In addition to the therapies described above, which are typically conducted by one therapist meeting with one therapy participant (called individual therapy), 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, and they can 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 since both the therapy participant, and their family members, are affected by the anxiety disorder. Therefore, both the person-in-recovery and their family members, generally benefit from psychoeducation about the illness. 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, much more often than a therapist could alone.
Living with someone who has an anxiety disorder can be very stressful and emotionally challenging. Family members may need their own therapy, or another form of support such as a support group. In some cases, well-intentioned family members unknowingly do things that impede the recovering person's progress. Ongoing weekly family therapy may be necessary and quite helpful.
Researchers investigating the Obsessive-Compulsive Disorder (OCD) are beginning to understand the powerful impact of family variables in determining treatment outcomes (see Steketee & Van Noppen, 2003 for a review of literature). This research suggests that family members of people with OCD tend to respond in either antagonistic or overly-accommodating ways. Both of these extreme approaches are not particularly helpful. Common antagonistic behaviors include harshly criticizing or yelling at their family member for engaging in OCD rituals. At the opposite end of the spectrum are overly-accommodating family members who typically over-extend themselves by allowing the person with OCD to comfortably engage in his/her rituals. This may mean complying with the rituals, such as washing items or objects repeatedly until the person-in-recovery feels they are clean enough; or by assisting them in less direct ways, such as buying anti-bacterial wipes. CBT therapists often aim for a more balanced response to the person with OCD. This consists of a loving and understanding environment in which family members recognize that the condition is extremely painful and challenging, while setting clear limits so that they do not become directly involved in the rituals.
In the case of children/adolescents, studies have shown that when parents are unable to effectively cope with their child's OCD, it leads to significant marital discord, which increases overall family tension; thereby impacting all members of the household. Adults with OCD and their families experience similar challenges. One study of 225 adults with OCD found that up to 80% of participants reported that their illness was disruptive to another family member's personal life (Cooper, 1996). Although there is less research about family variables and other anxiety disorders, it is reasonable to conclude that family involvement is an important factor in the prognosis for recovery.
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, so 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.
Group Therapy 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 groups that can be very effective in the treatment of anxiety disorders. First, there are treatment (or therapy) groups. This type of group is led by a mental health professional but their 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, but 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 a skills-training group. These groups are also led by a mental health professional but their role is to teach, train, and coach group members to develop and practice new skills. These groups are generally very structured and each meeting has a specific learning objective and a defined agenda. This type of group is commonly used in Dialectical Behavior Therapy. 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 by consciously controlling breath and relaxing muscles. Social skills training assists participants to learn and practice rudimentary social skills such as 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. These groups may or may not be led by a trained professional. The emphasis in support groups is to meet with others struggling with similar conditions or circumstances and to offer encouragement, hope, and support. 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, since it 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, a person with Obsessive-Compulsive Disorder 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.