Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute, edited by C.E. Zupanick, Psy.D. and Mark Dombeck, Ph.D.
In addition to the therapies described previously, many therapy participants benefit from the addition of family therapy, group therapy, and pharmacologic treatments (medication). Usually these types of therapies are considered adjunct therapies as they are intended to compliment and enhance individual therapy, not to replace it.
Family members can play a vital role in the treatment of anxiety disorders. Families are a valuable source of historical information. They help the therapist understand the familial context of the therapy participant. It is generally advantageous for family members to be included in the treatment process. This is because both therapy participants, and their family members, are affected by the anxiety disorder. For instance, everyone affected by the disorder can benefit from psycho-education about these disorders. In addition, while therapists usually spend a just few hours each week with a therapy participant, family members are able to provide daily support. As such, family members are in a better position to help the recovering person apply and practice new knowledge and skills more often.
Living with someone who has an anxiety disorder can be very stressful and emotionally challenging. Family members can benefit from their own therapy, or another form of support such as a support group. Sometimes well-intentioned family members unknowingly do things that impede the recovering person's progress.
When children are affected by a disease or disorder, it can lead to increased stress within a family and marital discord. However, another family variable that is important to consider is the presence of a psychiatric disorder in the parent of a child-in-recovery. Studies have shown that similar disorders tend to run in families. Therefore, it is not surprising to find a parent, or other family member, with the same or similar disorder as the child (Yaryura-Tobias, Grunes, Walz, & Neziroglu, 2000). However, these other family members may not have received treatment for their own disorder yet. Clearly, this could compromise their ability to play the role of a co-therapist/coach outside of therapy sessions. Family therapy is intended to address many of these issues.
The research literature regarding the effectiveness of group therapy for anxiety disorders is quite positive (Oei & Boschen, 2009). Usually these groups are intended to complement individual therapy.
There are several types of therapeutic groups. First, there are treatment (or therapy) groups. This type of group is led by a mental health professional. In contrast to individual therapy, the therapist's role is to facilitate discussion among group members; rather than to direct, lead, or teach. A group may have a specific focus such as exposure and response prevention therapy or cognitive therapy. These groups are typically guided by the needs of the group members. In this type of group, members learn from each other, along with the therapist's help and guidance.
A second type of group is called a skills-training group. These groups are also led by a mental health professional. In this type of group, the therapist's role is to teach, train, and coach group members to develop and practice new skills. These groups are generally very structured. Each meeting has a specific learning objective and a defined agenda. Skills training groups are often used for mindfulness training, breath and relaxation training, and social skills training. Mindfulness training teaches people how to quiet their mind and reduce anxiety by focusing attention on the present moment in time. Breath and relaxation training is intended to counteract the physiological symptoms of anxiety. This is achieved by consciously controlling breath and relaxing muscles. Social skills training assist participants to learn and practice essential social skills. This includes how to initiate a conversation, how to respectfully express displeasure, and how to attend to conversational cues.
A third type of group is a support group. A non-professional volunteer may lead these groups. The emphasis in support groups is to meet with others struggling with similar conditions or circumstances. By sharing common experiences, they offer encouragement, hope, and support to each other. These groups tend to be informal and may not meet as frequently as treatment-oriented groups.
The decision about when to begin group therapy is an important treatment decision. Group therapy may not be beneficial if recommended too early in the recovery process. For example, someone with Social Phobia may not be ready for a group setting until they have made some progress in individual therapy. Similarly, someone who has just begun their own recovery journey may become frightened and highly anxious upon hearing group members discuss their experiences with exposure and response prevention. Such an experience may cause them to prematurely rule-out this type of highly effective therapy.