Therapy for Anxiety and Stress: CBT and Other Professional Care

Why consider professional care

Self-help works for many people, but there is a point where professional support is the right step. NIMH says that if you are struggling to cope, or the symptoms of stress or anxiety will not go away, it may be time to talk to a professional. Psychotherapy (talk therapy) and medication are the two main treatments for anxiety, and many people benefit from a combination. [1]

People seek psychotherapy for many reasons, including severe or long-term stress from a job or family situation, the loss of a loved one, relationship problems, or symptoms with no physical explanation such as changes in sleep or appetite, low energy, persistent irritability, or excessive worry. [2] A health care provider may first rule out a physical cause. [2]

What psychotherapy is

Psychotherapy refers to a variety of treatments that aim to help a person identify and change troubling emotions, thoughts and behaviors, usually one-on-one with a licensed professional or in a group. [2] Goals include relief from symptoms, better daily functioning and better quality of life. [2] It can be delivered in person or by telehealth, and apps may support it. [3]

Elements can include: [2]

• Becoming aware of inaccurate or harmful automatic thoughts and questioning them (CBT).
• Identifying ways to cope with stress and building problem-solving strategies.
• Mindfulness and relaxation techniques, such as meditation and breathing exercises.
• Exposure therapy, a type of CBT for anxiety disorders, in which a person learns to tolerate distress in a supportive setting.
• Supportive counseling.
• Creating a safety plan for thoughts of self-harm or suicide.

Cognitive behavioral therapy (CBT)

CBT helps people notice automatic ways of thinking that are inaccurate or harmful, question those thoughts, understand how they affect emotions and behavior, and change self-defeating patterns to feel less anxious. NIMH says CBT has been well studied and is the "gold standard" choice for psychotherapy for generalized anxiety disorder; it is also commonly used for panic disorder. [3][4] The NHS lists CBT as a recommended treatment for many problems, including anxiety, social anxiety, phobias, OCD and PTSD. [5]

Supporting evidence:

Acceptance and commitment therapy (ACT)

ACT encourages nonjudgmental acceptance of thoughts and promotes engagement in meaningful activities, using strategies such as mindfulness and goal setting. NIMH says there is a growing body of research on its effectiveness for GAD. [3]

Medicines at an overview level

This is orientation only. The prescriber decides; never start, stop or change a medicine on your own.

• Antidepressants (SSRIs and SNRIs) are commonly used for depression and also treat anxiety; they may take several weeks to work, and side effects can include headaches, nausea or trouble sleeping, usually not severe if the dose starts low and rises slowly. [3]
• Benzodiazepines are sedatives that can quickly reduce anxiety, but tolerance and dependence can develop, so they are usually prescribed only for brief periods. [3]
• Buspirone is not a sedative, has less potential to be addictive and needs to be taken for 3 to 4 weeks to be fully effective. [3]
• Beta-blockers can help with physical symptoms such as rapid heart rate and tremor, and are not commonly prescribed for panic disorder. [4]

In England, a GP will usually advise trying talking therapies before prescribing medicine. [8] For interactions with supplements or alcohol, see How interactions work and Stress and anxiety safety.

How to find a therapist

• Start with a primary care provider, who can refer you to a psychologist, psychiatrist or clinical social worker. [3]
• Federal and national resources: SAMHSA's helpline and locator, your insurer's directory, a university or college health center, or an employer's Employee Assistance Program. [9]
• Questions to ask: credentials and experience, the approach and its evidence base, goals and number of sessions, how progress is measured, whether medication is an option, and confidentiality. [2]
• If you feel no better after a reasonable time, talk to your therapist; you may explore other professionals or approaches. [2]
• There is no formal approval process for psychotherapies like there is for medicines. Many have evidence from large studies, but ask about the evidence base. [2]

Where complementary approaches fit

Mindfulness, relaxation and healthy habits can support therapy, according to NIMH, but do not replace it. [3] See Mindfulness and meditation for stress and Anxiety disorders.

When to get help urgently

If you are in immediate distress or thinking about hurting yourself, call or text 988 in the US (free, 24/7), or call 911 in a life-threatening situation. [1][10] Elsewhere, use your local emergency number or look up your country's crisis line.