A meta-analysis of 20 studies revealed that, among children with separation anxiety, the risk of developing a panic disorder later on is more than three times higher than in children without separation anxiety (8 ). The epidemiological term for such longitudinal associations is “sequential comorbidity” (Figure ). This exists not only within the anxiety disorders among themselves, but beyond them as well: anxiety disorders elevate the risk of developing other mental illnesses such as depression or substance-related disorders (9 ). For example, a Danish study on a cohort of 3 380 059 persons showed that patients with anxiety disorders, in comparison to the general population, have an adjusted incidence rate ratio (IRR) of 3.0 for a depressive episode (95% confidence interval [CI]: [2.8; 3.1]) and an IRR of 5.0 for a recurrent depressive disorder (95% CI: [4.8; 5.2]) (10 ). Anxiety disorders presenting early in life increase the risk of developing other mental illnesses later on in life (sequential comorbidity) (modified from [e7] and reprinted with the kind permission of John Wiley, publishers) Anxiety disorders also play a major role in the development and prognosis of somatic diseases. Any attempt to discontinue medication should be gradual, e.g., over the course of 12 weeks if the duration of treatment until now has been 40 weeks (27 ). Benzodiazepines are approved in Germany for the acute treatment of “states of tension, excitation, and anxiety.” Nonetheless, the German guidelines on the treatment of anxiety disorders discuss the use of benzodiazepines for this purpose in decidedly critical terms: “Benzodiazepines are effective against panic disorder/agoraphobia/generalized anxiety disorder/social phobia (Ia; guideline adaptation). They should nonetheless not be offered to patients with panic disorder/agoraphobia/generalized anxiety disorder/social phobia because of their serious side effects (development of dependence, etc.). They can be used for a limited time after careful evaluation of the risks and benefits in exceptional cases, e.g., patients with severe cardiac disease, contraindications for standard drugs, suicidality, and other conditions.“ The discontinuation of benzodiazepines after they have been taken for months or years, as is often the case, is a special challenge in the treatment of patients with anxiety disorders (28 ). Drug discontinuation must often take place in an inpatient setting, and only a few of the pertinent treatment recommendations are supported by adequate evidence.

It attempts to develop hypotheses about the nature of the psychological deficits that are involved in anxiety disorders. The assumption that impairments in mechanisms of information processing underlie anxiety disorders is reflected in attempts to ameliorate them by the use of cognitive techniques.

Virtual reality exposure therapy in the treatment of fear of flying: A case report Behaviour Research and Therapy (1996) A Mühlberger et al. Virtual reality in the treatment of spider phobia: A controlled study Behaviour Research and Therapy (2002) P.M.G Emmelkamp et al.

Meyer Children’s Hospital – Florence, Viale Pieraccini, Firenze, ItalySection Editor: Per-Arne Lonnqvist Search for more papers by this author SIMONA CAPRILLI PhD , SIMONA CAPRILLI PhD Pain Service, A. Meyer Children’s Hospital – Florence, Viale Pieraccini, Firenze, ItalySection Editor: Per-Arne Lonnqvist Search for more papers by this author ANDREA MESSERI MD , ANDREA MESSERI MD Pain Service, A.

Abstract Attention bias modification (ABM) is a newly emerging therapy for anxiety disorders that is rooted in current cognitive models of anxiety and in established experimental data on threat-related attentional biases in anxiety. This review describes the evidence indicating that ABM has the potential to become an enhancing tool for current psychological and pharmacological treatments for anxiety or even a novel standalone treatment.