Treatments for anxiety
It’s important to get help to treat anxiety disorders. Left untreated, anxiety can last for a long time. It can become exhausting, debilitating and get in the way of us living our everyday lives. There are a range of effective treatments for anxiety, and you can get better.
Important things to know about getting treatment for anxiety include:
- there are lots of professionals to help you with anxiety
- there are also many types of treatments for anxiety, and you can get better
- you need a thorough check from a health professional before treatment is prescribed
- many people who have had anxiety have been able to seek help and live active, fulfilling lives.
Psychological therapies are the most effective way to treat and prevent the recurrence of most types of anxiety.
There are three broad categories of treatment for anxiety, these include:
- psychological treatments (talking therapies)
- physical treatments (medications)
- self-help and alternative therapies.
Depending on the type of anxiety, self-help and alternative therapies can be helpful. They can be used alone or combined with physical and psychological treatments. A thorough assessment by your doctor is needed to decide on the best combination of treatments for you.
Pregnancy and postnatal anxiety
Anxiety can sometimes occur on its own, or together with depression during pregnancy and the postnatal period (time after birth).
Psychological treatments can be one-on-one, group-based or online interactions. Psychological treatments are sometimes called ‘talking therapies’ as opposed to 'chemical therapies' (i.e. medications).
Talking therapies can help us change habits in the way we think, and cope better with life’s challenges. They can help us address the reasons behind our anxiety, and also prevent anxiety from returning.
There are a wide range of psychological treatments for anxiety, including:
- cognitive behaviour therapy (CBT)
- exposure therapy (behaviour therapy)
- interpersonal therapy (IPT)
- mindfulness-based cognitive therapy
- positive psychology
- narrative therapy.
Some of the above treatments can be accessed online. Evidence-based online treatments can be as effective as face-to-face treatments. These online treatments are often referred to as e-mental health programs.
Psychological therapies have been found to be most effective treatment for anxiety and relapse prevention over the long term. Sometimes, however, medication can be helpful working together with psychological therapies.
Cognitive behaviour therapy (CBT)
The Black Dog Institute recommends CBT for anxiety. Research shows that CBT is the most effective treatment for anxiety, and for preventing future anxiety.
When we have anxiety, we can have a worried and anxious view about ourselves and the world around us. We can start ‘catastrophising’ or thinking the worst will happen.
These thinking patterns can become so entrenched, that we don't notice errors of judgement caused by thinking in this way. They may also hold us back from recovering.
CBT aims to show us how our thinking affects our mood. It teaches us to think in a different way about life, perceived dangers, and stress. We can challenge our anxious thinking patterns and re-frame the way we think. We can also face stressors (rather than avoiding them) and learn ways to challenge them.
CBT is sometimes used together with ‘exposure therapy’ (or ‘behaviour therapy’) where we are exposed to fearful objects or situations over time.
- be conducted by trained therapists either in one-on-one therapy sessions or in small groups
- take between 6-10 sessions (the number will vary from person-to-person)
- include ‘homework’ between sessions. Sometimes this may include using e-mental health programs or tools
- help you look logically at the evidence for your negative thoughts to adjust the way they view the world around them.
CBT can be very beneficial for people of all ages who have anxiety.
Exposure therapy (or behaviour therapy)
There is good evidence suggesting exposure therapies are effective for post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), and specific phobias. Exposure therapies may also be useful for social phobia and panic disorder. Sometimes, exposure therapy is used together with CBT.
Exposure therapy subjects us, over a period of time, to the object or situation that makes us anxious.
Exposure therapy helps us ‘face our fears’ and challenge them in a controlled way. We may confront our fears in person, or even via virtual reality. Exposure therapy can be delivered in a practitioner’s rooms over several sessions, before we subject ourselves to the fear in real life.
Exposure therapy via virtual reality can be very effective in treating specific phobias. It might be virtual exposure to say a spider, a snake, or even a situation – like flying, speaking in public, or being in a lift.
Other types of exposure therapy include:
- systematic desensitisation: This involves using relaxation techniques, whilst being exposed to mental images or fears.
- flooding therapy: This gives a faster exposure to the fear, rather than a gradual build up.
- exposure-and-response prevention: Patients are exposed to the anxiety-producing thoughts or situations and then stopped from using their usual compulsions or rituals to address the anxiety.
These treatments must always be administered by a highly-trained mental health professional. Some situations can evoke distress and careful management is required.
Interpersonal therapy (IPT)
Vulnerability to anxiety and depression can often be traced to aspects of social functioning (work, relationships, social roles) and personality. The underlying assumption with interpersonal therapy is that mental health and interpersonal problems are interrelated.
The goal of IPT is to help us understand how our vulnerabilities can lead to anxiety and depression, or the risk of developing anxiety in the future.
IPT occurs in three main phases (and usually requires 12-16 sessions):
- an evaluation of the patient's history
- an exploration of the patient's interpersonal problem areas and the development of a treatment contract
- recognition and consolidation by the patient of what has been learnt and developing ways of identifying and countering depressive or anxious symptoms in the future.
Mindfulness-based cognitive therapy
Mindfulness-based cognitive therapy is an approach to treating anxiety adapted from Buddhist meditation principles. It is also useful in preventing the return of anxiety, and for assisting with mood regulation.
How can mindfulness help with anxiety?
Mindfulness is a form of self-awareness training. It’s about being aware of what’s happening in the present moment. At the same time, it helps us to not make judgements about whether we like or dislike what we think.
What does mindfulness involve?
- cultivating our ability to pay attention in the present moment
- disengaging from mental 'clutter' and having a clear mind
- responding rather than reacting to situations. This can improve our decision-making and our potential for physical and mental relaxation.
Mindfulness has also been found to have considerable physical health benefits.
How can I access mindfulness-based cognitive therapy?
Mindfulness-based cognitive therapy is usually undertaken in an 8-week group program format.
Sometimes psychologists use these techniques in one-on-one therapy sessions depending on their training and experience. You can also practice mindfulness at home and in everyday life.
See the Black Dog Institute’s Mindfulness in Everyday Life handout for tips and techniques on how to use mindfulness for yourself. There are also many good mindfulness apps. Mindfulness takes practice, and daily sessions can be entered on the daily mood chart
Positive psychology is an area of psychology that focuses on the conditions that contribute to flourishing or optimal functioning.
Positive psychology is not about putting on a happy face all the time. Life can be hard and worry and challenges are inevitable. Scientific research shows that there are some strategies that help us navigate challenges in life more effectively, and enjoy life despite the upsets. Positive psychology researchers have identified lots of everyday activities that improve wellbeing.
Everyday activities that can improve wellbeing include:
- Enhancing pleasure through:
- savouring – or giving attention to the experience of pleasure
- absorption – allowing yourself to be totally immersed in something
- seeking out a variety of experiences – and spreading pleasurable events out over time rather than repeating the same things.
- Engaging through:
- practicing mindfulness – try giving mindful attention to the present moment through meditation and mindfulness-based therapies.
- nurturing relationships – the most fundamental finding from positive psychology is that strong personal relationships have the greatest impact on your satisfaction with life.
- identifying and using your strengths – think about your personal strengths and how you might use them in your everyday life. Cultivate and use your strengths at work, in family life, and in your leisure time.
- seeking out ‘flow’ experiences – ‘flow’ is a state of joy, creativity and total involvement where problems seem to disappear and there is a feeling of transcendence. Some activities that can produce ‘flow’ are sport, games, music, bushwalking, craft, art and hobbies.
- Finding meaning through:
- learning to forgive and let go of anger and resentment
- keeping a gratitude diary
- reflecting on your life and making changes to match your priorities
- small acts of kindness – giving not only makes you feel good about yourself, it enhances your connection with others.
Psychotherapy is an extended treatment, usually provided over months or years, where a relationship is built up between the therapist and the patient. The relationship is used to explore aspects of a person's past in great depth and to show how these have led to anxiety. Understanding the link between past and present (gaining insight) is thought to resolve the anxiety and make a person less vulnerable to becoming anxious again.
Counselling encompasses a broad set of approaches and goals that are essentially aimed at helping us with solving long-standing problems in our family or at work. It is also helpful in addressing sudden major problems that may trigger anxiety (crisis counselling).
Narrative therapy is a form of counselling based on understanding the 'stories' that we use to describe our lives. The therapist listens to how we describe our problems as stories, and helps us to consider how the stories may restrict us from overcoming present difficulties.
Narrative therapy sees problems as being separate from people. It helps us recognise the range of skills, beliefs and abilities that we already have (but may not recognise) that we can apply to problems in our lives.
Narrative therapy differs from many therapies in that it puts a major emphasis on identifying our strengths. It examines where we have mastered situations in the past, and therefore seeks to build resilience rather than focus on shortcomings.
e-Mental Health Programs: a 21st century way to address severe anxiety
e-Mental health programs can be used in conjunction with a mental health professional or as a stand-alone option. Read more about e-mental health options.
The Black Dog Institute has developed myCompass, which is effective in treating anxiety and depression. We are also developing other new apps and tools to help treat anxiety.
What are e-mental health programs?
e-Mental health programs (also called 'e-therapies' or 'online therapies') are online mental health treatment and support services. You can access them on the internet using your smartphone, tablet or computer. The programs can help people experiencing mild-to-moderate depression or anxiety. Some e-mental health tools, such as myCompass, have been found to be as effective in treating mild-to-moderate depression as face-to-face therapies. e-Mental health treatments are based on face-to-face therapy, positive psychology and behavioural activation. These therapies mainly focus on reframing thoughts and changing behaviour.
Features of e-mental health programs
e-Mental health programs:
- are available throughout Australia (wherever there is an internet connection)
- are anonymous
- can mostly be accessed without a referral
- can be used in conjunction with the work you are doing with your GP, psychologist or counsellor
- are self-paced
- are free, or have a minimal cost.
The e-mental health programs we recommend have been researched, developed and tested in Australia. Some psychologists encourage their patients to use e-mental health tools in between face-to-face visits. Your psychologist or mental health professional can use the tools to monitor mood improvement and see which treatments are effective.
e-Mental health treatment programs you could try, include:
myCompass an interactive self-help service that aims to promote resilience and wellbeing for all Australians. myCompass was developed by the Black Dog Institute and is based on CBT, interpersonal psychotherapy, problem-solving therapy, positive psychology, and behavioural activation. myCompass has been proven to be effective in helping people experiencing mild-to-moderate depression and anxiety.
THISWAYUP offers proven online courses for depression, and anxiety that use CBT principles.
MoodGYM is a free self-help program to teach CBT skills to people vulnerable to depression and anxiety.
OnTrack offers free access to online programs, information, quizzes and advice to support the Australian community in achieving mental and physical health and wellbeing.
For more e-mental health treatment programs see seeking help for anxiety.
Your doctor should undertake a thorough health check before deciding whether medication is a good option for you. Taking medication for anxiety must be supervised by a doctor. If medication is prescribed as part of your treatment, your doctor should explain the reason for choosing the medication they’ve prescribed. Your doctor will discuss the risks and benefits, side effects, and how regularly you need check-ups. Your doctor can also advise what treatments can work together with the medication, such as psychotherapy, lifestyle changes (e.g. exercise) and other support options.It’s important to know that not all anxiety needs medication. Many people respond well to lifestyle changes and psychological treatments.
Medications for anxiety
These medications are used for very severe anxiety in anxiety types such as panic disorder, generalised anxiety disorder (GAD), and social phobia.
Anti-anxiety medications, such as benzodiazepines, can:
- be addictive
- become ineffective over time
- have other side effects like headaches, dizziness and memory loss.
Anti-anxiety medications are not recommended for long-term use.
Antidepressants were initially developed for treatment of depression but some antidepressants can also have a role in treating anxiety. We know that there are changes in brain chemistry that accompany anxiety, and sometimes antidepressants can address this. If anxiety and depression occur together, antidepressants may be prescribed. There are many kinds of anti-depressants. Selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs) are medications sometimes used in treating anxiety.
Beta blockers are more commonly used for heart and blood pressure issues. They are sometimes used to treat social phobia and anxiety around performance, such as speaking in public. Beta blockers may work by slowing a person’s heart rate when they’re experiencing the ‘fight or flight’ feelings associated with performance. Evidence suggests they are not an effective long-term solution for anxiety issues.
There are a wide range of self-help measures and therapies that can be useful for anxiety.
Depending on the type and severity of your anxiety, self-help or alternative therapies could be used alone or in conjunction with psychological treatments or medication.
It’s good to know that there are things you can do for yourself to feel better.
Self-help and complementary therapies that may be useful for anxiety include:
- good nutrition
- de-arousal strategies
- relaxation and breathing techniques
- alcohol and drug avoidance
Different types of anxiety respond to different kinds of treatments.
Severe anxiety may not respond to self-help and alternative therapies alone. These can be valuable adjuncts to psychological and physical treatments.
Researchers think exercise can be helpful for people with anxiety. We need more studies on the effects of exercise on the full range of anxiety disorders. Regular exercise may increase the level of brain serotonin, the neurotransmitter involved in regulating mood, sleep, libido, appetite and other functions. Problems in the serotonin pathways of the brain have been linked to depression and anxiety. Exercise can also increase the level of endorphins in the brain which have ‘mood-lifting’ properties. Regular exercise may alleviate symptoms of anxiety by:
- increasing energy levels
- improving sleep
- distracting from worries and rumination
- providing social support and reducing loneliness, if exercise is done with other people
- increasing a sense of control and self-esteem, having an active role in our own wellbeing.
Exercise does not need to be extremely vigorous to be helpful for anxiety, even a brisk walk each day can be beneficial.
There’s evidence that magnesium deficiency may contribute to some mental health issues, including anxiety. Long periods of stress and anxiety may also deplete our bodies of magnesium. Magnesium helps in many processes that go on in our bodies. It is known for its effect on ‘calming’ the nervous system. Eating well and boosting these nutrients may not be a stand-alone ‘cure’ for anxiety, but can work along with other nutrients and treatments to boost wellbeing. Vitamin D, B vitamins, omega-3, and omega-6 are all thought to be useful for reducing anxiety. There are many magnesium and vitamin B-rich foods you can try to add to your diet:
- dark green leafy vegetables
- unrefined grains like oats, brown rice and quinoa
- legumes including green beans
- beef, chicken, fish
- nuts and seeds
- bone broths (soups).
You should talk to your doctor before starting any vitamin and mineral supplements. If you’re anxious, it’s best to avoid caffeine and other stimulants. Try to choose unprocessed, fresh foods whenever possible.
There is evidence that omega-3 oils, commonly found in oily fish such as salmon, anchovies, trout, tuna, mackerel and swordfish, play a role in mental wellbeing.
This has particularly been in cases of bipolar disorder, but some studies also demonstrate antidepressant properties. We need more research into the effects of omega-3 on anxiety.
How does omega-3 affect mood?
There are several lines of evidence that suggest that omega-3 consumption may be associated with mental illnesses. Research suggests that omega-3 is related to a number of biological processes that have been found to be associated with brain functioning. Note that consuming large amounts of some fish may lead to ingestion of contaminants. You can learn more about this in our Omega-3 and mood disorders fact sheet.
There are also several very effective de-arousal strategies that you can practice to help with anxiety, such as:
- breathing techniques - using slow and controlled breathing to address hyperventilation
- relaxation training – letting go of tension and muscle relaxation can have a calming effect on the nervous system
- thinking strategies – identifying negative or anxiety-provoking thoughts, challenging them, and practicing more positive thinking patterns
- managing worry – through problem solving, decision making, and dealing with behaviours that ‘feed’ anxiety and worry.
For more information see St. Vincent’s Hospital Sydney’s treatment manual for generalised anxiety disorde.
Relaxation techniques can involve gradual and deliberate muscle relaxation, visualising a calm place, and breathing techniques. Relaxation techniques may help our anxiety by helping us to ‘un-clench’ and relax our muscles, and break the cycle of nervous and anxious thoughts. Studies show that relaxation techniques are effective across many types of anxiety including GAD, panic disorder, social phobia and some phobias. You can teach yourself relaxation techniques by looking online, or by seeing a professional. See our relaxation techniques fact sheet.
Yoga is an ancient Indian exercise philosophy that provides a gentle form of exercise and stress management. It consists of postures or 'asanas' that are held for a period of time and are often synchronised with the breathing.
Yoga is very helpful for reducing stress and anxiety. It can help through:
- calming the anxious ‘flight or fight’ response
- distracting from the cycle of worrying thought patterns
- producing endorphins
- building self-esteem and new mastery techniques.
A number of studies have shown that yoga breathing exercises are beneficial for anxiety and depression.
Massage therapy is believed to be helpful for people with anxiety, although further studies are needed to conclusively demonstrate this.
Massage produces chemical changes in the brain that result in a feeling of relaxation, calm and wellbeing. It can help reduce anxiety on the day of the massage and may help in giving some ongoing relief.
Massage also reduces levels of stress hormones, such as adrenalin, cortisol and norepinephrine.
Anxiety can sometimes occur on its own, or together with depression during pregnancy and the postnatal (time after birth) period.
Worrying thoughts around the health of your unborn baby or your own health are normal. These concerns usually settle with reassurance from your doctor.
About one in seven childbearing women show symptoms of an anxiety disorder. It’s a common medical problem during pregnancy and in the postnatal period.
If you are excessively anxious to the point of uncontrollable worry, an inability to relax and physical or mental restlessness, it’s important to seek help from your doctor.
Why do some people develop perinatal anxiety (pre and postnatal anxiety)?
Women are more likely to show increased levels of anxiety when they’ve:
- had previous pregnancy, labour or delivery complications
- had a history with miscarriage
- experienced the death or serious medical problems with their baby.
Also, a history of a specific phobia, generalised anxiety disorder (GAD), separation anxiety or obsessive compulsive disorder (OCD) increases the risk of anxiety symptoms in pregnancy and after birth.
Other risk factors for developing anxiety during pregnancy or postnatally:
- family history of mental health issues
- personality type – e.g. perfectionist, shy or nervous
- delivery complications
- lack of support from family
- stressful life events like divorce, death in the family, moving house
- difficulties with baby’s sleeping, feeding or crying.
Getting help for anxiety during the perinatal period
Sometimes pregnant women who are anxious might think things will get better once the baby arrives. This is often not the case.
If you’re feeling any of these problems, seek help as soon as you can. Getting help sooner can help with quicker recovery from anxiety, and minimise the effects on your baby and family.
Sometimes, you may not realise you have anxiety. Your partner, a family member or a friend might notice first. If you are concerned that someone you know might have anxiety, help them to get assistance.
Who can I talk to?
There are lots of people who can help you with your anxiety.
Start by talking to your GP. You can also talk to your obstetrician, child health nurse, a psychologist or your midwife.
If you have trouble talking to the first person about it, or they’re not giving you the help you need, keep persisting. Talk to someone else. There are lots of ways to help recover from anxiety, and you can feel better.
Treatment of anxiety in pregnancy and postnatally
The symptoms of depression or anxiety that occur among childbearing women are similar to those that occur at other times of life, however the choices for treatment may differ during pregnancy or when a woman is breastfeeding.
Treatment options include:
- psychological treatments
- psycho-educational treatments
- complementary therapies and lifestyle – like diet, exercise and meditation
It’s important to treat depression and anxiety as early as possible.
Being anxious causes distress for mothers, and our ability to cope with a new baby and our developing relationship.
Partners and young children can also feel stressed when a parent is anxious or depressed. Types of treatment vary with the nature and severity of anxiety symptoms.Psychological treatments
Psychological treatments (or ‘talking therapies’) are the most effective way to help recover from anxiety, and to stay well. Psychological therapies are effective for pregnant or postnatal women who may suffer from stress, experience relationship difficulties, or have personality styles which contribute to difficulties of coping with a newborn baby.
Counselling approaches such as cognitive behaviour therapy (CBT) and interpersonal therapy (IPT) can teach us the skills to deal with situations that trigger or increase distress. These therapies can be delivered individually or in groups and usually take place weekly for 6-12 sessions. They might be provided by a doctor, psychologist, social worker, midwife or mental health nurse trained in these methods.
There are also many new online e-mental health tools that may work together with face-to-face therapies. Learn more about our self-help tools and apps.
For women with long-standing problems arising in childhood, there are other forms of psychotherapies that require longer term treatment.
Some therapists will work with a mother and baby together, or with both parents together.
Couples counselling can be useful for problems in the parents’ relationship including communication problems and sexual difficulties.Psycho-educational treatments
These treatments are supportive, educational and aim to give a woman and her partner some understanding and acceptance of the causes for the anxiety.
It’s important to ask questions rather than worry in silence.
There are some situations where anxiety is triggered by unnecessary worrying, lack of information, or incorrect beliefs about a situation.
Doctors, midwives, child and family health nurses, and parent educators all play a part in providing information for new and prospective parents.
They have lots of information about pregnancy and the normal behaviours of newborn babies. They can also correct misinformation.
When symptoms persist despite reassurances and the provision of correct information, other treatment approaches can be considered.Lifestyle changes, family and social support for women with anxiety
Lifestyle changes can work together with psychological therapies to help us recover.
With the birth of a new baby, these might be harder to implement. The birth of a baby brings big changes to everyday life, and regular sleep and exercise may not be as easy to achieve.
Ask for help with childcare, so that you can try to fit a few enjoyable activities in to your family routine. Positive activities for reducing stress and anxiety you could try might be:
- pre / postnatal yoga
- listening to music
- going out for a walk with a friend.
Regular exercise can also help with symptoms of anxiety by helping metabolise adrenalin (a chemical produced by the body when anxious) and producing endorphins (‘feel-good’ chemicals).
These activities could accompany psychological therapies such as cognitive behaviour therapy (CBT) and regular appointments with your psychologist or GP.Medications
Always talk to your doctor before taking any medication whilst pregnant or breastfeeding.
If you are taking prescribed medications and plan to become pregnant, discuss your plans with your doctor before discontinuing your medication.
This is to ensure you don’t experience adverse withdrawal effects or a relapse of the condition being treated.
The use of medications in the perinatal period is avoided because of the risks of exposure for the developing or breastfeeding baby. However, decisions about the use of medication involve weighing up of risks against the benefits for each woman.
Your doctor will take into account the type of anxiety and the severity of the symptoms when prescribing medication. A mother who is seriously depressed or anxious will find it difficult to be emotionally available for her baby. This can interfere with the developing relationship between the mother and baby and her family.
In some situations, under medical guidance, medication may be required. Such decisions need to be weighed carefully and discussed in detail, ideally with both you and your partner or a family member present.
What can I do to help someone with pregnancy or postnatal anxiety?
Supporting women at this time is crucial. Always make sure they are seeking professional help first.Some practical things you could try to assist in helping a woman with perinatal anxiety might be:
- cooking some healthy meals
- helping with shopping or taking them to appointments
- helping with childcare
- helping with washing and folding
- giving them some company and checking in with how they’re feeling
- encourage them to rest or do some gentle exercise.
If you are concerned about someone you think may have anxiety or depression, always encourage them to seek help from their doctor.
Read more about pregnancy and depression.