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Psychotherapy - Anxiety Disorders

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There are three central cognitive-behavioral techniques in the treatment of anxiety: relaxation training, cognitive restructuring, and exposure. Relaxation training consists of tension-relaxation exercises involving different muscle groups and adaptations of the progressive relaxation techniques of Bernstein and Berkovec. Cognitive restructuring involves identifying cognitions associated with fear and modifying them into alternative, less distressing cognitions, as well as teaching coping strategies. Patients are also required to monitor thoughts and practice strategies outside therapy sessions. Exposure helps to manage phobias and consists of gradual real-life exposure or imagined exposure to the phobic situation. For example, a person with a phobia of the dentist, will, gradually and with therapist support, look at pictures of dentists, be in an examination room with a dentist and patient, and then have dental work performed. The patient is thus safely exposed to her or his fear.

There is virtually no research on psychotherapeutic treatment effectiveness in elderly anxious patients. However, Sheikh and Cassidy recommend that treatment strategies can be based on the research with younger populations and modified for older patients. The literature has demonstrated effectiveness of CBT for different anxiety disorders in adults, including generalized anxiety disorder (GAD), panic disorder, phobias, and obsessive-compulsive disorder. CBT interventions have been found successful, either alone or with medication for all of these disorders. Also, research suggests that post-traumatic stress disorder (PTSD) can be chronic, continuing into old age from an earlier event. Snell and Padin-Rivera have reported that group psychotherapy is effective in treating elderly veterans with PTSD.

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