The Florida Anxiety Clinic offers treatment for most all anxiety disorders.  Because depression is commonly associated with anxiety disorders, we also provide a separate treatment program for depression. 

All of our treatment programs utilize scientifically proven Cognitive-Behavioral Therapy (CBT) treatment protocols; however, we tailor the treatment to fit you and your situation.  We use whatever methods will be most effective to help you overcome your anxiety or depression.

Other forms of therapy, such as couples, family therapy, or lifestyle management, may be helpful in your case and are used in conjunction with the main CBT treatment. In addition, we often work hand-in-hand with your medical care provider to find the best medication for you, or to help you get off of your medication.

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Screening Procedures

All treatment begins with intensive screening to ensure that you and your problems are appropriate for our treatment. 

Screening involves the completion of questionnaires, telephone and in-person interviews, and the completion of a physical exam by your physician to rule out any medical reasons for your problems.  

Screening may also involve meeting with other significant people in your life, such as your spouse or children.  Sometimes other individuals close to you can provide useful insight into the origin and nature of your problem.

Before we can talk with your physician, family members, or others, however, you will need to complete Release of Confidential Information forms that give us authorization to communicate with them.

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The Treatment Protocols

Our treatment protocols are based on the empirically supported cognitive-behavioral treatment programs developed by  David A. Barlow, an internationally recognized expert on anxiety disorders.  Our anxiety treatment protocols are comprised of five core procedures: (1) Psychoeducation, (2) Breathing Retraining, (3) Cognitive Restructuring, (4) Exposure, and (5) Lifestyle Management. 

Psychoeducation.  Psychoeducation involves learning about the nature of your anxiety disorder through discussion and reading handouts.  Providing education about the disorder allows you to dispel commonly held myths about the disorder and to find out exactly why the anxiety or depression exists. 

For example, in the treatment of panic disorder and phobias, patients learn the role of sympathetic and parasympathetic nervous systems.  They also learn the evolutionary function of the uncomfortable symptoms they experience. Patients discover that the sensation of "butterflies in the stomach" is due to blood rushing away from the stomach.  This occurs because when your body is dealing with a potential threat, the blood is needed in your muscles and not for digestion.  Digestion is also inhibited in your mouth by reducing saliva, resulting in a dry mouth when you feel anxious. 

Breathing Retraining.  In retraining the unconscious habits of breathing, patients learn how to breathe slower, deeper, and more regular.  They learn how many breaths per minute they should be taking and how to monitor and adjust their breathing in anxious situations.  Breathing retraining teaches patients how to turn on their parasympathetic nervous systems and flood their body with chemicals that help to calm their body, just as some medications do.   

Cognitive Restructuring.  Cognitive restructuring refers to the process whereby patients learn how to identify and refute faulty thinking that is responsible for triggering anxiety, panic, and depression.  Research shows that our thoughts and images play a huge role in triggering the alarm system in our brain.  By learning how to change your habit of thinking and reevaluate certain beliefs, patients learn how to stop their bodies from being flooded with adrenaline and other stress hormones, which create the feeling of anxiety.  

Exposure.  In the exposure phase of treatment, patients are guided through a structured method of experiencing feared situations or sensations repeatedly until they no longer experience fear from the stimulus.  Exposure is highly effective and is based on the principles of extinction and habituation. 

In interoceptive exposure exercises, for example, patients learn how to bring on sensations that mimic the symptoms experienced during their panic attacks (e.g., rapid breathing, palpitations, and dizziness).  Activities used to induce the symptoms include hyperventilating, shaking their head from side to side, running in place, putting their head between their legs and then quickly lifting it up, or spinning in a chair for a minute. Patients learn to rate how intense and similar the induced sensations are in comparison to their usual panic feelings and to do the exercises repeatedly until the sensations no longer evoke fear. They also learn how to cope with the sensations through slow breathing and cognitive restructuring methods. 

Exposure exercises are the scariest for patients, but also the most effective.  All patients are encouraged to go at their own pace.  It is important to understand that the goal of the exposure exercises is NOT to bring on a panic attack.  The goal is to expose patients to the feared sensations repeatedly so that they no longer feel scared of the sensations or situation.

Exposure exercises may be conducted "in the field" when necessary (e.g., (e.g., in elevators, hospitals, or bridges) or done through imaginal exposure in which the patient is guided through the imagery of the situation repeatedly. 

Lifestyle Management.  In treatment, patients are encouraged to change their lifestyle (as is appropriate) in order to reduce their anxiety and depression.  These changes might include reducing their caffeine intake, engaging in regular physical exercise, and manage stress better through various methods and changes.  

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Use of Medication

Medications are very useful in treating anxiety disorders.  Selective Serotonin Reuptake Inhibitors (SSRIs) or other antidepressants are the preferred medication for anxiety disorders because they are not addictive. 

Medications in the benzodiazepine class (e.g., Xanax and Klonopin) work fast to calm you, but you can be physically addicted to them within two weeks of regular use.  Benzodiazepine withdrawal is a common among individuals with anxiety disorders.  We can work with you and your doctor to help you overcome these side-effects of addiction before enrolling you in any treatment program.

Research indicates that medications combined with cognitive-behavioral treatment is are just as effective as CBT alone.  Many of our patients have as their goal to stop or cut back on their medications and this goal is often accomplished while working with your medical care provider.

 Efficacy of Cognitive-Behavioral Therapy

Research demonstrates that CBT is the best treatment for anxiety disorders.  Without CBT, most patients relapse soon after taking their medications.  The advantage of CBT over medications is that there are no negative side-effects or relapse problems.  Anxiety patients who receive CBT treatment tend to improve over time in contrast to medication only patients who get worse over time. 

CBT is also better than any other form of psychotherapy, such as "insight-oriented" therapy that seeks to look for the core cause of the anxiety.  Unfortunately, there are very few licensed mental health professionals who are trained and experienced in CBT. 

Most any therapist will attempt to do some cognitive-behavioral interventions with patients, such as relaxation techniques or systematic desensitization.  This is the main reason that CBT has not worked for some patients--they never received a standard CBT treatment protocol from a seasoned CBT expert.  

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