What do the findings of psychology researchers suggest as the best options for managing anxiety? Anxiety can be understood as an emotionally based experience of discomfort, unease and distress associated with specific bodily and behavioral responses. A state of anxiety is associated with feelings of apprehension, self-doubt, dread and fear. Bodily responses include trembling, profuse perspiration, accelerated heartbeat and rapid breathing.
While anxiety is a normal part of day-to-day life and is in this context usually related to an event or experience, when it disrupts normal physical and psychological functioning and manifests at the level of a disorder, it is then less likely to be associated with specific stressors. It morphs into an undefined, persistent and overwhelming sense of worry or dread. It manifests with both physical and psychological symptoms and can become debilitating and overwhelming. Anxiety is the basis of a range of mental health disorders including panic attacks, phobias, generalized anxiety disorders and also has a strong association with many other mental health conditions including depression and substance abuse.
So how do the professionals tackle anxiety symptoms? What is the most validated form of therapy for alleviating anxiety? Cognitive Behavioral therapy (CBT) is without doubt viewed as a highly effective treatment for anxiety. Across a range of reviews and meta-analyses it is consistently viewed as the most effective form of treatment for alleviating anxiety with high levels of efficacy and promising treatment outcomes across specific approaches and different treatment populations.
CBT is generally a time limited, structured therapy that is goal focused and action oriented. It is focused on the treatment of specific symptoms, and so in the case of anxiety, would be focused on modifying the thoughts, feelings and physical responses associated with anxiety. The core assumption of CBT is that distorted thoughts processes and maladaptive behaviors drive dysfunctional feelings and behaviors and hence underpin the development and maintenance of mental health challenges. Hence the underpinning premise of CBT is that if thoughts can be modified and alternative behavioral/coping strategies developed then symptoms and dysfunctionality can be reduced. This is illustrated in the diagram below:
A person suffering from anxiety could enter into therapy with a pattern of thoughts, feelings and bodily/behavioral responses as reflected in the examples listed as points 1 in the diagram above. The aim of CBT would be to assist them to progress to points 2 in their thoughts, feelings and behaviors. So a client may enter into therapy with a cluster of thoughts including a thought like “I am a failure” which generates feelings of despair and dread and a bodily response of shallow, panicked breathing (among other behavioral and bodily responses). Through CBT the therapist would want to modify the thought to for instance “I am a capable person,” generate feelings of hope and confidence and modify the physiological response to deep, relaxed breathing. A CBT approach assumes that our thoughts, feelings and behaviors are interlinked and have a cyclical influence on each other. It primarily tackles the thoughts and behaviors thereby generating changes in the feelings a person experiences.
The cognitive element of CBT would help the clients learn to understand the relationship between the thoughts they have and the symptoms of anxiety they experience. Clients would be equipped with various skills and strategies to modify these thought processes and thereby reduce symptoms of anxiety. For instance a client may first be taught to monitor and become aware of maladaptive thoughts and then replace these thoughts with more positive and supportive thoughts using techniques such as thought stopping and thought replacement. The behavioral aspect of this therapy helps clients develop strategies to lessen or eliminate problematic bodily or behavioral aspects of their anxiety. For instance a client may be trained in guided relaxation and deep breathing techniques. An additional key feature of working with anxiety within a CBT approach is the notion of exposure. Typically clients with anxiety avoid the anxiety provoking experiences or triggers. Within a CBT framework that provides strategies for managing the anxiety exposure usually triggers, clients are encouraged to expose themselves to the anxiety provoking experience thereby reducing the anxiety associated with the trigger.
In the treatment of anxiety there is a place for the use of psychotropic medications (e.g. Benzodiazepines, SSRI’s). These medications manage and reduce the symptoms in contrast to therapy which equips the anxiety sufferer with skills and strategies. According to the Canadian Psychiatric association clinical guidelines use of CBT in both group and individual settings is viewed as being on a par with drug antidepressant medication. However the most common practice tends to be a combination of medication and Cognitive Behavioral Therapy. While CBT for anxiety is typically conducted via in-person therapy sessions, some online therapy providers offer it as well, so that would also be an option worthy of consideration for those limited by the budget or time required for traditional therapy.
CBT is considered a highly effective therapy for anxiety and most sufferers will notice a significant reduction or even elimination of symptoms within months or even weeks of starting therapy. For some sufferers there is a degree of chronicity to the disorder, and in these instances therapy can assist in reducing symptoms to a manageable, minimally disruptive level.