Anxiety Treatment: Therapy, Medication, Lifestyle & Self Help

How to Get Diagnosed With Anxiety

While you know yourself better than anyone else, insurance and some agencies require an official diagnosis to be able to move forward with anxiety treatment. This can be done with a doctor (primary care or psychiatry is appropriate), a psychologist (often, a PhD or PsyD), or a mental health professional (a licensed professional counselor or social worker).

When you meet with one of these professionals, it is most likely they will do an assessment of some kind with you to assess your mental health concerns, background, and other relevant history. They will likely use the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) in this process to compare your reported symptoms to a criterion of symptoms to discern the most appropriate diagnosis for you. Once an official diagnosis has been made, the care provider can send this diagnosis and their recommendation for treatment to your insurance or with a referral to a local mental health professional.

Therapy for Anxiety

For people experiencing any symptoms of anxiety disorders like worry, panic, intense fears, and physical tension, therapy for anxiety is a great treatment choice. Therapy or psychotherapy usually involves speaking to a therapist in an individual, group, or family setting. For added convenience, appointments can occur in the home, a school, an office, or virtually with phone and videoconferencing.

Many therapies for anxiety disorders are effective and evidence-based, so insurance companies will generally cover the majority of options. In an attempt to remove barriers preventing treatment, many insurances do not require a prescription or referral to start sessions. Fewer anxious symptoms may be only a phone call away.

Cognitive Behavioral Therapy

Perhaps the most helpful form of psychotherapy for anxiety disorders is called cognitive behavioral therapy (CBT). It works by having the client begin to identify and dispute the unhelpful thoughts that create or maintain anxious symptoms.² By replacing anxious thoughts with calm ones, the person changes the way they feel.

Exposure Therapy

Exposure therapy is a type of CBT useful for managing anxious symptoms. This method involves working with a therapist to confront worries in person or through imagery. A person who is afraid of heights may gradually go higher in an office building until they are standing on top of a tall building.²

Anxiety Music Therapy

Anxiety music therapy involves a careful selection of music that resonates with an individual’s preferences and emotional state to create a sense of calm, relaxation, and promote emotional balance.

Acceptance and Commitment Therapy

Acceptance and commitment therapy (ACT) helps to manage anxious symptoms with a combination of acceptance, mindfulness, and behavioral changes. By living in the moment without the need to analyze and judge themselves, people can experience fewer worries and fears. With the addition of behavior modifications to cope with harmful thoughts and feelings, ACT, like CBT, emphasizes the value of addressing thoughts and behaviors to limit anxiety.³

Dialectical Behavioral Therapy

Dialectical behavioral therapy (DBT) began as a way to address chronically suicidal clients and people with personality disorders, but good evidence suggests this treatment is effective for anxiety disorders as well. DBT for anxiety blends elements of CBT and mindfulness practices to focus on both acceptance and change.³

Eye Movement Desensitization and Reprocessing

Eye movement desensitization and reprocessing (EMDR) is a treatment style that seems to change the way the brain processes information. Where CBT, ACT, and DBT are all forms of talk therapy, an EMDR therapist guides the client through a process that permits them to experience fear, worries, and nervousness in less distressing ways.³

Empirical evidence supports EMDR use for post-traumatic stress disorder, and the therapy is being used more frequently for anxiety-related issues like panic attacks and phobias. Some EMDR clients note symptom resolution in as few as three 90-minute sessions.⁶

Other Types of Anxiety Therapy You May Encounter

Some other types of therapy or therapy techniques you may encounter for anxiety symptoms include:⁴

• Relaxation Techniques: Techniques like deep breathing, progressive muscle relaxation, guided imagery, and autogenic training, may be included as part of CBT sessions or independently from professional treatment. By calming the body and the mind, these treatments address the consequences of anxiety.
• Hypnotherapy: Hypnotherapy can help reduce anxiety, especially when linked to dental or medical procedures. At this time, though, there is not enough overwhelming evidence to fully support it as an anxiety treatment.
• Mindfulness Meditation: Studies have found mindfulness meditation helpful for anxiety across numerous groups of people. In the future, people can expect more research aiming to prove that mindfulness and other forms of meditation can definitively improve anxiety symptoms.
• Coloring Books: Using coloring pages for anxiety or buying adult coloring books is a relaxing activity that can help you focus more on the activity in the moment and less on the anxious thoughts you’re having.

Finding an Anxiety Therapist

When you think about starting therapy, it may feel overwhelming and maybe a bit scary. The process of finding a therapist may feel daunting, especially if you have not attended therapy before. If you are going through insurance, the first step is to figure out which therapists in your area are covered by your insurance. You can call the number on the back of your insurance card or use their online database to search for appropriate providers.

There are several ways outside of contacting your insurance that you can get help with the process.You can ask your doctor for a referral, you can contact local agencies and see if they have openings, or you can use an online directory that allows you to search by specialty and insurance coverage.

Questions to Ask about Therapy

When starting out with therapy, be sure to ask:²

• What therapy style would be best for my symptoms?
• Is it normal for therapy and thinking about therapy to make me more anxious?
• What is the role of homework and out-of-therapy treatment?
• What is the projected course of therapy? How often will we meet and for what duration?
• Will symptoms get worse before they improve?
• Have you successfully treated people with my symptoms?
• Would adding medication be a helpful way to improve my outcomes?
• Are there any risks to this treatment style?
• How much will this cost me?

Anxiety Medications

Alone, or in combination with therapy, medication for anxiety is an effective treatment option. People interested in medication must practice caution as some medications used for anxiety can result in unwanted, long-term effects like tolerance, addiction, and physical dependence. People concerned about these results, how medication may make them feel, and how long it will take for them to work, should consult with their prescriber, always take medications as prescribed, and may want to consider therapy first.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are a group of medications that all act by allowing the brain to absorb larger levels of serotonin with the goal of decreasing anxiety symptoms.⁵ These same medications are used in the treatment of depression and obsessive-compulsive disorder (OCD), a condition that shares many similarities with anxiety disorders.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Serotonin-norepinephrine reuptake inhibitors (SNRIs) operate much in the same way as SSRIs but with the added benefit of interacting with norepinephrine as well as serotonin.

These medications are equally effective as SSRIs, but medications from this category may work better than other drugs for some people. SNRIs are not typically as effective for OCD symptoms.⁵

How Long Does It Take for Them to Work?

This class of medications typically needs a month or more to become effective, so clients will do well to practice patience and flexibility, since it could take several trials to identify a helpful medication. People should never stop use or change the dose, frequency, or route of administration without their prescriber’s consent.²

Side Effects for SSRIs & SNRIs

Side effects from these medications are relatively mild and may include sleeping problems, sexual issues, and weight gain. This is not a comprehensive list of side effects and a doctor or pharmacist can have a more in depth conversation about all of the possible side effects.⁵

Other classes of antidepressants, called tricyclics and monoamine oxidase inhibitors (MAOIs), are still effective but used less frequently due to the problematic side effects they may cause.²

Benzodiazepines

Benzodiazepines are used specifically to address panic attacks, anxiety, and extreme fears.² These medications are very effective and produce results much quicker than antidepressants, but they do present several significant challenges.²

The primary drawback of benzodiazepines is the risk of tolerance. Over time, people need increasingly larger doses as the brain lessens its response to the drugs. Tolerance is linked to additional issues like physical dependence and addiction, so people should only use these medications for short-term anxiety treatment.²
The Drug Enforcement Administration (DEA) classifies benzodiazepines as a controlled substance, which means their prescription and distribution is closely monitored.

Beta-Blockers

Beta-blockers are usually prescribed to lower blood pressure, but they can also help to relieve the physical symptoms of anxiety. Anxious effects like quick heart rate, shakiness, and feeling flushed can all improve with beta-blockers.² Although these medications may not be the first choice for anxiety, they remain viable options.

How to Get Anxiety Medication

Medications for anxiety are offered by a number of prescribers including:

• Psychiatrists
• Pediatricians
• Primary care physicians
• Nurse Practitioners

Depending on the insurance plan, the specific medication, and dose, anxiety medications are regularly covered by insurance. Like other medications, they will be subjected to normal copays.

Questions to Ask about Medications

Important questions to ask the prescriber when starting medications include:²

• When will I see the benefit of this medication?
• What are the common and expected side effects of this drug?
• Does this medication carry any change for tolerance or dependence?
• How long can I be on this medication?
• How do I proceed if I encounter serious reactions?
• Can I stop this medication if I don’t like it?
• How much does this medication cost and will my insurance company pay for it?
• If a medication worked for a family member will it work for me?

Alternative Medicine Options for Anxiety

Though not necessarily classified as medications, some people will pursue the use of natural remedies for anxiety to improve their feelings of calm and limit the stress and tension.

Natural products which may aid anxiety treatment are:⁴

• Tea for anxiety:  Early studies that show chamomile extract as a way to manage generalized anxiety are encouraging but will require further inspection, and drinking other teas for anxiety can provide calming effects.
• Kava: Made from a root, using kava for anxiety (kava kava) seems to have a positive influence on anxiety, but the supplement may result in liver damage so people must understand this risk.
• Melatonin: Used as a natural way to support sleep, melatonin may assist with reducing anxiety, especially before surgery.
• Other possibilities: Some may find success in lowering their anxiety with natural products consisting of passionflower or valerian. With the current evidence, these products cannot be fully supported.

Like with other treatments, anyone considering the use of these alternative options should consult their treatment team to discuss the possible risks and benefits involved. Before starting any supplement, a person should also discuss the supplement with their prescriber or pharmacist to check for interactions with any prescription medications they are taking.

Lifestyle Changes for Anxiety

Professional treatment options for anxiety, like therapy and medications, are wonderful ways to improve symptoms, but lifestyle changes and self-help strategies for anxiety can serve as an additional way to shrink the influence of anxiety. If you’re in a relationship, you might find having sex helps relieve anxiety symptoms.

Dietary Adjustments

One of the first lifestyle changes your doctor or therapist may suggest is to monitor your eating habits.  Try to avoid the known foods that cause anxiety while increasing foods that help anxiety. Although there is limited research on this topic, the Mayo Clinic suggests that eating healthy and nutritious foods may be connected with lower anxiety symptoms. This suggestion also includes limiting caffeine intake as caffeine can affect anxiety levels and symptoms.⁷

Stopping or Cutting Back on Substance Use

Using substances may seem like an appealing way to increase comfort and feel calm, but drugs and alcohol used for self-medication typically create larger problems in the future. Avoiding these substances and pursuing healthier coping skills will lead to better long-term effects.

Exercise

Walking, weight training, biking, and swimming, can all help limit symptoms of anxiety. Physical activity helps change a person’s setting and can increase the levels of wanted brain chemicals.

Gentle movement activities like tai chi, qi gong, and yoga may create feelings of relaxation and peace that combat anxiety. Spending a few minutes engaged in these can improve a person’s physical and mental well-being as well.

Sleep

Good night’s sleep is critical for good mental and physical health. Poor sleep can impair you significantly and can make anxiety symptoms worse. The Center for Disease Control and Prevention (CDC) suggests that people 18 and older require 7 or more hours of sleep a night.⁸ If you are having difficulty sleeping in addition to your symptoms, you may want to talk to your doctor to see what can help.

Hospitalization for Anxiety

Inpatient psychiatric hospitalization represents the highest level of care for people with anxiety. Psychiatric inpatient treatment is a short-term treatment aimed at increasing symptom stability and ensuring safety for the person as well as the people around them. Inpatient hospitalizations are usually reserved for people who are actively suicidal or homicidal.

Aside from thoughts of death, people may consider inpatient treatment if anxiety is resulting in:

• Limited hygiene and self-care
• Dangerous coping skills like substance abuse or compulsive behaviors to manage symptoms
• Harmful diet or food restrictions linked to anxiety
• An inability to care for self and those dependent on them

Inpatient care typically focuses on brief interventions to adjust medications or connect to additional services once inpatient hospitalization ends. For people with intense anxiety or co-occurring anxiety and depression, inpatient treatment may be needed. In many situations, though, anxiety disorders can be well-managed with outpatient care.

Other Tips for How to Deal With Anxiety

Here are several more ways to deal with anxiety that are free, low-risk, and easily accessible:^1,2,4

• Listening to music: As simple as it may seem, listening to music can reduce the unwanted symptoms of anxiety. A few minutes of a favorite song can produce a positive impact.
• Stress management: Lowering stress might not eliminate a person’s anxiety, but it will help. By identifying sources of stress and exploring ways to minimize their effects, managing stress will help to manage anxiety.
• Support groups: Support groups involve people meeting with others who have similar experiences and symptoms to gain information and build a sense of community. Support groups differ from therapy groups, since the former groups lack professional facilitators. Some may find an online support group or therapy group helpful.
• Connecting with loved ones: Feeling connected to supportive friends and family members offers tremendous anxiety reduction. Communicating thoughts and feelings about the worries and fears can go a long way in reducing anxieties.
• Educate yourself about anxiety: Understanding anxiety’s role and how to communicate your symptoms can be an important part of getting appropriate care. You can do this by asking your doctor about anxiety or even pursuing independent research.⁷
• Relaxation techniques: Anxiety can make your body think it is experiencing a number of physical issues and, in turn, can often make you more tense without your awareness. Using appropriate breathing techniques, positive imagery (i.e. like finding your happy place), grounding techniques (i.e. touch, taste, and feel to calm and reorient yourself to base level), and yoga can all be helpful in lowering anxiety symptoms.⁷
• Mindfulness and meditation: Similar to relaxation techniques, engaging in meditation (guided or unguided) can be helpful in facilitating calm, lowering your anxiety symptoms, increasing your focus, and slowing down your thoughts.⁷ If you struggle to focus during meditation, using apps like Headspace or Calm can help you to meditate and calm your thoughts.
• Reframe negative thoughts: Anxious thoughts can be overwhelming and hard to track, especially if you’re having an anxiety attack. It can be helpful to identify these thoughts and either reframe them or back them up with facts. When you are reframing the thoughts, you are changing the connection and reducing your negative self-talk that anxiety can reinforce.
• Learn to be assertive: It is difficult to set boundaries or to be able to implement appropriate self-care strategies when anxiety kicks in. Learning healthy assertive communication skills is positive and healthy for you and others in your life.
• Try journaling: It may sound a little cheesy, but journaling has been observed in multiple studies to help track your stressors or triggers, changes to your mood and your habits, and even things that may be helping you. It can be helpful to be able to look back on these things for your mental health as well as to reassure you about the work you may be doing for yourself.⁷ Using anxiety journaling prompts can also help you process your emotions.

Where to Get Help

Starting the process to get help for anxiety symptoms may feel daunting. You may feel like you’re not sure what the first steps are or how to best communicate your concerns. A healthy first step is to start with scheduling a visit to your primary care provider (PCP) or a general family care doctor.

By starting with your PCP, this will allow you time to prepare to communicate your experience, know what questions you want to ask, and to get information about treatment for what is happening, as well as rule out any medical concerns that may be contributing to your anxiety. Your PCP should supply a referral to a good mental health professional or resources for mental health treatment.

Preparing for Your Appointment

Before your appointment, it can be helpful to make a list of your mental health concerns, life stressors, any physical or mental health issues that are already occurring, as well as family history of mental health issues and any medications you’re taking (this includes prescribed, non-prescribed, illegal or legal, and any supplements or herbs to avoid medication interactions).

Some basic questions to ask your doctor include:⁷

• Are there other factors (like physical health issues or family history) that could be playing a role in my symptoms?
• What can you tell me about anxiety that I should know?
• Are there any tests I should take?
• Would you suggest I take medication? If so, could you educate me about a generic version and/or side effects it may cause?
• Should I consider seeing a mental health professional, like a therapist, psychologist, or psychiatrist?
• Are there any self-care activities or suggestions I can try to do at home?
• Is there anything else you feel I should know about this conversation, medication, or my anxiety?

What to Expect From Your Doctor

You should also be prepared for the doctor to ask a number of questions to be able to assess you appropriately.

The questions your doctor could ask may include:

• When did your symptoms start?
• Tell me about your symptoms, their severity, and how much, if any, they’ve lowered or kept you from being able to function.
• Tell me about your mental and physical health history. Does anyone in your family have mental or physical health issues and, if so, what are they?
• Have your symptoms been ongoing, on-and-off, or only occurring in certain situations or moments?
• Have you been avoiding these situations as a result of feeling anxious?
• Is there anything that has made your anxiety lower or made you feel better?
• Have you experienced any trauma in your past? If so, tell me a little more about how long it has been and, to your comfort, what occurred.
• Do you take any medications or have you in the past?
• Do you use any alcohol or substances? If so, how often?
• Are you having thoughts of hurting yourself or anyone else?

Establishing & Sticking to a Treatment Plan for Anxiety

Creating a treatment plan you can stick to is an important part of helping to manage your anxiety symptoms. A treatment plan is generally created between the client, their therapist, their doctor or psychiatrist (if medication is involved), and, sometimes, the client’s family if requested. The goal for this plan is to help you stay on track, explore support options if you are struggling to stay on track, and, hopefully, for you to feel better and healthier, and experience reduced or no anxiety symptoms.

Your treatment plan may look like taking medications as suggested, maintaining regular therapy appointments, completing tasks or homework given in therapy sessions, and connecting with your support team if you are struggling.⁷ Therapy models like cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) may provide tasks that are completed outside of session; these tasks include cognitive or behavioral strategies geared towards reducing the effects of anxiety.

It may be difficult to stick to your plan sometimes, like if you feel the medications are not working, if you’re not seeing progress in therapy, or if you’re experiencing more anxiety and struggling to manage it. Reaching out to your support team or loved ones can be helpful in maintaining your plan, especially if they are positive roles in your life. It can also be helpful to journal during this time to track for yourself and for your PCP and mental health professional to see what changes are being made and, if so, how well they have worked for you. It is also important to validate yourself for continuing to work on managing your anxiety, maintaining healthy behaviors, and working with your team and loved ones; this is not an easy process.