8 NOVEMBER 2023IN MY OPINIONAnxiety-related disorders include specific phobia, social anxiety disorder, generalized anxiety disorder, panic disorder, agoraphobia, obsessive-compulsive disorder, and posttraumatic stress disorder. These conditions are highly common,1,2 with an estimated cost to society estimated to be in excess of $42 billion in 1990,3,4 the last time such an analysis was conducted, and substantial reductions in health-related quality of life.5 Fortunately, effective treatments are available. Cognitive-behavioral therapy (CBT) is an evidence-based, time-limited, action-oriented psychological treatment. Some of the most commonly used strategies for treating the anxiety-related disorders include: (a) exposure, in which patients are asked to gradually approach feared and avoided stimuli; (b) cognitive restructuring, in which faulty beliefs are challenged and the patient is encouraged to consider new perspectives, and (c) relaxation, which involves muscle- or breathing-related strategies aimed at reducing autonomic arousal.Exposure is a mainstay of CBT for anxiety-related disorders. In this procedure, patients are assisted to gradually reduce avoidant behavior and to confront feared situations, activities, or people. For example, a patient with a specific phobia of dogs might be instructed first to be in a room with a small dog, then to pet the dog, and work up to being in contact with larger dogs. This process can be duplicated across the anxiety-related disorders. For example, an individual with panic disorder might deliberately provoke feared physical sensations by hyperventilating, spinning, or running in place (a process termed interoceptive exposure). A patient with social phobia might be instructed to interact with others and even to make small "blunders" while doing so. A patient with obsessive-compulsive disorder and contamination fears might be instructed to touch progressively "dirtier" objects while refraining from handwashing (a Cognitive-Behavioral Therapy for Anxiety DisordersBy David F. Tolin, Ph.D., The Institute of Living/Hartford Hospital and Yale University School of Me
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