The Best Treatment Methods for Anxiety and Phobia

by Richard C. Raynard, Ph.D.

Most phobia treatments have been evaluated for effectiveness. I offer you a brief report about the effectiveness of the major treatments.

The use of medications has been a boon for some phobics, and a disappointment for others since the specific drug has widely varying effects on different individuals. For example, 20% to 25% of phobics prematurely drop out of drug treatment programs because of adverse reactions such as allergies, mood changes, or physical symptoms. Relapse rates after going off medication is fairly high, about 25% to 35% in most studies. And, some have shown agoraphobics have extreme sensitivity to even small doses.

Still, medications such as the MAO Inhibitors (Nardil, etc.), the tricyclic antidepressants (Imipramine, etc.), or the benzodiazepines (Xanax, etc.) bring improvement to 53% to 80% of those who can tolerate them. We urge their use when a phobic person is extremely depressed, is in almost continuous panic, is extremely obsessive and worrying, or when facing almost certain panic.

The effectiveness of psychoanalysis is difficult to determine since the reports are mostly of individual cases treated successfully, with little scientific merit. A few research reports show low or inconsistent results.

The body of literature on the more widely used forms of psychotherapy, using methods of understanding, insight, or emotional release report about 30% to 40% effectiveness, with relapse being common.

Attempts by phobic persons at self-help have often failed, and several authors have noted that phobias are remarkably persistent and long lived until effective help arrives. Attempts to "tough out" situations with the worst anxieties and panic usually bring back and reinstate the panic, and subsequent avoidance.

Flooding methods, which coach the phobic person to stay in the fearful place for hours, were some of the first to show promise, particularly for simple phobias such as those of animals or noises. Other helpful methods evolved, such as systematic desensitization, which trained the phobic to vividly imagine the fearful situation while being coached in relaxation. The substantial improvement rates continued to climb to 50% or higher, but not to uniformly high levels for all phobias.

The most recent treatment procedures in psychology have evolved around exposure therapy, which gradually introduces the phobic to more and more fearful situations and trains him/her to bring down anxieties to comfortable levels in a program of daily practice. These methods reach 60% to 70% effectiveness alone, and over 90% when used in judicious combination with medications. Specific techniques continue to be developed in exposure therapy, which improve the success rate to 70% to 80% levels. Group methods, residential or regular, have similarly good results. No symptom substitution or relapse after treatment is reported after 4 to 10 years followup.

There is increasing agreement that the more successful therapies help the person return to the place of fear and that the desensitization that follows when none of the anticipatory fears come true is a basic process that leads to recovery.

For more information on treatment methods, you may visit www.panicdoctor.com/treatments.htm. Dr. Raynard's latest book, Panic Free, covers this and other topics in much greater detail.
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