Introduction to Anxiety
Anxiety is a combination of many symptomatic conditions, which generally lead to an excessively worried person, who is not able to perform optimally in everyday tasks (Robinson, Biley and Dolk, 2009). It is also defined as “an unpleasant complex combination often accompanied by physical sensations such as heart palpitations, nausea, chest pain and/or shortness of breath, and feelings of inner nervousness” (Manilla Bulletin, 2008). Under the Diagnostic and Statistical Manual of Mental Disorders, this comprises of a set of conditions, namely acute stress disorder, generalized anxiety disorders, post-traumatic stress disorder, obsessive-compulsive disorder, specific phobias, social anxiety disorders and panic disorder respectively (Robinson, Biley and Dolk, 2009).
Anxiety can cause a number of complications in the life of the individual, the most prominent being “social and vocational impairment” (Katon and Roy-Byrne, 2007). The patient is not able to perform well in day-to-day activities due to preoccupation and worries about certain issues, which can lead to psychological as well as physical symptoms (Robinson, Biley and Dolk, 2009).
Anxiety and its whole phenomenon are very easily perceived if it is broken down into its components. Cognitive, somatic, emotional and behavioral components all combine to give a particular picture, of which the treatment is as complex and diversified as the condition itself. In most the people, general feelings of anxiety and the resultant changes in the body are natural. However in the case of anxious patients, such presentations are mostly exaggerated and can take place even in the absence of any cause. These symptoms are also likely to remain for longer duration and may not respond to normal routine methods of alleviation such as walk, socializing etc. (Manilla Bulletin, 2008).
There are however, many reasons why anxiety can take place in individuals. General anxiety disorder and post-traumatic stress disorder for example, are very frequent in patients who are suffering from cancer (Sheldon et al, 2008). Compared to this, there are other patients who may not have any problems in life and maybe leading even successful lives, yet still may be suffering from various forms of anxiety. Although the condition is the same and the patients are diagnosed with the same words, the difference is in the treatment planning and the method of approaching it. For a cancer patients, especially those in the terminal stages, the situation is likely to worsen with the passage of time. Here the role of medical personnel shifts slightly more towards empathy and symptomatic management of pain (Sheldon et al, 2008). Whereas in a patient where there is no such problem, the approach may be more towards behavioral and motivational practice. The results however, can also be different, since the cancer patients have to deal with the inevitability of death; whereas the other patient will have to reenter the life circle. These and many other examples show the complexity that surrounds patients with anxiety disorders. It is also not easy for the practitioners to decide what form of therapy and measures will work for whom. This therefore requires a careful examination of history and identifying astutely which methodology is more likely to succeed (Sheldon et al, 2008).
Types of Anxiety Disorders
It is important to understand that anxiety disorders are highly prevalent in the society. These should be understood and treated according to the type they represent.
The most common form of anxiety disorder is called the generalized anxiety disorder or the GAD. This form of anxiety is very likely to be found among adolescents and those people who are under pressure due to financial or social issues, or have experienced sudden changes in the life patterns. This type of disorder is very likely to take place in a majority of population at one point in time or the other. Mostly this disorder is likely to result in depressive conditions, and is most likely to be presented in the clinical setting (Anxiety Disorders, 2008).
Among the anxiety disorders, the panic disorder is one of the most serious and difficult cases to treat. Estimates show that about 3% of the US population suffers from panic attacks or is likely to suffer from them at some point in their lives. These attacks can present in various somatic forms of illness, which usually warrant emergency visits. As compared to depression, the panic attacks are not very seriously investigated in the emergency setting, although these are the most frequent patients who utilize the health care services in emergencies (Byrne et al, 2001).
Obsessive-compulsive disorder has gained widespread fame due to its excessive use in the media such as films and television. This type of disorder is represented by a constant compulsion for one particular aspect of life, chore, or thought. Most of the time, these worries are unnecessary such as washing of hands, cleanliness, placement of things in a particular orders etc. While some of these traits are normally found in every person, what distinguishes the patients is that they can spend hours over one simple task and repeat it unnecessarily without gaining any satisfaction. This type of obsession with things can affect the social life of the person, and the family may not very understand such extreme forms of behavior (Anxiety Disorders, 2008).
The post-traumatic stress disorder is very likely to be found in a person who has suffered a very traumatic event in life, for which the patient sought no counsel or psychiatric help. In such cases, the patients have repeated flashbacks of the same traumatic again and again, which lead to defensive behavior, which can border to violence. Army personnel who return after the war and conflict zones are very likely to show such behavior, and can become moody, violent and indulge in drug abuse. Socially they can become remote. Not only the patient but the patient’s family, is especially the spouse likely to be severely affected by such condition. It is reported that army men who return after the war become more violent towards their spouses due to repeated remembrance of their traumatic events in the war zone. Such cases show very high rates of suicide (Anxiety Disorders, 2008).
Social phobia is a very common outcome of children who have had traumatic childhood and family life. This phobia can take place when the parents are abusive, or the children are repressed in expressing themselves or displaying emotions. In such cases, the children are very likely to perceive all activity around them as against them, and may feel judged at all times. This leads to an increase in violence as a self-defense mechanism. Such people may start avoiding social congregations (Anxiety Disorders, 2008).
Presence of Chemical Dependency Among Anxiety Patients
There are now numerous studies that attest to the fact that anxiety disorders as well as chemical dependency is found concurrently, or are likely to develop if one of the condition arises (Osser, Renner and Bayog, 2000). The higher the DSM score, the more likely is the presence of chemical dependency (Osser, Renner, and Bayog, 2000).
However, there are many researchers who believe that the pharmacological intervention for anxiety is the main reason why substance dependence may take place in such individuals. This is not very unlikely, for some of the drugs that are used for such cases include benzodiazepines, azapirones, and/or antidepressants (Deas, 2008). These drugs hold a potential for dependency within themselves as well, which is primarily the reason why current researchers are advocating the use of behavioral therapies alongside pharmacotherapy, to watch for signs of developing drug dependence (Robinson, Biley and Dolk, 2009).
Relation Between Alcohol and Anxiety
Anxiety is one of the prominent features in alcoholic patients who decide to quit alcoholism (Schuckit and Hesselbrock, 2004). However, it is only one among the many disorders that are likely to occur in such cases. “Two out of three alcoholics are diagnosed with a major psychiatric disorder at some point in life”. (Schuckit and Hesselbrock, 2004). Since each type of anxiety disorder responds to different therapies in different manner, the patients should first be clinically identified for these subcategories. These groups are then directed to the dependency centers, where according to the similarity of their diagnosis they are placed into various behavioral therapies and medicine regimes (Deas, 2008). The medical or physical aspect that can contribute to the formation of any anxiety or mood disorder state must not be left out in the investigation, since the treatment regime for these cases is entirely different. Some of the facts that have been found about relation between alcohol and anxiety are as follows:
- Alcoholic patients are very likely to suffer from anxiety symptoms during therapy and withdrawal phase
- This anxiety can take the shape of panic attacks that occur in almost 80 percent of the cases.
- Many of such patients are very likely to engage in social relationships that also suffer from drug dependence problems or other forms of psychiatric problems, which creates tension in the social life of these individuals, thereby increasing anxiety levels.
- Most patients are unsure about the precedence of alcoholism or anxiety which led to the other. This is the reason why both the aspects should be treated together and considered as equal parts of the whole situation.
- The uses of stimulants show a very high risk for the creation of alcoholism as well as anxiety symptoms. Although alcohol intake is one of main causes of anxiety, a complete history should also look into the possibility of other possible drug abuse (Schuckit and Hesselbrock, 2004).
Hurdles in the Treatment of Anxiety
One of the main problems in anxiety disorders is that they remain undiagnosed most of the time (Katon and Roy-Byrne, 2007). On the other hand, a misdiagnosis is also not unlikely.
Another main complication in anxiety treatment is the lack of any assessment and evaluation scales to identify anxiety. Questionnaires are very few that curtail to identify anxiety conditions. For the most part, some of the questionnaires originally developed for depression screening are used for the screening of anxiety forms (Katon and Roy-Byrne, 2007).
Another main reason why anxiety patients are less likely to be diagnosed is that there is a less comprehensive framework for addressing these patients and the lack of network between health care personnel to ensure proper referral. Overcoming these is an important step that should be undertaken with the help of programs and staff training, so as to prevent cases from remaining undiagnosed (Byrne et al, 2001).
Still another complication is that the patients are very likely to display some other form of psychological disturbance as well. Patients suffering from bipolar disorders are 50 % likely to suffer from anxiety disorders as well (MacNeil and Salodof, 2006). When combined, these two conditions show a very high-risk rate of committing suicide among the patients. They are also likely to exhibit the symptoms of anxiety at earlier stages than those who suffer from one condition alone. History of post-traumatic stress disorder is also found very frequently in such patients (MacNeil and Salodof, 2006).
With mood disorders there is a 50-60% chance of developing anxiety disorders as well. There are also increased chances of remission in the patients (MacNeil and Salodof, 2006).
In many cases, the patients may not admit to using substances, and this may be further masked by the similar signs and symptoms that are the features of both the mental disorders as well as drug abuse. It is usually with the help of laboratory investigations as well as with time that clinicians are able to distinguish between drug abuse and mental disorder (Cutter et al, 2008).
State of Patient Care for Anxiety and Depression in the United States
Anxiety and depression afflicted patients do not receive the quality of care that they deserve in the health care practice. While there has been much focus on improving the treatment plans and care for such patients; in reality not everyone gets the care. The percentage of patients receiving such care is not even 50%, which means that there is a high risk that the actual number of people suffering from such mental disorders remains underestimated. Also, surveys and research have shown that the proper application of the various treatment regimes for anxiety and depression are not being properly applied and utilized even in those patients who are receiving therapy. The primary reason could be that there is lack of proper implementation of the numerous guidelines that have been made so frequently, while not giving attention as to how to apply those (Young et al, 2001). Treatment undertaking and acquisition have been found to be closely related to sex, socioeconomic status and insurance etc. This is also a reason why many patients may not be receiving care, although they may be aware of their problem (Young et al, 2001).
Diagnosis of Anxiety
One of the key features in identifying an anxious person is the frequent visits to the primary care centers. Such patients are very likely to report unexplainable symptoms and psychiatric comorbidity (Katon and Roy-Byrne, 2007). Patients may also display some of the symptoms in less dramatic fashion where they may take up smoking or choose a more sedentary and antisocial mode of life (Katon and Roy-Byrne, 2007). Many patients are either not diagnosed or if they are, are not receiving any mental treatments (Katon and Roy-Byrne, 2007).
Most common method of diagnosis is the high prevalence of patients entering the hospitals with generalized anxiety disorder, panic disorder, social anxiety disorder and post-traumatic stress disorder respectively (Katon and Roy-Byrne, 2007). These features are closely related to some form of functional impairment and depression levels.
The anxiety disorders can be diagnosed by some of the questionnaires that have been specifically formulated for this purpose. These include the GAD-2 and GAD-7 questionnaires, which have been very helpful in identifying cases of the four most common types of anxiety conditions (Katon and Roy-Byrne, 2007).
Dual Diagnosis
Dual diagnosis is known by many names. These include co-morbid disorders, co-morbidity, co-occurring disorders, concurrent disorders, dually diagnosed, and multiple disorders respectively. Defined as a condition where the patient suffers from both a mental disorder as well as some form of drug dependence, the dual disorder is perhaps one of the most complicated cases to treat in psychiatry. From the start of diagnosis to the identification of treatment plan and carrying out the therapy, the process is marked with many complications. These complications are essentially the various signs and symptoms that may lead to confusion in the clinician’s mind about the psychological condition. Again here the main question that the clinician needs to answer is that which condition came first.
In more than half of the cases, both drug abuse and mental disorders are found to co-exist, which probably explains why such cases are so difficult to treat (Cutter et al, 2008).
Treatment Options in Anxiety
The best results so far reported for anxiety treatments involve the use of behavioral techniques as well as pharmacotherapy, giving the treatment a multifaceted outlook and therefore, helping the patient utilize various techniques of reducing and controlling anxiety (Katon and Roy-Byrne, 2007).
But these are not the only treatment option. The anxiety treatment programs can be broadly classified as in-patient as well as outpatient programs. In-patient programs include medical detoxification programs, long-term residential programs as well as dual diagnosis treatment centers respectively. The outpatient programs include partial hospitalization, intensive outpatient program, intensive case management and counseling therapies. Mostly these programs try to include a social component in the overall treatment either in the form of group therapy, or helping patients to engage with their own social life, and not avoiding it (Cutter et al, 2008).
Due to the complicated presentation of the condition, anxiety is mostly treated with the combination of methods which are broadly classified as psychotherapy and pharmacotherapy respectively. As such it is important for the clinician to ensure the patient is able to carry out following actions to deal with anxiety.
- The patient must learn to “defeat” the various symptoms of anxiety and self-doubt through his or her own effort.
- For this he or she needs to develop a very good image of him or herself and motivate self into reducing anxiety. Self-talk is one of the most common methods that the psychologists prescribe.
- Since anxiety is likely to take place in a depressed individual or a person who is constantly engaged in negative surroundings or thoughts, there is emphasis on replacing the negative with the positive. This can be in the form of self-talk, as mentioned above, physical activity, engagement in a hobby or socializing.
- Systematic desensitization is also a very frequently used technique for such patients.
- Patients must learn from their physician the various symptoms of anxiety, both psychological as well as physical in order to learn to identify them and be able to cope with them accordingly (Manilla Bulletin, 2008).
A very important aspect of the treatment plan is identifying the patient as an individual who has become the victim of this condition due to his or her lack of adjustment to the surroundings that he or she faces. In this regard, it is also important to understand that no productive results can be expected if the patient is not willing or is not ready to improve his or her condition. Therefore, psychiatrists recommend that the patient should be first motivated and “self-activated” to try to solve their condition (Katon and Roy-Byrne, 2007). Since avoidance is the main hurdle that does not allow the condition to remit, the self-activation model helps the patient realize his or her active role in his or her own condition and how he or she can improve or worsen it. This in the eyes of the clinicians is the first step in the treatment of the patient, as only in reaching this stage can the patient actually receive the benefits of multimodal therapies (Katon and Roy-Byrne, 2007).
Utilizing Chemical Dependency Centers in the Treatment of Anxiety
Anxiety patients have shown a very high probability of swaying from their treatment regime and plan, as well as showing lack of compliance to the treatment. This makes their treatment a very difficult challenge, and may lead to insufficient attention in mental care. They may also show lack of interest in the various behavioral therapies for anxiety control (Katon and Roy-Byrne, 2007).
An advantage of various therapies when conducted in dependency centers is that the patient is able to connect and associate with other patients suffering from the same condition. In this manner, they are able to provide each other support and attain a better motivation to control their condition. However, another main advantage of these centers is that they are able to provide a very fertile place for various researchers to carry out researches and trials. Whatever the benefits of individual therapy, it is not able to provide the clinicians with an overall picture of the efficacy of various techniques in relation to one another. Therefore, such locations are a very good source of experimentation with various techniques and comparing the efficacy of one technique with the other.
The increasing evidence is showing the highly effective rates of recovery from anxiety disorders with the use of various behavioral modification and treatment methods (Deas, 2008). These techniques have already proven very effective in treating depression, and since depression is found very closely related to anxiety and related disorders, the combined approach will give better results (Hopko et al, 2006).
A noteworthy contribution in treatment of anxiety disorders is the formulation of a set of algorithms that aim to create a set of treatment strategies for dual conditions of anxiety and substance dependence (Osser, Renner and Bayog, 2000). These steps follow a gradual increase in the reinforcement either through behavioral modification or through the use of drug therapy. Initial stages may be very effective in treating low severity of anxiety, but advancement to higher levels of the algorithm are followed should the patient show signs of relapse or resistance to treatment (Osser, Renner and Bayog, 2000). However, a primary complication with this algorithm is the lack of any pharmacotherapy guide for the anxious patient. Anxiety causes can vary in such cases, in most it is due to preoccupation with the substance itself. In such a state, the use of another drug can lead to dependency on that substance in turn. This combined with the type of anxiety disorder that is present leads to a variety of approaches towards the resolution of the condition. A combination of drug as well as behavioral treatment regimes is an ideal combination sought by many psychiatrists (Osser, Renner and Bayog, 2000).
Care centers and mental health facilities are able to further the progress of the patients by ensuring a constant evaluation and care of the patient (Katon and Roy-Byrne, 2007). The physician may include a number of staff members, who are primarily engaged in educating and supporting the patients, keeping tabs on their progress and their compliance with therapy and carrying out changes in the treatment or drug regime should the need arise. Such programs have shown a lot of promise in improving the overall outcomes of anxious patients (Katon and Roy-Byrne, 2007).
In such locations, one of the advantages is that the person is under care for 24 hours a day, and therefore, is helped, guided, observed and treated by the health care personnel throughout the time. Alongside the presence of other patients with similar conditions and interacting with them helps in coping and then overcoming the condition (Manilla Bulletin, 2008).
In case of patients who suffer from alcoholism and resultant anxiety syndromes, the relapse can take place if the initial stimulus that led to alcoholic behavior in the first place is not identified and treated. Most patients have a history of a weak family structure, and family problems and environment, location of the house and paternal abuse of alcohol are the main causes that drive the person into alcoholism (Schuckit and Hesselbrock, 2004). In such situations, it is the anxiety that precedes the abuse of alcohol. In such cases, staying in dependency institutes may help alleviate the problem in the initial stages, but relapse will more likely take place when the actual cause of it is not removed (Schuckit and Hesselbrock, 2004). It is here that the use of dependency centers will be of benefit. Any group therapy involving problem drinkers can help them communicate their problems. Also the families of the person involved can take part in family therapies which can help in improving the outcomes of the patient. The dependency centers therefore, can act not only in treating the anxiety and alcohol problems of the patient, but can also educate the family of the patient in improving and maintaining the condition (Schuckit and Hesselbrock, 2004).
Byrne’s research in treating patients with panic disorders in clinical settings has shown better responses from the patients than when based on medication alone. (Byrne et al, 2001). In his opinion, the application of collaborative care as in the patients of depression for anxiety patients has shown better results that last longer, are more effective and are able to prevent or reduce relapse rates in the future (Byrne et al, 2001). His prime focus in the research was panic disorders, one of the most difficult cases to treat. By conducting research on one hundred and fifteen patients, Byrne was able to show better compliance with various therapies and medications and swifter outcomes. Therefore, primary care facilities and facilities providing similar sort of care and treatment can prove to be good locations for treating patients with anxiety disorders. Again, the main advantage is the constant care and vigilance of the patient’s condition, which ensures better outcomes (Byrne et al, 2001).
As to why such cases do not respond so easily and why the patients are not able to socially reintegrate themselves, there are many explanations:
- Patients feel more comfortable with people suffering from the same problem than those who are in the position to judge them
- They may be subjected to discrimination and ridicule from the members of the society, which increases their solitude and craving for drug abuse.
- Patients generally labeled with mental disorders are treated harshly by the society, which prevents the patient from receiving medical care and therefore, settle on being called a drug addict.
- Lack of coping mechanism in dealing with social issues before and after the uptake of drugs
- Economical and financial problems increase as there are lesser chances of such patients being hired, which increased their mental anxiety states and increases drug intake
- Relapse increasing the negative thoughts towards self, and creating a mixed reaction of anger, hatred, sadness and incapacity (Cutter et al, 2008).
Utilizing Alternative Medicine Techniques for Reduction of Anxiety
The growing research in the area of alternative medicine helping to reduce anxiety and related symptoms is now in full swing. In this matter, researchers are looking for anything and everything that can provide a new wave of treatments apart from pharmacotherapy. Psychotherapy however, still remains the mainstay of the investigations, for there is much more research required in this area to assess its full effects. But alternative therapies which help to reduce stress and improve patient outcomes continue to be sought. For example, kava is being considered for the reduction of anxiety, which has been used in Asian regions for many centuries. Although a somewhat recent introduction in the United States, researches shows some promise in providing an acceptable and less demanding relief from anxiety symptoms to the patients (Watt, Laugharne and Janca, 2008). But researchers and clinicians are not the only ones who are interested in alternative therapy. With increasing awareness, the public itself is inclining towards non-medical and less invasive procedures to help in their psychological stress states. These are all good signs, for they help reduce the burden on the already overworked health sector. Also, these alternative therapies can be used in conjunction with medical techniques to ensure more positive outcomes (Watt, Laugharne and Janca, 2008).
The Therapeutic Touch Intervention: An Example of Behavioral Treatments
Although a product of the 70s, the Therapeutic Touch intervention has with time shown a very significant role in the overall treatment of anxiety disorders. Reports advocate its effectiveness in treating the elderly and burns patients, and since then has been used frequently as a therapeutic choice for anxiety disorders (Robinson, Biley and Dolk, 2009). This particular therapy is based on the “Science of Unitary Human Beings Theory”, where the person is “a dynamic energy field, and the world in which human beings live as an energy system, suggests that there is a continual interaction within energy fields and with the environment. Any obstruction to the flow of energy results in illness” (Robinson, Biley and Dolk, 2009).
The method can be in many ways considered as alternative medicinal technique for it involves the kinesthetic evaluation of the tensions in the various body parts by the practitioner, and the balancing of the energy fields of the patient. The patient meanwhile, is encouraged to focus on the beneficial effects of the treatment. Such a practice has been termed to provide a “cumulative outcome” with repeated episodes at regular intervals in patients (Robinson, Biley and Dolk, 2009). However, like all other types of alternative treatments, the method has not been able to provide a conclusive evidence of its effectiveness in trials and scientific research. Still, it is widely practiced globally and continues to be a source of relaxation for many anxiety-driven patients (Robinson, Biley and Dolk, 2009).
However, the Therapeutic Touch intervention is one of the many alternative medicine techniques currently used for treating anxiety. Among other techniques are included self-help and relaxation techniques, proper lifestyle, laughing and breathing exercises, and meditation are also used in the treatment of anxiety (Manilla Bulletin, 2008).
The Behavioral Activation Technique
It is defined as “a therapeutic process that emphasizes structured attempts at engendering increases in overt behaviors that are likely to bring patients into contact with reinforcing environmental contingencies and produce corresponding improvements in thoughts, mood and overall quality of life” (Hopko et al, 2006).
The technique aims to increase the patient’s focus towards the positive events and aspects of life, and cope with various negative events of life with a positive attitude. Gradually, the researchers state this method helps in reducing the severity of anxiety and improve chances of avoiding relapse rates (Hopko et al, 2006).
Juggling Therapy for Reducing Anxiety Disorders
A very interesting research was carried out in 2007, where the efficacy of juggling in the improvement of anxiety disorders was studied. Nakahara et al selected 17 female subjects, each diagnosed with some form of anxiety disorder, and provided them with the standard therapy of psychotherapy, medication and counseling for 6 months duration. During this time, in the last 3 months, the patients were randomly assigned to a juggling and a non-juggling group respectively. The juggling group was told to practice juggling with bean bags, and afterward were evaluated and compared with the therapeutic results of the non-juggling group. The findings were very supportive of the juggling therapy in reducing anxiety. The main cause of this is related to the “visual-motor information processing network, akin to EMDR” (Nakahara et al, 2007). These findings were comparable in their efficacy as other forms of body relaxation techniques, such as yoga, meditation and relaxation. Although lacking due to a small number of participants, the study in itself has shown how various combination therapies and group applications are better able to provide clear ideas about treating anxiety disorders and achieving outcomes (Nakahara et al, 2007).
Researches Supporting the Effectiveness of Care Interventions in Various Settings
Katon’s research is among the many that show the effectiveness of collaborative care intervention in treating patients with anxiety disorders (Katon et al, 2002). Katon assigned 115 primary care patients with panic disorder to the intervention program. This program provided the patient education about his or her condition, and provided 2 visits with the on-site consulting psychiatrist. Meanwhile Katon carried out research on the cost-effectiveness of these interventions compared to those of primary care visits. The research was able to conclude very good outcomes of the collaborative care intervention, where the patients showed better compliance and recovery, but no significant differences in the costs (Katon et al, 2002).
What Constitutes Ideal Therapy?
For any therapy to succeed, whether it is individual or group therapy, there are a few important areas that it should encompass. The treatment should focus on eliminating the substance abuse as well as other behavioral addictions that are a very common feature of various anxiety-related disorders (Cutter et al, 2008). The codependency pattern that establishes in such patients is a very important area that needs to be addressed. Finding out about the reasons for the anxiety state, past history, sexual and behavioral thoughts, behavior and pattern and external pressures is also an essential part of the program (Cutter et al, 2008). Understanding the location and the social and family setup that a person is living in is also important since many of the group therapies will include family members as well. Finally identifying the various other aspects that the person needs to achieved and overcome in order to become a more successful and productive part of the society should also be taken into consideration (Cutter et al, 2008).
Conclusion
The use of chemical dependency centers for treatment of dual diagnosis and anxiety disorders is a very good treatment option that can ensure positive outcomes for the patients. There is need for more research in this area, however, for now the results seem promising. Several studies have shown that chemical dependency is a result of regular intake of drugs. New studies have suggested alternative treatment methods in order to avoid patient’s dependence on drugs. Pharmacological interventions are the main cause of drug dependency in these disorders. Several types of research have been carried out testify and suggest behavioral therapies to be beneficial apart from pharmacotherapy, or a combination of both. Chemical dependency centers specifically focus on some alternatives to provide complete rehabilitation for anxiety patients. Its spotlight is to eliminate chemical dependency and diminish the addiction to drugs while adopting other behavioral therapies to treat the patients. Further research will help exploration in this field and add to our knowledge about usefulness of chemical dependency centers.
References
Anxiety Disorders, 2008. Brief Overview of Anxiety Disorders. Anxiety Disorders Association of America. Web.
Peter P. Roy-Byrne, Wayne Katon, Deborah S. Cowley, Joan Russo, 2001. A Randomized Effectiveness Trial of Collaborative Care for Patients with Panic Disorder in Primary Care. Archives of General Psychiatry.
Deborah Cutter, Steve Elam, Jaelline Jaffe, and Jeanne Segal, 2008. Dual Diagnosis Information and Treatment for Co-Occurring Disorders.
Deborah Deas, 2008. Evidence-Based Treatments for Alcohol Use Disorders in Adolescents. Pediatrics Vol. 121.
Hopko, Derek R, Robertson, Sarah M. C., Lejuez, C. W., 2006. Behavioral Activation for Anxiety Disorders. The Behavior Analyst Today. Web.
Wayne Katon and Peter Roy-Byrne, 2007. Editorial, Anxiety Disorders: Efficient Screening is the First Step in Improving Outcomes. Annals of Internal Medicine Vol. 146, No. 5, pp 390-392.
Wayne Katon, Peter Roy-Byrne, Joan Russo, and Deborah Cowley, 2002. Cost-Effectiveness and Cost Offset of a Collaborative Care Intervention for Primary Care Patients with Panic Disorder. Archives of General Psychiatry.
MacNeil and Jane Salodof, 2006. Treating Anxiety, Mood Disorders Takes Time. Clinical Psychiatry News. Web.
Manilla Bulletin, 2008. Anxiety. Web.
Toshihiro Nakahara, Kazuhiko Nakahara, Miho Uehara, Ken-Ichiro Koyama, Kouha Li, Toshiro Harada, DaisukeYasuhara, Hikaru Taguchi, Sinya Kojima, Ken-ichiro Sagiyama and Akio Inui, 2007. Effect of Juggling Therapy on Anxiety Disorders in Female Patients. Biopsychosocial Medicine, Vol 1, No. 10.
David N. Osser, John A. Renner, and Rogelio Bayog, 2000. Algorithms for the Pharmacotherapy of Anxiety Disorders in Patients with Chemical Abuse and Dependence. Practice Guidelines. The Harvard Psychopharmacology Algorithm Project. Psychiatric Annals, 29:5 pp 285-301.
Robinson J, Biley FC, Dolk H, 2009. Therapeutic Touch for Anxiety Disorders (Review). The Cochrane Collaboration.
Sheldon, Lisa Kennedy, Swanson, Susan, Dolce, Amy, Marsh, Kathy, Summers, Julie, 2008. Putting Evidence into Practice [R]: Evidence Based Interventions for Anxiety. Clinical Journal of Oncology Nursing. Web.
Marc A. Schuckit and Victor Hesselbrock, 2004. Alcohol Dependance and Anxiety Disorders, What is the Relationship? Focus 2:440-453.
Gill van der Watt, Jonathan Laugharne and Aleksander Janca, 2008. Complementary and Alternative Medicine in the Treatment of Anxiety and Depression. Current Opinion in Psychiatry 21(1): 37-42.
Alexander S. Young, Ruth Klap, Cathy D. Sherbourne, Kenneth B. Wells, 2001. The Quality of Care for Depressive and Anxiety Disorders in the United States. Archives of General Psychiatry vol 58, No. 1, pp 55-61.