Friday, April 9, 2010

When the xanax kicks in, go for cognitive behavioral therapy

Putting aside all the pointless arguments about whether people should get so anxious, the practical reality is that they do. If this seriously disrupts their ability to lead normal lives, then something should be done. Common humanity requires that society makes reasonable provision for their treatment. The pharmaceutical industry would have us believe drugs are the best answer to all our problems and, when it comes to dealing with anxiety disorders, our doctors have a mass to choose from. We start of with antidepressants. Yes, the name apparently suggests their function is limited to treating depression, but they can be just as useful in treating anxiety disorders. So now your doctor decides which variety to try out on you. There are the SSRIs and the tricyclics, and do not forget the MAOIs. Then we get into the anti-anxiety drugs, most often derived from the benzodiazepines. If those do not take your fancy, there are always the beta-blockers. The cabinet in your bathroom can be filled to overflowing (subject to deciding whether all these options are covered by your health plan). But, for all this choice, there is one inconvenient truth. All the independent research evidence (that's the research not paid for by the pharmaceutical industry) shows psychotherapy to be more effective than medication. The problem with trying to treat an emotional problem with a pill is there cannot be a conversation about why you are feeling the emotion and how you are going to deal with its consequences. Talking through the problems with a mental health specialist has the best success record in restoring quality of life and avoiding a relapse into an anxiety state. For a start, it treats you as a human being. You become the focus of attention. People listen to you and advise you on how to improve the quality of your life. In the current healthcare market, you see your doctor for a few minutes, collect a prescription and pick up the bill on the way out. People respond well when they believe their interests are being taken seriously. Their treatment is progressed rapidly if the advice they receive is seen to be useful. There is no point in advising people out of books. This has to be a hands-on approach to changing each person's attitudes and habits. The best form of psychotherapy is cognitive behavioral therapy (CBT). "Cognitive" because you want people to understand their emotional responses to different situations. Only if they understand why they feel anxious can they begin the process of changing their responses. "Behavioral" because the therapist will train people to change the way they behave. This means forcing people to confront the situations in which they feel anxious or fearful, and teaching them how to react more positively. CBT usually lasts over a period of about twelve weeks. For most people, it works best on a one-to-one basis but, in cases of social phobia, part of the training can be in groups to help people become more used to social gatherings. Before starting on the course, it is useful for people to take xanax. This brings the anxiety levels down and provides a window of opportunity when they may learn new habits. But, for the majority of people, the use of xanax should be quickly tapered off. The aim is to enable people to respond more confidently without having to rely on a drug. Only then can people actually begin to feel confident about their own abilities rather than as people propped up by pills.


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