Theoretical and therapeutic considerations for the anxiety disorders

Everyone is familiar with that paralyzing state of dread known as anxiety. Although it is unpleasant, the experience of anxiety has adaptive aspects: it can serve as an impetus to effect beneficial life change and can facilitate psychological development. Anxiety becomes of clinical concern, however, when it interferes with intellectual function, or arrests normal social or vocational pursuits. Anxiety disorders are chronic illnesses. Treatment can eliminate many of the disease's debilitating features, but the underlying disorder is not usually cured. Discontinuation of treatment-pharmacological, behavioral, or both-often results in the recurrence of symptoms. The focus of treatment, therefore, generally centers on striking a balance between the goal of alleviating the patient's symptoms, and the need to avoid the deleterious effects which result from long-term treatment (1). The intention of this paper is to review theoretical and therapeutic considerations for four types of anxiety disorder: panic disorder, generalized anxiety disorder, social phobia, and obsessive-compulsive disorder. In doing this, emphasis will be placed on the physiological concomitants and, when possible, neuropsychological bases of these illnesses. Furthermore, pharmacological treatment will be related to the underlying substrata of the disorder whenever possible.