II. Management: General
- Offer Reassurance
- Not a serious physical disease
- Not insanity
- Not a sign of weakness or failure
- Not childishness or overdependency
- Not life-threatening
- Encourage Acceptance of anxiety as a life-long problem
- Innate response with years of reinforcement
- Complete calm always is unrealistic goal
- Set Goals for Therapy
- Decrease level of anxiety and maintain at low level
- Modulate future symptom responses
- Increase functioning
III. Management: Lifestyle Modification
- Daily Physical Exercise (e.g. Walking, Tennis, Aerobics, Bicycling)
- Likely effective, although less than with Major Depression, and with inadequate evidence to date
- Jayakody (2014) Br J Sports Med 48(3): 187-96 [PubMed]
- Stonerock (2015) Ann Behav Med 49(4): 542-6 [PubMed]
- Improve sleep quality
- Establish good Sleep Hygiene
- Consider new hobbies
- Consider Pet Therapy
- Avoid harmful intakes (See Anxiety Secondary Causes)
- Avoid Alcohol use
- Avoid Tobacco use
- Avoid Caffeine
- Avoid Substance Abuse
IV. Management: Psychotherapy
- Background
- Optimal effects are after 8 weeks of weekly sessions
- As effective as medication for the treatment of Generalized Anxiety Disorder and Panic Disorder
- Goals
- Increase self confidence
- Increase self control
- Promote emotional growth
- Specific areas of education
- Teach coping skills and Conflict Resolution
- Encourage patient to express themselves
- Practice goal directed behavior
- Redirect energy and creativity
- Identify a new source of fulfillment
-
Cognitive Behavioral Therapy
- First-line directed, time limited intervention for mild to moderate anxiety
- May be delivered in individual or group therapy, typically 12-20 week course, followed by months of booster sessions
- Recognize how thoughts affect mood and behavior, and then modify thinking and behavior
- Systematic Desensitization with exposure therapy (most effective single measure)
- Recognize, Reexamine and replace anxious thoughts
- Behavioral interventions include social skill training, relaxation and exposure
- James (2020) Cochrane Database Syst Rev 11(11):CD013162 +PMID: 33196111 [PubMed]
V. Management: Mindfulness and relaxation
- See Relaxation Training
-
Mindfulness-based Interventions (including stress reduction)
- Appears effective, but variable benefit in studies to date
- Non-inferior to SSRI therapy (Escitalopram) with sustained benefit at 6 months
- Progressive Muscle Relaxation
-
Relaxation Training
- Meditation
- Yoga
- Likely offers benefit, but effects appear small, adjunctive
- Hoffman (2016) J Evid Based Med 9(3):116-24 [PubMed]
- Self-Hypnosis
- Tai Chi
- Effective in older adults with anxiety (symptom control with less relapse)
- Song (2014) J Physiol Pathophysiol Pharmacol 6(1): 55-60 [PubMed]
- Biofeedback
- Breathing retraining (arousal reduction)
- Take a deep breath
- Let breath out through pursed lips
VI. Management: Measures to Avoid
- Virtual Reality Exposure Therapy does not appear effective and should not be used as therapy for GAD