Living with Anxiety: Evidence-Based Psychotherapy can Provide Sustainable and Long-Term Relief
Living with anxiety can mean a lot of different things: from experiencing uncomfortable and life-limiting physical symptoms, including things like headaches and gastrointestinal upset, to losing time to attentional difficulties and indecision, to altogether avoiding activities that result in a rich, full, and meaningful life (because of the desire to avoid anxiety and discomfort). Anxiety is a menace. It can be all-consuming and create real barriers to meaningful living.
What if I told you that no matter how long you’ve been living with your anxiety, you could learn to live in ways that could significantly limit anxiety’s impact?
What if you didn’t have to completely eliminate your anxiety, in order to live a rich, full, and meaningful life?
What if I told you that not all therapies are sufficient in treating anxiety?
Understanding anxiety
Anxiety is characterized by feelings of worry or fear and can begin to interfere with daily activities. It can take many different forms, including (but not limited to) chronic and persistent worry about the future, acute panic attacks, social anxiety, obsessions and compulsions, phobias associated with extreme avoidance (fear of driving, flying, vomiting, needles, etc.), and post-traumatic stress.
Occasional worry or anxiety is a normal part of life. Many people worry about various things, such as health, money, or family problems. People who experience more severe symptoms of anxiety experience more than temporary fear or worry; they may find that their anxiety worsens over time and significantly interferes with schoolwork, job performance, relationships, and the ability to fulfill personal responsibilities. People who experience anxiety often report some of the following experiences or sensations: feeling nervous, restless, or tense; having a sense of impending doom or danger, feelings of panic; increased heart rate, rapid breathing, sweating, trembling, trouble concentrating, difficulty fall and staying asleep, and headaches, nausea, and/or gastrointestinal problems.
Effective treatment for anxiety
“Supportive therapy” or general “talk therapy” is usually insufficient in treating chronic and persistent anxiety. While it can be nice to have a warm, supportive therapist to hear your concerns and listen to your weekly challenges, this kind of “week in review” therapy is typically insufficient in promoting significant, lasting change related to anxiety. Evidence-based psychotherapy for anxiety requires specific techniques, delivered by a competent specialist.
Evidence-based therapies are specific approaches that have been rigorously studied through randomized clinical trials (for years, sometimes decades!) and proven to be effective in bringing about desired change. These therapies work by matching specific interventions that science has shown to be capable of creating positive outcomes with specific problems. For example, Cognitive Behavioral Therapy (CBT) is a specific approach to therapy that has been rigorously studied and found to be very effective in helping people with sustainable anxiety reduction. Mindfulness-Based Cognitive Therapy (MBCT) and Acceptance & Commitment Therapy (ACT) are two types of CBT that are also effective in reducing anxiety. Similarly, exposure-based therapies, which involve helping people slowly and safely begin to approach situations they’ve been avoiding, are very effective in treating specific phobias, like fear of needles or fear of vomiting, and a specific type of exposure therapy called Exposure and Response Prevention is considered the “gold standard” treatment for Obsessive Compulsive Disorder (OCD). Evidence-based psychotherapies for trauma and PTSD include Cognitive Processing Therapy (CPT), Prolonged Exposure (PE) therapy, and Eye-Movement Desensitization & Reprocessing (EMDR). Knowing what treatments to ask for (and how to find a therapist who provides them) can help you get more effective, efficient treatment and get you on the road to feeling better, faster. Evidence-based therapies for anxiety will target your specific symptoms and help you work systematically on your anxiety, which will lead to more robust and sustainable results, compared to non-specific “talk therapy” or other pseudoscientific therapies that lack sufficient evidence related to immediate and longer-term relief. Evidence-based therapies won’t eliminate your anxiety (no therapy should promise you that!), however, they can teach you to reduce the impact of anxiety and help you move toward a rich, full, and meaningful life.
What should I expect from evidence-based therapy for anxiety?
We are fortunate to have a number of really great therapies that can be combined in important ways to result in an effective, individually tailored treatment experience. Some approaches focus on altering one’s physical response to anxiety. We can learn to use paced breathing and progressive muscle relaxation to slow or counter the stress response. A cognitive approach can help us learn to identify thoughts responsible for activating/enhancing anxiety and learn to respond to these thoughts in a different way. A behavioral approach might lead to increased engagement with pleasurable activities and experiences that provide a sense of accomplishment and mastery. There is also a vast body of evidence that supports the use of interventions that slowly begin to expose us to our fears (e.g., elevators, arachnids, bridges) in objectively safe situations, in order to promote new learning (i.e., feelings of fear are not proof of danger; riding in an elevator may feel scary but is not dangerous; I can ride in an elevator without bad things happening; I can cope with my anxiety in an elevator). All of these approaches are valuable. In particular, evidence-based psychotherapies, many of which contain a combination of two or more of the approaches listed above can help people feel better, faster, compared to psychotherapies that are not evidence-based.
If you seek evidence-based therapy for anxiety from a qualified therapist, you can expect your therapist to explain the types of interventions they recommend for addressing your concerns. You should feel like a full participant in the early planning process, and you should have enough information about the treatment suggested to give full consent to participate. Your therapist should welcome your questions and concerns and provide full and satisfactory answers regarding the steps you will be taking in therapy and the rationale for each skill and practice along the way. There should be no mystery about what you are doing together, and there should be no surprises.
A therapist providing evidence-based therapy for anxiety will ask you to describe your experience with anxiety; they will ask you many questions to understand, as best they can, how you experience anxiety. You can also expect your therapist to ask questions related to your goals for therapy and to check in regularly throughout therapy about whether you believe that you are making progress toward your stated goals. Your sessions may begin with “agenda setting” in which you and your therapist discuss a plan for the session, in order to make sure therapy is addressing your most significant concerns. You may complete self-report measures over time to measure whether therapy is helping to create the change you are hoping for. Your therapist will likely suggest ways that you can practice new skills that you are learning in therapy between sessions; this is a really important part of evidence-based psychotherapy for anxiety. Learning to apply the things you are learning in your one-hour weekly meeting to the other hours of your life!
Participating in evidence-based therapy for anxiety will likely feel difficult, but doable (when properly paced by a qualified therapist). You will feel some discomfort, if your therapist is properly challenging you, because any evidence-based therapy for anxiety is going to involve moving toward the things that anxiety leads us to avoid. If your therapy involves no discomfort and you don’t feel challenged to slowly and safely approach things your anxiety demands you avoid, then odds are very high that you are not actually receiving evidence-based therapy for anxiety. Evidence-based therapy for anxiety involves some amount of discomfort, but there is a great trade off! The short-term discomfort involved in reducing avoidance means you are learning and practicing new things with the help of your therapist and that you are well on your way to getting your life back!
How do I find a qualified therapist?
Many people have tried CBT for anxiety and concluded that “it doesn’t work” for them. Most often, when I talk to people who have drawn this conclusion, it becomes clear through conversation that CBT didn’t fail them. Typically, one of the following has happened instead:
They had a therapist who wasn’t adequately trained in CBT,
They had a therapist who delivered CBT in a way that was poorly paced, dry and boring, or not sufficiently tailored to meet the client’s needs, all of which typically leads to limited engagement and/or premature dropout, and/or
The timing wasn’t right for the client; the client didn’t have the necessary resources (i.e., time, energy, bandwidth, etc.) to participate fully in CBT at that time.
If you have tried CBT for anxiety with less than satisfactory results, I encourage you to give it another try! The following tips may help you find a better match this time around.
If you are seeking treatment for anxiety, it’s important to find a therapist who can provide evidence-based psychotherapies specially for anxiety. Here are some important questions to consider asking a prospective therapist and/or key words/phrases to look for on a website:
What psychotherapy approach do you use to helps clients who are experiencing anxiety?
Can you please tell me about specific training that you have received that helps you work effectively with clients who are experiencing anxiety [you can replace “anxiety” with relevant terms like phobias, OCD, PTSD, if applicable]?
Do you provide evidence-based therapies for anxiety [phobias, OCD, PTSD, etc.]? If so, which therapies do you provide?
Terms or phrases to listen for that are related to evidence-based psychotherapies for anxiety: learning about the relationship between thoughts, emotions, and actions, reducing avoidance behaviors, evidence-based therapy, Cognitive Behavioral Therapy, exposure-based therapies, Exposure & Response Prevention, mindfulness, Mindfulness-Based Cognitive Therapy, Acceptance & Commitment Therapy, Behavior Therapy.
Big ideas (in summary):
Anxiety sucks
There are really effective therapies for anxiety, and finding a qualified therapist is key
Not all therapies are the same; evidence-based therapies specific to anxiety are a game-changer
Not all therapists have the training required to successfully treat more severe and persistent anxiety; finding a qualified therapist is key to experiencing sustainable and lasting results
You don’t have to eliminate your anxiety in order to have a rich, full, and meaningful life
Evidence-based therapies will help you learn strategies for limiting the impact of your anxiety and restoring your sense of personal agency
An unsuccessful therapy experience in the past does not mean that you will not find good help in the future. It takes courage to try again, and it can be so worth it!