Cognitive behavioural therapy (CBT)
One of the most effective treatments for all types of anxiety is cognitive behavioural therapy. The main aim of the therapy is to teach the patient to recognise patterns of thinking and acting that cause anxiety and change these patterns to reduce anxiety. These skills, once learned, can be self-administered by the patient when necessary, thus a short course of treatment can have long-term effects, can help prevent relapse and is highly cost effective. There are several different forms of this therapy, and the best one may depend upon the patient and the type of anxiety.
Also called exposure therapy, behaviour therapy involves exposing people to the feared situation – either real, virtual (simulated or on computer) or imagined – with the aim of making them face and attempt to overcome their fears, rather than avoid them. Gradual exposure, as used in systematic desensitisation, starts with a mild stimulus (looking at a picture of a dog, for example) and builds up to the most feared stimulus (touching a real dog). “Flooding” involves intensive rather than gradual exposure.
Telephone and web-based counselling
There are several free counselling telephone and online services on offer, the main ones being Lifeline Australia and Kids Help Line, which is for people aged five to 25. Often these services are staffed by volunteers who are professional counsellors, psychologists and social workers. They’re best known for crisis support and are open 24 hours a day, seven days a week, providing a useful service for dealing with unexpected stressors and anxiety-provoking life events.
Pills and potions
Medications can be an effective short-term treatment in themselves, and a useful adjunct to other therapies for anxiety, especially for controlling symptoms in the initial phases of treatment. However, they’re not ideal as a long-term treatment because they don't address the causes of anxiety and may have undesirable side effects.
The most commonly administered medications for anxiety are antidepressants and anxiolytics (anti-anxiety drugs).
The main antidepressants prescribed for anxiety are:
- Selective serotonin re-uptake inhibitors (SSRIs): fluoxetine (for example Prozac), sertraline (Zoloft), paroxetine (Aropax), escitalopram (Lexapro) and fluvoxamine (Luvox).
- Serotonin-norepinephrine re-uptake inhibitors (SNRIs), for example venlafaxine (Efexor). The term noradrenaline is used interchangeably with norepinephrine.
- Noradrenergic and serotonergic specific antidepressants (NaSSAs), for example mirtazapine (Avanza, Remeron).
- Tricyclic antidepressants, for example clomipramine (Anafranil) and imipramine (Tofranil).
SSRIs and SNRIs are the most effective and the preferable first line of treatment if medication is to be considered. Given that many people with anxiety also suffer from depression, they may address both conditions. Side effects include headaches, nausea, sexual dysfunction and drowsiness, though of greater concern is a link between SSRIs and suicidal behaviour, and potential risks should be weighed up against potential benefits.
The main anxiolytic drugs are benzodiazepines, for example oxazepam (Serepax), alprazolam (Xanax), diazepam (Valium) and clonazepam (Klonopin). Anxiolytics can be highly effective for short-term use, but tolerance and addiction are issues associated with long-term use.
Xanax is popular culture’s 21st-century equivalent of Valium, becoming the go-to drug for dealing with life’s curve balls and is one of Australia’s two most abused prescription drugs (OxyContin is the other). But the highly addictive drug has been associated with adverse events, including traffic accidents, aggressive behaviour and withdrawal difficulties, and the Medical Board of Australia and the Royal Australian and New Zealand College of Psychiatrists have recommended its use be limited and definitely not be used as a first line treatment for anxiety.
(for example buspirone, brand name Buspar) are another class of anxiolytic drug that are recommended for generalised anxiety disorder. Like other medications they still have side effects, but they’re non-addictive and therefore more suitable for long-term use than benzodiazepines.
Several herbal medicines are recommended for people with anxiety disorders, with kava, valerian, lavender and St John's wort among the main ones. Of these, kava is the only one to have been found effective in clinical trials. However, it has been linked with liver toxicity and its use is restricted.