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Coping with Anxiety and Phobi... Health Article

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Diagnosis and treatment in children

Diagnosing these disorders in children can be difficult because fear and anxiety are also symptoms of many other conditions, including depression, bipolar disorder, and attention deficit disorder. Parents are not always sensitive to children's signs of anxiety; teachers often give helpful perspective because they have experience with many children for comparison. Before diagnosing an anxiety disorder, it is important to find out first whether the child has good reasons to be afraid, such as abuse by a relative or a classroom bully.

Cognitive behavioral therapy. Cognitive behavioral therapy is the best confirmed treatment for anxiety disorders in children and adolescents. Its effectiveness has been shown in studies lasting as long as four years. A common method is graduated exposure to frightening objects or situations, with rewards for success in facing fears. Young children with phobias, for example, can be placed near the feared object and allowed to do something reassuring and enjoyable like eating or playing with a favorite toy. Older children can be shown how to use deep breathing or muscle relaxation, or be taught to talk themselves out of self-defeating and fear-provoking thoughts. Another technique is modeling — asking the anxious child to emulate the therapist or another child who shows no fear.

Cognitive and behavioral methods often work best in groups, which provide shy and fearful children with opportunities for making friends, increasing self-confidence, and trying out new kinds of behavior.

Drug therapy. With the exception of selective serotonin reuptake inhibitors (SSRIs) for obsessive-compulsive disorder, the FDA has not approved any drugs for childhood anxiety disorders. But because some SSRIs have been found effective and are approved for the treatment of adult anxiety disorders, many pediatricians and psychiatrists also prescribe these antidepressants for anxious children.

Parents and other family members can help by learning techniques for managing a child's anxiety, providing models of self-confidence and problem-solving, and giving rewards for overcoming fears. Sometimes a family problem is the source of the child's anxiety, or an anxious child thinks he or she is the cause of any trouble in the family. In that case, joint family therapy, in which all members participate, may be a good idea.

Anxiety and aging

Anxiety disorders are the most common mental health disorders among older adults. Approximately 11% of people ages 55 and over suffer from an anxiety disorder, while less than 4% experience major depression. Although most anxiety disorders start in early adulthood, they tend to last well into the later years. In addition to enduring anxiety disorders from their youth, older adults become increasingly susceptible to anxiety that's caused by illness or a medication. That's because both illness and the need for medication become more common with age (see "Medical conditions that provoke or mimic symptoms of anxiety disorder" and "Substance-induced anxiety disorder").

Anxiety in older adults has received relatively little scientific attention. Most of what's known comes from studies of young and middle-aged adults, but the findings on anxiety medications don't all hold true for older people. Age-related changes in the absorption and metabolism of drugs tend to make drugs linger longer in the body, increasing the risk for harmful effects even at doses considered safe for younger people. In addition, older adults are more likely to use medications for a variety of conditions, and some of these drugs can interact with anxiety medications.

Anxiety disorders in older adults

Approximately 11% of adults age 55 or over have an anxiety disorder.

Because of the greater risk of side effects, doctors often prescribe anti-anxiety drugs in lower doses or recommend different therapies. Benzodiazepines are avoided whenever possible because they cause more side effects, such as sedation and impaired cognition, than some newer drugs, such as buspirone (BuSpar). If benzodiazepines are used, the best choices are the short-acting versions, such as lorazepam (Ativan), oxazepam (Serax), or temazepam (Restoril), which don't linger in the body as long as long-acting ones, for example, diazepam (Valium), clonazepam (Klonopin), or chlordiazepoxide (Librium). In general, short-acting drugs cause less sedation and cognitive impairment, making them safer for people who need to drive.

Buspirone is thought to be safer than the benzodiazepines; it doesn't cause sedation or cognitive impairment, and it doesn't lead to adverse interactions when taken with a variety of drugs commonly used by older adults, including certain heart medications and drugs to control blood pressure. However, research on buspirone has been disappointing, with a number of studies finding it less effective than benzodiazepines in treating anxiety. And buspirone carries two other drawbacks: It takes several weeks to take effect, and it does not improve insomnia, a frequent complaint among older people with anxiety.

Preliminary studies have found that cognitive behavioral therapy is effective for older individuals with panic disorder and social phobia. When used along with medication, it may reduce the amount of time the drug is needed. For older people who can't tolerate anti-anxiety medications, this form of therapy can be used by itself.