There are a number of highly effective treatments available for people who are struggling with anxiety and anxiety-related disorders. These treatments fall into three broad categories: psychotherapy, medication and complementary and alternative therapies. Patients diagnosed with anxiety may derive significant benefit from one or a combination of these therapeutic approaches. Emerging therapies and the role of different care providers are also explored.
Evidence-based therapies
Counselling
Counselling is talk therapy facilitated by a mental health professional who helps patients develop coping strategies to address specific concerns, such as stress management or interpersonal problems. Counselling is usually a short-term therapeutic intervention.
Psychotherapy
Distinguished by its longer-term nature, psychotherapy includes various modalities that address a wider range of issues, including behavioural patterns. The choice of psychotherapy depends on the individual’s specific anxiety diagnosis and personal preferences. The overall aim is to help patients regulate their emotions, manage stress and understand behavioural patterns that affect their interpersonal relationships. Evidence-based therapies such as Cognitive Behavioural Therapy (CBT), Prolonged Exposure Therapy (PE), and Dialectical Behavioural Therapy (DBT) have shown remarkable efficacy in the treatment of anxiety.
Cognitive behavioural therapy (CBT)
This short-term treatment approach helps patients recognise inaccurate and negative thought patterns associated with anxiety-provoking situations, such as panic attacks. CBT can be delivered through individual or group therapy sessions that bring together people with similar challenges. It focuses primarily on ongoing life difficulties and empowers patients to develop more effective coping strategies by changing their emotions, thoughts and behaviours. For PTSD, CBT can use a trauma-focused approach to process and reframe traumatic experiences that underlie symptoms. On average, CBT involves 10-15 weekly one-hour sessions, depending on the severity and type of symptoms.
Prolonged exposure therapy (PE)
Designed specifically for people with PTSD and phobias, PE helps patients manage the distress caused by trauma memories or confront their fears. Under the guidance of a licensed therapist, patients are gradually exposed to trauma memories or fear-inducing stimuli. Throughout the exposure, therapists use coping techniques such as mindfulness or relaxation therapy/imagery. The aim is to help patients realise that these trauma-related memories or phobias are no longer threatening and can be faced without avoidance. Typically, this therapy involves 8-16 weekly sessions.
Eye Movement Desensitisation and Reprocessing Therapy (EMDR)
EMDR is a psychotherapeutic approach that addresses distress and emotional disturbance caused by traumatic memories. Primarily used to treat post-traumatic stress disorder (PTSD), EMDR is similar to exposure therapy. Its aim is to facilitate the processing and healing of traumatic experiences.
During EMDR sessions, patients focus on a back-and-forth movement or sound as they recount traumatic memories. Over repeated sessions, the distress associated with these memories diminishes. Typically, EMDR sessions last 50-90 minutes and are given weekly for 1-3 months, although significant symptom reduction may be seen after only a few sessions.
Dialectical behaviour therapy (DBT)
DBT uses a skills-based approach to help patients regulate their emotions. It is often used to treat borderline personality disorder, but can also be effective for anxiety disorders such as PTSD. It teaches patients skills in emotion regulation, stress management, mindfulness and interpersonal effectiveness. It can be delivered in individual or group sessions and is usually a long-term treatment, lasting a year or more.
Acceptance and Commitment Therapy (ACT)
A form of CBT, ACT encourages patients to engage in positive behaviours despite the presence of negative thoughts and emotions. The primary goal is to improve daily functioning in the face of anxiety disorders. ACT is particularly useful for treatment-resistant generalised anxiety disorder and depression. The length of treatment varies depending on the severity of the symptoms.
Family therapy
Family therapy, a group therapy approach, involves the patient’s family to improve communication and develop conflict resolution skills. This therapy is useful when family dynamics contribute to the patient’s anxiety. During this short-term intervention, the patient’s family learns strategies to avoid exacerbating anxiety symptoms and gains a deeper understanding of the patient. The length of treatment varies depending on the severity of the symptoms.
Medication
Medications are sometimes prescribed in addition to psychotherapy. The most commonly prescribed medications for anxiety disorders generally have an acceptable safety profile, although potential side effects should be considered. The specific medication prescribed will depend on the patient’s symptoms and general health, as determined by their healthcare provider.
Antidepressants
Antidepressants are commonly prescribed medications to relieve symptoms of depression and can also be effective in treating symptoms of anxiety. Selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) are the main classes of antidepressants used to treat anxiety. Commonly prescribed SSRIs for anxiety include escitalopram (Lexapro) and paroxetine (Paxil, Pexeva), while SNRIs such as duloxetine (Cymbalta) and venlafaxine (Effexor XR) are also used.
Buspirone
Buspirone is a drug specifically indicated for the treatment of anxiety. It shows high efficacy in the treatment of generalised anxiety disorder and is particularly effective in reducing cognitive and interpersonal problems associated with anxiety. Unlike benzodiazepines, buspirone does not cause sedation or interact with alcohol. Importantly, the risk of developing dependence on buspirone is minimal. Side effects, although minimal, may include dizziness, nervousness and headache. Buspirone is available under brand names such as BuSpar and Vanspar.
Benzodiazepines
Benzodiazepines are sedatives used to treat anxiety, epilepsy, alcohol withdrawal and muscle spasms. While they provide short-term relief for generalised anxiety disorder and can help with sleep problems, their long-term use is not recommended because of their sedative effects and potential for dependence. Doctors may prescribe benzodiazepines for a limited time to relieve acute anxiety symptoms. It is worth noting that taking benzodiazepines with psychotherapy, such as Prolonged Exposure Therapy (PE), can reduce the effectiveness of exposure therapy. Common brand names include Librium, Xanax, Valium and Ativan.
Beta blockers
Beta blockers, also known as beta-adrenergic blocking agents, work by blocking the neurotransmitter epinephrine (adrenaline). In doing so, they reduce the force of the heart muscle to contract, resulting in a reduction in blood pressure. Beta-blockers have traditionally been prescribed to treat somatic symptoms of anxiety, such as increased heart rate and tremors, but they are less effective in treating generalised anxiety, panic attacks or phobias. Common brand names include Lopressor and Inderal.
Complementary and alternative therapies
Complementary and alternative therapies can be used alongside conventional treatments to reduce anxiety symptoms and improve overall well-being. While they are not intended to replace conventional therapies, they can be used as complementary therapies to improve patients’ quality of life. These non-invasive approaches include stress management techniques such as progressive relaxation, guided imagery, biofeedback, self-hypnosis and deep breathing exercises.
Stress Management
A collection of focused activities in which an individual consciously produces the relaxation response in their body. This response consists of slower breathing, resulting in lower blood pressure and a general feeling of well-being. These activities include: progressive relaxation, guided imagery, biofeedback, self-hypnosis and deep breathing exercises.
Meditation
A mind-body practice that teaches people to be aware of thoughts, feelings and sensations in a non-judgmental way. It has been shown to reduce symptoms of psychological distress in patients with anxiety.
Yoga
A mindfulness practice that combines meditation, physical postures, breathing exercises and a distinct philosophy. It has been shown to help reduce some symptoms of anxiety and depression.
Emerging therapies
There are also a number of experimental treatments that have shown promise in treating the symptoms of anxiety. These include brain stimulation (neurostimulation), acupuncture and psychoactive drugs (marijuana and ecstasy).
Neurostimulation
Anxiety is associated with abnormal patterns of activity in the brain. One way to treat anxiety is to target the abnormal nerve cell activity directly. Neuromodulation, or brain stimulation therapy, is a non-invasive and painless therapy that stimulates the human brain. In some recent clinical trials, patients who did not respond to more traditional forms of treatment (i.e. medication) showed a reduction in symptoms of depression and anxiety. There are two main types of neuromodulation:
Repetitive Transcranial Magnetic Stimulation (rTMS)
rTMS involves passing a high, brief current through a coil of wire placed on the front of the head, close to mood-regulating areas of the brain. The current creates a magnetic field that induces an electrical current in the brain, stimulating nerve cells in the targeted area. The depth of penetration is typically limited to about 5 centimetres, allowing precise targeting of specific brain regions.
Each session lasts 30-60 minutes and is usually performed without anaesthesia. Treatment involves 4-5 sessions per week over a period of approximately 6 weeks. The procedure is painless, but patients may feel a slight tapping sensation in the treated area. Side effects of rTMS are minimal, with possible occurrences of headache, tingling or discomfort at the treatment site. rTMS can be used as a stand-alone treatment or in combination with medication and/or psychotherapy.
Deep Transcranial Magnetic Stimulation (dTMS)
dTMS uses special coils that target deeper regions of the brain than rTMS. Patients wear a padded helmet similar to that used during fMRI scans. The FDA approved the use of dTMS for the treatment of depression in 2013, and it is currently being studied for anxiety disorders such as OCD. Treatment sessions last 20 minutes and typically last 4-6 weeks. Patients can return to normal activities immediately after each session.
Acupuncture
Acupuncture is a therapeutic approach derived from traditional Chinese medicine in which thin needles are inserted into specific points on the body. While evidence for its effectiveness in treating generalised anxiety is limited, ongoing research is investigating its potential benefits for PTSD. One study found that acupuncture reduced anxiety before surgery.
Psychoactive drugs
There is growing interest in using psychoactive substances in conjunction with psychotherapy, particularly cannabis (marijuana) and methylenedioxymethamphetamine (MDMA, also known as ecstasy or Molly). These substances are controversial because of their psychoactive effects. With the increasing legalisation of marijuana, it is important to investigate whether these substances can alleviate clinical anxiety symptoms.
Although there are few randomised clinical trials, certain forms of cannabis have shown beneficial effects on anxiety, particularly cannabidiol for social anxiety disorder and tetrahydrocannabinol (THC) for PTSD. However, caution is advised when using the herbal form of cannabis, as it may worsen symptoms. MDMA has shown some benefit for PTSD, but should only be used as an adjunct to psychotherapy under clinical supervision.
Types of care providers
A range of licensed mental health professionals are available to treat anxiety and related disorders:
Primary Care Physician
Primary care physicians (PCPs) are often the first point of contact for patients reporting symptoms. They will conduct a thorough physical examination to rule out other medical conditions and hormonal imbalances that may be contributing to the symptoms. If anxiety is diagnosed, PCPs may refer patients to psychologists or psychiatrists for further evaluation and treatment. PCPs work in hospitals, clinics and private practices.
Clinical psychologist
Clinical psychologists have a doctorate in clinical psychology and specialise in the treatment of emotional, mental and behavioural problems. They provide counselling, psychotherapy, psychological testing and treatment for mental disorders. While clinical psychologists generally do not prescribe medication (except in a few states), they often work with psychiatrists or PCPs who handle the medical aspects of treatment. Clinical psychologists work in a variety of settings, including hospitals, schools, counselling centres, and private practice.
Psychiatrist
Psychiatrists are medical doctors (MDs) who specialise in the diagnosis and treatment of mental disorders. They may provide psychotherapy and prescribe medication to treat symptoms. Psychiatrists work in hospitals, counselling centres and group or private practices.
Psychiatric nurse
Psychiatric nurses have a master’s or doctoral degree in mental health. They are qualified to diagnose and treat mental illness, provide psychotherapy and, in some states, prescribe medication. These nurses also act as patient advocates and provide case management services. Psychiatric nurses work in private practice, hospitals and schools.
Licensed Mental Health Counsellor (LMHC) – Licensed Clinical Professional Counsellor (LCPC) – Licensed Clinical Social Worker (LCSW) – Licensed Marriage and Family Therapist (LMFT)
These licensed mental health professionals have master’s degrees in various counselling disciplines (e.g. counselling, social work, marriage and family therapy). After completing their formal education, they undergo 1-2 years of supervised on-the-job training and pass a state exam to become fully licensed.
They are qualified to diagnose and treat emotional, mental and behavioural health problems through counselling, psychotherapy and other roles such as patient advocacy and care management. These professionals work in a variety of settings, including hospitals, community mental health clinics, private practices, schools, nursing homes, and social service agencies. Licensing requirements and titles may vary from state to state.
Clinical social worker
Clinical social workers (CSWs) typically have a bachelor’s degree in social work and receive additional training to provide mental health services. They are qualified to provide case management, hospital discharge planning and act as patient advocates. CSWs usually work in hospitals, schools, clinics, social service agencies or private practice.
Where to find treatment
Treatment providers for anxiety-related disorders can be found in a variety of settings, including hospitals, clinics, and private or group practices. Schools may have licensed mental health counsellors, clinical social workers or psychiatric nurses. In addition, the field of telehealth is expanding, allowing mental health professionals to provide services remotely through video streaming, conferencing or wireless communication. Telehealth is particularly beneficial for people who live in remote rural areas, far from mental health facilities. It is important to note that mental health providers offering telehealth services are typically limited to providing care within the state(s) in which they are licensed.
Dr. Yvonne Ogbonmwan is a postdoctoral fellow at the Grady Trauma Project at Emory University, a lab led by Dr. Tanja Jovanovic . She is currently studying the neurobiology that underlies PTSD in victims of inner-city violence. Her project focuses on the interaction of traumatic experiences on neurophysiology in mental disorders such as PTSD, depression and addiction. She conducts her research by administering standardized clinical interviews and psychophysiological tests. In 2015, Dr. Ogbonmwan completed her doctorate studying behavioral and pharmacological interventions for cocaine relapse under the guidance of Dr. David Weinshenker.
