Therapy for Anxiety: CBT, Exposure and Other Approaches

Anxiety is a common reason people seek therapy, and several approaches can help. Cognitive behavioral therapy (CBT) and exposure therapy are often used, and acceptance and commitment therapy (ACT) is another option. Therapy can be used on its own or alongside medication, and a prescriber can talk about whether medication is an option. The best approach depends on the person and the situation, and it is something to decide with a mental health professional.

The main anxiety disorders, in plain words

The National Institute of Mental Health (NIMH) describes several main anxiety disorders: generalized anxiety disorder, panic disorder, social anxiety disorder and phobia-related disorders. These are not checklists to self-diagnose. They are groups of conditions that mental health professionals assess. Generalized anxiety disorder involves persistent and excessive worry that is hard to control. Panic disorder involves recurrent unexpected panic attacks and worry about having more. Social anxiety disorder involves intense fear of social situations where a person might be judged. Phobia-related disorders involve intense fear of specific objects or situations. If you recognize yourself in these descriptions, a therapist or doctor can help you understand what is going on.

Approaches used in therapy for anxiety

Cognitive behavioral therapy (CBT)

CBT helps people identify and change thinking and behavior patterns that are unhealthy or ineffective. For anxiety, this often means noticing thoughts that fuel fear, examining them, and gradually changing how you respond. CBT is commonly used for generalized anxiety disorder. You can read more about what cognitive behavioral therapy (CBT) involves and how it is structured.

Exposure therapy

Exposure therapy is a type of CBT used for anxiety disorders. It helps people learn to manage their fear by facing feared situations or objects in a planned, gradual way, rather than avoiding them. Avoidance can keep anxiety going, and exposure aims to reduce that cycle. A therapist trained in exposure therapy will work with you to set up steps that feel manageable.

Acceptance and commitment therapy (ACT)

ACT encourages nonjudgmental acceptance of thoughts and feelings and uses mindfulness and goal setting, together with commitment to actions in line with a person’s values, to build psychological flexibility. For anxiety, ACT might involve learning to notice anxious thoughts without fighting them, and taking steps toward what matters even when anxiety is present. More on acceptance and commitment therapy (ACT) is available.

Other approaches

Interpersonal therapy (IPT) is a short-term treatment focused on issues such as unresolved grief, changes in social or work roles, conflicts with significant others and problems relating to others. It is not one of the approaches NIMH names for generalized anxiety disorder; a therapist can say whether it fits when those issues are part of the picture. Psychodynamic therapy is based on the idea that behavior and mental well-being are rooted in childhood and past experiences. Some people find it helpful for understanding anxiety patterns. Therapy can be individual, couple, family or group, for children and adults.

Therapy, medication, or both

Treatment for generalized anxiety disorder typically involves psychotherapy, medication, or both. Choosing a treatment plan should happen with a mental health professional. A prescriber (a psychiatrist, a psychiatric nurse practitioner or another doctor) can talk about whether medication is an option and answer questions about it. Therapy can be used instead of or alongside medication and other treatment.

What sessions involve

Goals of treatment, and how long and how often to meet, are discussed by the patient and therapist together. Sessions are typically held once every 1-2 weeks for about 30 to 50 minutes. In CBT and exposure therapy, you might practice skills between sessions, such as tracking thoughts or doing planned exposure steps. In ACT, you might work on mindfulness exercises and values-based actions. The pace is set collaboratively, and you can ask questions at any point.

Finding a therapist with this focus

Ways to find a provider include asking a primary care provider, using federal resources such as SAMHSA’s FindTreatment.gov locator, checking with national organizations, state and county agencies, your health insurer, universities, and employee assistance programs. Being examined by a health care provider first can help rule out a physical health issue, because symptoms like a change in mood or trouble concentrating are sometimes due to a medical condition. When looking for a therapist for anxiety, you can ask about their experience with CBT, exposure therapy or ACT, and whether they specialize in anxiety disorders. You can also check the state licensing board’s website to verify a license. For more on deciding when to reach out, see when to see a therapist: signs it may help.

Questions to ask a therapist

NIMH suggests asking about the therapist’s credentials, experience and any specialty; the approach and its rationale and evidence base; the goals of therapy; whether a time frame or number of sessions is recommended; how progress will be assessed; whether medication is an option and whether this therapist can prescribe; whether meetings are confidential and what the limits of confidentiality are; fees, whether insurance is accepted and whether there is a sliding scale. Rapport and trust are essential; you should feel comfortable with the therapist. If therapy has gone on for what feels like a reasonable time without improvement, talk to the therapist; it may make sense to explore other professionals or approaches.

Comparing approaches

What goes wrong

One common misconception is that therapy for anxiety must involve reliving traumatic events or being forced into feared situations. In exposure therapy, steps are planned collaboratively and gradually; a therapist should not push you into something you are not ready for. Another mistake is expecting quick results. Therapy takes time, and progress is often gradual. Some people try to manage anxiety alone for too long; reaching out earlier can help. Others may see a therapist who is not a good fit; it is okay to switch if rapport is not there. Also, therapy is not a one-size-fits-all; what works for one person may not work for another, and it is fine to ask about different approaches. Finally, confidentiality has limits: a psychologist, for example, may disclose without consent only where the law requires it or permits it for a valid purpose, such as protecting you or others from harm, and mental health professionals are mandated reporters of child abuse and neglect in many states; rules vary by state.

If you are in crisis

In the US, anyone can call or text 988 (the 988 Suicide & Crisis Lifeline) for free, confidential support 24/7, or call 911 in an emergency. The 988 line is for anyone who is struggling, not only for suicidal thoughts.

Paying for therapy

Costs depend on your insurance and the provider. If you have insurance, check with your plan about coverage for mental health services. Under the Affordable Care Act, Marketplace plans cover mental health and substance use disorder services as essential health benefits, including behavioral health treatment such as psychotherapy and counseling. Medicaid and CHIP also cover mental health services, but benefits vary by state. If you are uninsured or not using insurance, you should get a Good Faith Estimate of the cost when you schedule care at least 3 business days in advance, or when you ask for one. For lower-cost options, certified community behavioral health clinics (CCBHCs) serve anyone regardless of ability to pay, and HRSA-funded health centers offer sliding fee discounts. Employee assistance programs may offer free short-term counseling. Veterans can get help through the VA and Vet Centers.

A note on self-help and coaching

Coaching is not a licensed mental health profession. If you are seeking therapy for anxiety, look for a licensed mental health professional. You can ask any provider which state license they hold.