Can psychotherapy treat or cure anxiety?

We all get anxiety. That is, in the mental health world, anxiety is kind of like the common cold.

Feeling a little tense because of that upcoming exam you haven’t had enough time to study for? That’s anxiety.

Kind of nervous, and can’t relax ever since your boss notified you that he wants to see you at the end of the week?    Anxiety.

Hear an unfamiliar noise in your basement while your home alone?   Big-time anxiety.

This is the kind of anxiety that we all experience, and probably for good reason. Let's say that you never get anxious about anything, and you almost always live your life in a cool, cavalier manner where nothing bothers you. Life may catch you totally off-guard when it really counts.  You may flunk that test because you took it far too casually. You may get fired from your job because you never gave it any thought that your job may be on the line due to your lackadaisical lack of ambition.  And what if that unfamiliar noise in your basement is a no-good burglar? Nobody would want to ignore that, would they?

So this is what we mean by the statement that we all get anxiety. Now the difference between the common, run-of-the-mill anxiety that we all experience, and the other kind of anxiety-the detrimental, self-defeating pathological anxiety that cripples some people from functioning in the world and an adaptive, purposeful way, is just that.

What constitutes pathological anxiety-the form that mental health professionals treat in people in a clinical setting- is when these anxious feelings are excessive, unrealistic, and out of proportion to the demands of the situation. And because of these qualities, they significantly impair a person’s functioning across many dimensions, such as socially, in relationships, in the workplace, etc. 

One way they interfere with a person's functioning is by causing the sufferer to engage in avoidance behavior.  In other words, if something makes you so nervous that you avoid doing it, or avoid any exposure to it, and this happens to a significant degree, you will find that it is substantially interfering with your quality of life, and you may have a phobia.  

Phobias and Exposure therapy 

Phobias, or unreasonable, irrational fears, are fairly common forms of anxiety.   If you have a phobia, exposure therapy will almost always be implemented as part of your therapy.  As the term suggests, this form of behavioral therapy involves exposing people to their fears in gradual, increasing increments.

For example, if you fear spiders, you might start by looking at pictures of spiders, watching a film about spiders, and working up to hold a spider.  As a rule, any bone fide treatment of phobias will always at some point incorporate exposure to the phobic stimulus - whatever it is the person is fearful of.   

If I fear airplanes, it could compromise my life to the extent that it restricts certain travel destinations. Virtually anywhere I travel to has to be by car (or boat).  Worse yet, what if I fear riding in automobiles? That would really diminish the quality of your life.  And that is when we clinicians would say that this person is suffering from an anxiety disorder-specifically, a "phobia.”  And we would prescribe a treatment for you that involves some form of exposure therapy.  Now exposure therapy doesn’t mean that you get thrown in with whatever it is you’re afraid of-it’s much more systematized than that.  But it is true that the therapy does involve a person’s exposure to the feared stimulus, under the guidance and careful watch of the clinician, and usually in a progressive, scheduled format, the end result being the person is generally able to tolerate being exposed to whatever it is they were initially very frightened of.

The following is a list of some anxiety disorders that the APA shares that exposure therapy has been scientifically tested as a treatment option for:

• phobias - phobias are fairly common forms of anxiety characterized by unreasonable, irrational fears, and avoidance behavior. 

• panic disorders – sudden, temporary, but very intense feelings of fear and strong physical reactions in response to ordinary, nonthreatening situations.  Panic attacks have both biochemical components and psychological triggers.

• social anxiety disorder – a form of anxiety involving a strong fear and avoidance of social situations.

• obsessive-compulsive disorder (OCD) -  Obsessive-compulsive disorder is a long-lasting disorder in which a person experiences uncontrollable and recurring thoughts (obsessions), engages in repetitive behaviors (compulsions), or both.

• post-traumatic stress disorder (PTSD) - Post-traumatic stress disorder is a real disorder that develops when a person has experienced or witnessed a scary, shocking, terrifying, or dangerous event. These stressful or traumatic events usually involve a situation where someone's life has been threatened or severe injury has occurred.  Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.

• generalized anxiety disorder (GAD) – GAD is severe, ongoing anxiety that interferes with daily activities. Generalized anxiety disorder can occur at any age.  The condition has symptoms similar to panic disorder, obsessive-compulsive disorder, and other types of anxiety. These symptoms include constant worry, restlessness, and trouble with concentration. Generalized anxiety disorder symptoms can vary. They may include:

·         Persistent worrying or anxiety about a number of areas that are out of proportion to

the impact of the events

·         Overthinking plans and solutions to all possible worst-case outcomes

·         Perceiving situations and events as threatening, even when they aren't

·         Difficulty handling uncertainty

·         Indecisiveness and fear of making the wrong decision

·         Inability to set aside or let go of a worry

·         Inability to relax, feeling restless, and feeling keyed up or on edge

·         Difficulty concentrating, or the feeling that your mind "goes blank"

Psychotherapy for anxiety usually involves one of these approaches:

Cognitive behavioral therapy (CBT)

CBT is one of the most commonly used forms of therapy. According to the American Psychological Association (APA), it can help treat many conditions, including:

• anxiety

• depression

• addictions

One key to CBT is the basic tenet that a component of such psychological conditions (like anxiety and depression) are based in part on faulty thinking patterns and in part on learned behavior.  CBT works by identifying, addressing and reframing these faulty thought patterns and teach you the tools to identify anxiety when it flares up and to cope with and effectively manage it.   CBT teaches the anxious individual to identify and recognize patterns of distorted thinking (cognitive distortions) and reappraise those thoughts.  This is typically taught to the client along with relaxation and calming techniques such as slowed, paced breathing (breathing is an accurate mirror of your internal emotional states).

Earlier in my career, I was able to help many adolescents overcome their social anxiety through these techniques, and it was a skill that many of them told me they used in other situations in their lives. This technique worked particularly well with children and teens on the autistic spectrum.

Dialectical behavior therapy (DBT) & Acceptance and commitment therapy (ACT)

Dialectical Behavioral Therapy and Acceptance and Commitment Therapy are two forms of therapy used by clinicians to manage the anxiety levels of their clients who have fairly complex and deep emotional problems.  DBT is a specific type of CBT, which was originally developed by the pioneering psychologist Marsha Linehan, as an innovative treatment for her patients with borderline personality disorder (BPD).   Dr. Linehan incorporates ACT in DBT using a multitude of techniques such as behavioral therapy, strategies that improve coping and regulation of emotion, and mindfulness skills. The significance of DBT is apparent as it is the only treatment shown to be effective in reducing suicidal behavior. 

Psychodynamic  therapy

The goals of psychodynamic therapy are to address unconscious feelings and desires that may be at the root of your anxiety.  You typically work with a therapist who is trained to recognize and address things about yourself you might not currently be aware of. Once an individual becomes aware of this information, the therapist can then help you change behaviors that these thoughts and feelings may have created.

Psychodynamic therapy is a longer-term process-often a few years in length, and it is one of the oldest forms of modern therapy.  Sessions may focus on helping you work through a stalled stage of development. The effectiveness of online psychodynamic therapy for treating social anxiety disorder in particular is supported by recent research.

Interpersonal therapy (IPT)

Interpersonal psychotherapy (IPT) is a type of psychotherapy (talk therapy) that focuses on improving your relationships with others to relieve mental health symptoms. “Interpersonal” means “being, relating to or involving relations between persons.” During IPT, clients work with a mental health professionals to better understand their emotions and how they affect their relationships.  Clients also learn how to engage the support of loved ones and other significant people.  IPT is also appropriate to improve interpersonal relationships. As such, it is a good   therapeutic approach if anxiety impacting one’s social functioning, such as living with social anxiety disorder.  IPT usually takes place over a limited number of sessions.  When appropriate, the healthcare provider may recommend taking medication (pharmacotherapy) alongside IPT to best manage a mental health condition.

What kinds of conditions can IPT treat?

Psychologists and other mental health professionals mainly use IPT for people with major depressive disorder.  Psychologists usually recommend IPT once a week for 12 to 16 weeks for major depression.

Rational Emotive Therapy (RET)

Also called Rational emotive behavior therapy (REBT), Rational emotive therapy aims to help you identify, challenge, and replace self-defeating thoughts and feelings. This is typically a short-term treatment, with completion occurring in as few as five sessions, consisting of learning:

• problem-solving skills

• cognitive restructuring

• coping techniques

REBT has been evaluated to be an effective treatment method for various mental health conditions, including anxiety. It has also been demonstrated to be effective for adolescents and youth.

Emotional freedom techniques (EFT)

EFT, also known as "tapping" or "psychological acupressure," first came to prominence in the 1990s when developer Gary Craig published information about the therapy on his website. 

It involves tapping specific points on the body, primarily on the head and the face, in a particular sequence. While doing this, the person focuses on the issue that they wish to treat while experiencing emotional distress.

EFT typically takes place in five steps:

1.     identifying the issue

2.     evaluating the intensity at which the issue is felt

3.     establishing a mantra you can repeat when dealing with the issue

4.     learning the tapping sequence

5.     evaluating the intensity at which the issue is felt after tapping

What is EFT tapping? Evidence and how-to guide (medicalnewstoday.com)

 Multiple studies have found a variety of physical and mental health benefits to EFT, including a 40% reduction in anxiety, according to some research.

Eye movement desensitization and reprocessing (EMDR)

Intending to reduce the impact of traumatic experiences, EMDR is typically a short-term treatment option. Sessions occur one to two times a week, generally lasting no more than 6 to 12 sessions.

These sessions involve sharing a memory of a traumatic event while the therapist directs your eye movements. The idea is that these eye movements allow you to reprocess and restore the memory of the trauma in a way that doesn’t continue to cause trauma symptoms. Some people describe this as "taking the power out" of the traumatic memory.

While initially developed for the treatment of PTSD, research has found it to be an effective treatment option for any type of anxiety stemming from trauma.

If interested in obtaining psychotherapy, you might think of your first session as a kind of “audition” whereby you are self-assessing your level of comfort and confidence in the therapist.  Trust your own instincts!

To schedule your first appointment (my audition), please call 941-239-3045  An initial screening will be done via the phone.

If we feel compatibility with one another and I believe that I am able to help you, the appointment will be scheduled.  If I am unable to help you, I will attempt to assist you in finding a therapist who can help.