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New Challenges for Anxiety Disorders: Where Treatment, Resilience, and Economic Priority Converge

Published online by Cambridge University Press:  07 November 2014

Mark H. Pollack
Dr. Pollack is director of the Center for Anxiety and Traumatic Stress Related Disorders at Massachusetts General Hospital in Boston and associate professor of psychiatry in the Department of Psychiatry at, Harvard Medical School, in Boston.
Murray B. Stein
Dr. Stein is professor of psychiatry at the, University of California, San Diego and director of the Anxiety and Traumatic Stress Disorders program at the VA San Diego Healthcare System.
Jonathan R.T. Davidson
Dr. Davidson is professor of psychiatry and director of the Anxiety and Traumatic Stress Program in the Department of Psychiatry and Behavioral Sciences at, Duke University Medical Center, in Durham, North Carolina.


Anxiety disorders are highly prevalent, are increasing in incidence, affect individuals early in life, and significantly impact health care and quality of life. As such, they are serious public health problems that deserve attention now and in the future. Over the last 10–20 years, there has been marked improvement in pharmacologic and psychosocial interventions for anxiety. Due to their broad spectrum of efficacy against common comorbidities and lack of association with abuse and dependence, serotonergic and mixed serotonergic noradrenergic antidepressants are first-line therapies for anxiety disorders. Benzodiazepines are still widely used in clinical practice because they are well tolerated and work quickly and effectively. Other medications that are emerging as potentially useful for selected populations with anxiety include atypical neuroleptics and anticonvulsants. Cognitive-behavioral therapy (CBT) is at least as effective as medication for many patients with anxiety disorders and facilitates maintenance of benefit over the long term. Resilience, the capacity to bounce back from adversity, can be reliably measured with a psychometrically valid scale, the Connor-Davidson Resilience Scale. Compared with the general population, individuals with anxiety disorders exhibit decreased resilience. Studies have shown that pharmacologic treatment combined with CBT may increase resilience within 2–3 months. Emerging neurobiologic research indicates that noradrenergic pathways and 5-HT2 transporter efficiency may mediate effects on resiliency.

Monograph Supplement
Copyright © Cambridge University Press 2004

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