Treatment-Resistant Anxiety: Signs, Causes, & How to Manage

What Is Treatment-Resistant Anxiety?

Treatment-resistant anxiety occurs when an individual continues to experience persistent and intense feelings of worry, fear, and/or panic attacks despite many attempts to treat their anxiety. There are many reasons a person may have treatment-resistant anxiety, including biochemical imbalances, genetic predisposition, unhealthy environmental factors, or the presence of co-occurring mental health conditions.

Signs & Symptoms of Treatment-Resistant Anxiety

Signs and symptoms of treatment-resistant anxiety include frequent panic attacks, overwhelming anxiety that interferes with daily life and relationships, and an inability to find relief from symptoms despite having tried therapies or anti-anxiety medications that are typically effective for anxiety. Other signs may include an ongoing sense of unease, difficulty concentrating, and feeling constantly on edge.¹

Signs and symptoms of treatment-resistant anxiety include:

• Persistent and intense anxiety: Individuals with treatment-resistant anxiety often experience high levels of anxiety that persist over a long period of time despite receiving treatment.
• Lack of response to standard therapies: Despite undergoing various therapies, individuals with treatment-resistant anxiety do not experience significant relief from their symptoms.
• Limited response to medication: Treatment-resistant anxiety may involve a poor response to different types or combinations of medications used to manage anxiety symptoms.
• Frequent panic attacks: Treatment-resistant anxiety may be characterized by frequent and severe panic attacks that continue to occur despite attempts to manage or control them.
• Impaired daily functioning: The anxiety symptoms may significantly interfere with the individual’s ability to carry out daily activities, such as work, socializing, or maintaining relationships.
• Co-occurring mental health conditions: Treatment-resistant anxiety may be accompanied by other mental health conditions, such as anxiety and depression or obsessive-compulsive disorder (OCD).
• Chronic worry and distress: Individuals may experience persistent worry, fear, and distress that is difficult to alleviate, even with treatment.

What Does Treatment-Resistant Anxiety Feel Like?

Living with treatment-resistant anxiety can be incredibly challenging and overwhelming. It feels like constantly being trapped in a state of heightened anxiety, with persistent worry and fear that seem to have no end. Emotionally, it can be exhausting, draining both mental and physical energy, making it difficult to find joy or peace in everyday life.

Despite seeking various treatments and interventions, the feeling of being stuck in a cycle of anxiety and panic attacks persists, leaving individuals feeling helpless and frustrated. It can affect relationships, work, and overall well-being, creating a constant struggle to find relief and regain control over one’s life.

Causes of Treatment-Resistant Anxiety

The causes of treatment-resistant anxiety can be multifaceted and vary from person to person. Biological factors such as genetics and imbalances in brain chemicals may play a role. Psychological factors like the presence of other mental health conditions or a lack of coping strategies can contribute. Additionally, environmental factors such as chronic stress, trauma, or lack of support can result in treatment-resistant anxiety.

Common causes of treatment-resistant anxiety include:²

• Genetics: Some individuals may have a genetic predisposition to anxiety disorders, including treatment-resistant anxiety. Certain genetic variations can influence how an individual responds to medications and therapies, which can make managing anxiety symptoms more difficult.
• Co-occurring mental health conditions: Treatment-resistant anxiety often co-occurs with other mental health conditions like depression or obsessive-compulsive disorder (OCD). These conditions can complicate treatment and make it more challenging to treat anxiety, as it may require targeted interventions and specialized approaches.
• Incorrect initial diagnosis: If an individual with treatment-resistant anxiety was initially misdiagnosed or received an incorrect diagnosis, they may be receiving treatment that is not appropriate for their specific condition. This can lead to their symptoms not being properly managed and create an ongoing struggle with anxiety symptoms.
• Inadequate treatment: If the treatment provided for anxiety is not comprehensive or tailored to the individual’s specific needs, it may not address their unique symptoms. Not receiving the proper treatment can look like being prescribed the wrong medication dosage, having limited access to therapy or specialized treatments, or a lack of holistic approaches that address both the psychological and physiological aspects of anxiety.
• Substance use: Substance use, including drugs and alcohol, can exacerbate anxiety symptoms and make treatment less effective. Substance use can interfere with the effectiveness of medications and therapies while also contributing to increased anxiety and complicating the overall treatment process.
• Neurobiological differences: Some evidence suggests that alterations in brain circuits associated with anxiety, such as the amygdala and prefrontal cortex, may contribute to treatment-resistant anxiety. These alterations may lead to increased neural activity associated with anxious thoughts and behaviors, making it more difficult to manage anxiety symptoms.
• History of trauma: Traumatic experiences, such as abuse, violence, or natural disasters, can significantly impact an individual’s mental health and contribute to the development of treatment-resistant anxiety. Trauma can alter brain function and increase amygdala activity, leading to intrusive or distressing memories and heightened anxiety symptoms.
• Unhealthy lifestyle: Lifestyle factors such as poor sleep quality, insufficient exercise, unhealthy diet, and chronic stress can contribute to the development of treatment-resistant anxiety.

Reassessing the Treatment Plan for Treatment-Resistant Anxiety

Reassessing the treatment plan for individuals with treatment-resistant anxiety is crucial for improving symptoms and quality of life. This process involves carefully evaluating a person’s current treatment plan, including medications, therapies, and lifestyle that may impact their anxiety symptoms. By identifying areas where the plan may fall short, a mental health professional can adjust the plan and introduce new treatments to improve treatment success.

Reassessing the treatment plan can offer someone with treatment-resistant anxiety hope that it can be possible to manage their anxiety symptoms, which may otherwise feel impossible and lead to feelings of hopelessness and despair.

Medication Adjustments for Treatment-Resistant Anxiety

If a person’s current medication is not helping their treatment-resistant anxiety, their healthcare provider may consider switching to a different medication or adjusting the dosage. Sometimes, a combination of medications from different classes may be prescribed to target multiple aspects of anxiety and enhance overall effectiveness. Personalized medication adjustments can help individuals with treatment-resistant anxiety find the right balance of medication to ease their symptoms.

Therapy Changes for Treatment-Resistant Anxiety

Modifying a person’s therapy can play a crucial role in addressing treatment-resistant anxiety. Trying out different types of therapy for anxiety can provide a person with new coping skills for their anxiety symptoms. Additionally, increasing the number of therapy sessions, such as from once a week to multiple sessions per week, can allow for a more in-depth exploration of underlying issues and provide more support.

Here are some different types of therapies for treatment-resistant anxiety:

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) for anxiety is a structured approach that focuses on identifying and modifying the thoughts and behaviors that contribute to anxiety. It involves teaching individuals skills to challenge negative thinking patterns, develop coping strategies, and gradually face feared situations. With the therapist’s guidance, individuals learn to change their perspective and develop healthier patterns of thinking and responding to anxiety-inducing situations.

Exposure Therapy

Exposure therapy for anxiety is a therapeutic approach used to treat anxiety disorders by gradually exposing individuals to situations or objects that cause them anxiety in a safe and controlled manner. The goal is to help individuals confront and overcome their fears because repeatedly exposing them eventually decreases anxiety and increases feelings of control. Through this process, individuals learn that the things they fear most are unlikely to occur, leading to a reduction in anxiety symptoms.

Acceptance & Commitment Therapy

Acceptance and commitment therapy (ACT) for anxiety focuses on accepting and embracing one’s anxiety while committing to taking valued actions. It aims to help individuals let go of unhelpful thoughts and emotions and instead focus on leading a purposeful life aligned with their values. ACT utilizes mindfulness and acceptance strategies to develop psychological flexibility, reduce avoidance behaviors, and enhance overall well-being and resilience in the face of anxiety.

Eye Movement Desensitization & Reprocessing

Eye movement desensitization and reprocessing (EMDR) for anxiety is a therapy used to treat anxiety related to trauma. The individual is asked to recall the traumatic experiences while simultaneously tracking the therapist’s eye movements or other bilateral stimulation. This process can make them less anxious when remembering the trauma and help them to process the traumatic event.

Mindfulness-Based Stress Reduction

Mindfulness-based stress reduction (MBSR) combines mindfulness meditation, yoga, and awareness of the mind-body connection to help individuals develop skills for managing stress and anxiety. By cultivating present-moment awareness and non-judgmental acceptance, MBSR assists individuals in developing a more compassionate and mindful relationship with their anxiety, improving their ability to cope with anxious thoughts and sensations effectively.

Alternative & Emerging Therapies for Treatment-Resistant Anxiety

Alternative and emerging therapies can offer new avenues for managing treatment-resistant anxiety when traditional treatments fail to provide relief. These approaches include mindfulness techniques as well as natural remedies like acupuncture for anxiety. Other emerging therapies include virtual reality exposure therapy (VRET) and transcranial magnetic stimulation (TMS). While these therapies still require further research, they show promise for individuals struggling with treatment-resistant anxiety.

Other therapies for treatment-resistant anxiety that are worth exploring include:

• Ketamine-assisted therapy: Research suggests that ketamine, a dissociative anesthetic, may have rapid antidepressant and anxiolytic effects. Ketamine-assisted therapy for anxiety involves administering ketamine in a controlled clinical setting while engaging in psychotherapy. This approach shows promise in providing quick relief for individuals with treatment-resistant anxiety.
• Transcranial magnetic stimulation (TMS): TMS for anxiety is a non-invasive technique that uses magnetic fields to stimulate specific regions of the brain associated with anxiety. It has shown efficacy in the treatment of various mental health disorders, including treatment-resistant anxiety.
• Virtual reality exposure therapy (VRET): VRET involves using virtual reality technology to simulate anxiety-provoking situations in a controlled and safe environment. By gradually exposing individuals to their feared stimuli, VRET offers a way to practice coping strategies and reduce anxiety symptoms. This innovative approach holds promise in helping individuals with treatment-resistant anxiety.
• MDMA-assisted therapy: MDMA, commonly known as ecstasy, is being explored as a potential tool in therapy for individuals with treatment-resistant anxiety, particularly for those with post-traumatic stress disorder (PTSD). In MDMA-assisted therapy, the medication is administered under the supervision of trained therapists in a controlled setting. The therapy sessions aim to facilitate introspection, emotional processing, and connection, potentially leading to symptom relief and improved well-being.
• Mind-body interventions: Mind-body interventions encompass various techniques and practices that focus on the connection between the mind and body to promote relaxation and reduce anxiety symptoms. Examples of mind-body interventions include yoga for anxiety, tai chi, mindfulness, and breathwork. These practices integrate physical movements, breath control, and focused attention to encourage individuals to cultivate self-awareness, reduce stress, and promote a sense of calm.

Treatment-Resistant Anxiety & Co-Occurring Disorders

Identifying and addressing co-occurring mental health conditions or substance use disorders is crucial in managing treatment-resistant anxiety. When an individual has other mental health conditions or substance use disorders that are left unaddressed, they can worsen anxiety symptoms, lead to treatment-resistant anxiety, and prevent overall recovery. A person’s treatment team should take a comprehensive approach that considers and treats all of their conditions.

Finding Specialized Care for Treatment-Resistant Anxiety

For individuals with treatment-resistant anxiety, seeking specialized care can be important in finding effective treatment options. Specialized clinics or programs dedicated to treating treatment-resistant anxiety may offer a range of evidence-based therapies, new approaches, and experienced clinicians who specialize in managing complex cases. These specialized settings often have a deeper understanding of treatment-resistant anxiety and can provide a more comprehensive and tailored approach.

Collaborative care teams, consisting of different healthcare professionals such as psychiatrists, psychologists, therapists, and other specialists, can work together to provide integrated and holistic care.³ The expertise of different professionals allows for a collaborative approach to treatment planning, ensuring that individuals receive a treatment plan that addresses all aspects of their condition.

How to Find Specialized Care for Treatment-Resistant Anxiety

When seeking specialized care for treatment-resistant anxiety, there are several steps to consider. One helpful approach is to use an online therapist directory to search for mental health providers specializing in treatment-resistant anxiety. Alternatively, online anxiety therapy platforms offer the convenience of remote counseling and therapy through secure video conferencing, making it accessible for those who may have difficulty accessing in-person care or prefer the comfort of their own environment.

Online psychiatrist options are also available, connecting individuals with licensed psychiatrists who can remotely provide evaluations, prescribe medications, and monitor treatment. Overall, it is important to evaluate different options, consider personal preferences, and consult with healthcare professionals to determine the most appropriate path for specialized care in addressing treatment-resistant anxiety.

How to Cope With Treatment-Resistant Anxiety

Coping with treatment-resistant anxiety requires specific strategies tailored to the unique challenges each individual faces. In addition to general coping skills for anxiety, such as practicing deep breathing exercises, engaging in regular physical activity, and maintaining a healthy lifestyle, there are additional coping strategies that can be beneficial.

Here are nine ways to cope with treatment-resistant anxiety:

1. Eat a balanced diet: Nutrient-dense foods such as fruits, vegetables, whole grains, and lean proteins are all foods that help with anxiety.  A balanced diet provides essential vitamins and minerals that support brain health and help regulate mood.
2. Exercise daily: Regular exercise can significantly decrease anxiety by releasing endorphins, the body’s natural mood-boosting chemicals, and promotes better sleep, reduced stress levels, and improved overall well-being.
3. Utilize mindfulness: Mindfulness practices for anxiety, such as deep breathing exercises, can be beneficial for individuals with treatment-resistant anxiety. These techniques encourage focusing attention on the present moment, allowing individuals to observe their thoughts and emotions without judgment. By cultivating a non-reactive and accepting mindset, mindfulness can help reduce anxiety symptoms and increase emotional well-being.
4. Use stress reduction techniques: Stress reduction techniques, such as yoga, progressive muscle relaxation, and engaging in hobbies or activities that promote relaxation, can play a vital role in managing treatment-resistant anxiety by relieving tension and promoting a sense of calm.
5. Join a support group: Participating in in-person or online support groups can provide valuable emotional support for individuals with treatment-resistant anxiety. Connecting with individuals who understand the challenges of treatment-resistant anxiety can help reduce feelings of isolation, provide a sense of validation, and offer practical suggestions for managing symptoms.
6. Express your anxiety creatively: Engaging in creative activities, such as painting, writing, or playing a musical instrument, can serve as a form of self-expression, distraction, and stress relief, providing a healthy outlet for emotions surrounding treatment-resistant anxiety.
7. Work on time management: Developing effective time management skills can help to feel less overwhelmed and overcome procrastination. Breaking tasks into smaller, manageable steps and prioritizing activities can bring a sense of control and reduce anxiety levels.
8. Practice relaxation techniques: Practicing relaxation techniques for anxiety, such as guided imagery meditation for anxiety, aromatherapy, or taking warm baths, can help activate the body’s relaxation response and reduce treatment-resistant anxiety symptoms.
9. Improve sleep hygiene: Establishing a consistent sleep routine, creating a calm sleep environment, and practicing good sleep hygiene habits can improve the quality of sleep and contribute to overall well-being, which in turn can help manage treatment-resistant anxiety.

How to Help a Loved One With Treatment-Resistant Anxiety

Coping with treatment-resistant anxiety can be challenging, and it can make a big difference to a person to have loved ones who want to help and support them with their anxiety. With patience, empathy, and practical help, loved ones can play an essential role in supporting individuals with treatment-resistant anxiety to manage their condition and make progress toward their goals.

Here are some ways to help a loved one struggling with treatment-resistant anxiety:

• Open communication: Encouraging open communication and active listening can help loved ones feel seen and heard while expressing their emotions. Asking open-ended questions and acknowledging feelings can create a supportive environment for discussing struggles and finding solutions.
• Educate yourself: Learning about treatment-resistant anxiety can help loved ones better understand the condition and provide more informed input when making important decisions related to treatment and access. Additionally, educating oneself and what not to say to someone with anxiety is important, as your loved one is likely extra sensitive during this difficult time.
• Offer practical support: Offering practical support, such as running errands, helping with housework, or accompanying loved ones to appointments, can alleviate the added stress of everyday tasks and create opportunities for rest and self-care.
• Be patient and understanding: Coping with treatment-resistant anxiety can be an ongoing process with ups and downs. Being patient, understanding and not pushing loved ones to do things that are beyond their comfort level can help them feel supported and uplifted. Additionally, it is important to speak in a comforting manner to individuals with anxiety because speaking in an urgent manner can trigger more anxiety.
• Encourage healthy habits: Encouraging loved ones to engage in healthy habits, such as exercise, maintaining a balanced diet, practicing relaxation techniques, and getting adequate sleep, can contribute to managing treatment-resistant anxiety and improving overall well-being.
• Celebrate small victories: Acknowledging and celebrating small victories, such as completing tasks or engaging in social activities, can boost loved ones’ confidence and provide encouragement to keep moving forward.
• Connect with support: Encouraging loved ones to connect with support groups or find a therapist can provide additional guidance and specialized care to help manage treatment-resistant anxiety. Offering to help them research available support resources and accompany them to appointments can be helpful.