When it comes to anxiety - relax
By the faculty of Harvard Medical School for The Harvard Medical School Adviser

Q: My doctor diagnosed me with anxiety. I think she's right, but I don't want to take tranquilizers. Is there anything else I can do?

A: Yes. First, try to help yourself by reducing sources of stress and worry. Avoid caffeine, which can make you jittery. Don't medicate yourself with alcohol -- it never helps. Get enough exercise and sleep. Talk things over with trusted relatives and friends. And consider learning meditation or other relaxation techniques.

Many people need more help. Several types of psychotherapy can help people understand the source of their anxiety and teach them ways to control their symptoms without medication. Psychiatrists, psychologists and social workers use different techniques that are tailored to specific anxiety disorders.

Anxiety disorders are the most common psychiatric condition in the United States. They include a wide range of problems, including panic attacks, phobias (fears), obsessive-compulsive disorder and post-traumatic stress disorder. Recent research has uncovered some of the underlying brain differences that make some people more prone to anxiety (see illustration).

No two people have the same set of symptoms. But most people with anxiety disorders feel tense and worried and have unwarranted feelings of fear, dread or danger. Many also have physical symptoms, like trembling, nausea, hot or cold flashes and shortness of breath.

An effective nonmedicinal treatment for anxiety is cognitive behavioral therapy. As the name suggests, it has two parts. Cognitive therapy helps people change patterns of thinking that prevent them from overcoming their fears. Behavioral therapy works to change their reactions in situations that trigger anxiety. For example, people with social phobia become anxious in certain social situations. They may assume that others will think what they say is stupid, which is an example of negative thinking. As a result, these people may avoid being with or talking to others. This is an example of negative behavior. The goal of cognitive behavioral therapy is to break this chain of thoughts and reactions.

Negative thoughts and behaviors tend to show up when people are under stress. So the first step is to help you recognize when you're stressed. There are three parts to a stress reaction, often referred to as the ABCs: affect, behavior and cognition. Affect is how you feel. It refers to your emotional response to a particular situation. Behavior is what you do. Common examples are tensing your jaw, tapping your foot, pacing or overeating. Cognition is the thoughts you have when you are stressed. For example, thinking, "I'm going to miss my work deadline and get fired."

Cognitive behavioral therapy is effective for many types of anxiety disorders. It's usually done weekly for several weeks or months, either individually or in a group. Once your condition stabilizes, you may see your therapist once or twice a month or as needed if your symptoms return.

The therapist typically begins by asking you to record your thoughts and level of anxiety in certain situations. Then, you discuss these thoughts, evaluate how realistic they are and work together to substitute more productive thoughts.

The behavioral part of this therapy uses two main strategies. The first, called exposure or desensitization, has patients face their fears directly. One method is through role-playing. Another is to ask patients to imagine frightening situations and describe them. Yet another strategy is to give patients "homework" in which they put themselves in real-life situations that spark anxiety. The reasoning is that avoiding anxiety-causing thoughts and situations reinforces the individual's fears or false beliefs. In real-life situations, patients can practice recognizing negative thoughts and substituting more realistic ones. With repeated exposure, people eventually become desensitized to fearprovoking situations.

The other main strategy is to teach patients practical skills to use in difficult situations. For people who become extremely anxious when they have a lot to do, this may mean offering tips on setting goals and managing time. Those who are uneasy in social situations can be coached in conversational techniques and other social skills.

Although you may be reluctant to take medication, it's worth noting that for many people with anxiety, two treatments are better than one. Many doctors recommend cognitive behavioral therapy and medication together. The therapy component is clearly important, because research suggests that people who choose therapy and medication together have fewer symptoms and a lower chance of relapse than those who use medication alone. The good news is that in the long run, most of these patients are able to stop taking medication or lower their dose.

Anxiety disorders are common and complex. It's nice to know that self-help measures, talking therapies and medication can all help. Work with your doctor to find the combination that's best for you. By recognizing your problem for what it is, you've already taken the crucial first step that's so hard for many people.

Copyright 2006 the President and Fellows of Harvard College. Developed by Harvard Heal th Publications (www.health.harvard.edu). Distributed by UFS. Submit questions to harvard_ adviser@hms.harvard.e du.