The last two decades of the twentieth century saw an explosion of knowledge about different types of problems with anxiety and how to treat them. Seven major types of anxiety disorders were described:
A. Panic Disorder: Sudden episodes of acute, intense anxiety that appear to come out of the blue.
B. Agoraphobia: A fear of panic attacks in situations that are perceived to be far from safety or a safe place such as home, or from which escape might be difficult, such as driving on a freeway or waiting in line at the grocery store. This fear can lead to avoidance of a wide range of situations.
C. Social Phobia: A fear of embarrassment or humiliation in situations where you are exposed to the scrutiny of others or must perform.
D. Specific Phobia: A strong fear and avoidance of one particular object or situation, such as spiders, water, thunderstorms, elevators, or flying.
E. Generalized Anxiety Disorder: A chronic anxiety and worry for at least six months about two or more issues or activities, such as work or health.
F. Obsessive-Compulsive Disorder: Recurring obsessions, repetitive thoughts, and/or compulsions, rituals performed to dispel anxiety, that are severe enough to be time-consuming or cause marked distress.
G. Post-traumatic Stress Disorder: Development of anxiety and other symptoms following an acute and intense trauma such as a natural disaster, assault, rape, or accident or after witnessing an event that involves death or injury to another person.
Researchers and clinicians in both the United States and Britain have developed effective methods for treating these difficulties. Cognitive-behavioral therapy (CBT), the marriage of Aaron Beck's cognitive therapy and Joseph Wolpe's systematic desensitization, became and remains to this day the dominant and most helpful psychological treatment for all of the anxiety disorders.
Research and clinical experience has consistently demonstrated the efficacy of CBT. In its present form, cognitive-behavioral therapy consists of a combination of approximately six strategies, including:
1. Abdominal Breathing Training: Learning to breathe more slowly from your abdomen.
2. Muscle Relaxation Training: Learning to deeply relax all the muscles of your body.
3. Cognitive Therapy: Replacing catastrophic, fearful thoughts with more realistic, constructive thoughts.
4. Interoceptive Exposure: Desensitizing to internal sensations of anxiety.
5. In Vivo Exposure: Gradually facing phobic situations that have been avoided, often with a support person.
6. Exposure and Response Prevention: Refraining from compulsive behaviors when exposed to situations that would ordinarily provoke them.
With the advent of short-acting, high-potency tranquilizers in the 80s and selective serotonin reuptake inhibitor (SSRI) medications in the 90s, psychiatry has also developed effective psychopharmacological treatments for all of the anxiety disorders.
Current clinical practice often combines cognitive-behavioral therapy and medication, especially in the case of panic disorder, social phobia, and obsessive-compulsive disorder. Medications appear particularly helpful when anxiety symptoms are in the moderate to severe range of intensity.
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