CRUFAD - Clinical Research Unit for Anxiety and Depression



		The Anxiety Disorders Clinic St. Vincent's Hospital, Sydney The Anxiety Disorders Clinic Is a specialist clinic providing assessment and treatment for adults with Social Phobia, Panic Disorder, Agoraphobia, Obsessive Compulsive Disorder, Generalised Anxiety Disorder, and Body Dysmorphic Disorder. There are no costs for treatment. All treatments programs involve Cognitive Behaviour Therapy (CBT). Research throughout the world has shown CBT to be highly effective in the treatment of anxiety disorders. The clinic is also a research centre involved in a range of projects investigating the nature, causes and treatment of these disorders. Treatment Programs are conducted on an outpatient basis involving weekly sessions over six to ten weeks. Many of the programs are conducted in small groups of patients with similar diagnoses, but some programs are conducted on an individual basis. What is Cognitive Behaviour Therapy? Although the details of treatment vary for different disorders, a number of features are common to most programs. Education about the nature and causes of anxiety and panic Techniques for managing the physical symptoms of anxiety and panic Techniques for managing anxious thoughts Graded exposure to previously feared or avoided situations More detail about the different anxiety disorders and the structure of treatment programs is provided below. Social Phobia People with Social Phobia experience anxiety in a wide range of social situations, including talking to people in groups, talking to people in authority, meeting new people, and public speaking. The person with Social Phobia usually worries about appearing anxious, looking incompetent, or being seen to be inadequate in some way. Typically the person also worries that their physical symptoms of anxiety are visible (e.g. shaking, blushing, sweating) and that others will judge them harshly as a result. The Social Phobia program is conducted in groups of 6 to 8 people and involves seven half-day (9am to 1pm) sessions over seven weeks, followed by one-month and three-month follow-ups. Panic Disorder and Agoraphobia Panic Disorder is characterised by intense overwhelming episodes of anxiety commonly referred to as panic attacks. During these attacks the person can experience a wide range of physical symptoms such as dizziness, pounding heart, breathlessness, sweating, shaking and nausea. The main feature of both Panic Disorder and Agoraphobia is a fear of these attacks, and a belief that during these attacks they are going to die, collapse, lose control or go crazy.Agoraphobia is also characterised by an avoidance of places and situations where panic attacks might occur. The Panic Disorder program and the Agoraphobia program run for six and eight weeks, respectively, in groups of six to eight people. Both groups also have a follow-up session one month after treatment. Obsessive Compulsive Disorder People with OCD typically experience intrusive and unwanted thoughts, images or impulses which cause anxiety and distress (obsessions). These obsessions most commonly centre on themes of harm to oneself or others through contamination, negligence (e.g. forgetting to turn off the stove) or violence (e.g. images of killing a loved one).In response to these obsessions most sufferers develop compulsions which are designed to lessen their anxiety and prevent the dreaded event from occurring (e.g. washing, checking, counting and repeating actions or words). The OCD treatment program involves ten to fifteen individual sessions, with additional follow-up sessions. Each session lasts 30 minutes to one hour. Generalised Anxiety Disorder People with GAD experience long-standing and excessive worry about day-to-day concerns such as family, finances, work or illness. The person finds these worries very difficult to control and fears that they may not be able to cope if something goes wrong. The worry leads to a number of physical symptoms of anxiety including muscle tension, irritability, tiredness, disturbed sleep or concentration, and an inability to relax. The GAD treatment program is conducted in groups and involves nine half-day sessions over nine weeks, with a follow-up session one and six months after treatment. Body Dysmorphic Disorder People with Body Dysmorphic Disorder experience anxiety and distress about a particular aspect of their appearance which they believe to be abnormal or unattractive. As a result of these concerns they often repeatedly check their appearance, ask others for reassurance, seek surgical interventions or attempt to camouflage the area so that others will not notice. The Clinic conducts Body Dysmorphic Disorder treatment programs individually with weekly sessions for 15 weeks, and a follow-up session one month after treatment. How to make an appointment: It is necessary to have a written referral from a GP or psychiatrist to make an appointment for an assessment. Appointments are made over the phone by telephoning the clinic manager on 8382 1730 on weekday mornings from 9.30am to 12 noon. Initial assessments are two hours long and involve an interview as well as some questionnaires. Some of these assessments are Medicare billed with no extra charge. English comprehension and reading skills at a School Certificate level are essential for all treatment programs. Clinic policy requires that patients who are currently taking benzodiazepines or abusing alcohol must be free of these substances before commencing treatment. Patients whose anxiety disorder is the subject of legal proceedings for financial compensation are not accepted into treatment programs at this clinic, and no medico-legal reports are provided. Treatment programs are conducted by Clinical Psychologists and Psychiatrists. Suggested Reading Marks, I.M. (1978). Living With Fear. London: McGraw Hill. Andrews, G., Creamer M., Crino, R., Hunt, C., Lampe, L. & Page, A. (2002). The Treatment of Anxiety Disorders. Cambridge: Cambridge University Press. Andrews, G. & Moran, C. (1988). Exposure treatment of agoraphobia with panic attacks: Are drugs essential? In I Hand and H-U Wittchen (Eds.), Panic and Phobias II. Heidelberg: Springer-Verlag, pp. 89-99. Mattick, R.P., Peters, L. & Clarke, J.C. (1989). Exposure and cognitive restructuring for social phobia. Behavior Therapy, 20, 3-23. The Quality Assurance Project. (1985). Treatment outlines for the management of (a) anxiety states and (b) obsessive compulsive disorders. Australian and New Zealand Journal of Psychiatry, 19, 138-151, 240-253. March, J.S. (1990). The nosology of post traumatic stress disorder. Journal of Anxiety Disorders, 4, 61-82. * The Clinic is not able to provide individualised replies to email enquiries regarding assessment and treatment. For more information about the Clinic please telephone the information line on +612 8382 1749. Edited by Gavin Andrews MD, UNSW, 2007 ©2007 CRUfAD