Davidson Page |1

JoElle Davidson

Mr. Hellmers

Eng. 1201

30 April 2020

Suitable Treatments for Anxiety Disorders

Nearly 18% of the United States have experienced an anxiety disorder in any given year

(Anxiety and Depression Association of America). While anxiety is reported as the most

common mental disorder, only one-third of those affected receive treatment for their

disorder. Medication is used for nearly 40% of patients with anxiety (Roberge, Normand-

Lauziere and Raymond), with SSRI’s being the most prescribed, even though they have several

problems, such as side effects, loss of effectiveness, and overuse. There any suitable alternates to

SSRI’s available for anxiety disorders, like Cognitive Behavior Therapy (CBT), Mindfulness-

based cognitive therapy (MBCT), and even Cannabidiol (CBD).

What exactly is an anxiety disorder? An anxiety disorder

is categorized by extreme fear and worry. Anxiety disorders

include several disorders, such as; generalized anxiety disorder

(GAD), panic disorders or panic attacks, phobias, social anxiety,

selective mutism, and separation anxiety (Anxiety and

Depression Association of America). Disorders such as

Fig.1 A guide to symptoms of anxiety.

[ CITATION Anx2 \l 1033 ]
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Obsessive-Compulsive Disorder (OCD) and Post-Traumatic Stress Disorder (PTSD) aren’t

considered anxiety disorders but are closely related. Anxiety disorders not only affect the people

suffering from them but their countries as well. It is estimated that the USA spent 42.3 billion in

1990 for anxiety disorders[ CITATION Sad18 \l 1033 ].

While anxiety might seem like a 20th-century disorder, there are writings hinting at

anxiety being a symptom and disorder by Greco-Roman philosophers. Hippocrates has a

collection of medical texts called the Hippocratic Corpus. In part of the texts he talks about his

phobia of a man Nicanor, and the masses of terror that rose when he heard Nicanor coming.

Then throughout time there are other instances, like in 1692, The Anatomy of Melancholy by

Robert Burton, anxiety is included as a melancholia diagnosis. Later in the late 19th-century

anxiety became a diagnosis for neurasthenia to neuroses. Then coming to its current

classification the DSM-5 group, which includes anxiety disorders, OCD, and trauma-and-stressor

disorders. (Crocq)

Nearly 2/3 of participants in a GAD study had been prescribed a type of psychotropics

like SSRI’s (Roberge, Normand-Lauziere and Raymond). One short-term psychotropic is

benzodiazepines, which can have negative side effects if taken long-term. Though data suggest

that a large portion of people are taking it in the long term. One study showed that participants

who visited a family physician to get treatment for GAD were three times as likely to receive

adequate pharmacotherapy (Roberge, Normand-Lauziere and Raymond). It is not stated if this is

due to patients keeping medication to continually take or if doctors are prescribing it in the long
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term. Either way this can be dangerous to patient’s health, other treatment routes should be taken

or prescribed. 

SSRI’s, like benzodiazepines can have a number of side effects, normally they are

temporary and/or mild. These side effects include, insomnia, skin rashes, headaches, joint and

muscle pain, upset stomach, nausea, or diarrhea (Harvard Health). Medications like these can

also affect patients’ sex lives, since SSRI’s are known to diminish not only sexual interest and

desire but satisfaction and performance as well. This coupled with the fact that any

antidepressant, such as SSRIs, can lose its effects, from a patient’s brain becoming tolerant to the

effects of the drug. That can be easily remedied by upping a dosage or switching medications,

but this causes patients to deal with the side effects of a new medication or dosage once again.

Not only are there side effects, but SSRI’s has some effects that could be a little more deadly for

some patients as well. Since there is a risk that SSRI’s can reduce blood clotting capacities.

Mixing SSRIs with other medications can be risky as well. Taking aspirin or ibuprofen when on

SSRIs creates a higher risk for internal bleeding. Other drugs that help with serotonin levels can

be risky to take with SSRI’s as well, since it can cause Serotonin Syndrome to occur. Serotonin

Syndrome can cause some problems like; racing heart, sweating, high fever, high blood pressure,

and even delirium (Harvard Health). SSRIs do not seem to be the perfect solution to anxiety

disorders, especially in the long run.

One of the alternatives is Cognitive Behavior Therapy, it is one of the most common

therapy options for anxiety disorders. The goal of CBT is to decrease maladaptive behaviors and
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increase adaptive ones by modifying a person’s antecedents and consequences and by behavioral

practices that result in new learning (Otte). So, this could be taking someone with a panic

disorder, and identifying what is causing the panic and through practice, decrease stress and fear

of the panic. This treatment has varying ranges of success ranging from small to large effects

depending on the disorder studied. With Panic disorders we can see a smaller effect compared to

Acute Stress Disorder (Otte). 

As the most supported psychotherapy, Cognitive Behavior Therapy seems to be a great

choice in treating anxiety. In the USA it is the most frequently used psychotherapy for anxiety

disorders. While there is a range of success in CBT treatment for anxiety, most disorders seem to

fall in the medium effect category. So, while CBT might be more effective for some disorders, it

is still effective with most anxiety disorders. While it is easily available in the USA, it can be

hard to find in other countries, like for instance, Japan (Sado). There also seems to be a variance

in effectiveness across anxiety disorders. Looking at studies on CBT versus supportive therapy,

for those suffering from GAD there is not a significant difference in results between CBT and

supportive therapy (Otte).  

CBT can also be expensive, costing around $75-150, an average of $87.5 a session

(Legg). Since CBT usually includes weekly sessions for 5-10 weeks, this adds up. There are

some programs available to help people afford mental health care, but that is usually done by the

local community. Apps like BetterHelp and TalkSpace are also available as a cheaper alternative.

Still these apps can cost $35-80 a week (Legg). So, while this treatment can be effective for
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some forms of anxiety, it is not feasible for everyone and if treatment must be prolonged, it can

be a costly treatment. 

      From there we can look at CBT’s close relative, Mindfulness-based cognitive therapy.

MBCT is a combination of CBT and mindfulness-based stress reduction. Sado conducted a study

to test the effectiveness in using MBCT for anxiety, in the study they set up 8 weekly 2-hour

sessions. The sessions consisted of three parts; first practicing meditation and yoga. The second

part, sharing experiences. Third part, psychoeducational portions. In between the sessions the

participants were given an audio CD with instructions on other exercises to complete and were

encouraged to use them daily for 30 minutes to 1 hour. The participants had a range of anxiety

disorders, such as panic disorder, social anxiety disorder, OCD, and GAD. So far MBCT has

proven to be effective in relapse prevention of depressive episodes, chronic pain, as well as an

effective treatment for anxiety disorders (Sado). Though the study did not separate the data from

one disorder from another, so we cannot say if this treatment is effective for all anxiety types or

just a few. 

Studies have shown MBCT to be more effective in preventing relapse for several issues

like, chronic pain, depressive episodes, and psychological distress (Sado). For anxiety,

preventing relapse can help prevent anxiety attacks or episodes and help those afflicted worry

less. Sado’s study did show a 5% improvement across multiple scales for anxiety[ CITATION

Sad18 \l 1033 ]. Though quite a few anxiety disorders were included in the study, panic

disorders, social anxiety disorder, GAD, and OCD. OCD is technically under a different class

than the other three disorders, but is closely related to anxiety disorders (Anxiety and Depression
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Association of America). This shows us that MBCT can be effective as a treatment for anxiety

disorders, but there is a distinction of effectiveness between separate disorders. 

MBCT has a range of price options from a free app, Oxford MBCT (Goldberg and Segal)

to $650 full-tuition for an 8-week course, either in person or virtual

(UMassMemorialMedicalCenter). Making it an easily accessible treatment option for anyone

with an internet connection. Though options such as the video demonstrations and books don’t

have the added benefit of someone running the program and guiding them personally along.

Which could end up being crucial in completing the program. 

      Then we come to Cannabidiol (CBD), this is a newer treatment in the USA, since it became a

Federal Schedule I substance in 1970. Before that cannabis had been used to treat multiple

ailments, such as malaria, gout, epilepsy, nausea, and vomiting (Shannon, Lewis and Lee). So far

testing that has been done in the USA in terms of CBD being a possible treatment for anxiety has

been successful. In a 2019 study, a sample of adults with GAD was given a CBD treatment. Most

participants saw anxiety and sleep improve throughout the study, with a larger decrease in

anxiety scores than sleep scores (Shannon, Lewis and Lee). Few participants reported side

effects, with only one participant having to be taken off CBD due to inappropriate behavior.

There is also the issue that some people refused treatment due to religious or ethical reasons, and

some participants having side effects like dry eyes.

Since Cannabidiol is illegal federally in the USA, it isn’t the most easily accessible

treatment option. Even with its roots in the past as a medical treatment for a number of ailments.
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There are also concerns from people who don’t want to use it because of their religion or ethical

reasons. Meaning CBD is not the treatment for everyone. Price ranges vary for CBD, for

example, CBD oil can cost anywhere from $30 to $250, varying from 300mg to 1500mg. Since

the average dose is 20mg, a 300mg can last you half a month and the 1500mg could last over two

months. Making CBD, where it is legally available a cost-effective option. 

Though cannabidiol is far from a perfect treatment. There seem to be a few side effects

such as; fatigue, mild sedation, dry eyes, and one patient who exhibited increased sexually

inappropriate behavior, though they had a developmental disorder in addition to his anxiety

disorder (Shannon, Lewis and Lee). Some of these patients did not return to the study, it is not

known if it is because of the side effects or other reasons. Of the 72 original patients, 37.5%

stayed with the treatment after the final assessment. While only under half the participants stayed

with the treatment, it seems as though they had minimum side effects.  

This creates a lot of options for treating anxiety disorders. Looking at psychotherapy,

CBT, and MBCT while similar, both have their advantages and disadvantages. CBT is easily

available in the USA and has shorter sessions than MBCT. Though MBCT has a lower relapse

rate among patients. Therapy can be time-consuming though, and each session can add up to a

costly treatment. Though therapy help participants work through their disorders so they can live

life without them. That compared to pharmacotherapy, which usually works at increasing

serotonin levels in the body. Psychotherapy aims to teach patients how to live without their help,

while pharmacotherapy works at correcting chemical imbalances in the body.

 
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  Pharmacotherapy options like SSRIs and CBD are available but both have an adjustment

period for its patients. This paired with the fact that no pharmacotherapy is perfect for everyone

means there is some trial and error to find the right fit for a patient. SSRI’s have lots of options if

a certain medicine doesn’t pair well with a patient, while CBD doesn’t have any alternatives.

Side effects-wise, the side effects for CBD seem to be on the milder side, and most participants

who stuck with the treatment didn’t seem to have side effects. While SSRI’s can have a load of

side effects that are ever-changing due to changes in dosage, brand, or type of SSRI.

SSRIs are currently the most commonly used method to treat anxiety disorders. Therapy

can be time-consuming, with CBT being 45 minutes to 1-hour sessions, and MBCT can be 2-

hour sessions. While pharmacotherapy takes a session with a doctor to get a prescription or up a

dosage. Previous studies have said that pharmacotherapy is almost twice as effective to treat

anxiety disorders as psychotherapy. With CBD being illegal this makes pharmacotherapy, like

SSRI’s as the most effective option, but is it worth it? With all the side effects that come along

with SSRI’s like headaches, insomnia, and diarrhea. Having to go and change medication every

time your body adjusts to the medicine, resetting the side effects.

Looking at the four treatment options covered, Cognitive Behavior Therapy,

Mindfulness-based cognitive therapy, SSRI’s, and Cannabidiol, they are all viable treatment

options. They each have pros and cons. The one thing they all have in common is, they are not

absolute. None of these treatment options are 100% effective in treating anxiety, because anxiety

affects people differently. Each study had participants that the treatment did not work for them,

some of them even experienced negative effects on their anxiety. Two-thirds of anxiety sufferers
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don’t receive treatment, and with each treatment type having issues and even worsening some

participants anxiety. This makes it even harder for anxiety suffers to receive adequate treatment.

There are quite a few options for treating anxiety disorders. Each seems dependent on the

type of anxiety disorder and the people getting the treatment. CBT might not be the best option

for someone with a panic disorder, but a person with a stress-based anxiety would benefit

greatly. While MBCT is more effective across more variety of anxiety disorders. Then when we

look more into medical treatments, like CBD and SSRI’s. CBD could be an alternative to

traditional medication, since one of the most common prescriptions, benzodiazepines, should

only be taken in the short-term. CBD side effects vary from person to person. While SSRI’s

seem to have a place in helping in the short term, but with the side effect, dosage changes, and

risks, it doesn’t seem to be the best long-term treatment option. There are a number of suitable

alternates to taking SSRIs long-term, Cognitive Behavior Therapy (CBT), Mindfulness-based

cognitive therapy (MBCT), and even Cannabidiol (CBD).

Works Cited

“Anxiety Disorder.” NAMI Kenosha County, www.namikenosha.org/anxiety-disorder.html.

Goldberg, Simon B, and Zindel V. Segal. “Treatment: Mindfulness-Based Cognitive Therapy.”

Society of Clinical Psychology, www.div12.org/treatment/mindfulness-based-cognitive-

therapy/.

Harvard Health Publishing. “What Are the Real Risks of Antidepressants?” Harvard Health,

2019, www.health.harvard.edu/mind-and-mood/what-are-the-real-risks-of-

antidepressants.

“Home.” Home | Anxiety and Depression Association of America, ADAA, adaa.org/.

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Legg, Timothy J. Therapy for Every Budget: How to Access It. 20 July 2018,

www.healthline.com/health/therapy-for-every-budget.

“MBSR or MBCT: Tuition and Payment.” MBSR or MBCT: Tuition and Payment - UMass

Memorial Medical Center - UMass Memorial Health Care,

www.umassmemorialhealthcare.org/umass-memorial-medical-center/services-

treatments/center-for-mindfulness/mindfulness-programs/mbsr-or-mbct-tuition-and-

payment.

Otte, Christian. “Cognitive Behavioral Therapy in Anxiety Disorders: Current State of the

Evidence.” Dialogues in Clinical Neuroscience, Les Laboratoires Servier, 2011,

www.ncbi.nlm.nih.gov/pmc/articles/PMC3263389/.

Roberge, Pasquale, et al. Generalized Anxiety Disorder in Primary Care: Mental Health

Services Use and Treatment Adequacy. BMC, 2015,

bmcfampract.biomedcentral.com/articles/10.1186/s12875-015-0358-y.

Sado, Mistsuhiro. Feasibility Study of Mindfulness-Based Cognitive Therapy for Anxiety

Disorders in a Japanese Setting. BMC, 2018, bmcresnotes-biomedcentral-

com.sinclair.ohionet.org/articles/10.1186/s13104-018-3744-4#Abs1.

Shannon, Scott, et al. “Cannabidiol in Anxiety and Sleep: A Large Case Series.” The

Permanente Journal, The Permanente Journal, 2019,

www.ncbi.nlm.nih.gov/pmc/articles/PMC6326553/.