This is the ninth and final article in a series about anxiety.

Q: What are some final thoughts about treatment modalities for anxiety disorders?

A: From the University of Maryland Medical Center, there is Exposure and Response Treatment. This approach purposefully causes anxiety for a person by exposing that person, either in reality or by using visualization. This method starts with the most feared stimulus first. This treatment is different from desensitization because it does not include relaxation or a gradual exposure to the source of anxiety. Exposure treatments are either flooding or graduated. Flooding exposes the person for one to two hours to an anxiety-provoking stimulus. Graduated exposure gives the person greater control over the frequency and length of exposure. In both methods, the person is exposed to the anxiety source over and over until the stimulus eventually does not produce anxiety. Combining this approach with cognitive behavior therapy might be very beneficial. The combination works well for those persons with PTSD.

Anxiety Management Therapy is used as an alternative to CBT for Generalized Anxiety Disorder. This therapy includes patient education, relaxation training and exposure to anxiety-provoking stimuli. It does not include exercises for cognitive retraining. Additional forms of psychotherapy, called Emotion-based psychotherapy (EBT), deals more with the root cause of anxiety and usually requires longer treatment. All work is done during sessions. This approach is used more for generalized anxiety in order to heal from early fears or trauma. This modality is not effective with panic disorders unless used in combination with other treatment.

Relaxation training consists of three stages.

• Relaxation training uses muscle relaxation techniques and mental visualization to focus attention toward calming feelings. Some people find meditation techniques helpful.

• Breathing retraining might help reduce physical effects of anxiety. Hyperventilating is the primary symptom of panic disorders. By practicing controlled, measured breathing at the beginning of a panic attack, a person might be able to prevent a full-blown attack.

• Biofeedback uses special sensors that allow a person to recognize anxiety states by changes in specific physical functions. The changes are in pulse rate, skin temperatures and muscle tone. Eventually a person can learn to modify these changes, which then reduces anxiety. There is no research that substantiates that biofeedback provides long-term relief or elimination of symptoms.

Herbs and dietary supplements should be used only after clearing with one's doctor because they are not FDA approved. They can be harmful if used in combination with other medication or simply not effective. From, there are suggestions from the authors designed to reduce one's overall stress level and to help achieve emotional balance. Their first suggestion is to exercise because it reduces stress and decreases anxiety. Research shows a minimum of 30 minutes three to five times weekly provides significant relief from anxiety. For maximum benefit, a goal of an hour of aerobic exercise on most days will achieve that maximum. If practiced on a regular basis, relaxation techniques can increase feelings of emotional well-being. Such measures include meditation, progressive muscle relaxation (starting with toes and feet and progressing to head), visualization and controlled breathing.

Hypnosis is used sometimes combined with CBT. When the person is under hypnosis, the therapist makes post-hypnotic suggestions that are techniques to help facing one's fears and looking at them differently.

The last section of this article from helpguide reiterates how people can change their lives by making positive choices. Success means setting the stage by making a conscious decision to promote one's own relaxation, vitality and positive mental outlook. The first suggestion is to learn to understand one's own anxiety. Education alone does not cure anxiety but it does facilitate how someone can benefit from therapy.

Secondly, the authors propose cultivating one's connection with other people. Isolation and loneliness set up circumstances that promote anxiety. Reaching out to others decreases one's vulnerability to anxiety. Positive decisions are to see friends, join a support or self-help groups, share your concerns with a trusted friend or loved one.

Thirdly, helpguide advises adopting healthy lifestyles. Physical activity is necessary to relieve tension and anxiety, so regular exercise is critical. Avoiding the use of alcohol and other drugs to cope with anxiety is necessary. Furthermore, the stimulants of caffeine and nicotine can make anxiety worse.

Finally, people need to reduce the stress in their lives. They need to identify stressors and then figure out have to minimize these stressors. For example, avoiding people who make one anxious, if possible, is helpful. Saying no to extra responsibilities reduces stress. Making time for daily fun and relaxation reduces stress. Authors of this article "Therapy for Anxiety Disorders" are Melinda Smith, M.A., Robert Segal, M.A., and Jeanne Segal, Ph.D.

 Judy Caprez is professor emeritus at Fort Hays State University.