The Best Treatment for Anxiety Employs an Eclectic Combination of Skills and Approaches from a Variety of Treatment Modalities
CBT or Cognitive Behavioral Therapy
The crux of Cognitive Behavioral Therapy is the observation that our feelings of anxiety are accompanied by thoughts…and sometimes these thoughts are unproductive, exaggerated or simply false. Yet we take them at face value. That is, if we even realize they are happening. In therapy we explore why those “ schema” are your go- to explanations or predictions and consider other ways of looking at things that might not be so harsh, so scary, so unkind, so disastrous. The goal is not to convince oneself that the glass is half full instead of half empty, but rather to recognize that we may be habitually convincing ourselves of the worst case scenario when that’s only a small possibility.
CBT is an active, engaging way of doing therapy in which the therapist acts as a supportive coach, asking questions, proposing alternatives and supporting you in practicing new skills each week. This type of therapy is especially helpful in the case of insomnia, where inability to sleep generates more and more anxiety, which in turn further prevents sleep. CBT is also extremely helpful for OCD, in which beliefs about the absolute necessity of engaging in a compulsive behavior are examined and alternatives considered.
Behavioral therapy is focused on actions you can take to affect change. It is not about changing your thoughts, or having insight into why you have those thoughts. It’s more about doing something different, and practicing until it’s less frightening. Behavioral approaches can be very helpful in uncoupling troubling behaviors, such as the habit of overeating when one is distressed. Behavioral Therapy is used to help people who engage in hair pulling or skin picking to find alternative behaviors that relieve the urge and help them refrain. Behavioral therapy is the basis of using charts and rewards to motivate and stay on track. It sometimes involves identifying triggers for certain behaviors and offers alternatives so that the behavior doesn’t seem so inevitable. It is also the basis of overcoming phobias and avoidant behavior that are so common in people who have anxiety. By breaking down frightening behaviors into micro steps, and accompanying them with techniques of breathing, relaxation or mediation, you can slowly learn to partake in activities that previously caused too much distress.
DBT or Dialectical Behavioral Therapy
DBT focuses on specific tools to help you get less upset, to refrain from over reacting, to soothe and calm yourself. Sometimes when emotions come over us it feels like they are inevitable and we can’t do anything about it. But most people agree it doesn’t feel good to lose control. It’s a real asset to feel in control of regulating your emotions, to be able to tolerate distress without losing control, to identify and ask for what we need interpersonally and to get through difficult times without behaving in a way that we later regret. DBT teaches skills to put in your toolbox so that you have something concrete to do when things feel overwhelming.
In this type of therapy we identify situations between yourself and the people in your life which are problematic. Sometimes our pasts have left us ill equipped to advocate for ourselves in healthy ways. Things like grief, guilt, loss or former interpersonal struggles may make us especially sensitive to some situations, may make us overreact or misinterpret. The goal here is to recognize this and learn healthier ways of interacting with others.
The good news is that anxiety disorders are very treatable and you have every reason to believe that with the right help, be it medications, therapy or both, that help is on the way.