Anxiety Disorder Treatment

Agoraphobia

This is a specific type of panic disorder that occurs when an individual is in fear of being in places that would be difficult to escape, such as grocery stores, a car, crowds, open or closed spaces, etc.

Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD) is characterized by persistent and excessive worry about many aspects of life. Individuals may struggle to control their worry, leading to difficulty concentrating or general functioning.

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder (OCD) is an anxiety disorder that involves both obsessions (thoughts, images, or impulses that occur repeatedly) and compulsions (acts that a person repeatedly performs to make the obsession go away). The brain seems to get “stuck” on a thought or urge it cannot move past. Individuals with OCD often have the sense that if that “obsession” continues without them taking part in any compulsions, the anxiety will become intolerable.

Panic Disorder

Panic Disorder is a fight or flight response to anxiety, which can trigger intense reactions to perceived danger or threat. Panic attacks can be very frightening because the individual usually loses control of their body. It may feel like the person is having a heart attack, trouble breathing, and, in some cases, even feel like the individual is dying. A lot of people experience a panic attack in their lifetime, usually not having a repetitive occurrence. Panic attacks become Panic Disorders when stressful situations or trigger events ensue recurrent panic attacks. When they begin to happen frequently, it can affect the quality of life of the individual who fears their next panic attack.

Performance Anxiety

Performance anxiety is a common issue that many people face when they are required to perform in front of others, whether it's in a work setting, on stage, or during a public speaking engagement. The fear of being judged or making a mistake can lead to physical symptoms such as sweating, trembling, or a racing heartbeat. It can also lead to mental and emotional distress, causing individuals to doubt their abilities and worry excessively about their performance. While a certain level of anxiety can be expected, severe performance anxiety can be debilitating and impact one's overall well-being.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is an anxiety disorder that occurs after a person has personally experienced or witnessed a dangerous and life-threatening event. Individuals who are at risk for developing PTSD include but are not limited to: Soldiers who have been in combat, survivors or witnesses of violent crimes (including rape, kidnapping, robbery, etc.), individuals who have lived through a natural disaster, survivors of accidents or grave illness. Re-experiencing symptoms, sometimes known as “flashbacks,” make the individual relive the trauma over and over. This could include physical symptoms like a racing heart, sweating, bad dreams, or frightening thoughts. Sometimes, the individual uses coping mechanisms, also considered avoidance symptoms, such as staying away from places, events, or objects that are reminders or triggers of the experience. Other symptoms of PTSD include feeling emotionally numb, feeling intense guilt, depression, or worry. Some individuals lose interest in activities that were once enjoyable and also have trouble remembering the traumatic event.

Separation Anxiety

Symptoms of separation anxiety may include recurrent and excessive distress about anticipating or being away from home or loved ones. Children are especially prone to separation anxiety during times of stress and tend to become excessively anxious when separated from their parents.

Separation anxiety differs from normal clinginess. Separation anxiety disorder is diagnosed when symptoms are excessive for the developmental age and cause significant distress in daily functioning. Children with the disorder cannot think about anything but the present fear of separation. They may have nightmares or regular physical complaints. They may be reluctant to go to school or other places.

School Anxiety Issues

Along with Social Anxiety, some children suffer from school-related anxiety issues. This could start with symptoms such as a headache, stomachache, or nausea before school begins. Sometimes, these symptoms can even lead to school avoidance due to the severity of the anxiety. School Anxiety can stem from the general fear of school and the concern of not having parents with them.

Social Phobia

Social Phobia, also known as Social Anxiety Disorder, is characterized by marked and persistent fear of situations in which one must perform or interact socially with or in front of others. A person with social phobia fears situations where they are exposed to new situations or people. They, therefore, worry about behaving in a way that others might judge them as foolish, unacceptable, inappropriate, or inadequate. When a socially phobic individual is exposed to these situations, they feel anxious, both physiologically and emotionally. This disorder hurts the individual’s social, academic, and occupational functioning.

Specific phobias

A specific phobia is any form of anxiety disorder that amounts to an unreasonable or irrational fear related to exposure to particular objects or situations. As a result, the affected person tends to avoid contact with the objects or situations and, in severe cases, any mention or depiction of them.

Trichotillomania

Trichotillomania is a disorder characterized by the pulling of hair for non-cosmetic purposes, which can often result in significant hair loss. Hair is typically pulled from eyebrows, eyelashes, scalp, beard, and pubic area, though hair from other parts of the body may also be pulled.

Some individuals may experience anxiety as a result of an underlying health issue. In certain instances, signs and symptoms of anxiety could be the initial indicators of a medical condition. Medical problems that can be linked to anxiety include:

• Chronic obstructive pulmonary disease (COPD) and asthma
• Chronic pain 
• Diabetes
• Drug or alcohol use 
• Heart disease
• Hyperthyroidism
• Withdrawal from alcohol, anti-anxiety medications, such as benzodiazepines, or other medications

Other risk factors may include alcohol or drug use, a family history of anxiety, a history of trauma, certain personality traits, other mental health disorders, or stress.

RCBM is committed to accurately and thoroughly diagnosing anxiety disorders in individuals of all ages through our psychological screening process. All patients undergo a comprehensive diagnostic interview to understand their history and current concerns. Additionally, psychological testing helps us pinpoint the specific type of anxiety disorder along with co-occurring disorders.

CBT

The Rochester Center for Behavioral Medicine uses Cognitive Behavioral Therapy (CBT) for the treatment of anxiety and depressive disorders. This therapy combines behavioral exposure therapy and cognitive restructuring to help the patient confront avoidance, correct negative automatic thoughts, and return to optimal functioning.

Mindfulness-based therapies

Mindfulness-Based Cognitive Therapy (MBCT) combines mindfulness-based stress reduction techniques such as yoga or meditation with traditional CBT. Several studies have demonstrated that MBCT can effectively alleviate anxiety, and there is also evidence suggesting that it can be an effective treatment for depression. In addition, deep breathing, relaxation, and visualization are also helpful adjuncts in managing anxiety.

Acceptance and commitment therapy (ACT)

ACT builds on CBT principles and operates on the theory that trying to avoid anxiety can keep you feeling anxious. ACT can help you learn new ways to acknowledge and address complex thoughts and feelings as they arise. Studies show that ACT can be an effective treatment for anxiety.

Treatment for PTSD

At the Rochester Center for Behavioral Medicine, PTSD is treated with a combination of cognitive-behavioral therapy and, when necessary, medications. This practical approach can help individuals with PTSD identify situations that trigger their “fight or flight” response. Using the cognitive-behavioral techniques of flooding and systematic desensitization, the therapist and patient can work together to safely reintroduce situations that have become too anxiety-provoking for the patient. Over time, irritability, flashbacks, and nightmares subside, the patient can return to their pre-trauma functionality, and long-term success is within reach.

Medication management

Medications can help alleviate the symptoms and improve functioning. Common medications for anxiety disorders include:

Antidepressants: While antidepressants are primarily used to treat depression, they can also be beneficial for managing anxiety disorders. These medications work by regulating the brain's use of certain chemicals to enhance mood and alleviate stress. It's important to note that antidepressants may take some time to take effect, so it's essential to be patient. The most commonly prescribed types of antidepressants for anxiety are SSRIs and SNRIs. Tricyclic antidepressants are another option, but they tend to have more side effects.

Benzodiazepines:  These types of medications can reduce feelings of anxiety, panic, and worry. They work quickly, but you can become tolerant of them over time. They also have the potential for addiction, so you should use them with caution. Your healthcare provider might prescribe a benzodiazepine for the short term and then gradually reduce your dosage. Some benzodiazepines that can help with anxiety disorders are alprazolam, clonazepam, diazepam, and lorazepam.

Beta-blockers:  These medications can help reduce some of the physical symptoms of anxiety disorders, such as rapid heartbeat, shaking, and trembling, but they do not address the psychological aspects of anxiety disorders.

Medical Nutrition Therapy

Nutrition intervention is an essential adjunct to the treatment of anxiety. A variety of foods from all food groups provide important nutrients and maintain stable blood sugar levels, which is crucial in managing anxiety. Our registered dietitians can develop a personalized nutrition plan to help with the management of anxiety.

Higher level of care treatment

An inpatient stay is recommended for individuals who are unable to care for themselves or may be a risk to the safety and well-being of themselves or others.

This might include individuals who are:

• Actively suicidal
• Actively homicidal
• Flagrantly psychotic
• Depressed or anxious to the point that the patient cannot engage in activities of daily living

Partial Hospitalization Program (PHP)

• This level of care is recommended for individuals who:
• Exhibit psychiatric severe or co-occurring disorders
• Present a danger to themselves or others
• Have not had success using outpatient treatment

This level of care is necessary to provide structure for treating current symptoms that cannot be managed at a lower level of care when current intensive outpatient care has failed to improve functioning or acute coping skill deficits are severe and require daily assessment and intervention.

CBT is particularly effective for the anxiety disorder spectrum, such as panic disorder, post-traumatic stress disorder, obsessive-compulsive disorder, social anxiety disorder, and specific phobias. The hallmark of CBT is the patient’s role in learning and practicing skills outside the session to maximize the therapeutic benefit of this therapy. In mood disorders, the patient will learn coping skills to master tasks often thought too arduous for the depressed patient. The use of CBT with medication management is addressed, and the ultimate decision is made between the patient and the RCBM professional.

Using the cognitive-behavioral techniques of flooding and systematic desensitization, the therapist and patient can work together to safely reintroduce situations that have become too anxiety-provoking for the patient. Over time, irritability, flashbacks, and nightmares subside, the patient can return to their pre-trauma functionality, and long-term success is within reach.

Continue to work with your healthcare provider to determine the best medication combination and dosage for you. Do not adjust the dosage or discontinue medications without consulting your provider first. Your prescriber will monitor your progress to ensure the medicines are effective and do not cause any adverse side effects.

Medical nutrition therapy is also an essential intervention that works together with psychotherapy. Complex carbohydrates such as brown rice, oats, whole wheat, beans, and legumes can help increase serotonin levels in the brain, promoting peace and well-being. In addition, probiotics are helpful, as recent research shows a correlation between the lack of beneficial bacteria and microbes in your gut, resulting in anxiety. Our registered dietitians can help you include foods to manage your gut as an adjunct to treating your anxiety.

If you are a current patient at RCBM, don't hesitate to contact our office at (248) 608-8800. If you are new to RCBM, you can initiate the admission process by completing a new patient registration form. Once you submit the form, we will match you with one of our qualified clinicians who specializes in treating anxiety disorders. Please note that individuals must be residents of Michigan. We are committed to helping you, or your loved one live a quality life and look forward to working with you.