Treating Anxiety - A Client's View of What Worked, and What Didn't

We live in what some commentators call "the age of anxiety." One of the great poets, W.H. Auden wrote his last great poem entitled "The Age of Anxiety". It captured the experience of the affect of modernity on humanity beginning with a conversation of barroom strangers.

General Anxiety Disorder is one of the most common mental health issues in the U.S. with 19.1 million (13.3%) of the adult population (ages 18-54) affected by an anxiety disorder. Anxiety problems often go together with symptoms of depression.

Scott Stossel explores the challenges of treating anxiety disorders in an excellent recently released book, My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind  (2014, Alfred A. Knoff books).

Anxiety Disorders Affect 40 Million Americans

He comments that the National Institute of Mental Health reports that 40 million Americans, nearly one in seven, suffer from some form of anxiety in a given year, that the "lifetime incidence" of anxiety disorders is more than 25 per cent which means that one in four of us will experience a serious anxiety problem in our lifetime.

In the book he states that primary care doctors report that anxiety is one of the most common complaints of their patients. This has led to a massive expansion of anti-anxiety prescriptions. In 2001 alone Americans filled 53 million prescriptions for just two anti-anxiety medications: Ativan and Xanax. After 911 Xanax prescriptions jumped 9 per cent nationally and by 22 per cent in New York.

It is my experience that many primary care doctors are often reluctant to refer to mental health professionals for a variety of reasons. It seems doctors often do not understand how to refer to the public or private mental health systems.

Some doctors feel "that they might insult" their patients by referring to mental health professionals, their attitude furthering stigma which is the leading reason why people do not seek mental health treatment. Others just don't stay current on mental Health research and the efficacy of various mental health treatments, therefore believing medication is the best treatment approach for various mental health problems.

However there are primary care doctors who value mental health care and collaborate closely with psychologists and other mental health professionals. Often, because of difficulty acccessing psychiatric care, primary care doctors often by fiat, become prescribers of psychotropic medication.

Problems of Anxiety Are Finally Being Acknowledged

Stossel notes that it was only thirty years ago that anxiety did not exist as a serious mental health issue even though Freud and Kierkegaard had written extensively about the treatment of anxiety. It was only in Rollo May's, The Meaning of Anxiety written in 1950, that anxiety began to be acknowledged as a serious issue in modern psychology.

Stossel writes that today the debates about mind body permeate treatment approaches. In this debate there are professionals who emphasize medication, others that advocate for psychotherapy, and others that believe in a combination of both medication and therapy.

Current Treatment Approaches

In his book he gives an excellent summary of the major current approaches to treat anxiety disorders. These include the psychoanalytic, the behavioral, the cognitive-behavioral, biomedical and the experiential.

The psychoanalytic approach holds that there are unconscious conflicts that need to be brought into consciousness.

The Behaviorists believe we learn to be anxious, therefore we can unlearn how to deal with anxiety. Cognitive Behavioral Therapy, seen as the current best practice for treating anxiety, focuses on changing and restructuring thinking. 

Research on the biomedical approach has exploded over the last sixty years. The biomedical approach is concerned about how brain structures and genetics affect anxiety. This approach often involves the use of medication.

The experiential approach is the current practice of his current therapist, Dr. W., who describes his approach as an existential focus to treat anxiety disorders. This approach is concerned about coping mechanisms produced by the psyche in response to the threats to a person's integrity and self-esteem.

Experiential approach also involves guided relaxation to reduce anxiety symptoms as well as an examination of the existential issues that underlie the anxiety symptoms.

Stossel writes extensively about all the various medical and mental health treatments that he has received throughout the years and how his work with the experiential approach is providing some hope.

Anxiety itself is a simple basic feeling. If it isn't too excessive, it can actually help with vigilance, learning and general performance. In small amounts anxiety can be useful. However, in excess it's counterproductive and upsetting.

Impact of Anxiety in our Lives

Anxiety can reduce attention and performance, increase avoidance of feared situations, and stir up additional emotions, such as anger, shame, guilt and sadness. This is a painful situation that can snowball into other problems, such as panic attacks. 

Anxiety differs from "normal worrying" by overall intensity, and frequency and perceived uncontrollability of the worried thoughts. It can't be explained by substance use (like too much caffeine). 

Stossel describes his experience of anxiety from a very personal perspective. For those dealing with a history of anxiety, this book provides an excellent reference for both dealing with severe anxiety as well as the struggles of finding appropriate treatment.

Stossel's Book Provides Hope

The bottom line is that Scott Stossel provides the reader with hope that the advances in research and care for anxiety disorders will ultimately lead toward more effective medical and mental health treatment for millions of Americans.