People feel as if they have zero control over their bodies. Their hearts pound, they feel dizzy or faint, and they suffer from an intense sense of nervousness. They become short of breath, start to sweat, shake or feel uncomfortable in general. Many people report thinking they’re “going crazy.” People may also mistake the symptoms of a panic attack for those of a heart attack.

Panic attacks are fairly common. Some people experience panic attacks on a regular basis and are diagnosed with panic disorder. Roughly six million Americans experience panic disorder every year.

But there are ways you can prevent a panic attack from escalating or minimize attacks in general. Below, John Tsilimparis, MFT, director of the Anxiety and Panic Disorder Center of Los Angeles, shares the anti-anxiety techniques he uses with his clients.

• “Don’t believe everything you think.” Tsilimparis uses this motto with his clients. That’s because when you’re having a panic attack, it’s common to experience racing thoughts that feel intense and catastrophic. Remembering that these thoughts are simply a symptom of the panic attack — like a cough to a cold — can help to de-escalate it, he said.

• Ground yourself. Another common symptom of a panic attack is derealization, an unnerving feeling of being disoriented. People feel like they’re floating, and things just don’t seem real, says Tsilimparis, who’s also one of the therapists on A&E’s Obsessed, a show about severe anxiety disorders.

  He suggests that readers “ground themselves in something that feels tangible,” such as running your fingers along your keys or grabbing the doorframe.

• “Be reflective, not reactive.” This is another motto Tsilimparis uses to help clients stop letting irrational thoughts overwhelm them. It’s common to experience phobic thoughts that further accelerate your attack.

  For example, many people have thoughts such as, “I’m going crazy,” “I’m going to die” or “everyone will leave me,” Tsilimparis notes. Writing these negative thoughts down on paper helps your mind switch “from victim to observer.” It gets people outside their minds, he said.

  After recording their thoughts, Tsilimparis has clients “write up more rational and grounded statements,” such as “that phobic thought is just part of my panic attack” or “I have a loving family.”

• Practice positive self-talk. People can feel ashamed about their panic attacks and become very self-critical. Instead of pointing fingers, talk to yourself in positive ways. Remember that there’s no shame in experiencing panic attacks. You can say a statement such as “I’m going to be OK.”
• Use ice cubes. This technique can help you divert your attention away from a panic attack, especially if you’re in the throes of a particularly intense attack. Take out an ice cube and hold it to your hand for as long as you can (you can put the cube in a paper towel). Then, place the ice cube on your other hand. This focuses your mind on the discomfort, de-escalating your symptoms.
• Know the “anatomy of a panic attack.” Remember that the sensations you experience are simply symptoms of a panic attack, which occurs when your body’s fight or flight system is triggered, although there’s no real danger. For instance, even though you feel like you’re about to faint, chances are that you won’t.

  In 15 years of treating people with panic disorder, Tsilimparis has never known anyone to faint, become incapacitated, go psychotic or die from a panic attack. As he said, there’s a lot of catastrophic thinking that typically never occurs.

  Read more about the anatomy of an attack.

• Stimulate your mind. Engage in activities that stimulate your brain and keep you busy, such as getting outside, exercising or taking a shower.

  In fact, a recent study analyzing 40 randomized clinical trials of 3,000 people with various medical conditions found that people who exercised regularly experienced a 20 percent reduction in their anxiety symptoms compared to non-exercisers.

• Learn deep breathing. Shallow breathing can cause hyperventilation, but deep breathing helps to slow down a panic attack. Learn how to practice deep breathing.

General Practices to Help with Panic Attacks

Panic attacks can be debilitating and cause a lot of distress, but they’re very treatable, Tsilimparis says. “If you begin to look at your anxiety like you would diabetes or another condition, you start to get better quicker,” he asserts. “Understand that you have a condition and not a weakness.”

Psychotherapy, particularly cognitive-behavioral therapy (CBT) is highly effective for treating panic attacks. If a person experiences regular and intense panic attacks that impair daily life, medication also can help.

Making lifestyle changes is critical. That includes getting enough sleep, minimizing stress, being active, cutting down on caffeine (not just in coffee, but in other caffeine-packed foods, such as chocolate, tea and soda) and avoiding alcohol and drugs. For example, once alcohol’s sedating effects wear off, “the panic usually comes back much stronger because your defenses are done,” Tsilimparis says.

Finally, don’t isolate yourself. People with panic attacks may feel ashamed, keep to themselves and avoid seeking help. Again, anxiety is not a weakness, and having social support is vital to your getting better.

Photo by photologic, available under a Creative Commons attribution license.

In A Brief History of Anxiety: Yours and Mine, Pearson describes the Flu Wiki:

“The conversations ranged widely, from scientific discourses on virus mutation to historical analysis of pandemics, to tips for home fuel storage—on the presumption that self-quarantine would be the only effective protection from contracting the virus.”

Though she realizes that her fears may be unwarranted and absurd, she can’t stop stockpiling her house with twelve containers of freeze-dried vegetables and powdered butter, which requires 27 cups of water. Still, she isn’t hypervigilant about everything: She doesn’t fear house fires, terrorism, crime or harm striking her two small children.

But she fears other things, including the dark, the state of her finances and on one occasion, her car exploding. Her phobias are chameleons:

“My anxiety is a shape-shifter. It visits me in unfamiliar guises. Phobias, in particular, tend to take me by surprise, as they rear up and then fade away depending upon the stresses in my life. One minute, I’ll be going about my business, being the sort of person who likes to fly on airplanes and to marvel at the deceptive fluffiness of clouds, and the next thing I know I’m in a state of white-knuckled panic as the jet I’ve just boarded powers itself off the tarmac. After a few years, that phobia resolves and something else—some other act or object—unexpectedly becomes the embodiment of all that is terrifying.”

As she delves into her own anxiety — triggered by a devastating relationship — Pearson tries to understand our anxiety, too, wondering why America tops the list of countries with anxiety disorders. While 28.8 percent of us suffer from anxiety disorders, only 6.6 percent of Mexicans do. We’re also nine times more likely to be anxious than citizens in Shanghai.

For insight, Pearson looks to a variety of experts, including psychologists, psychoanalysts, psychiatrists, philosophers and writers. In turn, she creates a book that’s rich with research without being overwhelming or reading like a textbook. She weaves her own experiences with the work of today’s thinkers and luminaries from long ago. Her writing is witty, humorous and powerful. There’s no highfalutin’ language. No psychobabble. Individuals with anxiety may very well see themselves and find that Pearson captures perfectly the gnawing angst of anxiety:

“There are several ways to cope with dread, but I specialize in what psychologist Maria Miceli calls ‘hypothetical analytical planning.’ This is where you lie in bed at night and run through as many perspective scenarios as you can imagine and then rehearse them in French, or from the vantage point of a cat.”

“The signature vexation of anxiety is that it is objectless. It washes over one in formless waves, pulls one under until the pressure and constriction are tangible and panic rears: I’m in deep, I’m going to drown.”

Part of our problem, Pearson concludes, is that we turn to pills at a time when our anxiety might be telling us that we’re “caught and flailing in arrested development.” She draws on this conclusion after quoting Danish philosopher Søren Kierkegaard:

“Anxiety is an alien power which lays hold of an individual, and yet one cannot tear oneself away, nor has a will to do so; for one fears, but what one fears, one desires.”

Kierkegaard viewed his own time as “the cowardly age,” when a person “does everything possible by way of diversions and the Janizary music of loud-voiced enterprises to keep lonely thoughts away.” Pearson sees the same thing with today’s society, except that we push existential philosophy aside. We’ve also sidelined meaning, a result of rationalism, which was supposed to reduce our fears. Instead it’s only “invalidated meaning, which merely served to heighten our dread.” The idea that we can control our lives hasn’t helped us either.

Pearson also talks about the culture of the workplace, where employee loyalty has been replaced with fake “team building” and traits viewed as positive and polite in countries like Japan — “being deferential, soft-spoken, courteous and self-effacing” — are considered disordered here in the U.S. (i.e., “social phobia,” “avoidant personality disorder,” “workplace depression”).

She dedicates a chapter to “a drug’s odyssey,” in which she describes her own experience with medication. In the first few weeks taking Effexor, Pearson feels like it’s “heaven-sent.” But then she begins to feel “apathetic insincerity.” She likens her “secure and yet largely disengaged” state of being to her first job out of college ghost-writing letters at Ontario’s Ministry of Labour:

“I did not enjoy this ghostwriting job, mostly because I spent the day responding to genuine human calamity by (a) pretending that I was someone else, and (b) lying. Yet, it was effortless. Paperwork and coffee breaks and lunch, all at a placid pace. I watched the clock a lot, waiting for it to hit five. ‘Dear Widow Whose Husband Drowned in a Vat of Toner at the Wallpaper Factory, thank you for—‘Oh, five o’clock, gotta go.”

Pearson was addicted to Effexor for five years. Of her horrifying, heroin-like withdrawal, she writes:

“My withdrawal featured night sweats, muscle aches, and shortness of breath. There were the electric pulses but I was used to those from the times I missed a dose. (Seth Silverman in Slate best described them as feeling like someone had removed your skull cap and dragged a staticky blanket across your naked brain.)…On most days, I felt a sort of hypercaffeinated wiring and buzzing sensation, a feeling of continuous adrenal rush. It was like being mildly electrified. And then on certain days, it was as if someone had pulled the plug from the socket and the energy simply winked out. I experienced nothing but darkness, an unbearable density and weight that almost brought me to my knees.”

She faults her psychiatrist for failing to inform her of Effexor’s side effects, and criticizes psychiatry as a whole for steering away from talk therapy and withholding important information:

“How can so many thousands of people, very possibly millions, have been abandoned by so many of the practitioners of medical science and been made to fall back upon rumors and whispers about how to manage their meds? At first, I could only think that these particular doctors needed to be in control, to fix what they’re interested in fixing; they suspect that they’ll lose control if they allow their patients to make an informed choice. ‘I can repair your illness, but you need to know that you’ll become emotionally bland, sexually absent, likely fat, probably at risk of getting diabetes, and every time you miss a dose, you’ll feel like you’ve been shocked with a cattle prod. It’s up to you.’ They don’t want it to be up to you. They don’t trust your judgment. They think you’re nuts.”

It’s understandable why Pearson holds such a negative view of medication. Had she been provided with all the facts—which would’ve taken mere minutes to discuss—she could have avoided years of agony. However, as she scours history for insights on anxiety, she does little to explore all facets of pharmacology. Medication does help many people. It can be used to facilitate psychotherapy, jump-start recovery or help diminish debilitating, severe anxiety. But Pearson gives little in a well-rounded discussion. Her “cautionary tale,” as she describes it, certainly can help others to seek better treatment. If you’re considering medication, see a psychiatrist who specializes in anxiety disorders and who can answer all of your questions (and be sure to ask many). Don’t hesitate to do your own research and remember that you and your doctor are a team. You should never feel like a powerless bystander when it comes to your treatment.

Cognitive-behavioral therapy (CBT) is the first line of treatment for anxiety disorders — and a highly successful one at that. In fact, the success rates make other researchers envious, as one expert put it. So it’s disappointing that Pearson devotes just several pages to her experiences with the treatment. This does a disservice for readers who are learning about anxiety disorders for the first time. They may easily feel like there’s nothing out there that can help them. Pearson could’ve noted CBT’s efficacy and demystified the treatment for her readers.

What’s Pearson’s prescription for anxiety? For one, she calls for American society to grow up. She writes:

“What we need is to bend to the tempest like pine and palm trees—flexible, adaptive, attuned, yet fully rooted in our principles. What we need, in essence, is to grow up.”

We also should look inward and seek meaning. Pearson introduces her last chapter with a quote from the philosopher Rumi:

“Don’t look for the remedy for your troubles outside yourself. You are the medicine. You are the cure for your own sorrow.”

While this quote is empowering, it also implies that it’s best to treat an anxiety disorder on your own. And if you can’t reduce your anxiety, there’s something inherently awry. Again, anxiety disorders are treatable, and oftentimes, avoiding treatment only amplifies the anxiety. Seeking treatment means that you’re taking care of yourself; you’re seeking the resources that will help you get better. There’s no reason to suffer with anxiety. But Pearson’s point is important: Meaning is missing from our lives. In our “I want,” ever-entitled culture, it can be tough to find. But it’s key to us thriving.

Overall, Pearson’s book is a powerful read, which provides a refreshing perspective on anxiety in our age. It offers profound words of wisdom, coming from both Pearson and a slew of gifted, inspiring thinkers. And it can help jump-start your exploration into your own anxiety. At the same time, however, there’s no need to suffer. If you’re experiencing anxiety, make an appointment with a therapist who specializes in anxiety disorders.

A Brief History of Anxiety: Yours and Mine
By Patricia Pearson
Bloomsbury USA; Reprint edition (paperback) March 3, 2009
$13
208 pages

By educating yourself about panic attacks, you can begin to gain control of the problem. You don’t have to live in fear and uncertainty any longer. We’ll get you started on your journey toward well-being.

Accepting a panic attack for what it is can help to lessen its effect. To start feeling in control of your anxiety, make an appointment with your doctor and get a full physical exam. This will help you focus your approach, as you’ll find out for certain that you’re coping with panic attacks and not some other ailment. A clean bill of health can also help alleviate irrational fears of dying and doom, which can surface during a panic attack.

Also, your doctor can differentiate between occasional panic attacks and a more serious panic disorder, which may require professional treatment and possibly medication. Working with your doctor, you can also determine if you have a genetic susceptibility to panic attacks, and if your episodes are triggered in part by other conditions, such as a thyroid disorder or lactose sensitivity.

Recognize the Symptoms of a Panic Attack

Familiarizing yourself with panic attack symptoms can help you feel more in control while one’s happening. Once you realize you’re experiencing a panic attack and not a heart attack, allergic reaction, or some other serious ailment, you can focus on techniques for calming yourself.

Being able to recognize it for what it is will help you decide what action to take to overcome it. Although symptoms differ from person to person, and only a trained professional can provide a definite diagnosis, some common ones include:

• Irregular heartbeat
• Dizziness and lightheadedness
• Shortness of breath
• Choking sensations and nausea
• Shaking and sweating
• Fatigue and weakness
• Chest pain and heartburn
• Muscle spasms
• Hot flashes or sudden chills
• Tingling sensations in your extremities
• A fear that you’re going crazy
• A fear that you might die or be seriously ill

People who have phobias often are so overwhelmed by their anxiety that they avoid the feared objects or situations. Specific phobias involve a fear of an object or situation, such as small animals, snakes, closed-in spaces or flying in an airplane.

Social phobia is the fear of being humiliated in a social setting, such as when meeting new people, giving a speech, or talking to the boss. Most people experience these fears with mild to moderate intensity, and the fear passes. For people with social phobia, however, the fear is extremely intrusive and can disrupt normal life, interfering with work or social relationships in varying degrees of severity.

Fortunately, through research supported by the National Institute of Mental Health (NIMH), effective treatments have been developed to help people with phobias.

How Common Are Phobias?

Approximately 4 to 5 percent of the U.S. population has one or more clinically significant phobias in a given year.

Specific phobias occur in people of all ages. The average age of onset for social phobia is between 15 and 20 years of age, although it can often begin in childhood.

What Causes Phobias?

Traumatic events often trigger the development of specific phobias, which are slightly more prevalent in women than men. Research shows that social phobia may have a hereditary component and occurs in women and men in equal proportions. However, men may seek treatment for social phobia more frequently than women.

What Treatments Are Available for Phobias?

Social phobia can be effectively treated with medications including, MAOIs, SSRIs and high- potency benzodiazepines. People with a specific form of social phobia called performance phobia have been helped by drugs called beta blockers.

There is no proven drug treatment for specific phobias, but certain medications may help reduce symptoms of anxiety before one faces a phobic situation. A type of cognitive-behavioral therapy known as “exposure therapy” is also a very useful treatment for phobias. It involves helping patients become gradually more comfortable with situations that frighten them. Relaxation and breathing techniques are also helpful.

Can People With Phobias Also Have Other Physical and Emotional Illnesses?

People with phobias, particularly social phobia, may also have problems with substance abuse. Many people with social or a specific phobia become so anxious that they experience panic attacks, which are intense and unexpected bursts of terror accompanied by physical symptoms.

As more situational panic attacks occur, people with phobias may take extreme measures to avoid situations where they fear another attack might happen or where help would not be immediately available. This avoidance, similar to that in many panic disorder patients, may eventually develop into agoraphobia, an inability to go beyond known and safe surroundings because of intense fear and anxiety. Appropriate diagnosis and treatment of other disorders are important to successful treatment of phobias.

Specific Phobia

“I’m scared to death of flying, and I never do it anymore. It’s an awful feeling when that airplane door closes and I feel trapped. My heart pounds, and I sweat bullets. If somebody starts talking to me, I get very stiff and preoccupied.”

“When the airplane starts to ascend, it just reinforces that feeling that I can’t get out. I picture myself losing control, freaking out, climbing the walls, but of course I never do. I’m not afraid of crashing or hitting turbulence. It’s just that feeling of being trapped.”

“Whenever I’ve thought about changing jobs, I’ve had to think, ‘Would I be under pressure to fly?’ These days I only go places where I can drive or take a train. My friends always point out that I couldn’t get off a train traveling at high speeds either, so why don’t trains bother me? I just tell them it isn’t a rational fear.”

Social Phobia

“I couldn’t go on dates or to parties. For a while, I couldn’t even go to class. During my sophomore year of college, I had to come home for a semester.”

“My fear would happen in any social situation. I would be anxious before I even left the house, and it would escalate as I got closer to class, a party, or whatever. I would feel sick to my stomach — it almost felt like I had the flu. My heart would pound, my palms would get sweaty, and I would get this feeling of being removed from myself and from everybody else.”

“When I would walk into a room full of people, I’d turn red and it would feel like everybody’s eyes were on me. I was too embarrassed to stand off in a corner by myself, but I couldn’t think of anything to say to anybody. I felt so clumsy, I couldn’t wait to get out.”

Before undergoing any treatment for panic disorder, a person should undergo a thorough medical examination to rule out other possible causes of the distressing symptoms. This is necessary because a number of other conditions, such as excessive levels of thyroid hormone, certain types of epilepsy, or cardiac arrhythmias, which are disturbances in the rhythm of the heartbeat, can cause symptoms resembling those of panic disorder.

Several effective treatments have been developed for panic disorder and agoraphobia. In 1991, a conference held at the National Institutes of Health (NIH) under the sponsorship of the National Institute of Mental Health and the Office of Medical Applications of Research, surveyed the available information on panic disorder and its treatment. The conferees concluded that a form of psychotherapy called cognitive-behavioral therapy and medications are both effective for panic disorder. A treatment should be selected according to the individual needs and preferences of the patient, the panel said, and any treatment that fails to produce an effect within six to eight weeks should be reassessed.

Cognitive-Behavioral Therapy

This is a combination of cognitive therapy, which can modify or eliminate thought patterns contributing to the patient’s symptoms, and behavioral therapy, which aims to help the patient to change his or her behavior.

Typically the patient undergoing cognitive-behavioral therapy meets with a therapist for one to three hours a week. In the cognitive portion of the therapy, the therapist usually conducts a careful search for the thoughts and feelings that accompany the panic attacks. These mental events are discussed in terms of the “cognitive model” of panic attacks.

The cognitive model states that individuals with panic disorder often have distortions in their thinking, of which they may be unaware, and these may give rise to a cycle of fear. The cycle is believed to operate this way: First the individual feels a potentially worrisome sensation such as an increasing heart rate, tightened chest muscles, or a queasy stomach. This sensation may be triggered by some worry, an unpleasant mental image, a minor illness, or even exercise. The person with panic disorder responds to the sensation by becoming anxious. The initial anxiety triggers still more unpleasant sensations, which in turn heighten anxiety, giving rise to catastrophic thoughts. The person thinks, “I am having a heart attack” or “I am going insane,” or some similar thought. As the vicious cycle continues, a panic attack results. The whole cycle might take only a few seconds, and the individual may not be aware of the initial sensations or thoughts.

According to the National Institute of Mental Health (NIMH), each year roughly nineteen million adults within the United States experience anxiety disorders—which include obsessive-compulsive disorder (OCD), panic disorder (PD), post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), social anxiety disorder/social phobia, and specific phobias, such as fear of the outdoors (agoraphobia) or confined spaces (claustrophobia), among many others (http://www.nimh.nih.gov/publicat/anxiety.cfm).

Although prescription medications are the fastest method of treating anxiety disorders, they can have numerous side effects and consequences. Patients can easily become dependent on tranquilizers and sedatives, such as the benzodiazepines Atavin and Xanax, because of the (usually quite welcome, for anxiety sufferers) sense of calm they produce. Anti-depressants like Prozac and Zoloft, while not habit-forming, may cause a variety of physical side effects such as weight gain, insomnia, upset stomach, and diminished sexual appetite. These drugs can, when taken correctly, help sufferers of anxiety disorders to feel better—but most experts agree that for long-term improvement, patients should combine use of pharmaceuticals with psychotherapy.

Two common forms of psychotherapy utilized for treatment of anxiety disorders are behavioral and cognitive therapy: in cognitive therapy, the therapist helps the patient to adapt his or her problematic thought patterns into those which are healthier. For example, the therapist might help someone with panic disorder to prevent panic attacks—and make those that do occur less intense—by teaching him or her how to mentally re-approach anxiety-inducing situations. In behavioral therapy, the therapist will help the patient to combat undesirable behaviors which often come hand in hand with anxiety; for example, the patient will learn relaxation and deep breathing exercises to use when experiencing hyperventilation as a result of panic attacks (American Psychological Association).

Since these methods of treatment are such close cousins—both involving, in a sense, active re-education of the mind by the patient—therapists often use them together, in a broader classification of treatment called cognitive-behavioral therapy (CBT). CBT is used to treat all six forms of anxiety disorders listed above (CBT info).

The National Association of Cognitive-Behavioral Therapists (NACBT) lists on their website several different specific forms of CBT which have developed in the past half-century or so. These include:

Rational Emotive Therapy (RET)/Rational Emotive Behavior Therapy

Psychologist Albert Ellis, in the 1950s, believed that then-trendy psychoanalysis was an inefficient form of treatment because the patient was not directed to change his or her way of thinking; he originated RET, which was later developed further by neo-Freudian psychotherapist Alfred Adler. RET has roots in Stoic philosophy, such as in the writing of Marcus Aurelius and Epictetus; behaviorists Joseph Wolpe and Neil Miller seem also to have influenced Albert Ellis. Ellis continued working on his therapeutic approach, and in the 1990s—nearly forty years after first developing the treatment—he renamed it Rational Emotive Behavior Therapy, in order to make the treatment’s moniker more accurate.

Rational Behavior Therapy

One of Ellis’s students, physician Maxie C. Maultsby, Jr., developed this slight variation about ten years after Ellis first developed his. Rational Behavior Therapy is distinctive in that the therapist assigns “therapeutic homework” to the client, and places “emphasis on client rational self-counseling skills” (http://www.nacbt.org/historyofcbt.htm). Clients are urged to take added initiative in their own recoveries, even beyond that encouraged by many other forms of CBT.

Some other specialized forms of CBT are Schema Focused Therapy, Dialectical Behavior Therapy, and Rational Living Therapy. Many who are acquainted with CBT know of the therapy due to Feeling Good: The New Mood Therapy, the best-selling self-help book David Burns wrote in the 1980s (http://www.nacbt.org/historyofcbt.htm).

Finally, one form of behavioral psychotherapy which differs from CBT is Exposure with Response Prevention; usually used to treat specific phobias, Exposure with Response Prevention involves gradually making the patient familiar with the object or action causing anxiety—a sort of step-by-step “face your fears” treatment. In one successful case, a man who’d had a specific phobia of insecticides (after an incident of being poisoned himself while working in the fields of East Asia) for ten years became asymptomatic after ninety days of nearly consecutive treatment. His treatment included exposing himself to situations in which people were working with insecticides—sometimes the exposures were overseen by therapists, sometimes by his family members, and, eventually, by he alone. According to the authors of the study, the patient “was able to return to work at the farm and tolerate insecticides without much difficulty. Currently he is continuing with self-exposure sessions and maintaining well” (Narayana, Chakrabarti, & Grover, 12).

As with almost any illness, anxiety disorder patients must take some initiative in their treatment and recovery—whether it be by seeking help from a physician, taking medications properly and punctually, or attending and actively engaging in therapy sessions. CBT and other forms of psychotherapy, like Exposure with Response Prevention, are alternate forms of treatment for those who do not wish to take anti-depressants or other pharmaceuticals (or to only take those medications), but still wish to work towards recovery; the benefit of such therapies, which take them a step beyond pharmaceuticals, are thus: anti-depressants and other drugs seem to act as analgesics or, at best, vitamins; however, given the potential side effects, most patients might not wish to take them for their entire lives. With the aid of therapies—especially therapies in which they can most actively work towards recovery—patients can make the changes which will allow them to live with less anxiety for years to come.

References

American Psychological Association. (2004). Anxiety Disorders: The Role of
Psychotherapy in Effective Treatment. Retrieved December 14, 2005, from http://www.apahelpcenter.org/articles/article.php?id=46.

Narayana, K. C., Chakrabarti, S., & Grover, S. (2004). Insecticide Phobia Treated With Exposure and Response-Prevention: A Case Report. German Journal of Psychiatry, 7(2): 12-13.