Back to text of article | Info Centre Home | Contents | Search | eMJA Home

Norman et al,
Box 1 		Therapies for anxiety disorders

Therapies are ranked in order of importance. Most anxiety disorders are best treated with psychological therapies, and clinical judgement, based on the severity of the disorder, should be exercised as to whether a pharmacological treatment should be used at all. Psychological therapies can be used irrespective of severity and should be combined with drug therapies for patients with moderate to severe disorders as appropriate. Newer agents (venlafaxine, nefazodone) have not yet been systematically evaluated in the treatment of anxiety disorders.

DisorderPsychological therapies*Drug therapies
Panic disorder Unpredictable and unwarranted recurrent attacks of panic characterised by upsetting physical symptoms such as tachycardia, chest pain, sweating, tremor, nausea, and overwhelming sensations of fear or loss of control.
  1. Cognitive-behaviour therapy
  2. Group therapy (groups of patients with similar problems directed by a trained therapist)
  1. SSRIs
  2. TCAs
  3. Benzodiazepines
Agoraphobia Unwarranted anxiety about being in certain places (possibly in public, but also possibly alone at home), leading to avoidance of those places; may be accompanied by panic disorder.
  1. Cognitive-behaviour therapy
  2. Group therapy
  1. SSRIs
  2. TCAs
  3. Benzodiazepines
Social phobia Extreme and persistent anxiety about certain social situations, leading to avoidance of those situations, or pronounced anxiety attacks on exposure or even on anticipation of exposure to the situation.
  1. Behaviour therapy (i.e., training in exposure to the phobic situation)
  2. Cognitive-behaviour therapy
  1. Moclobemide** 
  2. Beta-blockers**
Specific phobias
  1. Behaviour therapy (i.e., training in exposure to the phobic situation)
    ***
Obsessive-compulsive disorder Anxiety marked by obsessional thoughts (recurrent, intrusive and inappropriate thoughts that cause marked anxiety), and compulsions (repetitive behaviours or mental acts that the person feels driven to perform in order to reduce anxiety).
  1. Cognitive-behaviour therapy
  1. SSRIs
  2. Clomipramine
Post-traumatic stress disorder Anxiety following a severe trauma, marked by intrusive memories, flashbacks, or dreams recalling the trauma, disturbed sleep, hyperarousal, irritability, difficulties in concentrating, depression.
  1. Debriefing
  2. Cognitive-behaviour therapy
  3. Eye movement desensitisation and reprocessing
  4. Group therapy
  5. Psychodynamic therapy (reconstruction of trauma, abreaction, catharsis; must be individualised)
  1. SSRIs
  2. TCAs
  3. Benzodiazepines
Generalised anxiety disorder Excessive anxiety and worry, occurring most days for more than six months, with symptoms of motor tension, autonomic hyperactivity, apprehensive expectation, vigilance and scanning.
  1. Support (guidance, advice,
  2. Counselling
  3. Relaxation therapy
  4. Stress management (relaxation, meditation)
  5. Cognitive-behaviour therapy
  1. Buspirone
  2. SSRIs
  3. TCAs
  4. Benzodiazepines
  5. Beta-blockers
*Psychological therapies remain controversial, as there are few controlled studies evaluating comparative efficacy. We have assessed the relative usefulness of psychological therapies according to experience in our unit.
**Limited studies1 suggest improvement with moclobemide; beta-blockers may be useful in performance anxiety.
***Drugs alone are generally not helpful. SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant.

Back to text . . .

    www.mja.com.au     © 1998 MJA