Approximately 30-40 percent of people who receive state-of-the-art treatment for their anxiety problems have limited recovery. They do not experience the relief they were hoping to find.

Of those people who do initially derive benefit from treatment, a significant percentage has a relapse after a period of time. In some cases the relapse is a temporary response to increased stress and may be overcome; in other, less fortunate cases, it seems to be enduring.

Why do some persons not get better in spite of good treatment? Why do others relapse? If you´ve not gotten better because you´ve not received appropriate treatment i.e., your therapist sat and just talked with you or tried some other form of treatment instead of cognitive-behavioral therapy, you need to keep looking until you find effective help.

So keep in mind that the reasons that follow assume you've already had proper treatment but have not improved as much as you would like.

1. YOU SHOULD CONTINUE TO PRACTICE THE BASIC TECHNIQUES AND STRATEGIES OF COGNITIVE BEHAVIORAL THERAPY.

Recovery from panic, phobias, obsessions and compulsions, or general anxiety requires consistent effort over a period of time. You need to make time each day to practice deep muscle relaxation, engage in aerobic exercise, challenge and counter anxiety-provoking self-talk, and incrementally face internal anxiety sensations or avoided external situations.

If you're unable or unwilling to make such an effort during a course of cognitive-behavioral therapy, you will probably not benefit much from it. And if you don't keep up with the basic practices of relaxation, exercise, and exposure following the completion of therapy, you increase your risk of relapse.

Recovery from an anxiety disorder requires a permanent change in lifestyle, with time allocated each day for practicing skills that keep anxiety and phobias from recurring.

If you find you're having difficulty maintaining a commitment to the daily practices that can ensure your long-term recovery, there are a couple of things you might do.

First, you might arrange with your therapist to have periodic "booster sessions", after you've finished therapy, to help you stay on track with your recovery program.

Second, if you live in a large metropolitan area, you can attend an anxiety disorders support group. Such a group needs to be a place where the focus is on what everybody is doing to maintain or enhance recovery, not just venting about their problems. If you don't have a support group in your area, you can find support through message boards and chat rooms online.

2. YOU SHOULD TAKE MEDICATION WHEN IT'S NEEDED OR STOP TAKING IT BEFORE IT HAS OFFERED ITS FULL BENEFIT.

Often prescription medication is unnecessary. However, if your problem is relatively severe, you may well need to combine medication with cognitive-behavioral therapy to get the best results. By "severe," I mean that your problem meets at least one of the following criteria:

• Your anxiety is disruptive enough that it's difficult for you to get to work and/or function on your job, or it has caused you to stop working.

• Your anxiety interferes with your ability to maintain fulfilling and close relationships with family members and/or significant others, or it prevents you from establishing a relationship with any significant other.

• Your anxiety causes you significant distress 50 percent of the time you're awake. It's not just a major nuisance or irritation; you often feel overwhelmed and find it hard to get through the day.

If you believe your anxiety problem meets any one or more of these criteria, it's likely you may benefit from a trial of medication subscribed by your doctor. Not to try medications because you're afraid or philosophically opposed to them may hamper your recovery if your situation is severe.

3. YOU SHOULD MODIFY YOUR LIFESTYLE IN A WAY THAT SUPPORTS GREATER PEACE AND EASE IN YOUR LIFE.

Even if you've received cognitive-behavioral therapy and have taken the proper medication(s), your recovery may still be limited if your lifestyle is so complicated and busy that you continually keep yourself at a high level of stress.

Anxiety disorders are caused by three factors: heredity, personality based on childhood experience, and cumulative stress. You can't do much about your genetic makeup or your early childhood, but you can do a lot to mitigate stress in your life.

If you reduce and manage your stress, you will reduce your vulnerability to anxiety. It's that simple. Stress arises from both external and internal factors. External stress factors include things like work demands, rush-hour commuters, smog, food additives, negative relatives, and noise pollution.

These types of stressors usually require external solutions. Internal stress factors have to do with your own attitudes, such as overemphasizing success at the cost of everything else, or a tendency to cram too many things into too short a time. They require internal solutions, basically shifting your attitudes and priorities.

Many persons do not recover from panic or anxiety until they are willing to place as much importance on their peace of mind and health as they do on career success and material accomplishment.

4. YOU SHOULD NOT FAIL TO ADDRESS PERSONALITY AND INTERPERSONAL ISSUES THAT PERPETUATE ANXIETY.

Cognitive therapy and exposure may help you to change panic-provoking thoughts and face your fears. However, they may not modify core personality traits that predispose you to be anxious in the first place.

If you grew up with perfectionistic, overly controlling parents, for example, you're likely to be perfectionistic yourself. Nothing in yourself or your life ever quite meets your overdrawn standards, and so you set yourself up for continuous stress.

Or if your parents were highly critical of you, you may have grown up with an excessive need to please and win approval. If you spend your life trying to please others at the expense of your own personal needs, you're likely to harbor a lot of unexpressed resentment and thus be more prone to anxiety.

Insecurity, over-dependency, over-cautiousness, and the excessive need for control are additional personality issues common to people with anxiety disorders. Such core personality traits are often associated with interpersonal problems, i.e., perhaps you expect too much of your spouse (perfectionism) or you don't ask enough (excessive need to please). Or you may resent your parents' attempts to control you, but you don't assert your needs with them.

5. EXISTENTIAL ISSUES

The problem at the root of your anxiety may lie still deeper than personality. Anxiety may persist in spite of therapy and medication because you experience a sense of emptiness or meaninglessness about your life.

In present times, with so many conflicting values and a loss of traditional authorities such as the church or social mores, it's easy to feel adrift and confused. The very pace of modern life can lead to feelings of confusion, if not outright chaos.

What has been called "existential anxiety" does not respond to cognitive-behavioral therapy and demands a different kind of approach.

If your life feels meaningless or without direction, perhaps you need to discover your own unique gifts and creativity, and then find a way to meaningfully express them in the world. I believe each of us has a unique gift to offer, a unique contribution to make.