Treatment and therapy for anxiety

Welcome to Your Guide on Treating Anxiety!

In this chapter, we are going to look at how psychologists and doctors help people manage anxiety. When someone’s stress response (like the HPA axis we studied earlier) stays "on" for too long, it can lead to an anxiety disorder. We will focus on two main ways to help: Biological treatments (using medicine) and Psychological treatments (using therapy). By the end of these notes, you will understand the "how" and the "why" behind the most common treatments in Health Psychology.

Important Context: This topic is part of Topic G: Health Psychology. We are focusing specifically on the treatments listed in your syllabus: SSRIs, SNRIs, and CBT.

1. Biological Treatments: Drug Therapy

The biological approach suggests that anxiety is caused by an imbalance of chemicals in the brain called neurotransmitters. The two main types of drugs used to treat anxiety are SSRIs and SNRIs. They both work by changing how your brain cells communicate.

A. SSRIs (Selective Serotonin Reuptake Inhibitors)

Serotonin is often called the "feel-good" neurotransmitter. It helps regulate mood, sleep, and anxiety. In many people with anxiety, serotonin levels might be too low or might be "recycled" by the brain too quickly.

How they work:
1. Usually, after a neuron sends serotonin into the synapse (the gap between neurons), it sucks the leftover serotonin back up to use it again. This is called reuptake.
2. SSRIs block this "vacuum cleaner" (reuptake) process.
3. Because the serotonin isn't being sucked back up, more of it stays in the synapse, giving it more chances to stimulate the next neuron.
4. This eventually helps improve mood and reduce anxiety signals.

B. SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)

These are similar to SSRIs but they have a "double action."

How they work:
They block the reuptake of both Serotonin and Norepinephrine. Norepinephrine is a chemical involved in the body’s "fight or flight" response and alertness. By balancing both, SNRIs can be very effective for people who don't respond well to SSRIs alone.

Analogy to help you remember: Think of a synapse like a dance floor and serotonin like dancers. Reuptake is like the security guard (the neuron) telling the dancers to leave the floor. SSRIs distract the security guard so the dancers can stay on the floor longer and keep the party (good mood/calmness) going!

Quick Review:
- SSRIs: Focus on Serotonin only.
- SNRIs: Focus on Serotonin AND Norepinephrine.

2. Psychological Treatments: Cognitive Behavioural Therapy (CBT)

CBT is based on the idea that our thoughts (cognitions), feelings, and actions (behaviours) are all connected. If we think negatively, we feel anxious, and then we act in ways that keep us anxious (like avoiding situations).

How CBT Works

CBT is a "talking therapy" that usually involves a few key steps:
1. Functional Analysis: The therapist and patient identify "trigger" situations and the irrational thoughts that go with them (e.g., "If I go to that party, everyone will laugh at me").
2. Cognitive Restructuring: The patient learns to challenge these thoughts. They ask, "Is there actually evidence that everyone will laugh at me?"
3. Behavioural Activation: The patient is encouraged to try new, positive behaviours. This might involve "homework" where they gradually face their fears.

Key Takeaway: CBT doesn't just look at the past; it focuses on providing practical tools to change how you think and act right now.

3. Evaluating Effectiveness

In Psychology, we don't just learn what a treatment is; we look at how well it works (its effectiveness). Here is a comparison to help you with your 8-mark and 12-mark exam questions.

Effectiveness of Drug Therapy (SSRIs/SNRIs)

Strengths:
- Ease of use: It is much easier to take a pill once a day than to attend weekly therapy sessions.
- Speed: Drugs can sometimes reduce physical symptoms of anxiety faster than therapy can.
- Accessibility: In many places, it is cheaper and easier to get a prescription than to find a specialist therapist.

Weaknesses:
- Side effects: Both SSRIs and SNRIs can cause nausea, sleep problems, or headaches.
- Relapse: Medication treats the symptoms, but not the cause. If a person stops taking the medicine, the anxiety may return.
- Ethical issues: Some argue that drugs are a "chemical straitjacket" that masks problems rather than solving them.

Effectiveness of CBT

Strengths:
- Long-term skills: CBT teaches patients skills they can use for the rest of their lives, even after therapy ends.
- No side effects: Unlike drugs, CBT doesn't have physical side effects on the body.
- Research Support: Studies like Avdagic et al. (2014) have shown that CBT is highly effective for Generalized Anxiety Disorder (GAD).

Weaknesses:
- Commitment: It requires a lot of hard work, motivation, and time from the patient.
- Not for everyone: Some people may be so anxious that they cannot focus on therapy until they have started medication first.
- Cost: Private therapy can be very expensive.

Did you know? Many doctors recommend a "combination treatment." This means using SSRIs to calm the physical symptoms down so the patient is stable enough to engage in CBT and learn long-term coping skills.

4. Summary Table for Revision

Drug Therapy (SSRIs/SNRIs)
- Approach: Biological
- Method: Change brain chemistry (Neurotransmitters)
- Focus: Reducing physical and emotional symptoms quickly

CBT (Cognitive Behavioural Therapy)
- Approach: Cognitive/Behavioural
- Method: Changing irrational thoughts and avoidant behaviours
- Focus: Teaching long-term coping strategies

Common Mistakes to Avoid in the Exam

1. Don't mix up SSRIs and SNRIs: Remember that the "N" in SNRIs stands for Norepinephrine. If the question asks specifically for SNRIs, make sure to mention both chemicals!
2. Don't just describe: If a question asks you to "Evaluate" or "Assess," you must give strengths and weaknesses. Just saying how a drug works will only get you half the marks.
3. Be specific about Neurotransmitters: Don't just say "brain chemicals." Use the terms Serotonin and Norepinephrine to show the examiner you know your stuff.

Key Takeaway:

Treatment for anxiety is rarely "one size fits all." While SSRIs and SNRIs address the biological side by increasing neurotransmitter availability in the synapse, CBT addresses the psychological side by restructuring thoughts and behaviours. Research generally shows that CBT is very effective, especially when used alongside or after initial biological treatment.