Several talk therapies or psychotherapies are available to treat anxiety, and your choice of a therapist will depend on the form of psychotherapy you are seeking. A variety of licensed mental health practitioners can provide talk therapies, including marriage and family counselors, psychologists, nurse practitioners, and psychiatrists. Some therapists are trained in cognitive behavioral therapy while others use a more psychodynamic or insight-oriented approach.
For anxiety disorders, several of these forms of therapy are considered to be “evidence-based,” which means that systematic studies have been performed that demonstrate their effectiveness. The type of psychotherapy that makes sense will depend on the specific anxiety disorder being treated. Many psychotherapists focus on a particular form of talk therapy as well as a particular form of anxiety disorder, but most therapists are able to incorporate a combination of approaches into their practices. Regardless of the form of therapy, it is crucial that the therapist has a certain level of empathy so that the patient’s emotional point of view is considered with sensitivity.
When choosing a therapist, you’ll want to review the clinician’s credentials and experience. It’s also important to discuss your particular goals of the psychotherapy. Whenever you meet with a psychotherapist, the information discussed is always considered confidential except when there is a medical emergency or imminent danger to the patient or others.
Psychotherapy may be an alternative to treatment with medications, but the approaches are often used together. Medications can help alter the balance of brain messengers that lead to anxiety symptoms, while psychotherapy can provide a psychological perspective as well as specific cognitive tools to help avoid anxiety triggers and diminish symptoms once they occur.
Cognitive Behavioral Therapy (CBT)
CBT helps patients identify the triggers, thoughts, feelings, and behaviors that are linked to their anxiety by combining cognitive therapy and behavioral therapy. Systematic studies indicate that CBT is effective in treating panic disorder, phobias, social anxiety disorder, and generalized anxiety disorder.
Where to find a Therapist?
The National Institute of Mental Health (NIMH) provides resources to help people find an appropriate therapist in their area. Below are examples of both professional and national advocacy organizations that list directories of professionals. You can easily find them online.
- • Academy of Cognitive Therapy
- • Association for Behavioral Therapies
- • American Academy of Child and Adolescent Psychiatry
- • American Association for Geriatric Psychiatry
- • American Psychiatric Association
- • American Psychological Association
- • Anxiety and Depression Association of America
- • National Association of Social Workers
- • Society of Clinical Psychology
- • International OCD Foundation
- • Mental Health America
- • National Alliance on Mental Illness
The cognitive therapy component of CBT helps patients recognize and alter the distorted thoughts and beliefs that influence their behavior and increase their anxiety. Once the patient has identified his distorted thinking and its resulting behaviors, the therapist can help him examine and better understand the negative impact they have. This allows the patient to then develop and learn alternative, more-realistic thoughts and beliefs, which in turn lead to healthier behaviors.
Let’s say a patient is unreasonably worried about her mother’s health and constantly feels nervous about it. Her therapist might ask her to make a list of the real facts about her mother’s health status and then compare that to a list of her exaggerated worries and thoughts. The process will help the patient accept and change the distorted thinking that influences her anxiety reactions.
Systematically writing down your reactions to your anxiety triggers will provide perspective and help you recognize how your automatic responses may be counterproductive and serve to reinforce your anxiety symptoms. This kind of recognition is the first step to learning healthier responses and breaking the chronic anxiety cycle.
The behavior component of CBT involves changing the patient’s behaviors in order to alter their thoughts, beliefs, and feelings. Let’s say a person has a habit of eating cookies in bed every night, and this causes him to feel guilty, remorseful, and anxious about his weight the next day. The therapist would encourage the patient to alter his cookie-eating behavior—perhaps by writing down exactly what he is feeling when the urge to eat cookies hits or maybe by simply throwing out all the cookies in the house. If the patient can agree to try this change, even just once, the reduced anxiety he experiences the next morning will reinforce his new healthy behavior and motivate him to skip the cookies again the following night.
When we fear something, it is our natural instinct to avoid it, but that very avoidance often serves to reinforce our fears. Exposure therapy is a form of behavioral therapy that helps patients face their anxieties through exercises that expose them—usually gradually—to situations or objects that stir up their anxiety.
With gradual exposure training, patients confront their fears in baby steps using systematic desensitization, which involves creating a hierarchy of feared scenarios. The patient is exposed to the least frightening scenario first. Once she overcomes her fear in that setting, she then moves on to the next most frightening experience. This gradual increase in exposure to a feared situation will serve to desensitize her to her fears.
Perhaps a patient suffers from agoraphobia and refuses to leave his house. His therapist may first help him open the front door and stand in the doorway. Once he’s comfortable there, he would move on to step on the porch, then walk slowly to the sidewalk, and so on. The exercises may first involve imagining the feared scenarios before moving on to actual in vivo or real-life exposure.
PSYCHOTHERAPIES FOR TREATING ANXIETY
- • cognitive behavioral therapy (CBT)
- • exposure therapy
- • relaxation therapy
- • acceptance and commitment therapy (ACT)
- • eye movement desensitization and reprocessing (EMDR)
- • hypnosis
- • psychodynamic psychotherapy
For a patient who fears swimming in a pool, a gradual exposure approach might first involve dipping a toe and then a whole foot into a swimming pool. Eventually, as that person becomes more comfortable with his body in the water, he can get closer and closer to overcoming his fear of swimming.
An alternate exposure approach is called flooding, wherein the patient is exposed to the most feared situation all at once. For instance, the patient who fears swimming would simply jump into the pool. The therapeutic coach in this situation would encourage the patient to jump in or possibly even push the patient into the pool. By doing this, the patient is forced to suddenly overcome her fear of swimming. This more drastic approach can sometimes be effective, but it also poses the risk of worsening the individual’s anxieties, escalating her fears, and harming the bond between patient and therapist.
Effective relaxation techniques can be learned on your own with self-help approaches or by working with a professional therapist. Whether it’s autogenic training, progressive relaxation, or meditation, it can be easier to learn these methods from a professional “guide” before trying them on one’s own.
The particular emphasis of relaxation therapy will vary depending on the experience and orientation of the therapist. However, if you have an interest in a specific technique, you may wish to ask your therapist whether they have experience using that approach. For these strategies to be effective, it’s essential to develop enough of a comfort level so that you can eventually practice them on your own without the direct guidance of the therapist.
Relaxation techniques complement other therapy methods. For example, a patient undergoing gradual exposure or desensitization therapy can use mindfulness techniques or deep breathing to help control both psychological and physical symptoms of anxiety triggered by the exposure therapy.
Acceptance and Commitment Therapy (ACT)
Some therapists use a strategy represented by the acronym ACT:
- • Accept your reactions and stay in the moment.
- • Choose a new direction that is consistent with your goals and values.
- • Take action—follow through with new behaviors more in line with reaching your goals.
This form of therapy combines cognitive training with mindfulness techniques. The ultimate goal of ACT is to help people manage their anxiety by developing more psychological flexibility. ACT does not aim to completely eliminate a patient’s psychological discomfort but instead teaches them to accept and live with anxiety-provoking situations while making a commitment to not overreact to their anxious feelings. Several systematic studies indicate that ACT is effective in treating anxiety disorders, and many experts believe it is comparable to CBT in its effectiveness.
Many practitioners of ACT believe that patients with anxiety disorders face four main psychological challenges and often use the acronym FEAR to represent them:
- Fusion with thoughts
- Evaluation of the anxiety-provoking experience
- Avoidance of the experience
- Reason-giving for inappropriate behavior
Eye Movement Desensitization and Reprocessing (EMDR)
Often used to treat various forms of anxiety as well as posttraumatic stress disorder, EMDR involves asking patients to remember a traumatic experience and any negative thoughts and feelings it invoked while at the same time performing specific eye movements. EMDR practitioners may use various approaches to stimulate the patient’s eye movements to achieve the desired therapeutic effect.
Some therapists use ruler-shaped boards to get the patient to track a light that travels back and forth along the ruler; others simply move their finger back and forth in front of the patient’s eyes while the patient recalls the traumatic event. Exactly how EMDR works is unclear, but a recent functional MRI study indicated that when research subjects make these eye movements while recalling a traumatic experience, neural activity increases between brain regions that process emotions. Although EMDR is used to relieve anxiety symptoms, it does not appear to be as effective as exposure therapy for treating specific phobias and panic disorders.
The therapeutic effects of hypnosis or hypnotherapy can have a great impact on reducing anxiety. Patients are induced into a heightened state of awareness wherein they can block out distractions and become receptive to suggestions that can help them change, whether they want to quit smoking or conquer a fear of flying. In addition to its use in treating pain, obesity, and other medical conditions, hypnosis has been used to treat a range of anxiety disorders such as generalized anxiety, agoraphobia, and panic. Systematic research indicates hypnosis is especially effective when combined with CBT.
After an initial induction phase, hypnotherapists use imagery and relaxation prompts to intensify the patient’s hypnotic state. When a deeply focused and calm state is achieved, the therapist then makes suggestions to help the patient alter his or her anxious thoughts and behaviors and remain relaxed after the hypnosis session. Once they get the hang of it, many people use self-hypnosis techniques to induce these states without the help of a therapist.
Psychodynamic or insight-oriented psychotherapy evolved from classic psychoanalysis and can be very helpful in reducing anxiety. The therapist helps patients become aware of the thoughts and feelings that shape their behavior, as well as gain perspective and understanding of how their past experiences influence their present feelings and actions. This form of therapy helps patients examine unresolved conflicts in order to improve their symptoms. Many clinicians trained in psychodynamic theory and treatment may combine this approach with CBT and other interventions, including medications and talk therapy.Image courtesy of Pixabay and some sources from these References