From the Guidelines
Before considering pharmacological treatments for anxiety, clinicians should offer individual or group therapy with evidence-based treatment options such as CBT, BA, structured physical activity, and psychosocial interventions with empirically supported components, as recommended by the ASCO guideline update 1. When managing anxiety, it is crucial to prioritize non-pharmacological interventions that have been proven to be effective in reducing symptoms.
- Cognitive-behavioral therapy (CBT) is a highly recommended approach, which can be delivered in individual or group settings, focusing on identifying and challenging anxious thoughts and behaviors.
- Behavioral activation (BA) is another effective option, which aims to increase engagement in activities that bring pleasure and fulfillment.
- Structured physical activity and exercise have also been shown to significantly reduce anxiety symptoms, with recommendations including at least 30 minutes of moderate aerobic activity, 3-5 times weekly.
- Psychosocial interventions with empirically supported components, such as relaxation techniques and problem-solving, can also be beneficial in managing anxiety symptoms. These interventions should be implemented and tried for at least 4-6 weeks before considering medication, as recommended by the guideline update 1, although patients with severe, debilitating anxiety may require concurrent pharmacotherapy alongside these behavioral approaches. Key lifestyle modifications, including regular exercise, healthy sleep habits, and limited caffeine and alcohol consumption, should also be encouraged to help alleviate anxiety symptoms. Overall, the focus should be on implementing evidence-based, non-pharmacological interventions as the first line of treatment for anxiety, as supported by the recent ASCO guideline update 1.
From the Research
Pre-pharmacological Interventions for Anxiety
Pre-pharmacological interventions for anxiety disorders include various forms of psychotherapy. The most commonly recommended form of psychotherapy is:
- Cognitive Behavioral Therapy (CBT) 2, 3, 4, 5, 6 CBT is a first-line treatment for anxiety disorders, offering longer-term maintenance of treatment gains 2. It includes core components such as psychoeducation, cognitive restructuring, exposure therapy, and relapse prevention 3.
Components of Cognitive Behavioral Therapy
The components of CBT relevant across anxiety disorders are:
- Psychoeducation: educating patients about their anxiety disorder
- Cognitive restructuring: helping patients identify and change negative thought patterns
- Exposure therapy: helping patients gradually become comfortable with situations or objects they fear
- Relapse prevention: teaching patients skills to maintain progress and prevent relapse 3
Other Forms of Psychotherapy
Other forms of psychotherapy that may be recommended for anxiety disorders include:
- Mindfulness-Based Cognitive Therapy (MBCT) 5
- Acceptance and Commitment Therapy (ACT) 5
- Psychodynamic therapy, which is recommended as a second-line treatment 6
Considerations for Treatment
When selecting a treatment, clinicians should consider: