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Anxious personality disorder: what is it and how to get rid of it? Cognitive-behavioral psychotherapy for anxiety disorder Psychotherapy for anxiety disorders.

Back in the 60s of the last century, the founder of cognitive behavioral psychotherapy, in his works on the treatment of depression, noted that the same method also works for excessive anxiety and anxiety disorders. Subsequently, in the 80s, Beck successfully applied his principle in working with clients.

Beck's global approach can still be applied today. Many psychotherapists familiar with Beck's work still do this. However, after A. Beck, significant improvements and clarifications were made to the model of anxiety disorders, and now we have much more a more efficient and fine-tuned approach To psychotherapy for anxiety disorder, which allows you to deal with customer problems in a shorter period of time.

A little history

The works of Clark, Salkovskis, Wells, Butler, Borkovec, Barlow, etc. played a significant role in the development of this approach.

Some time later, at Laval University in Canada and in the works of Adrian Wells, a protocol for psychotherapy of anxiety was created (a protocol is a sequence of psychotherapeutic treatment). This is something I would like to dwell on in more detail in this article.

In an adapted form, this approach can also be applied to any other anxiety disorders, such as social phobia, panic disorder, post-traumatic stress disorder, obsessive thoughts and actions, and simple phobias. It can also be used during psychotherapy of ordinary cases, without any disorders, but accompanied by a feeling of anxiety.

Main stages of psychotherapy for anxiety

So, cognitive psychologists have found that people with excessive anxiety and anxiety disorders have the following characteristics: peculiarities:

  • Negative problem orientation
  • Cognitive avoidance

Just a few words in more detail about these characteristics below, but for now I will say that psychotherapy according to the Laval-based protocol should address all these characteristics in turn.

Intolerance of uncertainty

I already wrote in more detail about this feature of all anxious people in the article “What if I’m an exception to the rule.”

Anxious people cannot tolerate uncertainty of any kind. They, like allergy sufferers, are overly sensitive and overly vigilant to uncertainty, and react to even the slightest hint of uncertainty. " D“Well,” they think, “the chances are 99.5% that nothing will happen, but what if! It's not 100% accurate." And their anxiety continues.

Also, anxious people react with excessive anxiety to small events in life - that is, the strength of the feeling of anxiety does not correlate with the “scale of the disaster.”

In order to cope with intolerance of uncertainty, people use the following strategy: they try to think through and project in advance all the possible consequences of an unpleasant situation. They are trying to “calculate” and take into account All possible negative outcomes. Since life is multidimensional events, everything can change every minute, such an idea - trying to take into account all the outcomes - is obviously doomed to failure. The result is anxiety.

This strategy is accompanied thoughts like " what if?» , because it seems to the client that this supposedly clarifies the situation for him and reduces the amount of uncertainty. However, everything happens exactly the opposite - thinking about “what if?” only increase the number of possible outcomes, and therefore increase uncertainty. The result is anxiety.

So on In the first stage of CBT for anxiety disorders, it is necessary to work out intolerance of uncertainty at the client's. Type tests or similar ones can be used to help the therapist. Processing is carried out by passing a test, discussing the test results, using Socratic dialogue and other standard methods of work in CBT.

Positive Beliefs About Anxiety

Strange as it may sound, all anxious people are convinced that their anxiety is somehow useful, necessary or beneficial to them, that anxiety has some positive function. At the same time, many are not even aware of this, and if you ask them directly “ How can your anxiety benefit you?“, they will not find anything to answer, or will even convince you that anxiety is completely unprofitable, unnecessary and even dangerous to your health. However, there is one point. No one in their right mind will ever do something, being sure of the uselessness, harm, and lack of benefit from what they are doing. No matter what anyone does, there will always be an explanation." I did it with the best intentions, I wanted the best“- and this is really so!

So again, all clients with anxiety disorders have positive beliefs about their anxiety. She supposedly helps someone increase motivation. It seems to someone else that by worrying today, you getting ready for trouble tomorrow and you'll freak out less. Someone else will say that worry helps you find best solution and allows don't look careless and with a devil-may-care attitude. This all needs to be worked out through Socratic dialogue, because such beliefs are irrational and do not help improve the quality of life. The task at this stage is to turn hidden and unconditional irrational beliefs into explicit, conditional and rational ones :)

If it is not obvious to the client what specific benefit they find in their anxiety, a test like Why Worry can be used, in which the client's responses can be sorted by type of benefit.

Negative attitude towards problems

All anxious people have a peculiar attitude towards problems that arise: problems seem to them hypertrophied, similar to a disaster and with a very high probability. Almost with a guarantee that the worst outcome will definitely happen.

In addition, people with anxiety disorders tend to worry about hypothetical rather than real problems. They are concerned about problems that can happen, and not those that may exist now. As a result, people spend much more energy on the future than on the present. If your anxiety disorder is severe, it may even feel like you are constantly “living” in the future tense.

The problems also seem unsolvable. They arise due to the fault of the person himself, “fall on his head” due to “unhappiness”, there are too many of them compared to other people, the problems look unfair and frightening. A key aspect of this negative attitude towards problems is the client's belief that he is unable to cope with problems: can’t, can’t, too weak, not smart enough, not quite healthy, etc.

These clients have poor judgment of their problem-solving abilities. On the other hand, they have a strong sense of personal responsibility for everything that happens, therefore, it is no wonder that, having found themselves in such a “vice” - on the one hand, the inability to solve problems, and on the other, a strong sense of responsibility - clients begin to experience severe discomfort and tension, and , as a result, even greater anxiety.

Accordingly, all these beliefs need to be “pulled out”, made explicit and discussed using Socratic dialogue or other techniques. When it comes to problem solving skills, the components of this skill need to be taught to the client:

  • Problem Definition
  • Formulation of goals for its solution
  • Development of alternative solutions
  • Selecting and applying solutions
  • Evaluating the effectiveness of the applied solution

With generalized anxiety disorder, a negative focus on problems can simply interrupt the process of solving them, preventing the person from even starting to do something.

In the process of learning problem-solving skills, you need to pay attention to the client’s characteristic ways of making decisions: either they make decisions too quickly, at random, as if trying to quickly throw the problem off one’s shoulders, while not paying attention to various circumstances. Often such decisions turn out to be reckless. Either they take too long to make decisions(if they accept at all): they study the situation from all possible sides, think about the circumstances, consult with a huge number of people - and, in the end, cannot make any decision.

Once the preferred method has been established, the client must be taught to do the opposite: those who make decisions quickly need to learn to do it more slowly, and those who tend to procrastinate for a long time in making a decision need to learn to make decisions quickly, “like jumping into water.” .

The most important thing: do not dive in particular


The most important aspect of psychotherapy for anxiety disorders is this: try not to consider content client's anxiety. Because in this case there is a danger of “choking” in a stream of various anxieties, each of which seems unsolvable. Each new day will bring a new stream of anxiety. As soon as you seem to successfully discuss a set of anxious thoughts about his health with a client, the next time the client presents a new set of concerns about finances or relationships.

The object for discussion, consideration and, ultimately, psychotherapy is the process of thinking and responding, and not its content. This needs to be discussed with the client at the very beginning so that there is no misunderstanding. Any “leakage” into the content during a session must be stopped gently but persistently and the client’s attention must be drawn to the process that is happening in his head at that moment. This “top-down” view of anxiety disorder can significantly alleviate the client’s condition from the first meetings.

Cognitive avoidance

This term refers to the tendency of clients with excessive anxiety to use different things to get rid of anxiety quickly. Most often, they use the following:

  • Switching from images to words (because words are less fearful than images)
  • Suppressing disturbing thoughts
  • Replacing anxious thoughts with neutral or positive ones
  • Using Distraction to Interrupt Anxiety
  • Avoiding situations that may trigger anxious thoughts

Since as a result of using these techniques it is still possible to temporarily reduce anxiety, it turns out that the use is, as it were, positively reinforced. Next time the client will remember that he has already “successfully” dealt with his anxiety, for example, by switching to something else. However, in the long term, these techniques only cause deterioration of condition, because they do not reduce the frequency of anxiety or its severity. Only on the contrary, since the client never got the opportunity to check how his anxiety will end, next time he will only get worse.

Consequences of excessive anxiety

Demoralization and powerlessness, depression, loss of interest in life, loss of pleasure in life - these are typical feelings in generalized anxiety disorder. Therefore, it is necessary to undergo treatment! The sooner you start, the faster and easier everything will turn out. Good luck!

Anxious states are familiar to almost everyone; this is a very unpleasant and vague feeling when a person’s thoughts are busy anticipating an unfavorable situation, he suffers from a lot of forebodings, anxiety and tension. Compared with ordinary fear, anxiety disorders are pointless, and with ordinary fear the presence of an object of fear is assumed, that is, a certain situation, action, or person. Anxiety is a person’s condition in which he has a tendency to worry, and in such cases, psychotherapy for anxiety disorders is used.

Basically, anxiety is caused by a person’s expectation of some social consequences, and this can be either a failure or a positive result. Both anxiety and anxiety always have a close connection with stressful conditions. A person’s individual sensitivity to stress is determined by the initial level of anxiety. Like a stressful state, the feeling of anxiety cannot be considered unequivocally bad or good. There are many situations where anxiety is natural, so it is adequate and even useful to a certain extent.

There are many situations in life when a feeling of anxiety arises even in the most strong-willed and restrained people. Moreover, if an unusual event is coming, everyone strives to properly prepare for it. Some people experience anxiety before speaking from the podium, others begin to worry when they find themselves on a dark street at a late time, and so on.

In this case, anxiety is regarded as an advantage, since it helps to better prepare for the exam, think through the upcoming route, and forces you to devote more time to preparing your speech. As for chronic anxiety, it is constantly present, and not only during stress, but for no reason at all.

If a person often experiences severe anxiety, it is likely that he suffers from one of the types of anxiety disorders. Generalized anxiety disorder is often diagnosed, which is characterized by inexplicable tension and anxiety, the occurrence of phobias, which are accompanied by an irrational destructive fear of objects, situations, and people. There may also be obsessive-compulsive disorder, and in this case, obsessive actions and thoughts create a significant problem for the person.

Psychotherapy for acute anxiety disorders is especially necessary, since in this case people experience psychological and physical ailments. There are signs that are typical of an anxiety disorder.

So, first of all, sweating, rapid pulse, trembling limbs, and breathing problems occur. Many patients complain of a “lump in the throat” and difficulty swallowing. There is discomfort and even pain in the chest area, nausea appears, dizziness, and it is difficult for a person to maintain balance.

Some note that objects in the environment seem unreal, there is a fear of going crazy, losing control over one’s actions, or dying. A person suffering from an anxiety disorder becomes alternately cold and hot, tension in the muscles, and a tingling sensation appear. The ability to relax is lost, such a patient is always irritated and loses his temper over trifles. There are difficulties falling asleep, it is difficult to concentrate.

Treatment

The question often arises as to whether an anxiety disorder requires treatment. According to modern medicine, a person must decide for himself whether he wants to continue to endure an unpleasant condition, then he is considered practically healthy, and psychotherapy for anxiety disorders is not necessary.

If you want to eliminate pathological anxiety and improve your quality of life, you will need the help of a professional. You can get rid of anxiety disorders by using psychotherapeutic techniques, as well as combining them with medications.

Practice shows that the use of behavioral therapy provides the most effective treatment. The technique consists in creating frightening situations that cause obsessions, and taking measures to get rid of unwanted reactions.

For anxiety disorders, excellent results are achieved with a combination of cognitive and behavioral therapy. In this way, it is possible not only to influence unwanted behavior, but also to change beliefs and thoughts that reinforce the symptoms of an anxiety disorder.

Features of treatment

If generalized anxiety disorder occurs, the person experiences persistent and exaggerated anxiety that has no basis in reality, which can relate to several situations. In such cases, the anxiety is not fixed, that is, there are no restrictions in the form of specific circumstances.

Most often, in such situations, a person experiences multiple fears of an uncertain nature, and at the same time he is constantly in motor tension, becomes excessively fussy, and autonomic disorders are noted.

Psychotherapy for anxiety disorders is carried out within the framework of rational cognitive behavioral therapy. During the treatment process, the psychological causes of anxiety are analyzed, and with the help of a psychotherapist, the patient consistently comes into contact with avoidable situations.

Anxiety disorder is a specific psychopathic condition characterized by specific symptoms. Every subject experiences anxiety periodically, due to various situations, problems, dangerous or difficult working conditions, etc. The occurrence of anxiety can be considered a kind of signal that informs an individual about changes occurring in his body, body or in the external environment. It follows that the feeling of anxiety acts as an adaptive factor, provided that it is not overly expressed.

Among the most common anxiety states today are generalized and adaptive. Generalized disorder is characterized by severe persistent anxiety, which is aimed at various life situations. Adaptive disorder is characterized by pronounced anxiety or other emotional manifestations that arise in combination with difficulties in adapting to a specific stressful event.

Causes of Anxiety Disorder

The reasons for the formation of alarming pathologies are not fully understood today. Mental and somatic conditions are important for the development of anxiety disorders. In some subjects, these conditions may appear without clear triggers. Feelings of anxiety can be a response to external stressful stimuli. Also, certain somatic diseases are themselves a cause of anxiety. Such diseases include heart failure, bronchial asthma, hyperthyroidism, etc. For example, organic anxiety disorder can be observed as a result of cardiocerebral and cardiac disorders, hypoglycemia, vascular pathology of the brain, endocrine disorders, and traumatic brain injuries.

Physical causes may include taking medications or drugs. Cancellation of sedatives, alcohol, and some psychoactive drugs may cause anxiety.

Today, scientists highlight psychological theories and biological concepts that explain the causes of anxiety disorders.

From the point of view of psychoanalytic theory, anxiety is a signal of the formation of an unacceptable, forbidden need, or a message of an aggressive or intimate nature, which motivates the individual to unconsciously prevent their expression.

Symptoms of anxiety in such cases are considered as incomplete containment or repression of an unacceptable need.

Behavioral concepts consider anxiety, and in particular, various phobias initially arise as a conditioned reflex response to frightening or painful stimuli. Subsequently, alarming reactions may occur without a message. Cognitive psychology, which emerged more recently, focuses on distorted and incorrect mental images that precede the development of anxiety symptoms.

From the perspective of biological concepts, anxiety disorders are the result of biological abnormalities, with a sharp increase in the production of neurotransmitters.

Many individuals who experience anxiety-panic disorder also have extreme sensitivity to small increases in carbon dioxide concentrations in the air. In accordance with domestic taxonomy, anxiety disorders are classified as a group of functional disorders, in other words, psychogenically determined disease states that are characterized by awareness of the disease and the absence of transformations in personal self-awareness.

Anxious personality disorder can also develop due to hereditary characteristics of the subject's temperament. Often these conditions of different types are related to behavior of a hereditary nature and include the following traits: fearfulness, isolation, shyness, unsociability if found in an unknown situation.

Symptoms of Anxiety Disorder

Signs and symptoms of this condition can vary significantly depending on the individual characteristics of the subject. Some suffer from severe anxiety attacks that come on suddenly, while others suffer from intrusive anxious thoughts that arise, such as after a news report. Some individuals may struggle with various obsessive fears or uncontrollable thoughts, while others live in constant tension that does not bother them at all. However, despite the various manifestations, all of this together will constitute an anxiety disorder. The main symptom is considered to be a constant presence or anxiety in situations in which most people feel safe.

All symptoms of a pathological condition can be divided into manifestations of an emotional and physical nature.

Manifestations of an emotional nature, in addition to irrational, immense fear and anxiety, also include a feeling of danger, impaired concentration, assumption of the worst, emotional tension, increased irritability, and a feeling of emptiness.

Anxiety is more than just a feeling. It can be considered as a factor in the readiness of the individual’s physical body to flee or fight. It contains a wide range of physical symptoms. Due to the variety of physical symptoms, subjects suffering from anxiety disorders often mistake their symptoms for a physical illness.

Symptoms of a physical anxiety disorder include rapid heartbeat, dyspepsia, intense sweating, increased urination, dizziness, shortness of breath, tremors of the limbs, muscle tension, fatigue, chronic fatigue, headaches, and sleep disturbances.

A relationship has also been noted between anxious personality disorder and. Since many individuals suffering from anxiety disorders have a history of depression. Depressive states and anxiety are closely interconnected by psycho-emotional vulnerability. That is why they often accompany each other. Depression can make anxiety worse and vice versa.

Anxious personality disorders are of generalized, organic, depressive, panic, mixed types, as a result of which the symptoms may differ. For example, organic anxiety disorder is characterized by clinical manifestations that are qualitatively identical to the symptoms of anxiety-phobic disorder, but to diagnose organic anxiety syndrome, the presence of an etiological factor that causes anxiety as a secondary manifestation is necessary.

Generalized anxiety disorder

A mental disorder characterized by general constant anxiety not related to specific events, objects or situations is called generalized anxiety personality disorder.

Persons suffering from disorders of this type are characterized by anxiety, which is characterized by stability (duration of at least 6 months), generalization (i.e. anxiety manifests itself in pronounced tension, restlessness, a sense of future troubles in everyday events, the presence of various fears and forebodings) , not fixed (i.e. anxiety is not limited to any specific events or conditions).

Today, there are three groups of symptoms of this type of disorder: anxiety and apprehension, motor tension and hyperactivity. Fears and worries tend to be quite difficult to control and last longer than in people who do not have generalized anxiety disorder. Anxiety does not focus on specific problems, such as the likelihood of having a panic attack, getting into a difficult situation, etc. Motor tension can be expressed in muscle tension, headaches, tremors of the limbs, and inability to relax. Hyperactivity of the nervous system is expressed in increased sweating, accelerated heartbeat, a feeling of dry mouth and discomfort in the epigastric region, and dizziness.

Typical symptoms of generalized anxiety disorder include irritability and sensitivity to noise. Other motor symptoms include aching muscle pain and muscle stiffness, especially in the shoulder region. In turn, vegetative symptoms can be grouped according to functional systems: gastrointestinal (feeling of dry mouth, difficulty swallowing, discomfort in the epigastric region, increased gas production), respiratory (difficulty in inhaling, feeling of constriction in the chest area), cardiovascular (discomfort in the cardiac region , rapid heartbeat, pulsation of cervical vessels), urogenital (frequent urination, in men - loss of erection, decreased libido, in women - menstrual irregularities), nervous system (staggering, feeling of blurred vision, dizziness and paresthesia).

Anxiety is also characterized by sleep disturbances. People with this disorder may have difficulty falling asleep and may feel restless when waking up. In such patients, sleep is characterized by intermittency and the presence of unpleasant dreams. Patients with generalized anxiety disorder often have nightmares. They often wake up feeling tired.

An individual with this disorder often has a peculiar appearance. His face and posture look tense, his eyebrows are frowned, he is restless, and there is often trembling in his body. The skin of such a patient is pale. Patients are prone to tearfulness, which reflects depressed mood. Other symptoms of this disorder include fatigue, depressive and obsessive symptoms, and depersonalization. The listed symptoms are secondary. In cases where these symptoms are leading, a diagnosis of generalized anxiety personality disorder cannot be made. In some patients, intermittent hyperventilation was noted.

Anxiety-depressive disorder

A modern disease can be called anxiety-depressive disorder, which significantly reduces the quality of life of an individual.

Anxiety-depressive disorder should be classified as a group of neurotic disorders (neuroses). Neuroses are psychogenically determined conditions characterized by a significant variety of symptomatic manifestations, the absence of transformations of personal self-awareness and awareness of the disease.

Over the course of a lifetime, the risk of developing anxiety and depression is about 20%. At the same time, only one third of sick people turn to specialists.

The main symptom that determines the presence of an anxiety-depressive disorder is a persistent feeling of vague anxiety, the objective reasons for which do not exist. Anxiety can be called a constant feeling of impending danger, a catastrophe, an accident threatening loved ones or the individual himself. It is important to understand that with anxiety-depressive syndrome, the individual experiences fear not of a specific threat that actually exists. He only feels a vague sense of danger. This disease is dangerous because a constant feeling of anxiety stimulates the production of adrenaline, which helps to intensify the emotional state.

Symptoms of this disorder are divided into clinical manifestations and autonomic symptoms. Clinical manifestations include a persistent decrease in mood, increased anxiety, a constant feeling of anxiety, sharp fluctuations in the emotional state, persistent sleep disorder, obsessive fears of various types, asthenia, weakness, constant tension, anxiety, fatigue; decreased concentration, performance, speed of thinking, and learning new material.

Autonomic symptoms include rapid or intense heartbeat, tremors, a feeling of suffocation, increased sweating, hot flashes, wet palms, pain in the solar plexus, chills, bowel disorders, frequent urination, abdominal pain, and muscle tension.

Many people experience similar discomfort in stressful situations, but to diagnose anxiety-depressive syndrome, the patient must have several symptoms in aggregate, which are observed over several weeks or months.

There are risk groups that are more likely to experience anxiety disorders. For example, women are much more likely than the male half of the population to suffer from anxiety and depressive disorders. Since the fair half of humanity is characterized by more pronounced emotionality compared to men. Therefore, women need to learn to relax and relieve accumulated tension. Among the factors contributing to the occurrence of neuroses in women are hormonal changes in the body in connection with the phases of the menstrual cycle, pregnancy or the postpartum state, and menopause.

People who do not have a permanent job are much more likely to develop anxiety and depression than working individuals. A feeling of financial insolvency, a constant search for a job and repeated failures at interviews lead to a feeling of hopelessness. Drugs and alcohol are also factors contributing to the development of anxiety and depression. Alcohol or drug addiction destroys an individual’s personality and leads to mental disorders. Constantly accompanying depression forces you to seek happiness and satisfaction in a new portion of alcohol or a dose of a drug, which will only worsen the depression. Unfavorable heredity is often a risk factor for the development of anxiety and depressive disorders.

Anxiety disorders are more common in children whose parents suffer from mental disorders than in children with healthy parents.

Old age can also be a prerequisite for the occurrence of neurotic disorders. Individuals at this age lose social significance, their children have already grown up and ceased to depend on them, many friends have died, they experience deprivation in communication.

A low level of education leads to anxiety disorders.

Severe somatic diseases form the most severe group of patients with anxiety and depressive disorders. After all, many people often suffer from incurable diseases, which can cause severe pain and discomfort.

Anxiety-phobic disorders

A group of disorders that arise as a result of a combination of psychological factors and external causes are called anxiety-phobic disorders. They arise as a result of exposure to psychotraumatic stimuli, family troubles, loss of loved ones, disappointments, work-related problems, impending punishment for a previous offense, danger to life and health. The irritant can have a single, super-strong impact (acute mental trauma), or multiple weak effects (chronic mental trauma). Traumatic brain injuries, various types of infections, intoxication, diseases of internal organs and diseases of the endocrine glands, prolonged lack of sleep, constant overwork, disturbances in diet, prolonged emotional stress are the factors that contribute to the occurrence of diseases of a psychogenic nature.

The main manifestations of phobic neurotic disorders include panic attacks and phobias of a hypochondriacal nature.

They can be expressed in the form of an all-consuming feeling of fear and a feeling of approaching death. They are accompanied by vegetative symptoms, such as rapid heartbeat, a feeling of shortness of breath, sweating, nausea, and dizziness. Panic attacks can last from a couple of minutes to an hour. Often, during such attacks, patients are afraid of losing control over their behavior or are afraid of going crazy. Basically, panic attacks appear spontaneously, but at times their occurrence can be triggered by sudden changes in weather conditions, stress, lack of sleep, physical overexertion, excessive sexual activity, and abuse of alcoholic beverages. Also, some somatic diseases can trigger the first panic attacks. Such diseases include: gastritis, osteochondrosis, pancreatitis, some diseases of the cardiovascular system, diseases of the thyroid gland.

Psychotherapy for anxious personality disorders is aimed at eliminating anxiety and correcting inappropriate behavior. Also during therapy, patients are taught the basics of relaxation. Individual or group psychotherapy may be used to treat individuals suffering from anxiety disorders. If the history of the disease is dominated by phobias, then patients need psycho-emotional support therapy to improve the psychological state of such patients. Behavioral psychotherapy and the use of hypnosis can eliminate phobias. Rational psychotherapy can also be used in the treatment of obsessive fears, in which the essence of their disease is explained to the patient and an adequate understanding of the symptoms of the disease is developed by the patient.

Mixed anxiety-depressive disorder

In accordance with the international classification of diseases, anxiety conditions are divided into anxiety-phobic disorders and other anxiety disorders, which include mixed anxiety-depressive disorder, generalized and panic disorder, obsessive-compulsive disorders and reactions to severe stress, adaptation disorders, including yourself with post-traumatic stress disorder.

A diagnosis of mixed anxiety-depressive syndrome is possible in cases where the patient exhibits symptoms of anxiety and depression to approximately the same degree of severity. In other words, along with anxiety and its vegetative symptoms, there is also a decrease in mood, loss of previous interests, decreased mental activity, motor retardation, and loss of self-confidence. However, the patient’s condition cannot be directly associated with any traumatic events or stressful situations.

The criteria for mixed anxiety-depressive syndrome include temporary or persistent dysphoric mood, which is observed with 4 or more symptoms for at least a month. Such symptoms include: difficulty concentrating or slow thinking, sleep disturbances, fatigue or fatigue, tearfulness, irritability, anxiety, hopelessness, increased vigilance, low self-esteem or feelings of worthlessness. Also, the listed symptoms must cause disturbances in the professional sphere, social or other important area of ​​the subject’s life, or provoke clinically significant distress. All of the above symptoms are not caused by taking any medications.

Treatment of Anxiety Disorders

Psychotherapy for anxiety disorders and drug treatment with drugs that have anti-anxiety effects are the main methods of treatment. The use of cognitive behavioral therapy in the treatment of anxiety allows one to identify and overcome negative thought patterns and illogical beliefs that fuel anxiety. To treat increased anxiety, five to twenty daily sessions are usually used.

Desensitization and confrontation are also used for therapy. During treatment, the patient confronts his own fears in a non-threatening environment that is controlled by the therapist. Through repeated immersion, either imaginary or real, in the fear-provoking situation, the patient gains a greater sense of control. Directly facing your fear allows you to gradually reduce your anxiety.

Hypnosis is a reliable and rapid mechanism used in the treatment of anxiety disorders. When the individual is in deep physical and mental relaxation, the therapist uses various therapeutic techniques to help the patient face and overcome their fears.

An additional procedure in the treatment of this pathology is physical rehabilitation, which is based on exercises taken from yoga. Studies have shown the effectiveness of reducing anxiety after performing a thirty-minute special set of exercises three to five times a week.

Various medications are used in the treatment of anxiety disorders, including antidepressants, beta blockers and tranquilizers. Any drug treatment shows its effectiveness only in combination with psychotherapy sessions.

Beta blockers are used to relieve vegetative symptoms. Tranquilizers reduce the severity of anxiety and fear, help relieve muscle tension, and normalize sleep. The disadvantage of tranquilizers is their ability to cause addiction, due to which the patient becomes dependent; the consequence of such dependence will be withdrawal syndrome. That is why they should be prescribed only for serious indications and for a short course.

Antidepressants are medications that normalize pathologically altered depressive mood and help reduce somatovegetative, cognitive, and motor manifestations caused by depression. Along with this, many antidepressants also have an anti-anxiety effect.

Anxiety disorders in children are also treated with cognitive behavioral therapy, medications, or a combination of both. There is a widespread belief among psychiatrists that behavioral therapy has the greatest effect in treating children. Her methods are based on modeling frightening situations that cause obsessive thoughts and taking a set of measures that prevent unwanted reactions. The use of medications has a shorter and less positive effect.

Most anxiety disorders do not require medication. Usually, a conversation with a therapist and his persuasion is enough for an individual with an anxiety disorder. The conversation should not be lengthy. The patient should feel that he has the therapist’s full attention, that he is understood and sympathized with. The therapist needs to provide the patient with a clear explanation of any physical symptoms that are related to anxiety. It is necessary to help the individual overcome or come to terms with any social problem related to the disease. Thus, uncertainty can only increase anxiety, and a clear treatment plan helps reduce it.

If you suffer from panic attacks, intrusive thoughts, persistent worries, or crippling phobias, you may have an anxiety disorder. But there is no need to live with anxiety and fear. Treatment will help, and for many anxiety problems, psychotherapy is a good place to start. Certain types of psychotherapy, such as cognitive behavioral therapy or exposure therapy, are particularly helpful. These types of psychotherapy will teach you how to control your anxiety levels, stop worrying thoughts, and conquer your fears.

Treatment of anxiety disorders in psychotherapy

When it comes time to treat anxiety disorders, research suggests that psychotherapy is the most effective option. This is because psychotherapy for anxiety—as opposed to drug treatment for anxiety—treats more than a symptom of the problem. Psychotherapy can help you uncover the underlying causes of your worries and fears, teach you how to relax, allow you to look at situations from a new, less frightening perspective, and provide the opportunity to develop better coping and problem-solving skills. Psychotherapy gives you a tool to overcome anxiety and teaches you how to use it.

Anxiety disorders are diverse and different from each other, so psychotherapy must take into account the characteristics of symptoms and worries. If you have obsessive-compulsive disorder (that is, a disorder of obsessive thoughts and actions), its treatment will be different from that of an anxiety disorder. The duration of psychotherapy also depends on the type and severity of the anxiety disorder. However, many types of psychotherapy for anxiety are relatively short-term. According to the American Psychological Association, many people feel significant improvement after just 8-10 sessions of psychotherapy.

Many different types of psychotherapy are used to treat anxiety disorder, but the leading approaches are cognitive behavioral psychotherapy and exposure psychotherapy. Each type of psychotherapy can be used separately or combined with other types of psychotherapy. Psychotherapy for anxiety can be carried out individually or in group psychotherapy, when you are surrounded by people with a similar problem.

Cognitive behavioral psychotherapy for anxiety

Cognitive behavioral psychotherapy (CBT) is the most widely used type of psychotherapy for anxiety disorders. Research suggests it is most effective for treating panic disorders, phobias, social anxiety disorder, and generalized anxiety disorder, among other variants of the disorder.

Cognitive behavioral therapy addresses the negative patterns and distortions through which we view the world and ourselves. As the name implies, it involves two main components:

  • Cognitive psychotherapy examines how negative thoughts—or cognitions—impact anxiety.
  • Behavioral therapy looks at how your behavior and your reactions to situations trigger anxiety.

The basic assumption of cognitive behavioral therapy is that our thoughts—not external events—influence how we feel. In other words, it is not the situation that determines our feelings, but how we perceive it. For example, imagine you are invited to a big party. Consider three different ways to perceive the invitation and how your thoughts would affect your emotions.

Situation: A friend invites you to a big party

Thought #1: Party - sounds like it's going to be a lot of fun. I love going out and meeting new people!
Emotions: Happiness, excitement

Thought #2: Parties are not my thing. I'd rather stay home and watch a movie.
Emotions: neutral.

Thought #3: I never know what to say or what to do at parties. I'll make a fool of myself if I go.
Emotions: anxiety, sadness.

As you can see, the same event can lead to completely different emotions in different people. It all depends on our personal expectations, attitude and beliefs. For people with anxiety disorders, negative ways of thinking fuel negative emotions of anxiety and fear. The goal of cognitive behavioral therapy for anxiety is to identify and correct these negative thoughts and beliefs. The idea is that if you change the way you think, the way you feel will change.

Challenging Anxious Thoughts in Cognitive Behavioral Therapy

Challenging anxious thoughts—called cognitive restructuring in cognitive therapy parlance—is a process in which you challenge the way you think that causes anxiety, replacing it with more positive, realistic thinking. This involves three steps:

  • Identifying Negative Thoughts. With anxiety disorders, situations are perceived as more dangerous than they actually are. For a person with a germ phobia, for example, shaking another person's hand seems like a threat to life. Although it is easy for you to see that this is an irrational fear that defines your own irrationality, frightening thoughts are difficult to bear. One strategy is to ask yourself what you were thinking when you first started feeling anxious. Your therapist will help you with this step.
  • Challenge Negative Thinking. In the second step, your therapist will teach you how to evaluate your anxiety-provoking thoughts. This means questioning the basis of your threatening thoughts, examining unhelpful beliefs, and testing the reality of negative predictions. Strategies for challenging negative thinking include experimenting, weighing the pros and cons of worrying or avoiding the underlying fear, and determining the realistic likelihood that what you're worried about will actually happen.
  • Replacing negative thoughts with realistic ones. Once you have identified the irrational projections and negative distortions in your anxious thoughts, you have the opportunity to replace them with new thoughts that are more accurate and more positive. Your therapist will also help you come up with realistic and calming thoughts that you can say to yourself when you anticipate or encounter situations that tend to increase your anxiety levels.

To understand how thought challenge works in cognitive behavioral therapy, consider the following example. Maria doesn't want to use the metro because she's afraid she'll lose consciousness and then everyone will think she's crazy. The therapist asks her to write down negative thoughts, identify errors—or cognitive distortions—in her thinking, and ultimately arrive at more rational interpretations. The result is described below.

Challenging Negative Thoughts

Negative thought #1: What if I pass out on the subway?
Cognitive distortion: Expecting the worst.
More realistic thought: I've never lost consciousness before, so it's unlikely that this will happen on the subway.

Negative thought #2: If I lose consciousness, it will be terrible!
Cognitive distortion: The acuity of thought is disproportionate to the event.
More realistic thought: If I feel weak, it will go away in a few minutes. It's not that terrible.

Negative thought #3: People will think I'm crazy.
Cognitive distortion: Jump to conclusions.
More realistic thought: People are more likely to worry about whether I'm okay.

Replacing negative thoughts with more realistic ones is easier said than done. Often negative thoughts are part of a thinking pattern that has been maintained throughout life. It will take practice to break the habit. This is why cognitive behavioral therapy includes practical tasks to do at home.

Cognitive behavioral therapy may also include:

  • Learning how to recognize when you are anxious and what bodily sensations you are experiencing.
  • Teaching stress management skills and relaxation techniques to combat anxiety and panic.
  • Confronting fears (either in imagination or in real life).

Exposure psychotherapy for anxiety

Anxiety is not a pleasant feeling, so it's natural to avoid it if possible. One way people do this is by taking control of the situation that is causing the anxiety. If you're afraid of heights, you may want to drive an extra three hours to avoid crossing the bridge. Or if a looming public appearance is making your stomach ache and your knees shake, you might skip your best friend's wedding to avoid the toast. Leaving aside the issue of discomfort, the problem with avoiding fears is that you never give yourself a chance to overcome them. In fact, avoiding situations or objects that frighten you only makes them stronger. Exposure psychotherapy puts you directly in front of the situation or object you fear. The idea is that by repeating this procedure, you will begin to feel more in control of the situation and your anxiety will disappear. Presenting yourself with a problem can be done in two ways. Your therapist may ask you to imagine a scary situation, or you may confront it in real life. Exposure psychotherapy can be used separately or carried out as a component of cognitive behavioral psychotherapy.

Systematic desensitization

Exposure psychotherapy typically begins and works with situations that are only moderately threatening, rather than confronting the most intense fears, which can lead to traumatization. This step-by-step approach is called systematic desensitization. Systematic desensitization allows you to gradually challenge your fears, build confidence, and master panic control skills.

Systematic desensitization includes three parts:

  • Relaxation skills training. First, your therapist will teach you relaxation techniques, such as progressive muscle relaxation or deep breathing. You will practice them in psychotherapy sessions and at home. Once you begin to manage your fears effectively, you will begin to use these techniques to reduce your physical reactions to anxiety (such as tremors and hyperventilation) and increase relaxation.
  • Write step-by-step instructions. Then, you will develop a list of 10-20 scary situations that move you towards your final goal. For example, if your ultimate goal is to overcome your fear of flying, you might start by looking at photographs of airliners and end up taking a flight. Each step should be as specific as possible and have a clear, measurable outcome.
  • Working through the steps of the list. With the guidance of a therapist, you will then begin to work through the list. The goal is to stay in each fearful situation until the fear goes away. This means that you will have experience, that the feelings will not harm you, and that they will pass. Once you relax again, you can bring your attention back to the situation. In this way, you will work through each step until you are able to complete each step without experiencing distress.

Adjunct to psychotherapy for anxiety disorders

As you become more familiar with anxiety disorder through psychotherapy, you may want to experiment with therapy designed to reduce any stressful experiences and help you achieve emotional balance.

  • Exercise. Exercising is a natural way to break stress and relieve anxiety. Research shows that even a small amount of exercise time—as little as 30 minutes, 5 times a week—will provide significant reductions in anxiety. For maximum benefits, aim for at least an hour of aerobic exercise almost every day.
  • Relaxation techniques. If practiced regularly, relaxation techniques such as mindfulness meditation, progressive muscle relaxation, controlled breathing and visualization will reduce anxiety and increase feelings of relaxation and emotional well-being.
  • Biofeedback. Use sensors that measure specific physiological processes - such as heart rate, respiration, muscle tension. This biofeedback will allow you to recognize your body's anxiety response and teach you how to control it using relaxation techniques.
  • Hypnosis. Hypnosis is sometimes used in combination with cognitive behavioral therapy to treat anxiety. When you are in a deep state of relaxation, the hypnotherapist uses a variety of therapeutic techniques to help you face your fears and see them in a new way.

How to make psychotherapy for anxiety more effective

There is no quick fix for anxiety. Overcoming an anxiety disorder will take time and commitment. Therapy involves facing your fears rather than avoiding them, so sometimes you will feel worse, but then you will feel better. The important point is to strictly adhere to treatment and follow the advice of the psychotherapist. If you are disappointed with the speed of recovery, remember that anxiety therapy is very effective in the long term. You will reap a rich harvest if you go through this process.

You can also enhance the effects of your own anxiety therapy by making positive decisions. Everything from your physical activity level to your social life affects anxiety. Set the bar for success by making conscious decisions that promote a relaxed, cheerful, and positive outlook on everyday life.

  • Learn more about anxiety. To overcome anxiety, it is important to understand the problem. This is where self-education begins. Education alone will not cure your anxiety disorder, but it will certainly help you get the most out of psychotherapy.
  • Cultivate friendships with other people. Loneliness and isolation provide fertile ground for anxiety. Reduce your level of vulnerability by communicating with other people. Make an appointment with friends; join a self-help or support group; Share your worries and concerns with the person you value and love.
  • Adopt healthy lifestyle habits. Physical activity relieves tension and reduces anxiety, so make time to exercise. Don't use alcohol or drugs to cope with symptoms, and try to avoid stimulants like caffeine and nicotine, which can make anxiety worse.
  • Reduce stress in your life. Analyze your life stress and find ways to minimize it. Avoid people who make you anxious, say no to additional responsibilities, and build time into your daily schedule for running and relaxation.