Anxiety disorders are the most common psychological disorders in the population, yet in the clinic, they show-up for therapy far less often than other problems such as depression. There are several reasons why anxiety sufferers are not seeking psychotherapy. A major one is that psychologists are not â€œgetting the word outâ€ that therapy is both available and effective for treating anxiety. Medication, by contrast, is better promoted even than Coca-Cola, and the effect of this marketing is obvious.
Many people have been seduced by the simplicity of â€œa pill for every ill,â€ to borrow a line from Aldous Huxleyâ€™s Brave New World. It should hardly need stating that Huxley’s portrayal did not intend holding out a worthy aspiration for society. Rather, it offered a biting social criticism. Huxley might well agree with my view that there are reasons why therapy may be a better option for you. There is a concern that the mantra of medications â€œcorrecting a chemical imbalanceâ€ is a fiction that overstates the sophistication of how drugs actually work, while downplaying the roles of psychological and environmental factors. A competing view that drugs only mask the symptom is substantiated by higher post-treatment relapse rates for medicine than psychotherapy. Even where medication is effective, the decision to take drugs is, for many, unacceptably disempowering. In taking medication, one relinquishes being an active agent in their own treatment, surrendering hope that there is something you can do to help yourself — your role is reduced to simple compliance with what you are told to take. Psychotherapy is active in engaging the client in a collaborative process that promotes rather than undermines self-reliance.
Psychotherapeutic methods available for treating anxiety are numerous. The major schools of thought are the Humanistic, Behavioral, Cognitive, and Psychoanalytic (or Psychodynamic). The Humanists approach anxiety by understanding it as a product of a self-concept damaged by the discrepancy between the how things actually are in life compared with the way things ought to be. In treatment, an accepting and non-judging situation is fostered that validates feelings, and allows the self-concept to expand and heal through reconciling â€œwhat isâ€ with â€œwhat should be.â€
The Behavioral perspective views anxiety as originating in a natural fear response which has become associated with a non-threatening stimulus through paired association. Treatment consists of performing procedures and home-work assignments that break down, or un-learn these learned associations.
Cognitive therapy endeavors to identify and challenge the negative automatic thoughts that are believed to precede and trigger anxiety.
Psychodynamic or Psychoanalytic approaches emphasize understanding how inner mental life is organized in relation to relationships, both present and past. This understanding sets the stage for understanding and resolving the maladaptive function that anxiety is serving in the patientâ€™s life in the present. In so doing, benefits in addition to symptom relief are often seen, such as improved interpersonal functioning and satisfaction in relationships.
A few words about the science and art of psychotherapy are in order. Fifteen years ago, a colleague succinctly characterized the field as a â€œcottage industry.â€ His evaluation stands equally true today. While many psychotherapists, especially the psychologists among us, emphasize a public image organizing around the scientific foundation of what we do, the reality behind that image is utterly different. I do not diminish the importance of research in saying so, but the skill in doing psychotherapy is vastly more art than science. Psychotherapists mostly work as lone craftsmen, honing their skills on a case-by-case basis. There have certainly been efforts to â€œindustrializeâ€ the field of psychotherapy in ways intended to foster the mass-production of therapists and hasten the through-put of customers. These have largely done a disservice to the public and to the field of psychotherapy. Mass production, it turns out, is not always a satisfactory alternative to craftsmanship. This is especially true where personalized service, crafted to be responsive to the needs of the individual is whatâ€™s called for.