Anxiety Drugs Or Psychological Therapy

Studies show Psychological Therapy’s high effectiveness and efficiency in treating anxiety compared to drugs.

When a person with anxiety problems comes to see us, they are expected to ask us what is better if anxiety drugs or psychological therapy, or if anxiety can be treated without drugs. 

Defining the concept of “Anxiety” is somewhat complex since it is normal to find confusion among the general public and health professionals.

Anxiety is an anticipatory response to future harm or misfortune accompanied by unpleasant dysphoria, somatic symptoms of stress, or avoidance behaviors.

In other words, there is, therefore, a consensus that anxiety itself is not a disorder but rather a normal adaptive response to the environment.

The definition collected by the Working Group of the Clinical Practice Counselor for the Management of Patients with Anxiety Disorders in a family practitioner, 2008, would be:

Only when it exceeds a certain intensity or duration or exceeds the person’s adaptive capacity and causes discomfort or significant deterioration with physical and psychological symptoms can it be considered pathological?

There is some confusion between anxiety, anguish, and stress, which are used interchangeably and confusing.

Although it seems generally accepted that the concept of anxiety refers to a combination of different physical and mental manifestations before a forecast of a dangerous situation, which predisposes the body to face this potential threat, that is, it would be an adaptive mechanism that anticipates potential dangers and prepares us for action.

Anxiety is a multidimensional response. That is, we can differentiate three interrelated components between them:

It is the most visible response; it is about external behaviors, behaviors that appear as a consequence of an increase in activation (trembling, stuttering), or behaviors that are launched to escape or avoid the event considered as threatening (freeze, flee, not approach, attack, etc.).

These are the consequences of the activation of the nervous system that arises before the anticipation of the situation considered as threatening, which implies physiological changes such as sweating, increased heart rate, blood pressure, sphincter relaxation, etc.

They are all the cognitions that appear before the possible threat, it refers to the thoughts, beliefs, interpretations, or sensations that arise automatically and involuntarily (fear, discomfort, fear, feeling of being in danger, apprehension, etc.)

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These responses interact, producing a conditioning of one another, which implies constant feedback from the three systems (physiological, cognitive, and motor).

Pharmacological treatment would directly reduce physiological symptoms; that is, it considers anxiety and depression as a “biochemical imbalance” that is tried to be corrected by acting on neurotransmitters.

In short, it is about preventing the body from reacting to threatening situations.

Two large groups of anxiety medications are generally used to reduce these symptoms: anxiolytics and antidepressants.

Anxiolytics

Within this group, we find the famous benzodiazepines, one of the most prescribed drugs.

Benzodiazepines are drugs that have a relaxing and anticonvulsant effect. They act by enhancing Gamma Amino Butyric Acid (GABA), an inhibitor of the Central Nervous System, reducing neurophysiological activation.

According to the duration of their effect, they are classified as:

  • Short Action:Its effects last up to 8 hours, and this group includes mainly Midazolam, Triazolam, and Bentazepam.
  • Intermediate Action:The effects last between 8 to 24 hours; within this group, Bromazepam, Alprazolam, Lorazepam, Pinazepam, temazepam, and oxazepam, among others.
  • Long Action:Its effects exceed 24 hours, and here are Clorazepate, Diazepam, Flurazepam, nitrazepam, and chlordiazepoxide.

Clinical Guidelines

In most of the reference anxiety treatment clinical guidelines and the technical data sheets, we find that the duration of anxiety treatment with Benzodiazepines will range from 8 to 12 weeks, including its gradual withdrawal in this period. In cases of longer duration, close patient monitoring should be carried out.

The studies available on their efficacy in prolonged treatments have shown that Benzodiazepines have a decrease in their efficacy after 4-6 weeks, their effect being similar to that of a placebo.

Benzodiazepines have been the subject of many studies where their effectiveness and cost-benefit have been questioned due to their adverse effects and the high risk of dependency they cause.

In addition, the lack of information provided to the patient about the risks derived from taking this medication is very high; 6 out of 10 patients state that they have not been informed about the adverse effects and the risk to their health.

That is, benzodiazepines are treatments for the relief of anxiety symptoms, where their treatment should not exceed 12 weeks since it loses its effectiveness due to the tolerance they cause, requiring a higher dose and generating a high dependence on it.

As common side effects of benzodiazepines, nausea, constipation, blurred vision, weakness, speech disorders, dizziness, lack of balance, drowsiness, feeling of tiredness, impaired coordination, etc. may appear.

They can also cause changes in memory, especially in the ability to store new information, which may cause a lack of attention and concentration, reduced ability to solve problems, etc.

Even when patients have been taking benzodiazepines for a long time (several months, years…), paradoxical reactions may appear; that is, they produce the opposite effect to what they have been prescribed, being able to increase irascibility, more significant anxiety, agitation, depression, etc.

The side effects, together with the tolerance they cause and the high dependency they produce, have led several international organizations to establish recommendations and alerts. Thus the British Medicines Agency refers to the fact that benzodiazepines should be between 2 and 4 weeks, which includes their gradual withdrawal, and the WHO advises against its use in the treatment of stress symptoms due to traumatic situations.

The dependence generated by this drug for anxiety is high, so its withdrawal must be carried out gradually and controlled since withdrawal symptoms may appear. If withdrawn suddenly, the “rebound effect” may arise, causing irritability, insomnia, nausea, confusion, anxiety, dizziness, etc.…

Antidepressants

Within this group of medications for anxiety, the antidepressants most prescribed for treating anxiety are those that act on the reuptake of Serotonin, a neurotransmitter not only involved in depression but also in anxiety disorders.

The dependency they cause is less than anxiolytics, but they do not have an immediate effect; instead, they begin to be noticed after 4-6 weeks of treatment. Likewise, its withdrawal must be gradual and controlled.

They also have side effects that must be taken into account, among which are nausea, weight gain, decreased sexual desire, hypertension, insomnia, a feeling of fatigue, dry mouth, dizziness, etc…

How Is Psychological Therapy For The Treatment Of Anxiety?

Psychotherapy focuses more on the origin that causes this dysfunctional anxiety and on providing psychological tools and resources so that people can face not only the problematic moment that they may be going through that has generated the anxiety but also the different situations that may arise.

The studies and investigations have clearly shown how psychological therapy is highly effective in treating anxiety disorders, maintaining the therapeutic changes produced in the long term, and with an apparent reduction in relapses.

Here the study by Fernandez-Arias, I., Labrador, FJ, and Cols (2013) stands out because they carried out a study to verify the effectiveness of psychological treatment in isolation of Anxiety Disorders.

In this study, they made two groups; the first only received psychological therapy, and the second received psychological therapy complemented with pharmacological treatment.

The results were surprising; although the two groups showed a high percentage of success and effectiveness, the most significant difference was in the treatment duration, with the group that received drug-reinforced psychological therapy taking longer.

These effects on treatment time seem to indicate that the drugs increase the costs and duration of anti-anxiety treatment, reducing the efficiency of the intervention.

Although cognitive behavioral therapy has the most scientific evidence, other state-of-the-art psychological therapies, such as acceptance and commitment therapy, are increasingly positioning themselves.

The American Psychological Association carried out an update in 2006 of treatments with empirical results based on evidence, cognitive behavioral therapy in anxiety disorders (Anxiety Disorders), the reference treatment, except in anxiety disorders. Mixed (Mixed Anxiety) where acceptance and commitment therapy are recommended.

These data are corroborated by the NICE in the United Kingdom, which recommends cognitive behavioral therapy as the first-line treatment for depressive disorder and panic phobias.…

Addiction Intervention

Fundacion Diagrama intervenes in ​​addictions, from a biopsychosocial model and a multidisciplinary approach, through the development of different initiatives in prevention, rehabilitation, awareness, and family, social, and labor insertion.

These areas of action and the programs that are carried out in them are included in the Helianthus Project, an extensive system that facilitates the care of people with addiction problems throughout their entire rehabilitation and reintegration process, in line with the principles contained in the National Plan on Drugs and in the National Institute on Drug Abuse (NIDA).

This innovative project, certified with the ISO 9001:2015 Standard and in the Region of Murcia with the NGO Quality Standard Version 5 by the Institute for the Quality of NGOs (ICONG), allows each user to receive support from the different communication devices. Those available (psychological and educational assistance, support for families, job placement…) to achieve greater autonomy in life. In this sense, it uses a network methodology that contributes to improving communication and coordination with the specific resources that each beneficiary needs (health centers, drug intervention, care centers, intervention services, Likewise, it reinforces the preventive aspects of intervention in this matter by developing different health promotion activities aimed at young people and adolescents.

Rehabilitation Area

Day Center ‘Heliotropes.’ Located in Murcia. From this resource, we work to facilitate the cessation and rehabilitation of people with addiction problems. An evaluation of the psychological, social, health, and educational factors that affect each person is carried out, and an individualized care plan is drawn up that includes a tutorial action plan (pre-employment workshops, sports…), a treatment plan (individual, group, and family) and an itinerary of social and labor insertion. Subsidized by the Murcian Health Service of the Ministry of Health, the Murcian Institute for Social Action (IMAS) of the Ministry of Social Policy, Families and Equality, and the Murcia City Council, which also finances its catering service.

Addiction Intervention Program. Therapeutic intervention carried out in the Social Integration Centers of Murcia, Alicante, and Ciudad Real, as well as in the Educational Treatment Unit of the ‘Murcia II Penitentiary Center.

Outpatient Program. Individual, group, and family therapeutic intervention is compatible with work developed in the urban environment, mainly at night. Developed in the following provinces:

Psychotherapeutic support program for relatives of people with addiction and dual pathology problems. Meeting space between families that have a member with addiction problems so that they can receive information and advice to learn about the addictive process and adequately deal with situations arising from it. The objective is for the family to be an active part in recovering from their relative’s addiction through a psychoeducational intervention. It is financed by the Ministry of Health (Government Delegation for the National Plan on Drugs) and the Murcia City Council and included in the Outpatient Program in Murcia, Alicante, and Ciudad Real.

Preventive Area

Universal Program ‘Education for health.’ Oriented to acquiring and maintaining healthy behaviors, providing information on addictive behaviors. Aimed at young people and adolescents in the Region of Murcia without addiction problems.

Selective Program ‘Prevention of drug use in juvenile offenders and their families.’ It focuses on groups of young people and adolescents whose specific characteristics increase risk factors for addictive behaviors. Aimed at minors or young people in a situation of social exclusion who comply with judicial measures in educational centers managed by Fundacion Diagrama in the Region of Murcia.

Indicated Program ‘Competences: young people and Family.’ Designed for youth with addictive behaviors. It has been taking place since 2013 at the ‘Heliotropos Day Center, aimed at young people and their families in whom addiction begins to be a problem on a physical, psychological, and social level.…

What Is A Cognitive Behavioral Therapy?

CBT is, first of all, a form of psychological therapeutics. It can be applied to many areas and problems, not just the office.

In the office, everything typically starts when a person does not feel well emotionally or has a behavioral problem and therefore decides to consult a psychologist.

Next, we will develop a series of essential points describing how the treatment is carried out.

Cognitive Behavioral Therapy Has Three Main Stages.

At Cognitive Behavioral Therapy, we organize ourselves into three stages: evaluation, treatment, and follow-up.

 In the first stage, the psychological evaluation, we get to know the patient and understand the problems he consults for. If there is a diagnosis such as Depression or Social Phobia, we try to find it now. In general, we explain what we discover in these first interviews to the patient; in this way, he begins to learn about his problem and gives us his point of view. Very essential: during this stage, the patient and the therapist talk and agree on the therapeutic objective and calculate them.

The second stage is the longest, the treatment itself. This is when the techniques to achieve the change that benefits the patient are applied, trying to achieve the achievements raised in the first stage. The techniques that are applied vary greatly depending on the problem, the patient, and the moment they are going through. In any case, the application of a procedure is always discussed in advance with the patient.

During the third stage, follow-up, we space out the frequency of consultations while applying procedures to maintain changes and prevent relapses. When the objectives are achieved, and the change is consolidated, we discharge the patient.

Cognitive Behavioral Therapy Is A Scientific Approach.

Although it may seem strange, not all therapies psychologists apply have a scientific basis. Cognitive Behavioral Therapy is a scientific therapy, which does not mean that it is infallible, but rather that the procedures applied are investigated with rigid empirical methods, today intently linked to advances in neuroscience. That is why we are most likely to obtain the goals. A scientifically validated procedure does not guarantee benefit but makes it much more likely.

Scientific research on the effectiveness of the procedures has resulted in the so-called “Empirically Supported Therapies” or “Effective Psychological Treatment Guides.” Simply put, these are lists detailing the most effective techniques for each problem. Of course, in Cognitive Behavioral Therapy, we rely on such guidelines.

Cognitive Behavioral Therapy Is Practical And Works With Objectives.

 Cognitive Behavioral Intervention focuses on solving the person’s current problems and the reasons that afflict them today and make them suffer. In some cases, when it is essential to understand the current trouble, we ask for information about the past; but the accent of the treatment is placed on solving the difficulties of today.

Practical objectives guide the dialogues between the patient and the therapist. It is not a spontaneous talk without direction, but we are guided by the reasons that brought the patient to the therapeutic.

In Cognitive Behavioral Therapy, The Psychologist Actively Intervenes.

The cognitive behavioral therapist is active; he questions, answers, suggests, and explains. We start from the idea that the patient seeks help because he has problems that cause him suffering, and he has been unable to solve them by his means. The cognitive behavioral therapist has scientific knowledge about what to do to alleviate the condition and, for this reason, applies it to the patient who is asking for it.

In particular, the cognitive behavioral therapist does not remain quiet, mysterious, aloof, or unknown. Instead, we foster a trusting and caring human bond within the confines of the therapeutic relationship.

Cognitive Behavioral Therapy Is A Short-Duration Intervention.

Cognitive Behavioral Therapy has an end, except in cases of chronic pathologies. The duration of therapeutic depends on many factors, but mainly two. First is the diagnosis because there are problems whose solution is faster and easier. Second, is the patient’s commitment; Well; in Cognitive Behavioral Therapy, we used to give patients exercises and tasks; the more the patient is dedicated, the faster the goals are achieved.

We do not have therapies lasting several years. Except for severe or chronic cases, psychological treatment rarely lasts much longer than a year and almost always lasts less than two years.

Cognitive Behavioral Therapy Is A Treatment With A Broad Spectrum Of Applications.

CBT is a treatment approach applicable to different problems and fields. In the clinic, in the doctor’s office, it is not only used for specific problems such as phobias or depression, but it is also effective in treating life crises, family and couple problems, and non-specific emotional discomfort. Besides, Cognitive Behavioral Therapy applies to different areas of the office, such as school or work.