Strategy for treating anxiety

Overcoming anxiety: Treatment

The strategy for treating anxiety

We start with the basics of self-care, optimizing psychosocial support and lifestyle.

Then we try some counseling or psychotherapy. If this isn't sufficient, or the anxiety is severe, then we may go on to try out medication and possibly hospitalization.

Let's talk more about the two most common treatment options; first: psychotherapy.

We distinguish between feeling brain anxiety and thinking brain anxiety. For feeling brain anxiety: “Don’t believe everything you feel”. Likewise, for thinking brain anxiety: “Don’t believe everything you think”.

In feeling brain anxiety, a sight, sound, smell, or some other sensation triggers a negative emotional memory in the amygdala, which in turn triggers a fight, flight, or freeze response. 

Exposure therapy tries to weaken the link between the trigger and the negative emotional memory. This is done through repeated exposure to the trigger, whether it be a thing, place, or situation. Exposure will initially trigger a fight, flight, or freeze impulse. But, instead of giving in to the impulse, resist it until the anxiety eventually calms down and you realize that nothing bad happened. Through this process, preferably done under the guidance of a mental health professional, the goal is to desensitize the amygdala to triggers of feeling brain anxiety.

In thinking brain anxiety, there are certain ideas or images that create negative beliefs or expectations that ultimately may activate the amygdala’s fight, flight, or freeze response. We cannot prevent ideas or images from popping up in our minds, but we may manage what negative beliefs and expectations are formed. The first step is to cultivate awareness and acceptance of what’s going on in our minds. We may then examine our beliefs and expectations, and if we find them flawed, faulty, and destructive, we may actively work on substituting them with true and helpful beliefs and expectations. When better beliefs and expectations dominate, the thinking brain anxiety may calm down, and we may realize that nothing bad will or has happened. Through this process, also preferably done under the guidance of a mental health professional, the goal is to minimize thinking brain anxiety by enhancing the thinking process.

Finally, the other common treatment strategy: Medication

SSRIs and SNRIs, also known as antidepressants, affect how nerve cells communicate through specific neurotransmitters like serotonin and noradrenaline. Beyond that, they also stimulate the growth of nerve cells and reduce inflammation. They may therefore promote rewiring of the brain and be beneficial, especially when combined with the learning process of psychotherapy.

Benzodiazepines increase the effect of GABA neurotransmitters. They slow down and sedate the amygdala and other parts of the brain. They work rapidly, but daily use will lead to dependence and negative long-term effects. Benzodiazepines may also reduce the effect of psychotherapy.

Beta-blockers block the effects of adrenaline, reducing symptoms associated with the fight, flight, or freeze responses, such as trembling or increased heart rate. They don’t reduce the body's stress response, only the symptoms associated with it.

It is time to seek treatment whenever your anxiety symptoms last for weeks and months, cause significant distress, or significantly interfere with your ability to function.

There are many effective treatment options. Most cases will improve with appropriate treatment. Decide which treatment option is preferable in consultation with your healthcare provider.