What are the next steps if medications are ineffective for anxiety disorder?

Doctor's Answers 2

There are several major types of anxiety disorders:

  • Generalized anxiety disorder is characterized by persistent worry or anxious feelings. People with this disorder worry about a number of concerns, such as health problems or finances. Symptoms include restlessness, irritability, muscle tension, difficulty concentrating, sleep problems and generally feeling on edge.

  • Panic disorder is marked by recurrent panic attacks that include symptoms such as sweating, trembling, shortness of breath or a feeling of choking, a pounding heart or rapid heart rate, and feelings of dread. People who experience panic attacks often become fearful about when the next episode will occur (anticipatory anxiety), which can cause them to change or restrict their normal activities.

  • Phobias are intense fears about certain objects (spiders or snakes, for instance) or situations (such as flying in aeroplanes) that are distressing or intrusive.

  • Social anxiety disorder is also known as social phobia. People with this disorder are fearful of social situations in which they might feel embarrassed or judged. They typically feel nervous spending time in social settings, feel self-conscious in front of others, and worry about being rejected by or offending others.

Cognitive Behavioural Therapy as treatment

The recommended treatment for anxiety disorders is psychological treatment (usually cognitive behavioural therapy). The best type of psychological treatment for anxiety disorders is cognitive behavioural therapy (CBT). When a person starts to do CBT he will start by learning about healthy anxiety and the way our brains handle anxiety. Then he will learn how to challenge his unhelpful thoughts and control his anxious thoughts and behaviours.

Treatment can help, and for many anxiety problems, therapy is often the most effective option. Therapy can help you uncover the underlying causes of your worries and fears; learn how to relax; look at situations in new, less frightening ways; and develop better coping and problem-solving skills. Therapy gives you the tools to overcome anxiety and teaches you how to use them. Many people improve significantly within 8 to 10 therapy sessions.

CBT addresses negative patterns and distortions in the way we look at the world and ourselves. As the name suggests, this involves two main components: Cognitive therapy examines how negative thoughts, or cognitions, contribute to anxiety; Behavior therapy examines how one behaves and reacts in situations that trigger anxiety.

The basic premise of CBT is that our thoughts—not external events—affect the way we feel. In other words, it’s not the situation you’re in that determines how you feel, but your perception of the situation. The same event can lead to completely different emotions in different people. It all depends on our individual expectations, attitudes, and beliefs. For people with anxiety disorders, negative ways of thinking fuel the negative emotions of anxiety and fear. The goal of cognitive-behavioural therapy for anxiety is to identify and correct these negative thoughts and beliefs. The idea is that if one changes the way he thinks, he can change the way he feels. Cognitive restructuring is a process in which one challenges the negative thinking patterns that contribute to your anxiety, replacing them with more positive, realistic thoughts.

Exposure therapy, as the name suggests, exposes one to the situations or objects one fears. The idea is that through repeated exposures, one will feel an increasing sense of control over the situation and your anxiety will diminish.

Exercise can help us to deal with stress and anxiety. As little as 30 minutes of exercise three to five times a week can provide significant anxiety relief. To achieve the maximum benefit, aim for at least an hour of aerobic exercise on most days.

Relaxation techniques such as deep breathing, progressive muscle relaxation and visualisation techniques, can reduce anxiety and increase feelings of emotional well-being.

It is also useful to examine our lives for stress and look for ways to minimize it. Avoid people who make you anxious, be assertive and say no when others give one extra duties and responsibilities.

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Dr Paul Ang

General Practitioner

Thank you for your question.

1) This is part of your anxiety. Looking for reassurances, answers, possibilities. You probably also asked the same question to your treating doctor many times.

2) You should always stick to the same treating doctor. Please go back and ask your doctor this question if you haven't done so.

3) There is an option to increase the dose.

4) Or wait for some time before it takes effect.

5) Change a medication or add on medications.

6) Go for psychotherapy in addition or in replacement of medications.

7) Seek a second opinion.

8) Reconsider if we got the right diagnosis.

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Is it normal to have chest discomfort if I have anxiety?

Thank you for sharing your problems. Chest pain and discomfort can be a very scary symptom. For most people, who are used to be in control of life; “suddenly” losing control over their own body can be extremely terrifying. Especially when we might have heard/seen other people having heart attacks or sudden deaths. The first step would be to see a family doctor and make sure the doctor feels that it is nothing serious to it. Left sided body aches and discomfort are quite common. In fact, everyone will feel it from time to time.

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Answered By

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Can anxiety disorder be diagnosed in a Singapore polyclinic?

Thank you for asking such an interesting question. The common types of anxiety disorder that are seen in Singapore include generalised anxiety disorder, phobic disorder, panic disorder, social anxiety disorder and others. The older version of the US classification system includes obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) under anxiety disorders. Yes, the doctors at the polyclinic are trained in psychiatry as all of them would have received teaching in psychiatry when they were medical students.

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Answered By

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