Management of Anxiety Disorders – Mild to Severe

Approximately 40 million Americans 18 and older experience an anxiety disorder every year, making it the most common mental illness in the country. However, anxiety disorders come in various severities, from mild to severe. The severity of the condition determines the type of treatment you should receive.

Let’s break down anxiety disorders based on severity and explore the most common and effective treatment options for each.

Anxiety Disorder Symptoms

Anxiety is an umbrella term for various mental health conditions characterized by excessive and persistent fears and worries that interfere with everyday life, preventing those who experience it from focusing on work, studies, and other significant elements of their life.

While symptoms vary according to the severity of the disorder, some of the most common ones include: 

• Excessive worry in routine situations
• A feeling of being constantly ‘on edge’
• Unexplained fatigue
• Difficulty focusing
• Irritability and muscle tension
• Sleep disturbances
• Physical symptoms like headaches and a racing heart
• Avoidance behaviors and panic attacks

Management of Mild Anxiety Disorders

Anxiety is considered “mild” when you can continue your day-to-day life even if you experience symptoms. “Mild” doesn’t mean that the anxiety “isn’t real” or that your symptoms are less valid. It means that your symptoms are relatively manageable with treatment. These are some of the conditions that can fall under the mild forms of anxiety.

Social Anxiety

People with this disorder struggle in social situations, crowds, and when around unfamiliar people, often manifesting as blushing, sweating, nausea, and stuttering. Social anxiety can potentially make your work, school, and personal life quite difficult, especially in customer-facing jobs or academic assignments that require you to address the class.

People with social anxiety can manage and overcome its symptoms with:

• Psychotherapy: Cognitive Behavioral Therapy (CBT) is one of the most effective psychotherapies for social anxiety, helping you recognize and change negative thought patterns, learn coping skills, and gain confidence in social situations. 
• Medications: In some cases, therapists may use medication in addition to providing psychotherapy. Common medications include the antidepressants Serotonin and Norepinephrine Reuptake Inhibitor (SNRI) or Selective Serotonin Reuptake Inhibitors (SSRIs). Medications can take several weeks to become fully effective.

Generalized Anxiety Disorder (GAD)

While occasional anxiety is not an indicator of a mental illness, persistent anxiety and fear are. People with GAD experience anxiety more frequently and intensely than those without and are often aware that their reactions are atypical.

They may frequently experience irritability, sleep disorders, restlessness, trouble concentrating, and physical symptoms like headaches and digestive problems.

Treatment for GAD is similar to that of social anxiety:

• Cognitive Behavioral Therapy: CBT is also effective for GAD. It’s a short-term treatment focused on learning the coping skills that help you face the situations that trigger your anxiety.
• Medication: The most common medications for GAD are the antidepressants SNRIs and SSRIs and the anti-anxiety medication Buspirone. In limited cases, therapists may prescribe benzodiazepines as a short-term solution for acute GAD. However, benzodiazepines can be habit-forming and are risky when mixed with alcohol, so they’re not a long-term solution.

Management of Severe Anxiety Disorders

Severe anxiety involves symptoms of constant worry and chronic feelings of threat or impending dread that go beyond the common emotional responses to stress, deeply affecting your day-to-day life.

While social anxiety and GAD can also be severe in many cases, the following types of anxiety often qualify as severe.

Phobias

A phobia is reacting with disproportionate fear to an object or situation, such as being in the dark, encountering insects, or flying. People with phobias often experience anxiety before confronting the object of their fear, as they worry it will happen even if it isn’t likely to. They may also:

• Go out of their way to avoid what they fear
• Endure the situation with intense fear
• Immediately become tense and fearful when encountering the feared object or situation

Treatment methods for phobias include:

• Psychotherapy: Especially CBT.
• Systematic desensitization: Also known as graded exposure, it involves gradually exposing you to parts of triggers. It helps you learn to cope with specific elements of triggers at increasing intensities.
• Flooding: It’s similar to desensitization, but it involves exposing you to the phobia triggers themselves rather than parts of them. It’s less common and must be administered cautiously by a trained professional (like any other form of therapy).
• Medications: Usually, a combination of antidepressants or anti-anxiety medications

Panic Disorder

Recurrent and unexpected panic attacks characterize panic disorder. Panic attacks involve overwhelming fear, rapid breathing and heartbeat, trembling, sweating, and feelings of impending doom. People with panic disorder often dread the next panic attack and may avoid situations where they may occur.

Treatment options for panic disorder include:

• Cognitive Behavioral Therapy: CBT is the most common psychotherapy for panic disorder. Treatment usually lasts 12 weeks, with one weekly session.
• Other Psychotherapies: If CBT doesn’t work, psychotherapies like panic-focused psychodynamic psychotherapy (PFPP) and panic-focused psychodynamic psychotherapy extended range (PFPP-XR) may help you manage panic disorder.
• Antidepressants: Most commonly, SSRIs and SNRIs.
• Fast-Acting Medications: Benzodiazepines like clonazepam may help manage short-term acute symptoms but can be habit-forming. Alternatives include gabapentin and mirtazapine.
• Other Antidepressants. Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) can be effective but come with side effects that many people don’t tolerate. 

Selective Mutism

Selective mutism stems from feelings of anxiety, often severe social anxiety, and results in becoming completely unable to speak in certain situations or to people outside of your family or close friends. People with this condition may also struggle to communicate in any way, including nodding.

Treatment depends on the patient’s age, how long they have had the condition, and the stress factors that trigger it. The goal is to reduce the anxiety around speaking. 

Treatment options include:

• Cognitive Behavioral Therapy: It helps patients understand their emotional reactions and how to change negative thought patterns into positive or neutral ones.
• Graded Exposure: By identifying the varying degrees of anxiety that specific situations cause, patients can start treatment by facing the least stressful triggers and improving from there.
• Shaping: This technique involves a gradual process toward 2-way communication, beginning with the easiest current form of communication for the patient, such as working up from making eye contact to non-verbal communication.
• Medication: While it is only effective on teenagers and adults, medications that reduce symptoms of anxiety and depression can place the patient in a more relaxed mental state.

Obsessive-Compulsive Disorder (OCD)

OCD causes a person to frequently experience uncontrollable thoughts, called obsessions, and engage in repetitive behaviors that typically occur in response to their obsessions. It is a time-consuming and often draining condition that can significantly impact a person’s life. 

OCD is often treated with Cognitive Behavioral Therapy, medication, or a combination of the two for a more comprehensive approach. 

Medications like antidepressants can balance out the chemicals in people’s brains and allow them to experience less anxiety and think more clearly.

It’s Possible to Manage Anxiety Disorders of All Severities

While anxiety disorders often have debilitating symptoms, with the right resources and support, it’s possible to mitigate their impact.

You can still enjoy life to the fullest and learn ways to prevent anxiety from taking complete control. Though it may take weeks or months to see the results of your treatment, know that you can always make progress.

Reach out to the people you trust and love, speak with your healthcare provider to find the best ways to manage your anxiety, and remember there is always a way forward.