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Friday, November 22, 2019

The therapy of Anxiety Disorders.

The therapy of anxiety disorders aims at two interrelated goals:

  1. Initially, to immediately reduce and progressively to completely remove the overt symptoms of the disorder(s).
  2. At the later stages, to address the predisposing factors of pathological anxiety.

The first goal is easily met with immediate agreement between the patient and the therapist. For example, the patient who is diagnosed with agoraphobia and the therapist who treats him/her agree that it is an improvement for the patient to be able to perform his/her daily activities unaccompanied.

The second goal is more complicated. Usually, the patient is not readily aware of the causes of his/her disorder. Often s/he experiences difficulties and presents complains on many different areas of life, beyond the somatic symptoms. These areas certainly contain elements of his/her own self-image. For example, s/he often thinks to himself/herself: “My agoraphobia is not active these days, but I feel sorry for myself when I think that I have mental problems”.

In addition, his/her agony extends to descriptions that center on his/her relations with other people. For instance, s/he may disclose to his/her therapist, after the initial reduction of the somatic symptoms: “I do not enjoy much marital life, but I shouldn’t really be thinking of taking a divorce, because my husband isn’t such a bad person”. It is important for the outcome of therapy and crucial for its long-term effectiveness to inform the patient in simple words about the relationship between his/her generalized anxiety and the specific anxiety disorder s/he was diagnosed with.

There are more than one therapeutic models or therapies for introducing the desired outcome. In recent years, Cognitive-behavioral spectrum approaches present an impressive promise for the somatic complaints. However, a considerable number of patients (approximately 1/3) fail to respond positively to CB oriented protocols. The reasons are:

  1. The comorbid clinical picture of the patient that remains either undiagnosed or at the periphery of the therapeutic effort.
  2. The fragmentary application of the CB scheme
  3. The limited nature of the psychometric evaluation of the patient that centers exclusively on the overt symptoms at baseline and at subsequent assessments.

Alongside the CB therapies there is a large number of other approaches that address different aspects of anxiety disorders and are given positive evaluations in the international literature. Especially well known among them are the systemic therapies, particularly the group systemic intervention that aims at bringing about a change in the way in which the patient interacts with other people, particularly those that are emotionally important to him/her.

There is no ideal therapy for all patients with anxiety disorders. The success or lack of success of a therapeutic effort for the treatment of an anxiety disorder depends decisively on the careful and selective application of the appropriate therapeutic scheme for each individual patient. Familiarizing the new generation of therapists with this openness to the modalities that are available beyond their own particular training and way of doing therapy, would be extremely beneficial for the effective treatment of patients with anxiety symptomatology.

Let your therapist know about:

  1. Your previous therapeutic experiences in treating your anxiety disorder. More specifically, let him/her know exactly what was helpful and what was not so helpful in your previous efforts.
  2. Your possible concerns about your ability to get well and stay well.

Ask your therapist:

  1. About the causes of your anxiety disorder.
  2. About how these causes relate to your anxiety symptoms.

Ask from your therapist:                                

To help you go beyond the somatic symptoms and support you in preventing a relapse in the future.

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