Anxiety disorders are a group of mental health problems. They include generalised anxiety disorders, social phobias, specific phobias (for example, agoraphobia and claustrophobia), and panic disorders. Depression is often related to anxiety disorders.
Anxiety disorders are common mental health problems that affect many people. Approximately 25% of the population have an anxiety disorder that warrants treatment at some time in their life and up to another 25% have less severe anxieties such as fears of spider and snakes.
Not all anxiety is a disorder
Everyone experiences anxiety and fear at times – these are normal and helpful human emotions that help us deal with danger. However, some people experience excessive and irrational anxiety and worries that become ongoing and distressing, and that interfere with their daily lives. This may indicate an anxiety disorder. Often there appears to be no obvious or logical reason for the way the person feels. This may make an anxiety disorder even more worrying to the sufferer.
Symptoms of anxiety disorders
The main features of an anxiety disorder are fears or thoughts that are chronic (constant) and distressing and that interfere with daily living. Other symptoms of an anxiety disorder may include:
- Panic or anxiety attacks or a fear of these attacks
- Physical anxiety reactions – for example trembling, sweating, faintness, rapid heartbeat, difficulties breathing or nausea
- Avoidance behaviour – a person may go to extreme lengths to avoid a situation that they think could bring on anxiety or panic.
Panic attacks are a common symptom
A panic attack is a sudden feeling of intense terror that may occur in certain situations or for no apparent reason. A panic attack does not mean a person is necessarily suffering an anxiety disorder. However, a panic attack is a common feature of each type of anxiety disorder. Symptoms of a panic attack may include:
- Shortness of breath
- Dizziness
- Rapid heartbeat
- Choking
- Nausea.
The cause of panic attacks is unknown, but they may be related to a chemical response in the brain, caused by actual threatening or stressful events or by thinking about stressful events. The brain response leads to physiological changes in the body, such as shallow breathing and rapid heartbeat.
Panic attacks can be frightening. Some people say they feel like they are going to die or go crazy. People affected by panic attacks may avoid situations in which they think attacks might occur. In some cases, this may lead to the development of other anxiety disorders including agoraphobia.
Types of anxiety disorders
Anxiety becomes a disorder when it’s irrational, excessive and when it interferes with a person’s ability to function in daily life. Anxiety disorders include:
- Generalised anxiety disorder
- Social phobias – fear of social situations
- Specific phobias – for example a fear of open spaces (agoraphobia) or enclosed spaces (claustrophobia)
- Panic disorders – frequent and debilitating panic attacks.
Generalised anxiety disorder
Generalised anxiety is excessive anxiety and constant worry about many things. The focus of the anxiety might be family or friends, health, work, money or forgetting important appointments. A person may be diagnosed with a generalised anxiety disorder if:
- The anxiety and worry have been present most days over a six-month period
- The person finds it difficult to control their anxiety.
Social phobias
People with social phobia are afraid of being negatively judged or evaluated by others. This leads to fear of doing something that may humiliate them in public – for example public speaking, using public toilets, eating and drinking in public, writing in public, or any social encounters such as parties or workplaces.
Some social phobia sufferers may only fear one type of situation. Others may be concerned about several types of situations. This can lead them to avoid the feared situations, which can then lead to severe isolation and avoiding people and activities they usually enjoy.
Specific phobias
A person with a specific phobia has a persistent and irrational fear of a particular object or situation. They may fear animals, places or people. Fear of the object or situation is so severe that a person may experience physical symptoms and panic attacks. Fears may include dogs, blood, storms, spiders or other objects or situations but, in all cases, the anxiety is both excessive and interfering.
The adult phobia sufferer usually knows that their fear is excessive or unreasonable. However, their need to avoid the object, place or person can significantly restrict their life.
Panic disorders
Panic or anxiety attacks are common. Panic disorders are less common, affecting about 2% of the population. For a person to be diagnosed with a panic disorder, they would usually have had at least four panic attacks each month over an extended period of time. Often panic attacks may not be related to a situation but come on spontaneously.
Panic disorder may be diagnosed if panic attacks are frequent and if there’s a strong and persistent fear of another attack occurring.
Exposure therapy is a kind of behavioral therapy that is typically used to help people living with phobias and anxiety disorders. It involves a person facing what they fear, either imagined or in real life, but under the guidance of a trained therapist in a safe environment. It can be used with people of all ages, and has been found to be effective.
Learning more about exposure therapy can help you make an informed decision about treatment and prepare you for what to expect.
In exposure therapy, a person is exposed to a situation, event, or object that triggers anxiety, fear, or panic for them. Over a period of time, controlled exposure to a trigger by a trusted person in a safe space can lessen the anxiety or panic.
There are different kinds of exposure therapies. They can include:
- In vivo exposure. This therapy involves directly facing the feared situation or activity in real life.
- Imaginal exposure. It involves vividly imagining the trigger situation in detail.
- Virtual reality exposure. This therapy can be used when in vivo exposure isn’t realistic, like if someone has a fear of flying.
- Interoceptive exposure. This therapy involves purposefully triggering a physical sensation that is feared, but harmless.
A 2015 research review showed that within those kinds of exposure therapies there are different techniques like:
- Prolonged exposure (PE). This includes a combination of in vivo and imaginal exposure. For example, someone might repeatedly revisit a traumatic event by visualizing it, and talking about it with a therapist simultaneously, and then discussing it to gain a new perspective about the event.
- Exposure and response prevention (EX/RP, or ERP). Typically used for people with obsessive compulsive disorder (OCD), this involves doing exposure homework, such as touching something considered “dirty,” and then refraining from performing the compulsive behavior that is triggered from the exposure.
Generalized anxiety
Treatment for generalized anxiety disorder (GAD) can include imaginal exposure and in vivo, but in vivo exposure is not as common. The 2015 research review above showed that cognitive behavioral therapy (CBT) and imaginal exposure improved general functioning in people with GAD compared to relaxation and nondirective therapy.
There is not a lot of research with exposure therapy and GAD, and more is needed to further explore its effectiveness.
Social anxiety
In vivo exposure is typically used for people with social anxiety. This can include things like going to a social situation and not avoiding certain activities. The same 2015 research review above showed that exposure with or without cognitive therapy may be effective in reducing symptoms of social anxiety.
Driving anxiety
Virtual reality exposure therapy has been used to help people with a driving phobia. A small 2018 study found that it was effective in reducing driving anxiety, but more research still needs to be done with this specific phobia. Other therapies may need to be used alongside exposure therapy.
Public speaking
Virtual reality exposure therapy has been found to be effective and therapeutic to treat anxiety about public speaking for both adults and teens. One small 2020 study found that there was a significant decrease in self-rated anxiety about public speaking after a 3-hour session. These results were maintained 3 months later.
Separation anxiety
Separation anxiety disorder is one of the most common anxiety disorders in children. Exposure therapy is considered the top treatment for it. This involves exposing the child to feared situations and, at the same time, encouraging adaptive behavior and thinking. Over time, the anxiety lessens.
Obsessive compulsive disorder (OCD)
Exposure and response prevention (ERP) uses imaginal and in vivo exposure and is often used to help treat OCD. In vivo exposures are done in the therapy session as well as assigned for homework, and the response prevention (not engaging in compulsive behaviors) is part of that. An individual lets the anxiety decrease on its own instead of performing the behaviors that would get rid of the anxiety. When in vivo exposure is too hard or impractical, imaginal exposure is used.
While a 2015 research review showed that ERP was effective, ERP is comparable to cognitive restructuring alone and ERP with cognitive restructuring. Exposure therapy for OCD is most effective when guided by a therapist and not done independently. It’s also more effective when using both in vivo and imaginal exposure, as opposed to solely in vivo.
Panic disorder
Interoceptive exposure therapy is often used to treat panic disorder. According to a 2018 research review of 72 studies, interoceptive exposure and face-to-face settings, meaning working with a trained professional, were associated with better rates of effectiveness, and people were more accepting of the treatment.
Exposure therapy is effective for the treatment of anxiety disorders. According to EBBP.org, about 60 to 90 percent of people have either no symptoms or mild symptoms of their original disorder after completing their exposure therapy. Combining the exposure therapy with cognitive behavioral therapy (CBT), relaxation techniques, and other treatments may enhance the effectiveness as well.
As with other mental health conditions, exposure therapy may be used in conjunction with other treatments. This can depend on the severity of your anxiety disorder and your symptoms. Your therapist may suggest using exposure therapy with things like cognitive therapy or relaxation techniques.
Medication may also be helpful for some people. Talk with your therapist or doctor about what treatments may be beneficial for you along with exposure therapy.
Exposure therapy is done by psychiatrists, psychologists, and therapists with the proper training. Especially with certain kinds of exposure therapy, like prolonged exposure, it is important to work with a therapist with training in how to safely and properly use exposure therapy so that you are not caused undue distress or psychological harm.
To find a therapist who is qualified to offer exposure therapy, you can find a cognitive behavioral therapist who is part of reputable organizations like the Association of Behavioral and Cognitive Therapists.
Ask them questions about their training and what techniques they use.
Exposure therapy is a safe and effective treatment for a variety of anxiety disorders. It can be used alone or in combination with other treatments. If you think it might help you, talk with your doctor about finding a therapist who is experienced in the technique.