Anxiety can be difficult to live with and impair your day-to-day life to the point you feel like giving up. Even though there are coping methods you can try, therapy can help you even more. But you may think ‘What type of therapy is best for me?’.
Here are 10 ideas for different therapies you can try for your anxiety.
Some types of therapy will focus on ‘healing’ the anxiety. Others will explore your anxiety and its source. There are also therapies that don’t even seek to ‘cure’ anxiety. Instead, their goal is to teach you how to face your anxiety and learn from it.
1. Art Therapy
Art therapy uses art exercises to help you step back and look inside. You can identify your strengths and weaknesses by creating visible depictions of your mental states. It borrows elements from psychoanalysis, cognitive-analytic therapies, compassion-focused therapy and others.
Art therapy is especially suitable for those who want to try other interventions than medication and classic talking therapy.
This type of therapy is for people who find it difficult to put things into words. As anxiety is many times difficult to put into words, art therapy can help you explore and manage anxiety symptoms. Also, it allows you to communicate things you may be ashamed of, or afraid to express into words in the presence of a stranger like a therapist.
Read here the interesting case of a Dutch woman in her fifties. She suffered from severe anxiety. Symptoms of anxiety occurred in her twenties when she experienced a panic attack on a train. Later, she developed a fear of being trapped in trains. This fear expanded to fear of driving a car, fear of elevators and fear of losing orientation when walking outside alone.
The case study follows her art therapy sessions and the gradual progress she made. It minutely describes the sessions, accompanied by the drawings as well.
“Verbal therapy is hard work. You must dig into yourself so much. You do not always feel like opening up, sometimes you just do not feel like it, or it is quite tough. With art therapy it is also hard work, but differently. You can lose yourself for a moment in what you are doing. Art therapy addressed relaxation. I was not really concerned with my emotions, but much more focused on making it flow”.
cited in Abbing, A. C., et al, 2019
If you are curious, try some art exercises.
2. Behavioural Therapy
Behavioural therapy is the opposite of cognitive therapy in which you change your thoughts to change your behaviour. For example, rather than telling yourself, “There’s no danger when I go out.” you would change the behavior by actually going out and having the experience of being safe. That experience would help you change your thoughts regarding the danger of going out, and (hopefully) resolve your fear.
Exposure therapies are difficult to practice because you have to be willing to endure those situations and feelings that you find extremely distressing and seek to avoid. But exposure exercises are effective because they force you to tolerate what you fear. Then you realize you survived that which you were afraid of. Your fear-based thoughts and beliefs are challenged this way.
There are two types of exposure treatments: gradual exposure and flooding.
You expose yourself to a bit of anxiety and get used to it before moving toward more discomfort.
Straight into the swimming pool. There’s nothing gradual about it. With flooding, there is no gentle ease into your discomfort, but forces you to confront it directly.
3. Biodynamic therapy / body psychotherapy
This type of therapy focuses on your body awareness and the role of the body in psychotherapy.
The approach can include touch, breathing, and movement techniques but also massage.
Anxiety is experienced both mentally and physically. The physical symptoms can be especially unpleasant. The physical and emotional exercises practiced in body psychotherapy can help you relieve the tension you experience because of your anxiety. The therapist will try to understand the information hidden in these symptoms in order to increase the tolerance for anxiety.
Body psychotherapy is considered a holistic therapy because addresses all three levels of the experience of anxiety (Thielen, 2013).
Physical level (muscle tension, raised blood pressure, fast breathing, etc)
Emotional and cognitive level (dread, feelings of exposure and helplessness etc)
Behavioural level (reactions such as freezing, shivering or shaking, flight reaction and panicky movements, avoidance of anxiety-inducing situations and of eye contact).
The relation between the therapist and the client is much closer. The therapist is not the eternally cold and self-composed person who stares at you while you talk. Interaction and transparency are critical. Sometimes, the therapist may express to the client her own feelings about the situation.
The therapist is more focused on how you say things instead of what you say. As this is a bodily centered type of therapy, your body language is the most important means of communication.
There is a lot of space for further research on how body psychotherapy helps patients with anxiety. But integrating body-based techniques may make up an effective treatment for anxiety. (Berg, Sandell, Sandalh., 2009).
4. Cognitive Therapy
As the word ‘cognitive’ suggests, this type of therapy is all about changing mindsets and locating the thought patterns that cause you distress. It involves homework and practical exercises. You will explore how the way you perceive yourself is causing you to act in a self-destructive way (here goes a bit towards the behavioral part, but it’s not the same as CBT).
This is one of the types of therapy that lasts for a short period. There is no exploration of the past or hidden / unsolved issues.
5. Cognitive Behavioural Therapy (CBT)
CBT uses elements of both cognitive and behavioural therapy in order to strengthen the effects of the other.
It goes through your ideas and responses and tries to establish which of them reflect reality and which are mistaken and unhelpful. You will explore a set of alternative thoughts and responses with your therapist with which to replace the old ones. The counsellor will also give you exercises that you can use to retrain your mind.
1. Your therapist will give you exercises to help you identify and record the thoughts that run through your mind. In these exercises you write your worried thoughts and the beliefs that underlie them, rather than just stating them aloud to your therapist or letting them whirl around in your head.
2. Next, the counsellor teaches you how to test the accuracy and helpfulness of your thoughts.
3. You replace the unhelpful thoughts with more accurate and adaptive ones. This way you change your beliefs and become less fearful.
There are also lots of books, apps and online programs designed to help you apply CBT techniques by yourself. Still, CBT is usually more effective when a therapist assists you.
6. Existential Psychotherapy
This is the opposite of CBT (no fast cure in brief time).
Existential therapy starts from a deep concern about existence and meaning and purpose, and mental health struggles and mental health symptoms.
Existential psychotherapy aims to see people through the anxiety of realizing that life is pain and struggle. It is not as palatable as CBT or art therapy, but it can lead to long-time results. Being realistic about the facts of life enables you to find ways of dealing with them. By being alert to the limits of existence (death, aging, illness, etc) you can find more ways of dealing with them than by simply blocking them out, or by feeling defeated.
At a first glance, this type of therapy may seem gloomy. Still, existential therapy will help you embrace life with hope rather than dread. It will empower you because you build resilience. You learn how to make personal choices. You realize you are free, competent, and most important, responsible to create personal meaning.
Existential psychotherapy walks you through the four dimensions of life (Iacovou, 2015) and explores your perspective over them. The four dimensions are:
The physical dimension (life and death, suffering and pleasure, health and illness)
The social dimension (belonging and isolation, acceptance and rejection)
The intimate, personal dimension (identity and confusion, confidence and doubt, strengths and weaknesses)
The spiritual dimension (meaning and absurdity, purpose and emptiness)
Anxiety encompasses at least one of these dimensions, if not all of them. For example, there is health anxiety that many of us struggle with. Social anxiety is all about fear of rejection and isolation. Anxiety robs you from your self-confidence and hides your strengths while highlighting your weaknesses.
What is important is that you will have a safe space to explore and face those dimensions that terrify you.
7. Gestalt Theraphy
One of the major area of emphasis in Gestalt Therapy is the idea of awareness. Most of the techniques used in Gestalt Therapy rely on awareness. You will learn to pay attention to your senses and to the world around you. You will learn to face your emotions and fully experience them rather than hide them in the fog. This type of therapy will also focus on the individual’s body awareness. So you will learn to notice how your body is feeling.
One effective technique is to remain in the here and now. Each session will focus on what happens in the present moment. The counsellor will use questions to help you enhance awareness.
The Gestalt therapist will use also language to increase awareness. He or she will pay attention to your words and to what you may avoid expressing. For example, there is this belief that by using the word “I” more often, you will increase your sense of ownership over situations. Also, you will learn to accept responsibility for your actions.
7. Integrative Psychotherapy
Not all types of therapy are effective for all individuals, mental problems, and contexts. Each psychotherapeutic model and approach has its pros and cons and works well for some people only. With integrative psychotherapy, the approach is flexible enough to suit different persons with distinct problems.
Integrative psychotherapy employs ideas from many therapies in order to help you achieve a sense of integration. This sense of integration is built by bringing together all the three dimensions of life similarly with body psychotherapy. Still, the body does not have a central place here.
The therapist does not aim at combining all the psychotherapeutic models into one. The primary purpose is to create a ‘dialogue’ with different approaches in order to the find the right combination for each client.
Integrating the personality: helping you assimilate and harmonize the contents of your ego states, relax the defense mechanisms, relinquish the script, and reengage the world with full contact.
Principle 1 – relates with our need for positive life change. Integrative psychotherapy will do more than teach you some new behaviors or coping skills designed to get you through today’s crises. It must somehow affect your life script (the set of stories you tell yourself and the world about you).
Principle 2 – focusses on integrating your rigid and limiting life script into a flexible and open acceptance of learning and growing from each experience.
8. Person-centred Psychotherapy
This type of therapy emphasizes the relationship between the counsellor and the client.
The therapist genuinely cares about the client, the client feels nurtured by the relationship. It’s all real, nobody’s pretending. Accurate empathy is one tenet of person-centered psychotherapy. The other ones are unconditional positive regard and authenticity. Positive regard refers to full acceptance of the client. The therapist cannot let himself be influenced by personal opinions or biases.
‘ It is that the individual has within him or herself vast resources for self-understanding, for altering her or his self-concept, attitudes, and self-directed behaviour—and that these resources can be tapped if only a definable climate of facilitative psychological attitudes can be provided.’
The person-centred approach perceives positive growth and self-actualization) the full activation of all capacities of a person) as its most important goal. There is a firm belief in an individual’s change without the counsellor intervening. You should make a progress as long as the counsellor provides empathy, acceptance and authenticity.
9. Psychodynamic Psychotherapy
A psychodynamic therapist will encourage you to explore your past (e.g. coping mechanisms learned in your childhood) in order to understand your anxiety in the present. If behavioural therapy focuses on how to act differently, psychodynamic psychotherapy looks at what makes you act that way.
A greater understanding of your acts and reactions will open the way for you to do them differently.
On the same line, this approach will explore your defense mechanisms. These are ways to repress distressing thoughts and feelings. Your defense mechanisms can take so many forms. Examples can include sarcasm, changing the subject, not talking or talking too much, irritability, working too much, overeating, etc (Hendel, 2018).
A study was made to test the efficacy of CBT and short-term psychodynamic psychotherapy on clients with anxiety. They split the group of people in two. Counsellors used the CBT approach on one group and psychodynamic psychotherapy on the other. Both approaches led to significant improvements in measures of anxiety. Still, the outcome of short-term psychodynamic psychotherapy in generalized anxiety disorder may be optimized by focusing more on worrying as a defense mechanism (Leichsenring D Sc, Falk, et al, 2009).
Psychosynthesis goes beyond your problem or crisis. The counsellor will try to create the right conditions in which you can deal successfully with distress and pain. ‘What’s trying to emerge through this difficulty? What’s seeking expression in this person’s life?’. The counsellor will equip you to handle problems as they arise without being overwhelmed by then.
Psychosynthesis places high value on inner freedom. During therapy, the client will explore his or her possibilities and choices. He or she will establish what is meaningful and worthy.
Also, there is no ideal of a ‘healthy individual’. The definition of psychospiritual health is ‘written’ during therapy. The counsellor’s task is to empower the client to envision his own ideal.
What I find encouraging is that in Psychosynthesis the therapist is no longer a blank screen, a stony face. He or she is more active, participative. Assagioli, the founder of this type of therapy, sustained the idea of a genuine relationship between the counsellor and the client. This is because the client will not trust the therapist enough to create the space for growth and healing (Whitmore, 2013).
There is no limit to the techniques used by this type of therapy: meditation, visualization, movement, free-form drawing, and writing. They may also encourage you to cry, swear, or scream, (Grose, 2011).
This type of therapy addresses the existential or spiritual anxiety. At the root of spiritual anxiety lies a conflict because we suppress our spiritual nature and our potential while yearning for both (Assagioli, 2011). We want to grow, but we fear, because growth involves changes and abandoning the familiar for the unknown. When these changes are far-reaching, they arouse anxiety. However, there are no research studies on therapeutic work with anxiety and anxiety states.
Behavioral, systemic, cognitive, psychodynamic; short-term or long-term. There are many types of therapy, and it’s difficult to choose which one is the best for you. Should you try quick results at the risk of being superficial? Or do you risk wasting time and money on an open-ended therapy with no guarantees?