Therapy for Anxiety Disorders

In some cases, medications have a role in treating anxiety disorders. But for many, therapy—alone or in combination with medication—is the most effective treatment option. The reason being that therapy, unlike medication, gives you the tools to manage the anxiety yourself, now and in the future.

Different therapeutic techniques have been developed to treat anxiety and have evolved over time from psychoanalytic approaches to the newest cognitive behavioral therapies.

Understanding Anxiety Disorders

About 19% of U.S. adults and 31% of adolescents age 13 to 18 experience anxiety each year, according to the National Institute of Mental Health (NIMH). Several major types of anxiety disorders can be treated using therapeutic approaches, including:

• Panic disorder is a condition characterized by frequent, sudden panic attacks.
• Obsessive-compulsive disorder (OCD) involves obsessions and compulsions that create distress and interfere with daily life.
• Phobias are irrational fears of a situation or object.
• Generalized anxiety disorder (GAD) is marked by constant worry and anxiety about a wide variety of concerns in the absence of a specific threat.
• Social anxiety disorder (SAD) involves an irrational fear of being observed, judged, or embarrassed that causes severe anxiety in social situations.
• Post-traumatic stress disorder (PTSD) involves anxiety symptoms following a traumatic experience.

Regardless of the specific disorder, the underlying processes that drive them often follow a similar pattern. People with anxiety tend to react to unpleasant thoughts, feelings, and situations in a more extreme way and may try to manage those reactions by avoiding triggers. Unfortunately, this type of avoidance only serves to reinforce fears and worries.

Types of Anxiety Therapy

The goal of all therapeutic approaches is to help you understand why you feel the way you feel, what your triggers are, and how you might change your reaction to them. Some types of therapy even teach practical techniques to help reframe your negative thinking and change your behaviors.

Anxiety disorders differ considerably, so therapy is tailored to your specific symptoms and diagnosis. It can be conducted in an individual, family, couple, or group setting. How often you meet with your therapist and how long will depend on your specific symptoms and diagnosis.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is the most widely-used therapy for anxiety disorders. Research has found it to be effective in treating SAD, GAD, phobias, and panic disorders, among other conditions.

The premise of CBT is that your thoughts—not your current situation—affect how you feel and subsequently behave. So, the goal of CBT is to identify and understand your negative thinking and ineffective behavior patterns and replace them with more realistic thoughts and effective actions and coping mechanisms.

During this process, your therapist acts like a coach, teaching you helpful strategies. For example, you might do a lot of "black-and-white" thinking, where you assume that things are all bad or all good. Instead, you would replace those thoughts with the more realistic perception that there are many shades of grey in between.

Exposure Therapy

Exposure therapy is one of the most common CBT methods used to treat a variety of anxiety disorders, including specific phobias, SAD, and PTSD. The basic premise behind exposure therapy is that if you're afraid of something, the best way to conquer it is head-on.

During exposure therapy, your therapist will slowly introduce you to anxiety-producing objects or situations. This is often done using a technique known as "systematic desensitization," which involves three steps:

1. Relax: Your therapist will teach you relaxation training to help combat your anxiety. Examples of relaxation training include progressive muscle relaxation, deep breathing, meditation, and guided imagery.
2. List: Create a list of your anxiety-provoking triggers, ranking them in intensity.
3. Expose: In this final step, you'll gradually work through your listed anxiety-provoking objects or situations, using relaxation techniques when necessary.

There are several ways your psychologist may expose you to anxiety-provoking stimuli. Here are the most common:

• Imaginal exposure: In this type of exposure, you'll be instructed to imagine your anxiety-provoking object or situation vividly.
• In vivo exposure: In this method, you'll face your anxiety-provoking object or situation in real life. So with this type of exposure, a person with social anxiety might be instructed to give a speech in front of an audience.
• Virtual reality exposure: In some cases, virtual reality can be used when in vivo exposure isn't possible. Virtual reality therapy uses technology to combine elements of in vivo and imaginal exposure. This method has proven especially helpful for soldiers and others with PTSD.

Dialectical Behavioral Therapy

Dialectical behavior therapy (DBT) is a highly effective type of CBT. Originally used to treat borderline personality disorder (BPD), DBT is now used to treat a variety of conditions, including anxiety.

DBT focuses on helping you develop what seems like a "dialectical" (opposite) outlook, acceptance, and change. During DBT treatment, you'll learn to accept your anxiety all the while actively working to change it. It's similar to the notion of loving yourself the way you are while still trying to change yourself for the better.

DBT treatment teaches four powerful skills:

• Mindfulness: Connecting with the present moment and notice passing thoughts (like anxiety) without being ruled by them
• Distress tolerance: Managing your anxiety when faced with a stressful situation
• Interpersonal effectiveness: Learning how to say no, or ask for what you need
• Emotion regulation: Managing anxiety before they get out of control

Acceptance and Commitment Therapy

Acceptance and commitment therapy (ACT) is another form of therapy that has been shown effective for a variety of anxiety disorders. ACT involves identifying your life values and acting in ways that match your values.

ACT has two main components:

• Accepting that thoughts and feelings don't necessarily need to be controlled
• Making a commitment to take actions that help a person live life according to their values 

Art Therapy

Art therapy is a non-verbal, experience-oriented therapy. It involves either using visual art (such as painting, drawing, sculpting) to express and process emotion or using art to practice mindfulness and relaxation. Although it can be provided as a standalone therapy, it's commonly used in combination with other treatment methods such as CBT.

Being a newer form of therapy, more research is needed to confirm its effectiveness in reducing anxiety symptoms.

Psychoanalytic Therapy

According to this Freudian model, anxiety symptoms reflect unconscious conflicts. The purpose of psychoanalytic therapy is to resolve them. In psychoanalysis, you and your therapist examine your thoughts, fears, and desires to better understand how you view yourself and to reduce your anxiety. This is one of the most intensive forms of treatment; it can take years to identify patterns in your way of thinking.

Interpersonal Therapy

Interpersonal therapy (IPT) focuses on social roles and relationships. In IPT, you'll work with your therapist to identify any interpersonal issues you may have, such as unresolved grief, conflicts with family or friends, changes in work or social roles, and problems relating to others. You'll then learn healthy ways to express emotions and ways to improve your communication with others.

Although originally developed to treat major depression, IPT may be used if your anxiety relates primarily to your relationships with other people, as is the case with SAD.

Efficacy of Anxiety Therapy

Anxiety is highly treatable. Psychotherapy can be very effective, but medications, lifestyle changes, and relaxation strategies can also help.

One meta-analysis found that several types of therapy were effective in treating anxiety symptoms, including individual and group CBT, mindfulness therapies, and psychodynamic therapy. Online therapy, eye movement desensitization reprocessing (EMDR), and interpersonal therapy also demonstrated efficacy. 

The study found that the treatment option with the highest efficacy combined individual CBT with medication.

What to Expect From Anxiety Therapy

A common misunderstanding about therapy is that you'll immediately start to feel better. Sometimes this is the case. But much of the time, you feel worse before you start feeling better. Surprisingly, feeling worse is often a sign of progress. And if you think about it, that makes sense.

When you make the decision to enter into therapy, it's often because you haven't been able to work through your anxiety on your own. Therapy involves exploring your anxiety and the reasons behind it in a deeper, more meaningful way. This can cause a temporary spike in your anxiety.

It's important to understand that though the process won't always feel good, it will be completely worthwhile in the end.

How to Make the Most of Therapy

Trying to make a change can be a challenge. Anxiety therapy is no exception. However, if you are persistent, you should see improvement.

Here are a few ways to make the most of your therapy—and actually see some results:

• Don't pretend to be OK
• Ask questions
• Tell your therapist anything and everything
• Do the work outside your sessions
• Focus on your goals
• Practice healthy lifestyle choices
• Make sure you have a social support system
• Reduce stress in your life that makes your anxiety worse

In this way, you can see that putting in an effort and being present throughout the therapy process will have the biggest impact on how well it works for you.

A Word From Verywell

If you live with anxiety and it impairs your day-to-day functioning, it is important to seek help from your doctor or mental health professional. If you are diagnosed with an anxiety disorder, an effective treatment plan that includes one of the therapies mentioned above can be devised that will help you to overcome symptoms and manage your anxiety.