When You Need Support: The Best Therapy For Anxiety

Anxiety and depressive disorders can interfere with daily life, often causing chronic and intense sadness, hopelessness, fear, and/or worry. These feelings tend to get worse when left unaddressed, but several types of evidence-based talk therapy can be used to help improve symptoms. Cognitive behavioral therapy (CBT) is typically considered the gold standard for treating anxiety and depression. We’ll explore this and other common types of therapy that can treat depression and anxiety—from lifestyle changes to selective serotonin reuptake inhibitors—below.

Anxiety disorders: A brief overview

Many people experience anxiety during stressful life events such as giving a presentation or taking an exam, for instance. However, individuals with a diagnosable anxiety disorder may frequently experience excessive worry or fear about daily occurrences. Sometimes, anxiety disorders manifest as persistent worry (common in individuals with generalized anxiety disorder), or they may include severe symptoms of intense fear or terror (known as panic attacks, which can indicate panic disorder). 

Anxiety disorders constitute the most common type of mental health condition in the United States. The American Psychiatric Association estimates that around 30% of adults experience an anxiety disorder at some point in their life. Some common types of anxiety disorders include: 

• Social anxiety disorder
• Panic disorder
• Specific phobias
• Generalized anxiety disorder
• Separation anxiety disorder

The symptoms of an anxiety disorder may vary depending on the specific condition and the individual, but they could include things like:

• A sense of impending danger
• Increased heart rate
• Restlessness
• Hyperventilation 
• Trouble thinking about anything other than the source of the worry 
• Sweating, clammy hands, and/or patchy skin
• Difficulty controlling worry or negative emotions
• Avoidant behaviors
• Gastrointestinal distress

Several factors may contribute to the development of an anxiety disorder, including life experiences, genetics, and medical conditions. Chronic stress, other mental health conditions, and substance use (formerly known as “substance abuse”) may also increase your risk of developing an anxiety disorder. 

Major depressive disorder: A brief overview

While most people feel sad occasionally, diagnosable depressive disorders are usually characterized by persistent sadness and other symptoms that last for at least two weeks. Depression is one of the most common mental illnesses in the United States. In 2020, nearly 15 million US adults experienced at least one major depressive episode. There are several types of depressive disorders, including the following: 

• Major depressive disorder (MDD) is the most common type of depressive disorder. Around 21% of adults develop MDD at some point in their lives. 
• Persistent depressive disorder (PDD) is a form of mild to moderate depression that lasts for two or more years. 
• Premenstrual dysphoric disorder (PMDD) is depression that occurs when premenstrual syndrome (PMS) symptoms co-occur with clinical mood symptoms. PMDD symptoms typically improve after your period starts, but they may significantly interfere with daily life until that point.. 
• Seasonal affective disorder (SAD) is a type of depression that is related to seasonal changes. Often, SAD develops during the fall and resolves during the spring.
• Peripartum depression, formerly called postpartum depression, occurs during pregnancy or after childbirth. People of any gender can experience peripartum depression, including non-birthing parents and adoptive parents.
• Bipolar disorder is a psychiatric disorder characterized by extreme mood swings from energetic highs to depressive lows. In some cases, the depressive lows may meet the diagnostic criteria for major depressive disorder. 

Depressive symptoms can vary, but common signs of depression include:

• A persistent sad, low, or empty mood or chronic unhappiness
• Feeling hopeless or pessimistic
• Frequent crying
• Ongoing irritability, restlessness, or other uncomfortable feelings
• Angry outbursts
• Loss of interest in things you used to enjoy 
• Difficulty concentrating or making decisions
• Sleep disruptions
• Social isolation
• Physical symptoms, including gastrointestinal issues, headaches, and other unexplained chronic pain
• Changes in eating habits, which may lead to unintentional weight loss/gain
• Thoughts of self-harm or suicide

Though the exact cause of depression is unknown, researchers believe that risk factors for depressive disorders include genetics, brain chemistry, medical conditions, other mental health conditions, stressful life events, and certain medications. 

The link between depression and anxiety disorders

Individuals with this comorbidity are more likely to experience severe symptoms, greater disruption of daily activities, and a higher risk of suicide. The reason for these high rates of co-occurrence is not fully understood, though researchers theorize that personality traits, genetic predispositions, or overlapping symptoms may play a role.

Types of therapy to treat depression and anxiety

Many forms of talk therapy can be effective as both anxiety and depression treatments. Here are some of the most common types of therapy used for clinical or subclinical anxiety and depression. Speak to a therapist or psychiatrist for advice on the best therapy for depression and anxiety for your situation before you begin treatment.: 

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) combines cognitive therapy and behavioral therapy to help clients identify automatic thoughts, question them, and then reframe them. This type of talk therapy is often considered the gold standard of psychotherapy. 

Common therapeutic strategies that may be used during CBT include psychoeducation, cognitive restructuring to adjust unhelpful thinking patterns and behavioral patterns, exposure therapy, relaxation techniques, behavioral activation. Unlike some forms of psychotherapy, effective CBT typically requires only 6-20 sessions. The shorter duration of treatment is linked to the goal of CBT: to teach clients to assess their own thoughts and behaviors and apply learned skills outside of therapy sessions. 

Dialectical behavioral therapy

Dialectical behavior therapy (DBT) is a type of talk therapy adapted from CBT. It can be an effective anxiety and depression treatment. The focus of DBT is acceptance and healthy coping skills for people who experience intense emotions that are difficult to manage. DBT can also be used to address suicidal thoughts and symptoms of borderline personality disorder, post-traumatic stress disorder, and binge eating disorder. 

Unlike cognitive behavioral therapy, DBT typically takes six months or longer in order to be effective. This process often involves developing healthy coping skills, including mindfulness meditation, distress tolerance, interpersonal skills, and emotional control. 

Interpersonal therapy

Interpersonal therapy (IPT) is a type of psychotherapy that focuses on social relationships and how they impact mental health. 

IPT techniques often focus on: 

• Examining social support sources
• Determining attachment style and communication style
• Evaluating interpersonal challenges 

For individuals diagnosed with a depressive disorder, IPT can sometimes be an effective alternative to CBT and/or pharmacotherapy. For people with problematic relationships that trigger or contribute to depression, IPT may be particularly beneficial. IPT is generally used as a short-term therapy over 12-16 sessions, though the number of sessions needed may vary based on diagnosis and symptom severity.

Psychodynamic therapy

Psychodynamic therapy (PDT) is a traditional type of talk therapy that focuses on evaluating the past to understand present challenges. Unlike other types of therapy, which tend to evaluate present feelings and thought patterns, PDT is generally a more open-ended and exploratory long-term treatment. 

PDT is considered generally effective for depressive disorders and some types of anxiety disorders, though it’s been suggested to be most effective for borderline personality disorder. 

Mindfulness-based cognitive therapy

Mindfulness-based cognitive therapy (MBCT) is an evidence-based approach that combines mindfulness practices with cognitive therapy techniques to help individuals manage anxiety and depression symptoms. By helping cultivate present-moment awareness and addressing negative thought patterns, MBCT aims to reduce relapse rates and improve overall well-being in those experiencing anxiety and depression.

Problem-solving therapy

Problem-solving therapy (PST) is a structured, goal-oriented method that teaches individuals practical skills to effectively manage and overcome challenges contributing to anxious and depressive symptoms. By breaking psychological disorders into manageable components and developing action plans, PST can help individuals regain a sense of control over their behavior patterns so they can improve their mental health outcomes. PST is sometimes used in family therapy settings as well. 

Can talk therapy be done online?

Many forms of talk therapy can be effectively done online. A growing body of research indicates that online CBT in particular may be an effective part of a treatment plan for an individual with depression or anxiety.
A 2017 study suggests that it may be a helpful tool for addressing symptoms of depressive disorders, generalized anxiety disorder, social anxiety disorder, panic disorders, phobias, substance use disorder (formerly known as “substance abuse disorder"), bipolar disorder, and obsessive-compulsive disorder. Additionally, the study reports that this type of therapy is often more cost-effective than in-person CBT, especially for those who don’t have health insurance, and more convenient for people living in rural areas. 

For individuals with anxiety and/or depressive disorders, online therapy may be less intimidating than in-person therapy as well. Platforms like BetterHelp can match most people to a mental health professional in as little as 48 hours, so you can get started shortly after you decide to try therapy. 

Other options for treatment

In addition to talk therapy, additional approaches may help a person manage or reduce symptoms of anxiety and depression, including the following: 

• Lifestyle changes: Getting enough sleep, engaging in regular physical activity, practicing mindfulness, eating nutrient-dense foods as often as possible, and leaning on social support from family members and friends or support groups may help you cope with anxiety and depression. 
• Medications: Medications such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or others may sometimes be prescribed by a doctor to help manage anxiety or depression symptoms. Certain medications may have side effects or dangerous interactions, so be sure to speak to your doctor before starting, stopping, or changing selective serotonin reuptake inhibitors or any other medication.
• Transcranial magnetic stimulation (TMS): TMS may be recommended for individuals who have not experienced symptom relief from therapy, medications, or other interventions. 

While options like lifestyle changes, selective serotonin reuptake inhibitors, and TMS may provide some symptom relief on their own, they’re not typically recommended as a replacement for mental health care through psychotherapy.