|
Frequently Asked Questions
Questions:
Answers:
Are some anxiety disorders more difficult to treat than others?
Some anxiety disorders are easier to treat successfully both with medications
and with cognitive behaviour therapy (CBT). However, this difference in
treatability is changing rapidly as new medications are found and more refined
CBT are used. For example, several years ago the success rates for Generalized
Anxiety Disorder (GAD) were very modest. However, new approaches, some of which
were developed in Canada, have greatly improved success rates for GAD. A similar
statement can be made with posttraumatic stress disorder.
There are many other factors, however, that are much more important in the
success of treatment than diagnosis. Most obvious is the complexity of the
person’s problems. Many people who have an anxiety disorder will also have
additional anxiety disorders or mood disorders. Generally, the more complex the
person’s psychopathology, the more difficult it is to obtain successful
outcomes. For example, an American researcher recently reported that
approximately 80% of people who have uncomplicated Panic Disorder report no
panic attacks after treatment. However, those people who were also depressed or
who had severe Agoraphobia in addition to their panic disorder faired far less
well with only about 50% showing no panic attacks at the end of treatment. This
is likely true of all anxiety disorders. If a person has additional problems
with anxiety or depression, the course of their treatment may be more difficult.
This is not to say that treatment will not work or that complex cases are
hopeless, it may just take a little more time, perseverance, and courage.
Back to Questions
What are some treatment options for anxiety problems?
Thirty years ago a person experiencing anxiety would have had a large variety
of treatment options. There were probably a half dozen medications that were
used to treat anxiety. Similarly, there were at least as many types of
psychotherapy purporting to reduce anxiety problems. Fortunately, now choices
are fewer. Why is it good to have fewer choices? Well, research, often supported
by the National Institute of Health in the United States, began addressing the
issue of effectiveness of treatments for all sorts of medical and psychological
problems. Part of this was the result of insurance companies who were unwilling
to pay for treatments that promised results, but that failed to deliver.
Psychoanalysis is an example. People could spend years in analysis and still
have severe problems with anxiety.
What does research show to be our best treatment alternatives today? Two
types of treatments, one pharmacological and one psychological, appear to
provide the best results. However, neither is perfect. Both have benefits and
problems. Let’s discuss both treatment options.
Medications. Generally speaking, the preferred pharmacological
(medications) treatments appear to be the selective serotonin reuptake
inhibitors (SSRIs) such as Paxil, and the newer selective serotonin and
noradrenalin reuptake inhibitors (SNRIs) such as Celexa. These medication work
by altering two important brain chemicals: serotonin (SSRIs) or serotonin and
noradrenalin (SNRIs). These chemicals are important messengers for transmitting
messages from one brain cell (neuron) to another. The SSRIs and SNRIs usually
take longer to reduce anxiety compared to the benzodiazepines (tranquilizers),
but have more long-term benefits. When taken properly the SSRIs and SNRIs often
lead to a large reduction or elimination of anxiety. This is less true of the
tranquilizers. Although tranquilizers can produce an almost immediate reduction
of anxiety, when they are used alone anxiety often returns when they are
discontinued. This is far less true with SSRIs and SNRIs. In addition, the SSRIs
and SNRIs have fewer problems associated with addiction. However, SSRIs and
SNRIs have their own problems. Many people experience unpleasant side effects to
some of these medications and they are expensive.
Psychological approaches. The psychological treatment of choice is
cognitive behavior therapy (CBT). CBT is an active type of therapy where people
are taught new ways of dealing with symptoms of anxiety and are expected to
practice these skills outside therapy. This is in contrast to many of the older
“talking” therapies such as psychoanalysis. With CBT the person with anxiety is
expected to become his or own co-therapist. In CBT, which may be done in an
individual or in a group format, the consumer (patient) is taught how to change
the way they think about their anxiety. For example a person with panic disorder
may be taught to realize that her racing heart and difficulty breathing is the
result of anxiety and not a heart attack. This is the cognitive part of
cognitive behaviour therapy. In addition, the consumer is also asked to confront
that which they fear. The purpose of this “exposure” to feared events and
objects is to demonstrate that the events and objects need not produce anxiety
and fear. For example, a person with social anxiety may be asked to speak out in
situations where they fear they might look foolish. Since looking foolish rarely
happens, this leads to changes in the way we think about our fears. Hopefully
exposure will help us understand that most of the things we fear need not make
us fearful or anxious.
There is more to CBT, of course, but the general purpose of CBT is to help
the person who has an anxiety disorder develop coping skills. Most people who do
research on anxiety disorders now consider CBT to be the treatment of choice
because people treated with CBT are usually less likely to relapse. If they do
relapse, they can often, using the skills they have learned, reduce their
anxiety on their own.
Unfortunately, CBT does have some problems. First it is sometimes difficult
to get access to good treatment. This is especially so in rural areas. Secondly,
if CBT if done by a private practitioner it can be quite expensive. The good
news is that new CBT treatments are being developed that can be used on the
internet. In Manitoba people are very lucky. In addition to having a world-class
anxiety disorders clinic at the St. Boniface General Hospital, we have the
Anxiety Disorders Association of Manitoba (ADAM) that provides effective group
treatments at a minimal cost throughout Manitoba.
Back to Questions
Can I pass on my anxiety disorder to my child?
The short answer is possibly, but not likely intentionally. Research has
shown that most forms of anxiety run in families. For example, if we took one
hundred people with panic disorder and one hundred without and carefully
interviewed all the first-order family members (parents, siblings and
children—if they are old enough) our results would show that approximately 25 %
of the family members of those with panic disorder would also meet criteria for
the disorder. However, we would only find panic disorder in about two-percent of
the family members of those who don’t have panic disorder. Furthermore, if we
compared identical twins who share 100 % of their genes with fraternal twins who
share, on average, 50 % of their genes we would find that if one twin has an
anxiety disorder his or her identical twin would be far more likely to have the
disorder than would the fraternal twin. However, this does not necessarily mean
that anxiety disorders are transmitted through genes.
Lets look at the causes of anxiety. This will help us understand how anxiety
disorders can go from one generation to the next. Recent research trying to
determine if genetic factors play a role in anxiety disorders has shown that we
must consider three factors—the genes a person shares with his/her parents,
siblings and children; the shared experiences that children in one family will
have; and the unique experiences the child has that his siblings will not
experience. Let’s look at the latter two of these factors.
First, let’s look at shared experiences such as having an alcoholic parent.
If the substance abuse problem occurred after the children were born, all would
have experienced the same alcoholic parent to a greater or lesser degree. For
example children born ten years apart may have very different experiences with
the alcoholic parent. For example, the parent may have become more or abusive
over the ten years. If however, a person is a twin he or she will experience a
greater shared environment than will children who are different in age by ten
years. Identical twins will have a greater shared environment than will
fraternal twins. Thus early, traumatic childhood experiences should be more
likely to lead to similar types of problems later in life for identical twins
than with other siblings.
Now, let’s consider experiences unique to one child. Even though identical
twins spend more time together than do other siblings, they are not always
together and bad things can happen to only one of them. For example, one child
might be bitten by a dog, but not the other.
Genetic factors
How do these three factor contribute to the
development of anxiety problems? First, there is no question that genetic
factors operate to increase the likelihood of a child developing an anxiety
disorder. However, this influences is greater for some disorders (e.g., panic
disorder and obsessive compulsive disorder) than others (e.g., post-traumatic
disorder). But having the genes for a disorder does not necessarily mean that a
person will develop the disorder.
Most people working in the field of mental illnesses have adopted a diathesis
model of mental illnesses. This means that we accept that genetic factors (or
negative early childhood experiences) can set the occasion for the development
of a disorder. However, other factors such as life experiences are necessary for
the disorder to fully develop. Let’s consider some f the things that might lead
to the development of anxiety disorders.
Fearful childhood experiences
If children learn that the world is a
frightening or untrustworthy place, they are at great risk of developing a
fearful way of approaching life. Danger lurks every where. Let’s consider two
examples. First, consider a infant who when he is hungry and cries sometimes he
is feed, but sometimes he is ignored. The infant may also, on some occasions be
spanked for crying. This child may develop a belief that people are not
trustworthy and that the world is a frightening place. This type of child is
more likely to develop an anxiety disorder than is one who grows up believing
that people can be trusted and the world is not a frightening place.
Modeling fear
Let’s imagine that a parent is terribly afraid of
going outside after dark. This person will also communicate, in a protective
manner, the horrible things that could happen if you were alone out side after
dark. You could be mugged, raped, a wild animal might attack you, or you might
get lost. Young children often believe their parents are “experts” on all
things. If a child perceives his parent or parents to be very fearful of things
or events, it is very likely that the child will adopt these fears.
In summary, it is possible for a parent to influence whether or not a child
develops an anxiety disorder. The parents may pass on genes that lead to a
general fearfulness, may though poor parenting teach the child to be distrustful
and fear the world, or, finally, teach the child to be fearful either by
modeling fear or by being overly protective of his/her children.
Back to Questions
|
©2007 Anxiety Disorders Association of Manitoba, All rights reserved.