiety,” says Dr. Saltz.
Medication for Anxiety Disorders
For some patients, therapy for anxiety may be enough. But medication can be a critical part of the treatment plan too. “When the anxiety is so severe that there is significant impairment and suffering, you look to augment with medication,” says Khadijah Watkins, MD, psychiatrist at New York-Presbyterian Hospital, Weill Cornell Medicine.
Typically, SSRIs (or selective serotonin reuptake inhibitors) are the first-line medication for treating many types of anxiety disorders. “They allow your brain to have more of the neurochemical serotonin around,” says Dr. Saltz, “which is a chemical that does seem to play a large role in both depression and anxiety.”
Another option is a class of drugs known as benzodiazepines. Because of their addictive qualities, these are a short-term approach to relieving anxiety symptoms (for example, before giving a presentation or taking a flight). Another reason doctors may prescribe benzodiazepines is if a patient’s symptoms are severe and urgent. SSRIs can take two to four weeks to kick in, so doctors may also prescribe benzodiazepines temporarily to reduce anxiety, according to Dr. Saltz.
Many people make the mistake of thinking they don’t need treatment for an anxiety disorder until they’re having panic attacks or thoughts of self-harm. (Learn more myths about anxiety disorders here.)
But the earlier you begin treatment for generalized anxiety disorder, the more effective it is. Delaying treatment can allow your anxiety to progress and for negative thought cycles to become more entrenched in your brain—which makes them more difficult to unlearn. Chronic anxiety can also take a toll on your entire body.
“You could be a much better version of you if you didn’t have this backpack on your back of all this anxiety,” says Dr. Saltz. “It’s really worth tapping in for an evaluation to see how severe this is, how much this is something that could really be dealt with, and how much better you could feel.”
Dr. Saltz is a clinical associate professor of psychiatry at the NewYork-Presbyterian Hospital and Weill Cornell Medicine and a psychoanalyst with the New York Psychoanalytic Institute.Ben Michaelis
Dr. Michaelis is a clinical and media psychologist in New York City.Khadijah Watkins
Dr. Watkins is an assistant professor of psychiatry in the division of child and adolescent psychiatry at Weill Cornell Medicine and an assistant attending psychiatrist at NewYork-Presbyterian Hospital.Jennifer L. Hartstein
Dr. Hartstein is the owner of Hartstein Psychological Services, a group psychotherapy practice in New York City.
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Well, anxiety disorders are one of the most common
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disorders in this country, and the good news is,
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there are actually many potential treatments for
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Generalized Anxiety Disorder is treated through
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a combination of psychotherapy and medication.
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The most common research-based therapy is cognitive
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The clinician will sit with you and help to identify
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particular thoughts or cognitions that are negative,
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that you repeat to yourself, that are worry based,
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and help you to identify them, ascertain whether they
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really fit into the scenario, and then whether you might
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replace them with a more positive thought
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or positive behavior.
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Some patients respond well to psychodynamic psychotherapy,
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which is exploring conflicts that are causing you to worry.
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So when you have two disparate feelings in your mind
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to some degree, you might have anxiety about that,
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and understanding and bringing to consciousness
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what those conflicts are, can also help diminish anxiety.
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So the first line treatment for anxiety is
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However, when the anxiety is so severe that there's
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significant impairment and suffering,
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you look to augment with medication,
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and the class of medication that typically is
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used for anxiety are SSRIs.
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They allow your brain to have more of the neurochemical
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which is a chemical that does seem to play a large role
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in both depression and anxiety.
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The second line of medication is in the realm of
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what's called benzodiazepines, and these are,
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and should be short term use medications,
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because they are addictive.
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And so, someone who presents with an anxiety disorder
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may be given a serotonin reuptake inhibitor,
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but in the short term, might be given a
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benzodiazepine to help them until the
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serotonin reuptake inhibitor, which can take
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two to four weeks to kick in,
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starts to work.
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Most anxiety does not go away on its own.
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Anxiety thoughts are sticky thoughts,
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and they just kind of keep pulling more thoughts in there,
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so it can just get bigger and bigger and bigger.
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You may be living with an anxiety disorder for a long
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time and think, but this is just me.
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This is just the way life is,
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when in fact, you could be a much better version of you,
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if you didn't have this backpack on your back of
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all this anxiety.
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And so, if you're thinking, oh maybe this is an issue.
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It's really worth tapping in for an evaluation to see
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how severe this is, how much this is something
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that could really be dealt with and how much better
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you could feel.
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Beyond worry: how psychologists help with anxiety disorders. American Psychological Association. (Accessed on January 8, 2021 at http://www.apa.org/helpcenter/anxiety.aspx.)
Bystritsky A, Khalsa SS, Cameron ME, Schiffman J. Current diagnosis and treatment of anxiety disorders. P T. 2013 Jan;38(1):30-38, 41-44, 57.
Psychodynamic psychotherapy brings lasting benefits through self-knowledge. American Psychological Association, 2010. (Accessed on January 8, 2021 at http://www.apa.org/news/press/releases/2010/01/psychodynamic-therapy.aspx.)Treating anxiety disorders. Silver Spring, MD: Anxiety Disorders Association of America. (Accessed on January 8, 2021 at https://adaa.org/sites/default/files/Treating%20Anxiety%20Disorders.pdf.)