What Is the Best Anxiety Treatment?

Anxiety can be treated with psychotherapy, medication, or both. Lifestyle changes, including diet, can help reduce anxiety triggers and improve resilience but lifestyle changes alone are not treatments.

The best treatment for anxiety depends on a number of factors including the specific anxiety issues, any coexisting medical or psychological issues, and the person’s preferences. Before any treatment, a diagnostic evaluation by a qualified professional is recommended to determine if symptoms are due to an anxiety condition or something physical.

Research and experience show that most people get the best results from treating anxiety or panic attacks and fears without medicine. Psychotherapy using cognitive behavioral therapy (CBT) is considered to be the best practice treatment for anxiety, even if you are taking anti-anxiety medication. Virtual reality can help with cognitive behavioral therapy, as explained below.

A large study found that although people taking medication for panic got faster symptom relief initially, they did less well in the long term. Those treated with medication had more ongoing fear of panic and their panic attacks were more likely to return after they stopped taking the medicine [1]. Other studies show that taking a medicine makes relapse and return of fear more likely [2, 3].

In certain situations, medications may be the best option. For example, someone who needs an emergency MRI but is too anxious to go into the machine may benefit from a fast-acting anti-anxiety medication such as alprazolam (Xanax).

Cognitive Behavioral Therapy for Anxiety

Cognitive behavioral therapy (CBT) is a psychotherapy technique that helps people change their thoughts and beliefs (cognition) as well as their actions (behavior).

CBT for anxiety includes information and exercises that helps you:

• Understand the causes of anxiety and the anxiety cycle.

• Identify your personal anxiety cycle including fears, triggers, and panic actions.

• Reduce your triggers.

• Challenge your fears and change your thinking.

• Change your actions and resume a normal life.

• Learn additional techniques for increasing your resilience and dealing with possible recurrences.

Virtual Reality Therapy for Anxiety

Virtual reality (VR) technology enables a user to feel like they are ‘inside’ a 3-dimensional virtual environment. This illusion is created by a VR headset that contains a computer graphic display, lenses, sensors, and speakers. The headset tracks the user’s location and head position to adjust the 3-D graphics in real-time and create the appearance of being within the virtual environment.

Conceptual view of a VR headset that uses a smartphone to create 3D virtual environments

For VR therapy, the client wears a VR headset and experiences the virtual environment. The therapist does not use a headset, but they can monitor and control what the client is seeing on their workstation. 

Therapist workstation display enables the therapist to monitor and control the client’s virtual environment

Virtual reality therapy uses VR technology to enhance several parts of cognitive behavioral therapy, including diagnosis, skills training, reward/relaxation, and relapse prevention. The most powerful use of VR in therapy is for the ‘exposure’ portion of therapy. 

During the exposure portion of therapy, the client repeatedly faces activities and situations that cause anxiety while practicing new ways of thinking and acting which they have learned earlier in therapy. Exposure to virtual environments, controlled by the therapists, is much more realistic and efficient than alternate ways of doing of exposure such as imagining the situation (imaginal exposure) or facing the situation in real life (called in vivo exposure). 

About the Author

Dr. McMahon has specialized in brief effective treatment for anxiety-related issues for over 40 years and teaches continuing education courses for therapists. She has been using VR with clients since 2010 and has written a textbook on VR therapy for anxiety. Her qualifications include 32 years at Kaiser Permanente Medical Group where in addition to helping hundreds of clients, she coauthored best practice guidelines for anxiety treatment and trained post-doctoral psychologists. See About Dr. McMahon for more information.

Call Dr. McMahon at 1-415-625-3565 for more information or to arrange an appointment.

Medication Note

If you take medication for anxiety, continue taking it as directed until you receive new instructions from your health care provider. Certain anti-anxiety medications must be discontinued gradually to avoid problems.

References

[1] Barlow, B. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2000). Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. JAMA, 283(19): 2529-2536.

[2] Marks, L., Sinson, R. P., Basoglu, M., Kuch, K., Noshirvani, H., O’Sullivan, G., et al. (1993). Alprazolam and exposure alone and combined in panic disorder with agoraphobia: A controlled study in London and Toronto. British Journal of Psychiatry, 162, 776-787.

[3] Powers, M. B., Smits, J. A., Whitley, D., Bystritsky, A., & Telch, M. J. (2008) The effect of attributional processes concerning medication taking on return of fear. Journal of Consulting and Clinical Psychology, 76(3), 478-490.