How To Manage Anxiety: Exploring Different Evidence-Based Methods

An anxiety disorder may interfere with your ability to enjoy your favorite activities and manage your daily life. Finding an effective treatment may be one of your most pressing priorities if you’re living with a condition like panic disorder or generalized anxiety. This article will review the various types of anxiety disorders and explain which strategies may work best.

What qualifies as anxiety disorders?

A moderate amount of anxiety about things like upcoming deadlines or preventable accidents can help you prepare better for life’s ups and downs. Though you might be able to find better ways to manage these feelings, getting rid of them entirely may not be possible or desirable.

Anxiety disorders, on the other hand, can involve intense anxious feelings that may persist for unusually long periods. They can have a serious negative impact on your quality of life. The mental symptoms of anxiety—including excessive worry, cognitive impairment, and confusion—can impact your social, occupational, and personal life. In addition to challenges related to mental health, issues with physical health can arise out of anxiety. An anxiety disorder can cause muscle tension, impact sleep quality, and create gastrointestinal distress. 

While the exact causes of anxiety disorders are unknown, it is thought that several risk factors can contribute to their development. These include a family history of anxiety, an underlying medical condition (e.g., cardiovascular disease), the use of recreational drugs, elevated stress levels, and traumatic experiences (e.g., the loss of a loved one). 

Psychiatric treatment often provides significant relief of the symptoms of these disorders. The American Psychological Association (APA) reports that most people who receive therapy for anxiety decrease or overcome their symptoms within a few months of treatment.

Exploring different types

Anxiety disorders fall into several categories that can have very different symptoms and causes. The most effective treatment for anxiety may depend on the specific disorder you have. These conditions include:

Generalized anxiety disorder (GAD)

GAD involves severe feelings of worry and dread that persist throughout day-to-day life. These emotions may be “free-floating” and unconnected to specifics, or they can involve exaggerated anxiety about typical stressors such as work, relationships, and responsibilities.

Separation anxiety disorder

Characterized by nervousness and worry at the prospect of parting with a loved one, separation anxiety disorder can cause an individual to become excessively concerned about the well-being of the subject of their apprehension. People with this anxiety disorder may avoid leaving home because of their fear of separation. 

Social anxiety disorder (SAD)

Also sometimes called “social phobia”, SAD is characterized by an unrealistic fear of being rejected, judged, or humiliated in social situations. These worries can make scenarios that might otherwise be pleasant, such as family get-togethers or outings with friends, feel extremely stressful.

Panic disorder

People with panic disorder experience repeated panic attacks — episodes of intense anxiety and fear that trigger bodily symptoms like nausea, trembling, racing heartbeat, and shortness of breath. Those with this condition often worry a lot about having a panic attack at the wrong time, which may lead them to avoid even benign situations.

Specific phobia

A phobia means a severe fear of something specific, such as spiders, closed spaces, or going to the doctor. Some phobias, like a fear of public speaking or a fear of driving, can cause significant difficulty in navigating daily life.

Agoraphobia is defined by a persistent fear and avoidance of situations that could be difficult or socially awkward to leave. (Common examples include crowded spaces, public transportation, and enclosed areas.) It often originates as a complication of panic disorder — the person’s fears may be linked to the possibility of having panic attacks in uncomfortable situations.

Selective mutism

This disorder most commonly manifests in young children. It’s marked by an extreme shyness about speech that causes them to verbal communication except at home, among close family members. Many children grow out of this condition without treatment, but others may need psychological assistance.

Psychotherapy for anxiety disorders

The APA’s clinical practice guidelines indicate that psychotherapy is often the most effective form of anxiety treatment. It tends to produce better outcomes than medication alone and may be more likely to lead to a long-term reduction in symptoms of anxiety disorders.

If you decide to pursue talk therapy, a thorough discussion of your symptoms will likely be necessary to help your mental health provider identify the right therapeutic modality. For example, if you communicate to your therapist that your fears are related to a specific phobia—as opposed to more general concerns—they may utilize exposure therapy instead of a broader form of cognitive behavioral therapy. The following are several commonly utilized psychological therapies for anxiety management. 

Cognitive-behavioral therapy to decrease symptoms

Cognitive-behavioral therapy (CBT) is one of the most thoroughly studied forms of psychotherapy, and out of all of the treatment options for anxiety disorders, it has the strongest evidence of effectiveness. According to the American Psychiatric Association, cognitive behavioral therapy “can help a person learn a different way of thinking, reacting and behaving”, potentially alleviating both the mental and physical symptoms that manifest when they feel anxious.

During therapy appointments, you’ll generally work with a mental health professional to modify the habitual thoughts and behaviors that reinforce your feelings of anxiety. This may involve things like countering worst-case-scenario thoughts with more reasonable predictions, or practicing ways to manage stressful situations without getting overwhelmed. These methods can help you break out of unhelpful cycles of anxious thoughts and emotions.

CBT is typically focused on relieving specific symptoms, and it’s generally a time-limited treatment. A course of 8-20 hour-long sessions is typical. Cognitive-behavioral theory may be especially helpful for treating generalized anxiety disorder.

Exposure therapy 

Though it’s technically considered a type of cognitive-behavior therapy, exposure therapy often places a heavier emphasis than most forms of CBT on confronting anxiety-provoking situations. Research suggests that avoiding anxiety triggers can often reinforce a person’s worries, increasing the severity of symptoms. In some cases, this may play a major role in how ordinary anxiety worsens and develops into a psychological disorder.

Exposure therapy typically guides the client toward facing their fears, either in real-world situations or imagined scenarios, to help them gradually get used to them and let go of their anxiety. This method may be most effective for anxieties related to specific situations, such as SAD or agoraphobia, though there’s also some evidence that it can treat panic disorder and GAD.

Psychodynamic therapy 

The origins of psychodynamic therapy (PDT) are found in the psychoanalytic approach to therapy pioneered by Sigmund Freud, but the method has been considerably updated and revised based on modern research. In clinical trials, PDT has demonstrated a significant ability to relieve symptoms of anxiety disorders.

Psychodynamic treatments for anxiety are likely to involve discussing your symptoms, emotions, and life history to gain greater insight into the sources of your disorder. Your therapist might also suggest different ways to think about the situations that cause you stress and worry.

A psychodynamic therapist may sometimes encourage new ways to approach and manage anxiety-triggering situations. However, there tends to be less emphasis on behavior modification than in treatments like CBT. Patients who struggle with exposure and other behavioral adaptations in cognitive-behavioral therapy may find PDT to be a better option.

Acceptance and commitment therapy 

Acceptance and commitment therapy (ACT) is based on the principle that trying to fight or suppress challenging emotions often increases distress instead of helping. When used to treat anxiety, ACT may aim to help patients recognize and accept the things in their lives that are beyond their control. By learning to dwell less on their worries, clients may be able to function better in life and reduce the discomfort, fear, and avoidant behavior that can make anxiety disorders so debilitating.

Though acceptance and commitment therapy is not as well-established as some other treatments for anxiety, there’s evidence that it can have a significant positive impact. A 2020 meta-analysis reported that ACT showed substantial benefits compared to waitlists, placebos, and even some other forms of therapy.

Considering medication

Not everyone responds equally well to psychotherapy. In individuals with severe anxiety disorders, a combination of medication and therapy may work better than either method on its own.

Selective serotonin reuptake inhibitors (SSRIs)

These medications are classified as antidepressants, but evidence suggests that they can also be effective at treating anxiety disorders, especially SAD. SSRIs slow down the rate at which nerve cells reabsorb serotonin, which can have positive effects on mood and relaxation. Treatment with SSRIs typically requires 2-4 weeks to take effect, and you may need to take them for at least 8 weeks to feel the full impact. They can sometimes have unpleasant side effects, including flattened emotions and sexual dysfunction.

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

SNRIs work very similarly to SSRIs, though they also slow down the uptake of norepinephrine, an excitatory neurotransmitter. Both types of drugs appear effective for treating anxiety disorders, but SNRIs may not be as dose-dependent as SSRIs. The potential side effects of these two medications can overlap considerably. SNRIs have some additional known side effects, such as constipation, lack of appetite, and nausea.

Tricyclic antidepressants (TCAs)

Sometimes called “first-generation” antidepressants, TCAs increase concentrations of serotonin and norepinephrine in the brain by blocking specific channels in nerve cells. They may be used for anxiety disorders, but they’re usually only tried after SSRIs have failed, because they may be more likely to have adverse side effects.

Benzodiazepines

By increasing the effect of the calming neurotransmitter gamma-aminobutyric acid (GABA), benzodiazepines can create a fast-acting calming effect. This anti-anxiety medication can be useful for managing conditions like panic disorder.

Unlike antidepressants, benzodiazepines can provide rapid relief of symptoms during an acute anxiety attack. However, taking them over the long term can carry a risk of addiction. Other possible side effects may include dizziness, fatigue, and slowed reflexes.

Lifestyle changes to manage symptoms

Making certain kinds of changes in your daily routine can also sometimes decrease anxiety and improve your overall mental health. Studies suggest that everything from using herbal remedies (e.g., long-term chamomile therapy) to participating in support groups and deciding to quit drinking caffeinated beverages

can help reduce anxiety symptoms. These strategies can address concerns related to mental health, problems with physical health, and emotional challenges. 

By themselves, the use of lifestyle changes and natural remedies may not be enough to overcome an anxiety disorder, but they may enhance the effectiveness of other treatments and lead to improved stress-management skills. The following are research-backed self-help strategies for managing anxiety:

• Eating nutritious foods
• Practicing relaxation exercises
• Adopting a more restful sleep schedule
• Exercising more frequently
• Taking up meditation
• Spending more time in nature

Online therapy

Certain kinds of anxiety, such as agoraphobia, can make it difficult to seek in-person anxiety treatment. Some people may also experience pragmatic difficulties like limited transportation or a shortage of local treatment providers. Attending therapy online can be a much more convenient way to reach psychological treatment for anxiety. Though research is still in the early stages, clinical trials have shown that online therapy can be effective at reducing symptoms of anxiety. This type of treatment seems to work in routine care as well as in controlled experimental scenarios. A significant proportion of patients find relief from anxiety symptoms through Internet-based treatment.