NR 547 Week 2 Discussion; Collaboration Cafe - Treatment of Anxiety

3. One possible approach regarding treatment for treatment refractory anxiety is psychotherapy, speci昀椀cally CBT (cogni琀椀ve behavioral therapy). CBT is considered a 昀椀rst-line treatment because of its therapeu琀椀c e昀昀ec琀椀veness shown through research. Some studies show a higher e昀昀ec琀椀veness with CBT as an adjunct to pharmacological agents such as SSRIs but some CBT may be conducted alone because it enhances e昀昀ec琀椀veness, however, combined treatment is best and is best approached by adding one modality (either CBT or medica琀椀on) to the other modality that has been deemed as ine昀昀ec琀椀ve [ CITATION Pet22 \l 1033 ]. Another approach that has been demonstrated e昀케cacy in the treatment of treatment refractory anxiety is the GABA-related agent Gabapen琀椀n. Because of medica琀椀on’s e昀昀ect on GABA and the unique mechanism of blocking the alpha delta calcium channel, it has similar e昀昀ec琀椀veness to benzodiazepines with fewer adverse e昀昀ects regarding high abuse risk and dependency [ CITATION Pet22 \l 1033 ]. Although Gabapen琀椀n is widely used for treatment of anxiety, it is typically not the 昀椀rst-line treatment ini琀椀ated by clinicians and should be recognized more o昀琀en because of its proven e昀케cacy and decreased side e昀昀ect pro昀椀le, especially in comparison with benzodiazepines. Benzodiazepines in addi琀椀on to SSRIs are the most commonly used adjunc琀椀ve therapy given for refractory anxiety but there have been no studies proving that this augmenta琀椀on strategy is superior compared to u琀椀lizing Gabapen琀椀n or switching the SSRI to an SNRI prior to ini琀椀a琀椀ng benzodiazepines [ CITATION Pet22 \l 1033 ]. 4. The appropriate response to a client who states that they use marijuana to manage their anxiety would be to provide the client with evidence-based information regarding what marijuana can actually do for someone experiencing anxiety, which ultimately has the potential to make their symptoms worse. First and foremost, the most important step in discussing the treatment issue with a client is to develop a positive client-provider relationship as that is the foundation for treatment. A strong relationship with the client will help to ensure the patient listens empathetically and helps to improve adherence and retention. Listening to the client’s concerns non-judgmentally, engaging in the conversation, and providing support can help improve the therapeutic relationship prior to addressing the issue. Studies show that there is currently no evidence-based science proving that marijuana is effective or in any way beneficial for treating any psychiatric disorder including anxiety and in fact, marijuana use has been known to be associated with the onset of psychiatric disorders because of its potential side effects [ CITATION And21 \l 1033 ]. Increased anxiety and panic are two of the most common side effects associated with marijuana use although tension relief and relaxation are the most commonly identified expectations. However, the use of marijuana, THC specifically, has been shown to decrease anxiety if taking at a lower dose and increase anxiety and panic in higher doses according to a recent study [ CITATION Sus17 \l 1033 ]. Ensuring the patient has accurate, evidence-based information regarding marijuana use and its association with anxiety is an important responsibility for