Understanding and Treating Anxiety

Cognitive and behavioral therapies for generalized anxiety disorder (GAD) refer to a variety of techniques that can be provided individually or in combination. The basic premise underlying the therapy approaches is that thoughts, feelings and behaviors are inter-related, so altering one can help to alleviate problems in another (e.g., changing negative thinking will lead to less anxiety). The excessive, uncontrollable worry that is the hallmark of GAD is thought to be maintained through maladaptive thinking about the utility of worrying, a tendency to repeat worries instead of problem-solving, difficulties relaxing, and unhealthy behaviors, including attempted avoidance of negative thoughts and images, as well as situations that might provoke worry. The cognitive therapy techniques focus on modifying the catastrophic thinking patterns and beliefs that worrying is serving a useful function (termed cognitive restructuring). The behavioral techniques include relaxation training, scheduling specific ‘worry time’ as well as planning pleasurable activities, and controlled exposure to thoughts and situations that are being avoided. The purpose of these exposures is to help the person learn that their feared outcomes do not come true, and to experience a reduction in anxiety over time.

The research evidence suggests that both cognitive or behavior therapy on their own can be helpful for GAD (especially cognitive restructuring or applied relaxation). However, there may be some advantage to combining the approaches, with some studies finding that the treatment is more powerful when therapy involves cognitive work, exposures and relaxation. Cognitive Behavior Therapy (CBT) typically refers to a combination of the various cognitive and behavioral approaches, and ‘Anxiety Management Training’ usually refers to the particular combination of relaxation and cognitive restructuring. The therapies can be conducted individually or with a group, and CBT is helpful for older adults with GAD as well.

Integrating cognitive-behavioral techniques with concepts from Eastern meditation, dialectical behavioral therapy, or DBT, combines acceptance and change. DBT involves individual and group therapy to learn mindfulness, as well as skills for interpersonal effectiveness, tolerating distress, regulating emotions. Learn more about our DBT treatment.

Under certain conditions eye movements appear to reduce the intensity of disturbing thoughts. A treatment known as eye movement desensitization and reprocessing, or EMDR, seems to have a direct effect on the way that the brain processes information. Basically, it helps a person see disturbing material in a less distressing way.

EMDR appears to be similar to what occurs naturally during dreaming or REM (rapid eye movement) sleep. Scientific research has established EMDR as effective for Post-traumatic stress disorder. And clinicians also have reported success using it to treat panic attacks and phobias.

Mindfulness based cognitive therapy (MBCT) is a type of therapy born from the union of cognitive therapy and meditative principles.

• Cognitive therapy aims to help clients grow and find relief from symptoms of mental illness through the modification of dysfunctional thinking (Beck Institute, 2016).
• Mindfulness can be summed up as the practice and state of being aware of our thoughts, feelings, and emotions on a continuous basis (Greater Good Science Center, 2017). Mindfulness also contributes to an acceptance of the self as it is, without attaching value judgments to our thoughts.

The marriage of these ideas is MBCT, a powerful therapeutic tool that can be successfully applied to depression, anxiety, bipolar disorder, and more.

HeartMath is a science-based technology program for taking charge of your life. HeartMath research has demonstrated that different patterns of heart activity (which accompany different emotional states) have distinct effects on cognitive and emotional function. At Privé-Swiss, the HeartMath intervention program uses the Inner Balance Sensor or the emWave2. These sensors help take charge of how you feel by tracking your heart rate variability.

It can be easy to feel scattered, anxious and overwhelmed.  The HeartMath Interventions program emphasizes the role of the heart as a key component of the emotional system. It teaches you how to change heart rhythm patterns to create physiological coherence; a scientifically measurable state characterized by increased order and harmony in our mind, emotions and body. Heart coherence triggers positive hormonal releases. This makes it easier to experience peace, positive feelings and a deeper meditative state more quickly.  Coherence is a measure of the pattern in the heart’s rhythm and it reflects an orderly and harmonious synchronization among various systems in the body such as the heart, respiratory system and blood-pressure rhythms.

The clinician at Privé-Swiss will teach you to utilize many different strategies to change your heart rate variability. The first technique you will learn is the The Heart-Focused Breathing (HFB) Technique which is an easy-to-use, energy-saving self-regulation strategy designed to reduce the intensity of a stress reaction and to establish a calm, but alert state.

HeartMath technology is an innovative approach to improving emotional wellbeing. The coherence-building techniques taught in the HeartMath program are effective in producing immediate and sustained reductions in stress and its associated disruptive and dysfunctional emotions. It stops energy drains and increases energy. At the emotional level, use of the HeartMath system has shown across diverse populations to produce significant reductions in depression, anxiety, post traumatic stress disorder, anger, hostility, burnout and fatigue and corresponding increases in caring, cognitive flexibility, enhanced problem solving, contentment, gratitude, peacefulness and vitality. It is also conducive to healing, emotional stability and optimal performance. Through this process people start to experience powerful and meaningful changes in whole body systems that can facilitate learning new perceptions and behaviors.

There is growing scientific evidence about complementary and alternative treatments. Interest in complementary and alternative medicine, or CAM, is growing as consumers and health care professionals search for additional ways to treat anxiety, depression, and other mental health disorders.

Complementary medicine is used along with conventional medicine. An example is in-home treatment to help modify symptoms of panic attacks. Alternative medicine can include a special diet to treat cancer instead of undergoing surgery, radiation, or chemotherapy recommended by a medical doctor.

Before beginning CAM or any type of treatment, talk to your mental health provider or primary care doctor. Visit the National Center for Complementary and Integrative Health to learn more about CAM treatments.

The following complementary and alternative practices may be used to treat anxiety and depressive disorders. We advise that you speak with your primary physician and/or mental health provider before selecting any alternative or complimentary treatment:

Stress and Relaxation Techniques

Relaxation techniques may produce modest short-term reduction of anxiety in people with ongoing health problems. These techniques have also been shown to be useful for older adults with anxiety.
Meditation
Moderate evidence suggests that meditation is useful for symptoms of anxiety and depression in adults.

Acupuncture

There are preliminary positive findings for acupuncture in the treatment of chronic anxiety associated with PTSD. A systematic review of acupuncture for PTSD found that the evidence of effectiveness is encouraging (Kim 2013): All four reviewed randomized controlled trials (RCTs) indicated that acupuncture was equal to or better than orthodox treatments, or that it added extra effect to them when used in combination.

Three of the four are Chinese studies that used earthquake survivors and one similar RCT (Wang 2012) was too recent to be included in the review. It found that both electroacupuncture and paroxetine resulted in significantly improved scores for PTSD, but that the improvement was greater with electroacupuncture.

There is also some evidence that the acupuncture effects may continue for at least a few months after the treatment course is finished (Hollifield 2007). A review that looked at the effects of combining brief psychological exposure with the manual stimulation of acupuncture points in the treatment of PTSD and other emotional conditions found evidence suggesting that tapping on selected points during imaginal exposure quickly and permanently reduces maladaptive fear responses to traumatic memories and related cues (Feinstein 2010).

Kim’s review (Kim 2013) also included two uncontrolled trials (they too had positive outcomes). A more recent uncontrolled pilot study found that acupuncture appeared to be a therapeutic option in the treatment of sleep disturbance and other psycho-vegetative symptoms in traumatised soldiers (Eisenlohr 2012).

Although more high quality trials are needed to substantiate these results, the overall evidence does lie promisingly in a positive direction, and, given the very low level of side effects and lack of demonstrably superior outcomes from other interventions, acupuncture could be considered as one possible therapeutic option alongside the existing repertoire.
In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body’s homeostatic mechanisms, thus promoting physical and emotional well-being.

Research has shown that acupuncture treatment may specifically benefit anxiety disorders and symptoms of anxiety and stress by: Acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for anxiety and worry (Hui 2010); Regulating levels of neurotransmitters (or their modulators) and hormones such as serotonin, noradrenaline, dopamine, GABA, neuropeptide Y and ACTH; hence altering the brain’s mood chemistry to help to combat negative affective states (Lee 2009; Zhou 2008); Stimulating production of endogenous opioids that affect the autonomic nervous system (Arranz 2007). Stress activates the sympathetic nervous system, while acupuncture can activate the opposing parasympathetic nervous system, which initiates the relaxation response; Reversing pathological changes in levels of inflammatory cytokines that are associated with stress reactions (Arranz 2007);

Massage

There are preliminary positive findings for acupuncture in the treatment of chronic anxiety associated with PTSD. A systematic review of acupuncture for PTSD found that the evidence of effectiveness is encouraging (Kim 2013): All four reviewed randomized controlled trials (RCTs) indicated that acupuncture was equal to or better than orthodox treatments, or that it added extra effect to them when used in combination.

HeartMath

The HeartMath Stress Relief System is a form of Biofeedback which focuses on heart wave variability and coherence. The goal of HeartMath Biofeedback is to teach you how to bring your brain, mind, body and emotions into balanced alignment. (See more information above.)