The fact is that cognitive-behavioral therapy and medications work. Countless people all over the world have been helped by either one or a combination of both of these approaches. Research and clinical practice have repeatedly supported their efficacy. No self-respecting clinician who is knowledgeable about anxiety disorders fails to utilize them.

But not everyone who receives cognitive-behavioral therapy and/or medication achieves satisfactory recovery. And there are some persons who, having received good treatment, get better for a while and then relapse. Thus it appears that, at least sometimes, something more than CBT and medication is needed to ensure a lasting and high level of recovery.

The technologies of cognitive-behavioral therapy and psychopharmacology, while very helpful, might not always be sufficient.

If, for example, people didn’t change their lifestyles, work on overcoming anxiety-prone personality traits such as perfectionism, address interpersonal conflicts at home or work, or find some larger meaning in their life, they might continue to remain anxious in spite of the best efforts of their cognitive-behavioral therapists and psychiatrists.

Rather than offering specific techniques to address physiology, thoughts, and behavior, the approach taken in these articles deals with the whole person. As you read through them, you’ll be examining such issues as:

• how to simplify your life to achieve greater peace of mind

• how to address difficult personality issues that create anxiety

• what “alternative” therapies might be helpful

• how learning to meditate regularly can reduce worry

• how finding your unique life purpose and embracing a more spiritual outlook might offer a deep healing in your life

You didn’t develop an anxiety disorder out of the blue. It happened because of an accumulation of stress over a long time, or perhaps just one major stressor, in combination with your genetic makeup; your childhood; and your particular lifestyle, priorities, personality, and interpersonal situation as an adult. Yes, of course, you want to get rid of your symptoms. But you might also view your symptoms as an ally.

Your symptoms are calling you to understand yourself better to really examine yourself and figure out what changes you need to make in yourself and your life to feel better.

Look at it this way: If your anxiety disorder didn’t stop you in your tracks and call you to pay attention, you might have gone on in your habitual ways until something even more serious happened. Your body is giving you a warning signal that you need to make some changes.

The change required may be to deal with a long-standing personality pattern, resolve an interpersonal conflict, make a shift in your priorities and values, and/or find new meaning in your life.

When you figure out what is needed and make the necessary changes, your whole life works better and you start to feel better. Your problem with panic, phobias, or obsessive worry will certainly get better and so also may your depression, headaches, insomnia, and/or tendency to be short-tempered or irritable. All of you get better.

Approximately 30-40 percent of people who receive state-of-the-art treatment for their anxiety problems have limited recovery. They do not experience the relief they were hoping to find.

Of those people who do initially derive benefit from treatment, a significant percentage has a relapse after a period of time. In some cases the relapse is a temporary response to increased stress and may be overcome; in other, less fortunate cases, it seems to be enduring.

Why do some persons not get better in spite of good treatment? Why do others relapse? If you´ve not gotten better because you´ve not received appropriate treatment i.e., your therapist sat and just talked with you or tried some other form of treatment instead of cognitive-behavioral therapy, you need to keep looking until you find effective help.

So keep in mind that the reasons that follow assume you’ve already had proper treatment but have not improved as much as you would like.

1. YOU SHOULD CONTINUE TO PRACTICE THE BASIC TECHNIQUES AND STRATEGIES OF COGNITIVE BEHAVIORAL THERAPY.

Recovery from panic, phobias, obsessions and compulsions, or general anxiety requires consistent effort over a period of time. You need to make time each day to practice deep muscle relaxation, engage in aerobic exercise, challenge and counter anxiety-provoking self-talk, and incrementally face internal anxiety sensations or avoided external situations.

If you’re unable or unwilling to make such an effort during a course of cognitive-behavioral therapy, you will probably not benefit much from it. And if you don’t keep up with the basic practices of relaxation, exercise, and exposure following the completion of therapy, you increase your risk of relapse.

Recovery from an anxiety disorder requires a permanent change in lifestyle, with time allocated each day for practicing skills that keep anxiety and phobias from recurring.

If you find you’re having difficulty maintaining a commitment to the daily practices that can ensure your long-term recovery, there are a couple of things you might do.

First, you might arrange with your therapist to have periodic “booster sessions”, after you’ve finished therapy, to help you stay on track with your recovery program.

Second, if you live in a large metropolitan area, you can attend an anxiety disorders support group. Such a group needs to be a place where the focus is on what everybody is doing to maintain or enhance recovery, not just venting about their problems. If you don’t have a support group in your area, you can find support through message boards and chat rooms online.

2. YOU SHOULD TAKE MEDICATION WHEN IT’S NEEDED OR STOP TAKING IT BEFORE IT HAS OFFERED ITS FULL BENEFIT.

Often prescription medication is unnecessary. However, if your problem is relatively severe, you may well need to combine medication with cognitive-behavioral therapy to get the best results. By “severe,” I mean that your problem meets at least one of the following criteria:

• Your anxiety is disruptive enough that it’s difficult for you to get to work and/or function on your job, or it has caused you to stop working.

• Your anxiety interferes with your ability to maintain fulfilling and close relationships with family members and/or significant others, or it prevents you from establishing a relationship with any significant other.

• Your anxiety causes you significant distress 50 percent of the time you’re awake. It’s not just a major nuisance or irritation; you often feel overwhelmed and find it hard to get through the day.

If you believe your anxiety problem meets any one or more of these criteria, it’s likely you may benefit from a trial of medication subscribed by your doctor. Not to try medications because you’re afraid or philosophically opposed to them may hamper your recovery if your situation is severe.

3. YOU SHOULD MODIFY YOUR LIFESTYLE IN A WAY THAT SUPPORTS GREATER PEACE AND EASE IN YOUR LIFE.

Even if you’ve received cognitive-behavioral therapy and have taken the proper medication(s), your recovery may still be limited if your lifestyle is so complicated and busy that you continually keep yourself at a high level of stress.

Anxiety disorders are caused by three factors: heredity, personality based on childhood experience, and cumulative stress. You can’t do much about your genetic makeup or your early childhood, but you can do a lot to mitigate stress in your life.

If you reduce and manage your stress, you will reduce your vulnerability to anxiety. It’s that simple. Stress arises from both external and internal factors. External stress factors include things like work demands, rush-hour commuters, smog, food additives, negative relatives, and noise pollution.

These types of stressors usually require external solutions. Internal stress factors have to do with your own attitudes, such as overemphasizing success at the cost of everything else, or a tendency to cram too many things into too short a time. They require internal solutions, basically shifting your attitudes and priorities.

Many persons do not recover from panic or anxiety until they are willing to place as much importance on their peace of mind and health as they do on career success and material accomplishment.

4. YOU SHOULD NOT FAIL TO ADDRESS PERSONALITY AND INTERPERSONAL ISSUES THAT PERPETUATE ANXIETY.

Cognitive therapy and exposure may help you to change panic-provoking thoughts and face your fears. However, they may not modify core personality traits that predispose you to be anxious in the first place.

If you grew up with perfectionistic, overly controlling parents, for example, you’re likely to be perfectionistic yourself. Nothing in yourself or your life ever quite meets your overdrawn standards, and so you set yourself up for continuous stress.

Or if your parents were highly critical of you, you may have grown up with an excessive need to please and win approval. If you spend your life trying to please others at the expense of your own personal needs, you’re likely to harbor a lot of unexpressed resentment and thus be more prone to anxiety.

Insecurity, over-dependency, over-cautiousness, and the excessive need for control are additional personality issues common to people with anxiety disorders. Such core personality traits are often associated with interpersonal problems, i.e., perhaps you expect too much of your spouse (perfectionism) or you don’t ask enough (excessive need to please). Or you may resent your parents’ attempts to control you, but you don’t assert your needs with them.

5. EXISTENTIAL ISSUES

The problem at the root of your anxiety may lie still deeper than personality. Anxiety may persist in spite of therapy and medication because you experience a sense of emptiness or meaninglessness about your life.

In present times, with so many conflicting values and a loss of traditional authorities such as the church or social mores, it’s easy to feel adrift and confused. The very pace of modern life can lead to feelings of confusion, if not outright chaos.

What has been called “existential anxiety” does not respond to cognitive-behavioral therapy and demands a different kind of approach.

If your life feels meaningless or without direction, perhaps you need to discover your own unique gifts and creativity, and then find a way to meaningfully express them in the world. I believe each of us has a unique gift to offer, a unique contribution to make.

This is a question that crops up rather a lot and personally I find it a hard one to answer. For instance, if someone tries a new food for the first time, they often say it tasted like chicken. For me, trying to explain what an anxiety attack feels like is similar to trying to explain what strawberries taste like to someone who has never eaten a strawberry. It’s a totally unique flavour. A strawberry tastes like a strawberry so how can I explain it.

In addition to this there are many different and varied symptoms that can occur when someone is gripped by an anxiety or panic attack. For example, some people can have heart palpitations whilst others might experience difficulty in breathing. In my own experience the feeling wasn’t so much physical but psychological. Everything became surreal.

I’ve been clear of anxiety attacks for about 6 years now but I vividly remember how they affected me. When I suffered an anxiety attack I felt totally alone and cut off from everything. My surroundings were exactly the same but I felt completely detached from them. I felt as if I didn’t have a link or bond with anyone or anything.

This is the best way that I can sum up what an anxiety attack feels like and I hope it made some sense. If this sounds familiar to you and you have experienced similar feelings then unfortunately you are likely to be suffering from an anxiety disorder. If you haven’t consulted with your doctor already then it might be time to do so. Don’t let this condition fester and ruin your life.