Editing Anxiety disorder (section)

==Treatment==
Treatment options include [[psychotherapy]], medications and lifestyle changes. There is no clear evidence as to whether psychotherapy or medication is more effective; the specific medication decision can be made by a doctor and patient with consideration for the patient's specific circumstances and symptoms.<ref name="NEJM20152">{{cite journal | vauthors = Stein MB, Sareen J | title = CLINICAL PRACTICE. Generalized Anxiety Disorder | journal = The New England Journal of Medicine | volume = 373 | issue = 21 | pages = 2059–2068 | date = November 2015 | pmid = 26580998 | doi = 10.1056/nejmcp1502514 }}</ref> If, while on treatment with a chosen medication, the person's anxiety does not improve, another medication may be offered.<ref name="NEJM20152"/> Specific treatments will vary by sub-type of anxiety disorder, a person's other medical conditions, and medications.

===Psychological techniques===
[[Cognitive behavioral therapy]] (CBT) is effective for anxiety disorders and is a first-line treatment.<ref name="NEJM20152"/><ref>{{cite journal | vauthors = Cuijpers P, Sijbrandij M, Koole S, Huibers M, Berking M, Andersson G | title = Psychological treatment of generalized anxiety disorder: a meta-analysis | journal = Clinical Psychology Review | volume = 34 | issue = 2 | pages = 130–140 | date = March 2014 | pmid = 24487344 | doi = 10.1016/j.cpr.2014.01.002 }}</ref><ref>{{cite journal | vauthors = Otte C | title = Cognitive behavioral therapy in anxiety disorders: current state of the evidence | journal = Dialogues in Clinical Neuroscience | volume = 13 | issue = 4 | pages = 413–421 | year = 2011 | pmid = 22275847 | pmc = 3263389 | doi = 10.31887/DCNS.2011.13.4/cotte }}</ref><ref>{{cite journal | vauthors = Pompoli A, Furukawa TA, Imai H, Tajika A, Efthimiou O, Salanti G | title = Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 4 | pages = CD011004 | date = April 2016 | pmid = 27071857 | pmc = 7104662 | doi = 10.1002/14651858.CD011004.pub2 }}</ref><ref name=Ol2016>{{cite journal | vauthors = Olthuis JV, Watt MC, Bailey K, Hayden JA, Stewart SH | title = Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 3 | pages = CD011565 | date = March 2016 | pmid = 26968204 | pmc = 7077612 | doi = 10.1002/14651858.CD011565.pub2 }}</ref>{{Excessive citations inline|date=September 2021}} CBT is the most widely studied and preferred form of psychotherapy for anxiety disorders.<ref name="Szuhany 2022" /> CBT appears to be equally effective when carried out via the internet compared to sessions completed face-to-face.<ref name=Ol2016/><ref>{{cite journal | vauthors = Mayo-Wilson E, Montgomery P | title = Media-delivered cognitive behavioural therapy and behavioural therapy (self-help) for anxiety disorders in adults | journal = The Cochrane Database of Systematic Reviews | issue = 9 | pages = CD005330 | date = September 2013 | pmid = 24018460 | doi = 10.1002/14651858.CD005330.pub4 | pmc = 11694413 }}</ref> There are specific CBT curriculums or strategies for the specific type of anxiety disorder. CBT has similar effectiveness to pharmacotherapy and in a meta analysis, CBT was associated with medium to large benefit effect sizes for GAD, panic disorder and social anxiety disorder.<ref name="Szuhany 2022" /> CBT has low dropout rates and its positive effects have been shown to be maintained at least for 12 months. CBT is sometimes given as once weekly sessions for 8–20 weeks, but regimens vary widely. Booster sessions may need to be restarted for patients who have a relapse of symptoms.<ref name="Szuhany 2022" />

[[Exposure_therapy#Exposure_and_response_prevention_(ERP)|Exposure and response prevention (ERP)]] has been found effective for treating OCD.<ref>{{Cite journal |last1=Hezel |first1=Dianne M |last2=Simpson |first2=H Blair |date=January 2019 |title=Exposure and response prevention for obsessive-compulsive disorder: A review and new directions |journal=Indian Journal of Psychiatry |language=en |volume=61 |issue=Suppl 1 |pages=S85–S92 |doi=10.4103/psychiatry.IndianJPsychiatry_516_18 |doi-access=free |pmid=30745681 |pmc=6343408 }}</ref> [[Mindfulness]]-based programs also appear to be effective for managing anxiety disorders.<ref name="Roemer">{{cite journal | vauthors = Roemer L, Williston SK, Eustis EH, Orsillo SM | title = Mindfulness and acceptance-based behavioral therapies for anxiety disorders | journal = Current Psychiatry Reports | volume = 15 | issue = 11 | pages = 410 | date = November 2013 | pmid = 24078067 | doi = 10.1007/s11920-013-0410-3 }}</ref><ref name="Lang">{{cite journal | vauthors = Lang AJ | title = What mindfulness brings to psychotherapy for anxiety and depression | journal = Depression and Anxiety | volume = 30 | issue = 5 | pages = 409–412 | date = May 2013 | pmid = 23423991 | doi = 10.1002/da.22081 | doi-access = free }}</ref> It is unclear if meditation has an effect on anxiety, and [[transcendental meditation]] appears to be no different from other types of meditation.<ref>{{cite journal | vauthors = Krisanaprakornkit T, Krisanaprakornkit W, Piyavhatkul N, Laopaiboon M | title = Meditation therapy for anxiety disorders | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD004998 | date = January 2006 | pmid = 16437509 | doi = 10.1002/14651858.CD004998.pub2 }}</ref> A 2015 [[Cochrane review]] of [[Morita therapy]] for anxiety disorder in adults found not enough evidence to draw a conclusion.<ref>{{cite journal | vauthors = Wu H, Yu D, He Y, Wang J, Xiao Z, Li C | title = Morita therapy for anxiety disorders in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 2 | pages = CD008619 | date = February 2015 | pmid = 25695214 | doi = 10.1002/14651858.CD008619.pub2 | pmc = 10907974 }}</ref>

===Medications===
First-line choices for medications include [[Selective serotonin reuptake inhibitor|SSRIs]] or [[Serotonin–norepinephrine reuptake inhibitor|SNRIs]] to treat generalized anxiety disorder, social anxiety disorder or panic disorder.<ref name="Szuhany 2022" /><ref name="NEJM20152"/><ref name="Bald2005">{{cite journal | vauthors = Baldwin DS, Anderson IM, Nutt DJ, Allgulander C, Bandelow B, den Boer JA, Christmas DM, Davies S, Fineberg N, Lidbetter N, Malizia A, McCrone P, Nabarro D, O'Neill C, Scott J, van der Wee N, Wittchen HU | title = Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology | journal = Journal of Psychopharmacology | volume = 28 | issue = 5 | pages = 403–439 | date = May 2014 | pmid = 24713617 | doi = 10.1177/0269881114525674 | url = https://tud.qucosa.de/api/qucosa%3A35384/attachment/ATT-0/ }}</ref> For adults, there is no good evidence supporting which specific medication in the SSRI or SNRI class is best for treating anxiety, so cost often drives drug choice.<ref name="NEJM20152"/><ref name="Bald20052">{{cite journal | vauthors = Baldwin DS, Anderson IM, Nutt DJ, Allgulander C, Bandelow B, den Boer JA, Christmas DM, Davies S, Fineberg N, Lidbetter N, Malizia A, McCrone P, Nabarro D, O'Neill C, Scott J, van der Wee N, Wittchen HU | title = Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology | journal = Journal of Psychopharmacology | volume = 28 | issue = 5 | pages = 403–439 | date = May 2014 | pmid = 24713617 | doi = 10.1177/0269881114525674 | url = https://tud.qucosa.de/id/qucosa%3A35384 }}</ref> [[Fluvoxamine]] is effective in treating a range of anxiety disorders in children and adolescents.<ref name=Kwint2022>{{cite journal | vauthors = Kwint J  |title=Antidepressants for children and teenagers: what works for anxiety and depression? |journal=NIHR Evidence |date=November 2022 |doi=10.3310/nihrevidence_53342 |doi-access=free }}</ref><ref name="Boaden_2020">{{cite journal | vauthors = Boaden K, Tomlinson A, Cortese S, Cipriani A | title = Antidepressants in Children and Adolescents: Meta-Review of Efficacy, Tolerability and Suicidality in Acute Treatment | journal = Frontiers in Psychiatry | volume = 11 | pages = 717 | date = 2 September 2020 | pmid = 32982805 | pmc = 7493620 | doi = 10.3389/fpsyt.2020.00717 | doi-access = free }}</ref><ref name="Correll_2021">{{cite journal | vauthors = Correll CU, Cortese S, Croatto G, Monaco F, Krinitski D, Arrondo G, Ostinelli EG, Zangani C, Fornaro M, Estradé A, Fusar-Poli P, Carvalho AF, Solmi M | title = Efficacy and acceptability of pharmacological, psychosocial, and brain stimulation interventions in children and adolescents with mental disorders: an umbrella review | journal = World Psychiatry | volume = 20 | issue = 2 | pages = 244–275 | date = June 2021 | pmid = 34002501 | pmc = 8129843 | doi = 10.1002/wps.20881 }}</ref> [[Fluoxetine]], [[sertraline]], and [[paroxetine]] can also help with some forms of anxiety in children and adolescents.<ref name=Kwint2022/><ref name="Boaden_2020" /><ref name="Correll_2021" /> If the chosen medicine is effective, it is recommended that it be continued for at least a year to mitigate the risk of a relapse.<ref name="Szuhany 2022" /><ref name="Batelaan Bosman Muntingh et al 2017">{{cite journal | vauthors = Batelaan NM, Bosman RC, Muntingh A, Scholten WD, Huijbregts KM, van Balkom AJ | title = Risk of relapse after antidepressant discontinuation in anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder: systematic review and meta-analysis of relapse prevention trials | journal = BMJ | volume = 358 | pages = j3927 | date = September 2017 | pmid = 28903922 | pmc = 5596392 | doi = 10.1136/bmj.j3927 }}</ref>

Benzodiazepines are a second line option for the pharmacologic treatment of anxiety. Benzodiazepines are associated with moderate to high effect sizes with regard to symptom relief and they have an onset usually within 1 week.<ref name="Szuhany 2022" /> Clonazepam has a longer half life and may possibly be used as once per day dosing.<ref name="Szuhany 2022" /> Benzodiazepines may also be used with SNRIs or SSRIs to initially reduce anxiety symptoms, and they may potentially be continued long term. Benzodiazepines are not a first line pharmacologic treatment of anxiety disorders and they carry risks of [[physical dependence]], [[psychological dependence]], [[Opioid overdose|overdose death]] (especially when combined with opioids), misuse, [[cognitive impairment]], falls and motor vehicle crashes.<ref name="Szuhany 2022" /><ref name="Thomas 1998">{{cite journal |last1=Thomas |first1=RE |title=Benzodiazepine use and motor vehicle accidents. Systematic review of reported association. |journal=Canadian Family Physician |date=April 1998 |volume=44 |pages=799–808 |pmid=9585853|pmc=2277821 }}</ref>

[[Buspirone]] and [[pregabalin]] are second-line treatments for people who do not respond to SSRIs or SNRIs. Pregabalin and [[gabapentin]] are effective in treating some anxiety disorders, but there is concern regarding their off-label use due to the lack of strong scientific evidence for their efficacy in multiple conditions and their proven side effects.<ref name=":12">{{cite journal | vauthors = Hong JS, Atkinson LZ, Al-Juffali N, Awad A, Geddes JR, Tunbridge EM, Harrison PJ, Cipriani A | title = Gabapentin and pregabalin in bipolar disorder, anxiety states, and insomnia: Systematic review, meta-analysis, and rationale | journal = Molecular Psychiatry | volume = 27 | issue = 3 | pages = 1339–1349 | date = March 2022 | pmid = 34819636 | pmc = 9095464 | doi = 10.1038/s41380-021-01386-6 }}</ref>

Medications need to be used with care among older adults, who are more likely to have side effects because of coexisting physical disorders. Adherence problems are more likely among older people, who may have difficulty understanding, seeing, or remembering instructions.<ref name="Calleo" />

In general, medications are not seen as helpful for [[specific phobia]]s, but [[benzodiazepines]] are sometimes used to help resolve acute episodes. In 2007, data were sparse for the efficacy of any drug.<ref>{{cite journal | vauthors = Choy Y, Fyer AJ, Lipsitz JD | title = Treatment of specific phobia in adults | journal = Clinical Psychology Review | volume = 27 | issue = 3 | pages = 266–286 | date = April 2007 | pmid = 17112646 | doi = 10.1016/j.cpr.2006.10.002 }}</ref>

===Lifestyle and diet===
Lifestyle changes include exercise, for which there is moderate evidence for some improvement, regularizing sleep patterns, reducing caffeine intake, and stopping smoking.<ref name="NEJM20152"/> Stopping smoking has benefits for anxiety as great as or greater than those of medications.<ref>{{cite journal | vauthors = Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, Aveyard P | title = Change in mental health after smoking cessation: systematic review and meta-analysis | journal = BMJ | volume = 348 | issue = feb13 1 | pages = g1151 | date = February 2014 | pmid = 24524926 | pmc = 3923980 | doi = 10.1136/bmj.g1151 }}</ref> A meta-analysis found 2000&nbsp;mg/day or more of omega-3 polyunsaturated fatty acids, such as fish oil, tended to reduce anxiety in placebo-controlled and uncontrolled studies, particularly in people with more significant symptoms.<ref name="SuTseng2018">{{cite journal | vauthors = Su KP, Tseng PT, Lin PY, Okubo R, Chen TY, Chen YW, Matsuoka YJ | title = Association of Use of Omega-3 Polyunsaturated Fatty Acids With Changes in Severity of Anxiety Symptoms: A Systematic Review and Meta-analysis | journal = JAMA Network Open | volume = 1 | issue = 5 | pages = e182327 | date = September 2018 | pmid = 30646157 | pmc = 6324500 | doi = 10.1001/jamanetworkopen.2018.2327 }}</ref>

===Cannabis===
{{as of|2019}}, there is little evidence for the use of [[cannabis]] in treating anxiety disorders.<ref>{{cite journal | vauthors = Black N, Stockings E, Campbell G, Tran LT, Zagic D, Hall WD, Farrell M, Degenhardt L | title = Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis | journal = The Lancet. Psychiatry | volume = 6 | issue = 12 | pages = 995–1010 | date = December 2019 | pmid = 31672337 | pmc = 6949116 | doi = 10.1016/S2215-0366(19)30401-8 }}</ref>

===Treatments for children ===
Both therapy and a number of medications have been found to be useful for treating childhood anxiety disorders.<ref name=Wang2017>{{cite journal | vauthors = Wang Z, Whiteside SP, Sim L, Farah W, Morrow AS, Alsawas M, Barrionuevo P, Tello M, Asi N, Beuschel B, Daraz L, Almasri J, Zaiem F, Larrea-Mantilla L, Ponce OJ, LeBlanc A, Prokop LJ, Murad MH | title = Comparative Effectiveness and Safety of Cognitive Behavioral Therapy and Pharmacotherapy for Childhood Anxiety Disorders: A Systematic Review and Meta-analysis | journal = JAMA Pediatrics | volume = 171 | issue = 11 | pages = 1049–1056 | date = November 2017 | pmid = 28859190 | pmc = 5710373 | doi = 10.1001/jamapediatrics.2017.3036 }}</ref> Therapy is generally preferred to medication.<ref name="Higa-McMillan"/>

[[Cognitive behavioral therapy]] (CBT) is a good first-line therapy approach.<ref name="Higa-McMillan">{{cite journal | vauthors = Higa-McMillan CK, Francis SE, Rith-Najarian L, Chorpita BF | title = Evidence Base Update: 50 Years of Research on Treatment for Child and Adolescent Anxiety | journal = Journal of Clinical Child and Adolescent Psychology | volume = 45 | issue = 2 | pages = 91–113 | date = 3 March 2016 | pmid = 26087438 | doi = 10.1080/15374416.2015.1046177 | doi-access = free }}</ref> Studies have gathered substantial evidence for treatments that are not CBT-based as effective forms of treatment, expanding treatment options for those who do not respond to CBT.<ref name="Higa-McMillan" /> Although studies have demonstrated the effectiveness of CBT for anxiety disorders in children and adolescents, evidence that it is more effective than [[Standard treatment|treatment as usual]], medication, or [[Wait list control group|wait list controls]] is inconclusive.<ref>{{cite journal | vauthors = James AC, James G, Cowdrey FA, Soler A, Choke A | title = Cognitive behavioural therapy for anxiety disorders in children and adolescents | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 2 | pages = CD004690 | date = February 2015 | pmid = 25692403 | pmc = 6491167 | doi = 10.1002/14651858.CD004690.pub4 }}</ref> Like adults, children may undergo psychotherapy, cognitive-behavioral therapy, or counseling. [[Family therapy]] is a form of treatment in which the child meets with a therapist together with the primary guardians and siblings.<ref name=CRD2017/> Each family member may attend individual therapy, but family therapy is typically a form of group therapy. Art and [[play therapy]] are also used. [[Art therapy]] is most commonly used when the child will not or cannot verbally communicate due to trauma or a disability in which they are nonverbal. Participating in art activities allows the child to express what they otherwise may not be able to communicate to others.<ref>{{cite journal | vauthors = Kozlowska K, Hanney L |title=Family Assessment and Intervention Using an Interactive Art Exercise |journal=Australian and New Zealand Journal of Family Therapy |date=June 1999 |volume=20 |issue=2 |pages=61–69 |doi=10.1002/j.1467-8438.1999.tb00358.x }}</ref> In play therapy, the child is allowed to play however they please as a therapist observes them. The therapist may intercede from time to time with a question, comment, or suggestion. This is often most effective when the family of the child plays a role in the treatment.<ref name="CRD2017">{{cite journal | vauthors = Creswell C, Cruddace S, Gerry S, Gitau R, McIntosh E, Mollison J, Murray L, Shafran R, Stein A, Violato M, Voysey M, Willetts L, Williams N, Yu LM, Cooper PJ | title = Treatment of childhood anxiety disorder in the context of maternal anxiety disorder: a randomised controlled trial and economic analysis | journal = Health Technology Assessment | volume = 19 | issue = 38 | pages = 1–184, vii–viii | date = May 2015 | pmid = 26004142 | pmc = 4781330 | doi = 10.3310/hta19380 }}</ref><ref>{{cite book |doi=10.1037/10439-012 |chapter=Humanistic play therapy |title=Humanistic psychotherapies: Handbook of research and practice |year=2002 | vauthors = Bratton SC, Ray D |pages=369–402 |isbn=978-1-55798-787-7 }}</ref>