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Therapy for Anxiety

 

(Note: Nothing below should be considered “treatment” for anxiety or any other mental health problem, though some of it may be helpful to you or others.  If you have significant distress that you are not able to resolve on your own, you are encouraged to see a qualified therapist or other health provider.)

 

Information about Anxiety

Anxiety comes in many forms, but if you are looking for help with anxiety, you probably feel anxious a lot, and/or worry a lot, and/or have acute episodes of anxiety that come out of the blue, often referred to as “panic.”  Related symptoms or problems that overlap with “anxiety” (though they have been classified differently in the most recent version of the DSM-5, the “bible” of psychiatric diagnoses) include (i) “post-traumatic” symptoms: i.e., difficulties related to effects and memories of past traumatic events (e.g., sexual, physical, or other abuse or victimization; experiences at war; traumatic accidents or other experiences) and (ii) “obsessive-compulsive” symptoms: needing to repeat otherwise pointless behavior to keep anxiety at bay (e.g., repeatedly washing your hands or checking things), or having intrusive, unreasonable, and disturbing thoughts (e.g., that you are going to act in an unwanted but out-of-control way).

Assessment

If you come in for help with anxiety, I would do some assessment, including of (i) your symptoms (e.g., what type(s) of anxiety you have been experiencing, and in response to what; when and how long you have been experiencing it; and associated symptoms such as physical symptoms or insomnia); (ii) past history (generally, and your history of experience of anxiety and/or other mental health/emotional symptoms); and (iii) possible “triggers” – events or circumstances that may play a role in bringing on your anxiety or in making it worse.  Sometimes I may go through a questionnaire with you that quantifies anxiety symptoms, which can be helpful both in diagnosis and in keeping track of severity and improvement.

Helping You with Therapy for Anxiety

Research indicates that psychotherapy for anxiety and medication for anxiety (see * below) are both effective – and roughly equally effective – in treating most types of anxiety.  (For obsessive-compulsive symptoms, psychotherapy may be even more effective than medication.)  Medication and psychotherapy for anxiety are also often combined.  If you are considering seeing me, you are probably looking to get help from psychotherapy for your anxiety.  If appropriate or warranted, I will also discuss the option of adding medication to your treatment.  (I am not a medical doctor and therefore do not prescribe medication.  If medication was warranted and you were interested in trying it, I would refer you to your primary care doctor (primary care doctors prescribe the bulk of medication for anxiety in the US), or to a psychiatrist if you preferred or if the complexity of your anxiety warranted the expertise of a specialist.)

Therapy for anxiety symptoms often starts helping within the first several sessions (especially if the symptoms are mild and are limited to and the result of a recent triggering event, circumstance, or stressor), and even in other cases there is often significant improvement within several months. 

Psychotherapy for anxiety, as for other psychological and emotional problems, starts with a good relationship, in which you feel understood and supported by your therapist. Beyond this critical foundation, I use an “eclectic” approach (i.e., involving a mix of orientations), but with lots of “cognitive-behavioral” aspects.  I start with elaborating on the idea that the experience of anxiety often entails an element of fear.  While the following description is brief and simplified, anxiety disorders, by definition, involve an unhelpful and typically exaggerated fear reaction in the present.  For example, one may feel (i) “anxious” generally, or in certain circumstances (e.g., about being negatively perceived in interpersonal situations – “social anxiety”), out of proportion to the real (or likely) risks or dangers of those circumstances; or (ii) prone to worrying about things excessively – i.e.: exaggerating the likelihood or extent of negative/harmful/dangerous outcomes of events or circumstances, and dwelling on that negative anticipation in unhelpful and distressing ways; or (iii) in cases of panic disorder, one suddenly, intensely fears loss of control and/or catastrophe (“like I’m gonna’ pass out or die…”).

In therapy for anxiety, I attempt to help you (i) identify the (unrealistic, unhelpful) cognitions giving rise to the fear and/or worry; (ii) recognize such cognitions, when they occur, for what they are: your automatic anxiety thoughts/reactions, which are not objective, reasonable/logical, or helpful, and rather are distressing and problematic.  I encourage clients to start explicitly labeling such reactions as the “problem,” the “symptom” we are focusing on, rather than as thoughts “worth listening to” or taking at face value; and (iii) to come up with alternative, more helpful ways of reacting to the triggers of such anxious thoughts/reactions and/or to your initial anxious reactions. 

Such interventions used in “cognitive-behavioral" therapy for anxiety are examples of application of my “bumper sticker summary of psychotherapy”: “Don’t believe everything you (initially/automatically) think.”  In this case, critical to overcoming anxiety is “not believing” your anxious reactions: that is, not treating them as reasonable and worth listening to or “investing in.”  Rather, it can help to think of such reactions, once you have learned to label them as such, as unfortunate neuropsychological hiccups: You may not be able to keep them from happening, but you can work on not “believing,” or buying into, what they say to you.

At the same time, I would encourage you to do things (part of the “behavioral” part of “cognitive-behavioral” therapy) that we know help people with anxiety: (i) use breathing and other relaxation techniques that I would teach you; and (ii) get more physical activity or exercise of some sort.

Please read this: Some people may benefit from simply reading therapeutic ideas and rationales such as the ones I outline above – a brief type of “self-help” reading.  For many, though, effectively treating your anxiety may require a therapist’s help: to apply these ideas to your experience, to encourage and support you and bolster your confidence, and to help you work through roadblocks that may arise.

In any event, if you are looking for counseling or therapy for problems with anxiety in the Madison WI area, good for you for considering getting help.  Feel free to call me, at 608-271-8799: I would be happy to meet with you and try to help.



*Broadly speaking, there are two types of medication for anxiety: “benzodiazepines” (including “Xanax” and “Valium”), which start working shortly after you take them, last for a number of hours, and have potential for addiction; and medications referred to as “antidepressants,” but which have been found in the last several decades to be effective for anxiety as well.  (The most popular current antidepressants for the treatment of anxiety are a family of medications referred to as “SSRI’s”, which includes “Zoloft,” “Paxil,” “Prozac,” “Celexa,” and “Lexapro.”)