Therapy for Different Types of Anxiety

Anxiety therapy is a game changer for people with anxiety. It is the most common mental disorder according to the World Health Organization-an estimated 301 million people in 2019¹ (WHO, 2023). Women are nearly twice as likely as men to be diagnosed with anxiety disorders (McLean et al., 2011²). Most commonly, clients have come to me for: GAD, PTSD and OCD. Many clients are not looking for a formal diagnosis but know they are worriers and over-thinkers.

Generalized Anxiety Disorder

GAD involves worries that can be all over the place and not specific to certain situations. Women with GAD have a very hard time relaxing and just letting things go.  (Borkovec et al., 2004³). This chronic worry pattern involves attempts to avoid emotional experiences (Newman & Llera, 2011⁴). Because of this, generalized anxiety therapy will focus on self-care and on getting into the present. For anybody this is a good idea but chronic worry takes a huge toll of the body. Exercising and mindfulness practices are recommended, too. These approaches are supported by research showing CBT’s effectiveness for GAD (Hofmann et al., 2012⁵).

Post Traumatic Stress Disorder

PTSD occurs when a traumatic event has been over at least a month but the person is haunted by it afterwards. The impact may be present years later. The sense of powerlessness over the memories is intense. It may involve responses to things that happened that the person can’t even remember. This is because the psyche has protected the person. For many it was not just one traumatic event but many different events or a traumatic event that was ongoing over a period of time. This pattern of repeated or prolonged trauma is known as complex trauma (Herman, 2015⁶).

Women I have worked with have often have lived through combinations of traumatic events, including.

• witnessed domestic violence growing up
• been the victim of domestic violence
• been coerced to be involved in prostitution or pornography
• been sexually abused
• been sexually assaulted in a dating situation
• been sexually harassed in a workplace
• been sexually harassed on the street

Group Therapy for PTSD

Obsessive Compulsive Disorder

OCD is not experienced the same by every person who suffers from it. Some people don’t do compulsive rituals like hand washing or over-the-top cleaning routines. “OCD presents differently across individuals, with varying combinations of obsessions and compulsions (Abramowitz et al., 2009⁷). For some people OCD has them stuck in obsessive thoughts which they mostly understand are not reasonable. This is one of the things that frustrates people with OCD. They know it’s a weird way to think but still can’t “just stop.” There are people who have both obsessive thoughts and compulsive behaviors. Whatever combination, OCD sufferers spend long periods of time every day struggling.

Fortunately, therapy is effective to help people with OCD. Exposure therapy is a process that has people face the fears and test out the worry thoughts and live through them. Exposure and Response Prevention (ERP) is considered the gold standard treatment for OCD (Foa et al., 2012⁸).

• Specify the Obsessive/Compulsive Loop-we identify the obsessive thoughts and the compulsive actions.

• Breaking the Cycle-using cognitive behavioral therapy and sometimes exposure and response prevention, we teach your brain that the “danger” isn’t real.
• Taking Back Your Power-it’s not just about stopping the rituals, it’s about having your time and energy back and trusting your own ability to trust yourself.

Cognitive Behavioral Therapy for Anxiety

CBT is one of the most effective of the evidence-based therapies for anxiety. Research demonstrates CBT’s strong efficacy across anxiety disorders (Hofmann et al., 2012⁹; Beck, 2011¹⁰).It is a process of identifying ways of thinking that are misguided attempts to survive your life. Using CBT in therapy involves bringing out thoughts that are problematic. We don’t want to keep believing them but also really don’t want to look at them or take them apart either. For those who are fed up enough and brave enough, CBT can really change things around. If clients want to do homework or in session exercises, the David Burns Feeling Great book is very useful. (Burns, 2020¹¹). The approach I will take will vary from client to client. If you do not want therapy that involves homework, it is perfectly okay for us to just talk about what’s up. I can be flexible.

Individual therapy is helpful to process issues with all the attention on your own history and life now. Another vital type of anxiety therapy is a group of women getting honest and real with one another. It is absolutely life-changing. Process groups allow participants to share in depth about what they are going through. Focused topical groups like Seeking Safety¹² and Helping Women Recover¹³ are important treatments. Group members see commonalities with others and this supports the healing.

EMDR

Another form of anxiety therapy is EMDR. Eye Movement Desensitization and Reprocessing is another approach a lot of therapists use to help people with PTSD especially. ¹⁴ I do not provide this but I know a lot of people have found it very beneficial. Here is a great resource: Stillpoint Therapy Services. Virtual in WA and in person in Edmonds, WA annepleas.com

Questions? debdettman@wisewomantherapy.com

Ready now? Set up a free phone consultation.

Individual therapy: $200/session. I provide Super Bills for clients seeking reimbursement from their insurance companies. PPO plans often reimburse 60-80%. Limited availability for reduced fee for those with financial need.

References

• 1. WHO-World Health Organization. (2023). Mental disorders fact sheets.
• 2. McLean, C. P., Asnaani, A., Litz, B. T., & Hofmann, S. G. (2011). Gender differences in anxiety disorders: Prevalence, course of illness, comorbidity and burden of illness. Journal of Psychiatric Research, 45(8), 1027-1035.
• 3. Borkovec, T. D., Alcaine, O. M., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder. In R. G. Heimberg et al. (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 77-108). Guilford Press.
• 4. Newman, M. G., & Llera, S. J. (2011). A novel theory of experiential avoidance in generalized anxiety disorder: A review and synthesis of research supporting a contrast avoidance model of worry. Clinical Psychology Review, 31(3), 371-382.
• 5. Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427-440.
• 6. Herman, J. L. (2015). Trauma and recovery: The aftermath of violence—from domestic abuse to political terror. Basic Books.
• 7. Abramowitz, J. S., Taylor, S., & McKay, D. (2009). Obsessive-compulsive disorder. The Lancet, 374(9688), 491-499.
• 8. Foa, E. B., Yadin, E., & Lichner, T. K. (2012). Exposure and response (ritual) prevention for obsessive-compulsive disorder: Therapist guide (2nd ed.). Oxford University Press.
• 9. Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427-440.
• 10. Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). Guilford Press.
• 11. Burns, D. D. (2020). Feeling Great: The revolutionary new treatment for depression and anxiety. PESI Publishing
• 12. Najavits, L. M. (2002). Seeking Safety: A treatment manual for PTSD and substance abuse. Guilford Press.
• 13. Covington, S. S. (2008). Helping Women Recover: A program for treating addiction (Rev. ed.). Jossey-Bass.
• 14. Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (3rd ed.). Guilford Press.