What You Can Do

By Jeffrey Kluger

BEHAVIORAL THERAPY When the brain sets anxiety alarms ringing, our first inclination is to find the off switch. Behavioral scientists take the opposite approach. They want you to get so accustomed to the noise that you don't hear it anymore. The standard behavioral treatment for such anxiety conditions as phobias, obsessive-compulsive disorder (OCD) and panic disorder is to expose patients to a tiny bit of the very thing that causes them anxiety, ratcheting up the exposure over a number of sessions until the brain habituates to the fear. A patient suffering from a blood phobia, for example, might first be shown a picture of a scalpel or syringe, then a real syringe, then a vial of blood and so on up the anxiety ladder until there are no more rungs to climb. There is a risk that if treatment is cut short (before the patient has become inured to the anxiety triggers), the anxious feelings could be exacerbated. But done right, behavioral therapy can bring relief from specific phobias in as little as two or three sessions. Social anxiety takes somewhat longer, and OCD may take a good deal longer still.

COGNITIVE THERAPY Rather than expect patients to embrace anxiety, cognitive therapists encourage them to use the power of the mind to reason through it. First popularized in the 1980s, cognitive therapy teaches people who are anxious or depressed to reconfigure their view of the world and develop a more realistic perspective on the risks or obstacles they face. Patients suffering from social-anxiety disorder, for example, might see a group of people whispering at a party and assume the gossip is about them. A cognitive therapist would teach them to rethink that assumption. Some behavioral therapists question cognitive techniques, arguing--not without some justification--that a brain that was so receptive to reason wouldn't be all that anxious in the first place. Cognitive therapists dispute that idea, though some have begun incorporating behavior-modification techniques into their treatment.

ANTIDEPRESSANTS When talk therapy doesn't work--or needs a boost--drugs can help, especially the class of antidepressants called selective serotonin reuptake inhibitors. Prozac is the best known of these drugs, which work by preventing the brain from reabsorbing too much of the neurotransmitter serotonin, leaving more in nerve synapses and thus helping to improve mood. Another SSRI, Paxil, was recently approved by the Food and Drug Administration specifically for the treatment of social-anxiety disorder, though the others seem to work as well. A third, Zoloft, has been approved for OCD and panic disorder. Each formulation of SSRI is subtly different--targeting specific subclasses of serotonin. And side effects--which can include dry mouth, fatigue and sexual dysfunction--will vary from person to person. A new group of antidepressants, known as serotonin-norepinephrine reuptake inhibitors, may be even more effective in treating anxiety disorders than the SSRIs are. As the name implies, the SNRIs target a second neurotransmitter called norepinephrine, which is secreted by the adrenal gland and plays a role in triggering the fight-or-flight response--thus actually increasing anxiety symptoms in many situations. However, norepinephrine also helps control emotion and stabilize mood, and, properly manipulated along with serotonin, may be able to do just that for the anxious person.

MINOR TRANQUILIZERS If the antidepressants have a flaw, it's that they sometimes don't start working for weeks--a lifetime for the acutely anxious. For this reason, many doctors recommend judicious doses of fast-acting relaxants such as the benzodiazepines Xanax, Valium or Klonopin to serve as a temporary bridge until the SSRIs have a chance to kick in. The downside of such drugs is that they can be highly addictive and may merely mask symptoms. For this reason, doctors will prescribe them very carefully and strictly limit refills.

EXERCISE Before turning to drugs or talk therapy, many people prefer to try to bring their anxiety under control on their own. Unlike most emotional or physical conditions, anxiety disorders respond well to such self-medication--provided you know how to administer the treatment. One of the most effective techniques is simple exercise. It's no secret that a good workout or a brisk walk can take the edge off even the most acute anxiety. Scientists once believed the effect to be due to the release of natural opiates known as endorphins, but new research has called this into question. Regardless, working out regularly--most days of the week, if possible for at least 30 minutes or so--may well help recalibrate the anxious brain.

ALTERNATIVE TREATMENTS One of the most popular self-treatments is yoga, which is both a form of exercise and a way to quiet the mind by focusing attention on breathing. Indeed, even without yoga, breathing exercises can help quell an anxiety episode, if only by slowing a racing heart and lengthening the short, shallow breaths of a panic attack. Many anxiety sufferers have found relief through meditation or massage--even just a 10-min. foot treatment. For those willing to travel a little farther from the mainstream, there's aromatherapy (enthusiasts recommend rose and lavender scents), guided imagery (a form of directed meditation used with some success by people recovering from cancer and open-heart surgery) and acupuncture.

LIFESTYLE CHANGES If all else fails, go back to basics and try cleaning up your lifestyle. For starters, you can cut back or eliminate the use of sugar, caffeine, nicotine, alcohol and any recreational drugs you may be taking. Are you eating right and getting enough sleep and leisure time? Finally, if your job or the place you live is making you anxious, you might consider moving to a less stressful environment or finding a different line of work.

--By Jeffrey Kluger. With reporting by Sora Song/New York

With reporting by Sora Song/New York