Treatments and Therapies for Anxiety Disorders'

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Treatments and Therapies for Anxiety Disorders.

• Biological Approach-
• 1. Chemotherapy (Drugs)
• Anti-anxiety drugs/minor tranquillisers
  (benzodiazepines such as valium librium)
• All used for treating GAD and phobias, some for
  Panic attacks but not used for OCD or PTSD. Fast
  acting benzodiazepines (alprazolam) used for
  panic attacks (put under tongue can work in 5
  mins!)
• Probably work by mimicking / blocking the action
  of naturally occurring neurotransmitter
  substances.
• Depresses CNS activity therefore reduces
  Symp.NS activity. This leads to a decrease in HR,
  RR e.t.c.
• Side effects-
• Drowsiness Lethargy Dependence
• Withdrawal Rebound anxiety when stopped
• Dangerous if overdose taken -gt death.

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• Antidepressant drugs such as tricyclic
  antidepresseants and SSRIs. (e.g. Tofranil,
  Prozac)
• Useful for treating agoraphobia, OCD PTSD
• Piccinelli(1995) - antidepressants (e.g.
  clomipramine) most effective for short term
  treatment of OCD.
• Buspirone mild tranquilizer used for GAD and
  OCD
• Mode of action effective at the synapses of
  neurons
• involved in the action of serotonin
  noradrenaline, results in elevated levels of
  both.
• Side effects each drug may have one /more of -
• Some require patient to stick to special diet
• Dry mouth Heart arrhythmias
• Blurred vision Urinary retention
• Weight gain Hand tremors
• Depresses reactions Impaired memory

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• 2. Psychosurgery
• Last resort very rarely used because of risks.
• Used to treat OCD effective (Hey et al, 1993)
• Cingulotomy cuts the cingulum bundle a small
  bundle of fibres connecting the prefrontal cortex
  with parts of the limbic system.
• Many side effects possible, some severe
  permanent. Irreversible.
• Continues to have a negative image both with
  public professionals due to misuse in the
  past.
• 3. Electro-Convulsive Therapy
• (see text book for details on this treatment
  method)
• Was used widely but much more restricted now.
• Occasionally used in the treatment of certain
  OCDs.

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Behavioural Approach-

• Implosion and Flooding - used in treatment of
  phobias.
• Based on producing extinction of fear response.
• Flooding is more effective than systematic
  desensitisation (Marks, 1987)
• Effectiveness of Implosion systematic
  desensitisation (Gelder et al, 1989)
• Systematic Desensitisation
• Developed by Wolpe,1958.
• Useful for specific phobias not so useful for
  agoraphobia
• Live desensitisation more effective than other
  desensitisation techniques Wilson OLeary
  (1978)
• More ethical than flooding therapy

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• Techniques modified slightly and used to treat
  OCD PTSD exposure therapy Ritual or
  response prevention
• Berman Norton(1995) - behaviour therapies are
  significantly better than other approaches in the
  treatment of agoraphobia.
• Behaviour Modification -Three steps
• 1.Identify the undesirable behaviour
• 2.Identify the reinforcers that maintain the
  behaviour
• 3. Restructure the environment so that the
  maladaptive behaviour is no longer reinforced.

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• Removal of reinforcers extinction
• Use aversive stimuli to punish voluntary
  maladaptive behaviours.
• Use positive reinforcement to increase desirable
  behaviours.
• May be used to treat Compulsive behaviour
  phobias.
• Probably not useful in treating PTSD GAD/PD

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• Psychodynamic Approach - Psychoanalysis
• Example of Little Hans phobia real source of
  fear must be identified.
• Identify the problem
• Free association
• Dream analysis
• Behaviour interpretation
• Producing improvement
• Catharsis
• Transference
• Insight
• According to Freud useful for all kinds of
  anxiety disorders, but may not be appropriate for
  OCD.

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• Effectiveness?
• Eysenck(1952) less effective than other
  therapies spontaneous remission this study
  has been severely criticised.
• Smith Glass(1977) show it is more effective
  than no treatment at all.
• Sloans et al (1975) - more effective with less
  severe problems.

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Cognitive Approach (Cognitive behavioural
approach)

• Modelling (Albert Bandura)
• useful in treatment of phobias. Aims to change
  thoughts as well as behaviour. Participant
  modelling more effective than symbolic modelling.
• Assertiveness training / social skills training
  use principles of modelling and behavioural
  rehearsal useful in treating social phobias.
• Ellis REBT
• Less effective for agoraphobia than other
  therapies
• Its effectiveness is limited to certain types of
  people. (Bransma et al,1978)

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• Becks Cognitive Restructuring Therapy
• Useful in counteracting panic attacks (Clark et
  al,1994) phobias
• Not useful for treating OCD (James Blackburn,
  1995)
• One-to-one therapist-client
• Therapist client work together to identify
  restructure faulty thinking.
• Therapist gently points out errors in thinking,
  client has to decide for themselves whether their
  thinking is accurate.

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