Therapy approaches for anxiety?

January 5, 2018 12:11 PM

I'm hoping to find a therapist to help me address anxiety and some other stuff. I've been looking at the Psychology Today directory, and there are a lot of possible therapists who are covered by my insurance, who have a variety of approaches and methods. Can you suggest approaches that might best address my issues or keywords that I could look for to narrow down my list of possibilities?

I did a lot of therapy when I was a teenager, mostly for eating-disorder-related stuff. I didn't find it hugely helpful: it involved a lot of exploring the origins of my problems, and not very much thinking about solutions or work-arounds. I think I have a tendency to ruminate self-indulgently, and I would like to avoid any kind of therapy that encourages that. I've also seen a psychiatrist to be diagnosed with ADHD and to adjust my medication. I take Adderall, which seems to work for me. I would like to avoid taking any other medication, at least until I've explored other options.

A couple of years ago, I asked my GP for a referral to a therapist, and I ended up with someone who was not a good match for me. She immediately told me I needed anti-anxiety meds and shamed me relentlessly for not wanting to take them without exploring other options, and she also told me that I was overeducated and thought too much, which is not a perspective that's going to work for me. (I would like to redirect my thoughts to more-productive avenues, but I don't believe it's possible to think too much, and I'm going to have a hard time working with someone who wants to cure me of my basic personality.) So anyway, that was kind of a demoralizing experience, and I would like to avoid repeating it.

Here are the things I'd like to work on:

1. I would like to develop better coping mechanisms for anxiety. Right now, I have a lot of problems with avoidance, which makes my anxiety worse. I would like to get better at addressing things that are making me anxious when that's possible, rather than avoiding them. I would also like to get better at dealing with intrusive thoughts about things that can't be fixed. Basically, I would like to spend less time worrying about the fact that I haven't paid the water bill, hopefully by just paying the freaking water bill, and I would like to spend less time freaking out about what happens after you die or whether I said something stupid at dinner last night, because there's nothing I can do about it and losing sleep over it is not going to help anything.

2. I would like to get better at being assertive. I want to be able to identify my wants and needs (which is a problem for me), to feel entitled to ask for the things I want or need, and to react appropriately when I don't get the things I want or need.

3. I would like to learn to handle negative emotions better. I want to feel entitled to have and express negative emotions, and I would like to develop more constructive ways to deal with anger than silently seething.

Anyone have any thoughts about the best kind of therapy for me? A lot of the therapists specialize in Cognitive Behavioral, Dialectical Behavioral, or Acceptance and Commitment Therapy, and I don't know if any of those would be better than any other or whether I should look for something else.

posted by ArbitraryAndCapricious to Health & Fitness (8 answers total)

Cognitive Behavioral Therapy is very solution focused, works around developing specific skills with practice and coaching, and is one of the most effective treatments for Anxiety.

Dialectical Behavioral Therapy is related to CBT, but is primarily focused on building skills for emotional regulation/suicidality.

ACT is somewhere between the two. I'd start with CBT.
posted by goggie at 12:17 PM on January 5, 2018 [4 favorites]

she also told me that I was overeducated and thought too much

Fuck her, but CBT is useful for smart people.

I did this a few years back and it was life changing. I have a nice therapist who is a lot like me in some ways and unlike me in some other ways. We got off to a somewhat rocky start (recommended Tolle to me, no thank you!) but we worked through it and she's been really helpful in suggesting some stuff, some ways to untangle thought patterns that are... suboptimal, and ways to be kinder to myself.

I do take occasional medication but usually only when I'm stuck in a spiral or getting work-impacting insomnia. She's helped me work through some of my feelings surrounding that. Additionally, we don't really spend a lot of time talking about the past. I mean I'll explain where I think a feeling or thought comes from but not a lot of "Here's how I feel about my mom and something that happened to me when I was eleven" it's mostly about constructive ways to manage the feelings I currently experience and gently probing questions about some of the choices I make.

It's not entirely simple, there are some things that push me out of my comfort zone to be sure, but it's always in the frame of "Why don't you try this sort of thing to see if it helps you with that?" and if I come back and say "I gave it an honest try and it wasn't my thing" she's fine with that. I had a weird childhood with some crappy parents, and it's been challenging for me to learn to speak up and be assertive enough in therapy to get what I want out of it (I am a pleaser) but it's helped me find the space to not only do that but work out some more of what i want out of my own life.

So: tl;dr CBT and mindfulness/acceptance stuff worked for me. I know you don't want to be ruminating, but there are some forms of meditative exercise that feel like they might just be that, but wind up not being. Best of luck, happy to chat more.
posted by jessamyn at 12:24 PM on January 5, 2018 [5 favorites]

Don't narrow your list of potential therapists down too much early on. When I was looking for someone, I was surprised how hard it was to find a therapist who was:
a) taking new clients,
b) conveniently located (I'm in a big city, this should not be tricky)
c) available at the times I was available and
d) willing to answer phone calls / email to set up an appointment.
Then once you start going you have to decide if they are:
e) helpful for you or not.
So to spin this a little positively... maybe you have less of a problem than you think, as many of the therapists on your list will weed themselves out by not being available, etc.
posted by Vatnesine at 12:50 PM on January 5, 2018 [3 favorites]

Agreed with what Vatnesine says - you've got a bunch of legwork to do just to whittle down to a list of actually available options. THEN you can usually get some additional information from them, usually they either have a website or brochure or introductory spiel where you can get more detail of their approach and orientation.

CBT and ACT are generally considered first line of methodology for anxiety. You may want to explore my two big recs, The Anxiety and Phobia Workbook (I see it now has a competitor, the Anxiety and Worry Workbook) and The Mindfulness and Acceptance Workbook for Anxiety to get a feel for CBT and ACT respectively. You could do one of those and take it with you when you eventually secure a therapist, and use it as a jumping off point (even if you don't like it, it's something to talk about).
posted by Lyn Never at 1:05 PM on January 5, 2018 [3 favorites]

I think you have this backwards.

Process oriented therapy is going to give you tools to manage your anxiety. But they're tools. You have to be acutely aware of your mental state to know when to use them, so the benefit of reducing anxiety in the moment is somewhat offset by always paying attention to yourself. The rumination actually increased, it was just more socially acceptable.

Analytical therapy is going to give you a clear space for rumination with professional oversight. Once I began to trust my therapist, ruminating without his input felt less effective. So I started to just mentally notice "THIS IS IMPORTANT" and then set it aside instead of needing to research the pants off it.

It took me a long time to get there. And I still struggle with it. But what I'm realizing is that we're meant to be interdependent. It's just the social constructs we've created are so unhealthy and exploitative (and compounded by my personal family history), I try to be independent to a point that is not manageable for any one person.
posted by politikitty at 1:16 PM on January 5, 2018 [1 favorite]

I actually used Psychology Today successfully and found a fantastic therapist that way. I would recommend calling a therapist you're considering and literally reading them the three bullet points you wrote above. That's basically what I did: after trying 6 different therapists, I knew exactly what I was looking for (and it sounds like you do too. If it helps, great job writing down a list of exactly what you want and need! lol) I actually wrote down a paragraph about what I wanted in a therapist, and when I called her, I said something like, "I wrote down what I'm looking for in a therapist. Can I read it to you to see if you think we're compatible?" Then I read her my list. (I told her, among other things, that I wanted self-directed therapy where I told her at each session what I wanted to talk about that day.) However, don't think that this was a grandiose display of assertiveness - oh no, my voice was actually shaking and I was so scared reading the list that I almost cried. Happy ending: It was worth it. She thought the list was great and we have a great relationship.

As far as I know, therapists are aware that there are good "matches" and bad "matches," and many of them offer a free first session, or at least a free 15 minute phone call, for the express purpose of finding out if you both think you're compatible. Knowing that can help take some pressure off the decision.
posted by quiet_musings at 2:07 PM on January 5, 2018 [2 favorites]

I have an anxiety disorder that I take medication for and the medication is helpful to me. Still, it doesn't work 100%. I enrolled in a Managing Your Anxiety (or understanding it or whatever) course at Kaiser that was free to Kaiser members. It was a group class over 5 weeks. I actually only attended 3 classes for reasons but it was super helpful! Like, anxiety is a false alarm from your brain! Exposure and practice are ways to retrain your brain! Mindfulness practices can help me with my anxiety! Not trying to talk you into meds or out of therapy. Just noting that depending on your health care provider, you may have access to this kind of resource as well. I wish I'd known about that class and taken it years ago. Good luck!
posted by Bella Donna at 5:23 PM on January 5, 2018 [2 favorites]

I second the recommendation to call up a couple of therapists to whittle things down--in the past I have had success by taking about 10-15 minutes per therapist, giving them a brief summary about me and what I was looking for at that time, and asking them about their approach to therapy. It is ok to ask probing questions--after all, you'll be paying them to do the same with you. The therapists in question were always very open to having such a conversation, and I was able to identify one or a few that might work each time. If you're really unsure about someone after a first session, try out one or a few more before committing. Sometimes it takes a little longer with one therapist to figure out if they are a fit or not--it is also ok to decide that someone is no longer a fit at any point, as your priorities will shift with time and you might find that one approach works for a while and then doesn't. I did CBT for anxiety for years, and it taught me a lot. After getting these tools under my belt, I realized I needed to do some deep diving again to understand some patterns to which I may need to apply the tools, so I switched to mindfulness therapy (and switched therapist; even though I liked my last one, I got to a point where our sessions no longer felt as useful as they once did, probably because she taught me so many tools). It sounds like, by exploring, you're getting some good practice on the assertiveness and ascertaining and communicating your needs things--well done, you, and good luck!

PS: not to push on the anxiety meds thing, but after resisting the idea for a really long time, I finally decided to try them. It took a while to figure out which to take, but I have to say that they have helped with the thought loops so much more than anything else has. They make it easier to apply the tools I learned in CBT. That said, my anxiety is chronic and has pretty much been lifelong. I wrote an anonymous questions on here about getting on meds once and got helpful answers; feel free to pm me if you'd like the link.
posted by dubhemerak3000 at 9:57 PM on January 5, 2018 [1 favorite]