Anxiety Therapy: Types, Techniques and Worksheets

anxiety-therapySuffering from anxiety generally involves worry, fear, and rumination about the future.

Such anticipatory anxiety makes enjoying each moment a difficult endeavor. Unfortunately, anxiety disorders represent a serious and prevalent problem for children and adults worldwide.

The lifetime prevalence rate for anxiety disorders is estimated at 33.7% of the population—an estimate that has remained quite stable over the years (Bandelow & Michaelis, 2015).

Overall, anxiety disorders represent the most common psychiatric disorders within the general population (Ost, 2008), and the number one mental disorder among women (Chambala, 2008).

While anxiety may serve a useful purpose (e.g., alerting us to dangers), too much anxiety impairs functioning and performance in certain activities (e.g., the ‘Yerkes-Dodson law;’ Yerkes & Dodson, 1908).

If you are depressed you are living in the past. If you are anxious you are living in the future. If you are at peace you are living in the present.

Lao Tzu

When anxiety reaches the clinical level, it interferes with the ability to live life to the fullest—often causing significant social and occupational impairment. Anxiety disorders cover a lot of territories; they include:

  • generalized anxiety disorder (GAD),
  • panic disorders (including agoraphobia),
  • post-traumatic stress disorder (PTSD),
  • specific phobias,
  • social anxiety disorder (SAD), and
  • obsessive-compulsive disorder (OCD).

Anxiety disorders may be terrifying for their victims, causing physiological, cognitive, and emotional symptoms (e.g., rapid heart rate, the sense of going crazy, and excessive worry, respectively) (Hart, 1999). Those experiencing panic attacks often end up in the emergency room, believing they are dying. It is also common for anxiety disorders to occur concomitantly with other disorders (e.g., depression).

On the positive side, there are several effective therapeutic approaches for anxiety disorders (e.g., exposure therapy), as well as a variety of techniques, and worksheets individuals may apply themselves.

This article will describe these approaches while also addressing the specific issues of social and childhood anxiety disorders. By shedding light on anxiety disorders and their treatment, the goal is to provide useful suggestions, tools, and above all, hope for individuals negatively impacted by these under-recognized but highly prevalent conditions.

Can Anxiety Be Cured with Therapy?

While anxiety covers a range of areas and may be debilitating, there is good news: It is highly treatable.

Despite the enormous stressors to which we are subjected in modern society, there are ways to respond without succumbing to serious anxiety problems. Anxiety has been described as “the absence of the happy messengers that keep us tranquil” (Hart, 1999, p. 5).

Rebuilding such tranquility is possible thanks to a number of psychological treatment approaches. This article will focus on the non-pharmaceutical approaches that have been found effective for reducing and even curing individuals of anxiety disorders and associated symptomatology.

 

6+ Popular Anxiety Therapy Options

Man is not worried by real problems so much as by his imagined anxieties about real problems.

Epictetus

Indeed, it is generally the case that severe anxiety is more a reflection of worry over anxiety itself as opposed to the problem underneath.

For example, an individual with a public speaking phobia is typically terrified of looking like a fool in front of an audience because of his/her anxiety symptoms (e.g., hyperventilating, throwing-up, passing-out, sweating, stuttering, etc.).

Thus, it is not fear of public speaking per se that is the real problem, but rather, it’s the anticipation of associated anxiety that causes distress. It is by confronting such anxiety that individuals often experience relief.

Although the nature of intervention needs to be individualized based on the particular type of anxiety disorder, the following anxiety treatments have shown effectiveness for many people.

 

1. Cognitive Therapy

Cognitive therapy is the most common psychological treatment for anxiety disorders.

This approach involves working with therapists to identify the feelings, thoughts, and beliefs that impact an individual’s ability to modify behaviors. For example, a person with a phobia of dogs would work to uncover the irrational beliefs that surround this phobia, such as the inherent danger in approaching all dogs.

Cognitive therapy is typically combined with behavior therapy (i.e., cognitive behavior therapy) such that beliefs and cognitions are addressed in conjunction with working toward ways of changing behaviors.

For example, the dog phobia patient might also try approaching docile dogs while also working with a therapist on his/her irrational fears. This approach is also termed ‘exposure therapy,’ which will be described subsequently.

 

2. Cognitive behavior therapy (CBT)

Cognitive behavior therapy is widely used for anxiety disorders because it encompasses each of the underlying tenets that are related to clinical anxiety.

More specifically, CBT is grounded in the following ideas:

  • mental health disorders involve key learning and information processing mechanisms (e.g., a phobia patient’s irrational beliefs about perceived dangers);

  • behaviors are better understood by exposing their true functions (e.g., a panic disorder patient’s belief that sweating and heart palpitations will result in death);

  • new adaptive learning experiences can be used to substitute prior nonadaptive learning processes (e.g., a phobia patient who becomes increasingly exposed to the feared object will develop new beliefs about his/her fears); and

  • clinicians take on a scientific approach to therapy by creating hypotheses about patients’ cognitive and behavioral patterns; by intervening and observing outcomes; and by reframing original hypotheses as needed (Hazlett-Stevens & Craske, 2004).

In this way, the CBT approach is tailored to the individual needs of the client and is modified based on his/her progress (Hazlett-Stevens & Craske, 2004). In other words, CBT is grounded in the assumption that “emotional [i.e., anxiety] disorders are maintained by cognitive factors, and that psychological treatment leads to changes in these factors through cognitive and behavioral techniques” (Hofmann & Smits, 2008, p. 621).

CBT contains a variety of potential components; such as

  • exposure,
  • social skills training,
  • cognitive restructuring,
  • problem-solving training,
  • self-monitoring or journaling of symptoms,
  • homework, and
  • relaxation training.

Also, it may be implemented via brief therapy or over a longer duration depending upon the client and his/her presenting problems.

Meta-analyses have determined that CBT is an effective approach for the treatment of anxiety disorders (e.g., Butler, Chapman, & Forman et al., 2006; Deacon & Abramowitz, 2004; Hofmann & Smits, 2008; Stewart & Chambless, 2009).

In addition, CBT implemented by primary physicians with minimal mental health training (i.e., ‘The Calm Program’) has been reported as an acceptable and encouraging way for primary doctors to help anxious patients who might otherwise remain untreated (Craske, Roy-Byrne, & Stein, 2009).

 

3. Attention bias modification

Attention bias modification is a newly emerging approach that involves the use of computer-based attention training with anxiety patients to affect hyperattention to perceived threats in the environment (Bar-Haim, 2010).

In this way, problematic attentional biases (e.g., an agoraphobic patient who is highly attuned to perceived threats in his/her environment) may be modified in such a way as to reduce anxiety.

Attention bias modification is similar to CBT because it involves exposure to feared objects or situations, but it is also unique because of its focus on specific attentional bias targets (Hakamata, Lissek, & Bar-Haim et al., 2010).

Although studies investigating this approach are minimal, attention bias modification represents a promising new approach for the treatment of anxiety disorders (Hakamata et al., 2010).

 

4. Hypnosis

Hypnosis also has been found to benefit individuals dealing with anxiety.

Hypnosis is defined as “a state of consciousness involving focused attention and reduced peripheral awareness characterized by an enhanced capacity for response to suggestion” (Elkins et al., 2014, p. 6).

Hypnosis is like meditation, but with added objectives based on the needs of the individual. It may involve varying states of consciousness during which attention is focused and distractions are tuned-out (McNeal, 2019).

Importantly, hypnosis is not an out-of-control experience, as the patient has power over and awareness of what’s going on. Additionally, its goals are achievable within a minimal time commitment (Straub & Bowman, 2016).

Hypnosis (including self-hypnosis) has been widely used within the mental health field (Valentine, Milling, & Clark et al., 2019). It also has been reported as a useful tool for patients dealing with:

  • dental anxiety (Potter, 2013),
  • surgical anxiety (i.e., perioperative anxiety; Capafons & Mendoza, 2009),
  • anxiety-related to sports competitions (Mendoza, 2010),
  • social phobia (Capafons & Mendoza, 2013), and
  • anxiety disorders in general (Hammond, 2010).

 

5. Psychodynamic therapy

Psychodynamic therapy as a therapeutic approach often conjures up antiquated images of psychiatrist couches and patients re-living early childhood experiences. Rather, psychodynamic therapy, which is rooted in Freudian theory, involves building strong therapist-patient alliances in which patients may develop the psychological tools needed to deal with fears and anxieties.

Although treatment may be lengthy, short-term psychodynamic therapy also has been reported as an effective approach for anxiety.

For example, one study reported that a 30-session psychodynamic treatment was helpful for the treatment of GAD—although this approach was less successful than CBT (Leichsenring, Salzer, & Jaeger, 2009).

Additionally, in a study examining long-term follow-up after psychodynamic therapy, significant reductions were reported for anxiety symptoms—with short-term approaches producing quicker improvements and long-term approaches providing longer-lasting improvements (Knekt, Lindfors, & Härkänen, 2008).

Finally, in a study comparing psychodynamic therapy with CBT, both approaches produced significant positive effects for SAD (Bögels, Wijts, & Oort et al., 2014).

In contrast, a comparison of CBT and short-term psychodynamic therapy for patients with hypochondriasis (i.e., excessive health-related anxiety) indicated significant improvements only for those who received CBT (Sørensen, Birket-Smith, & Wattar et al., 2010).

 

6. Vagus nerve stimulation

In this unique treatment approach, an anticonvulsant device sends electrical stimulation to the vagus nerve. The vagus nerve is targeted because of its ability to modulate anxiety.

Although this approach is typically used for epilepsy and treatment-resistant depression, studies also have demonstrated its effectiveness for treatment-resistant anxiety disorders (George, Ward, & Ninan, 2008).

Additionally, studies in which vagus nerve stimulation was used to treat epilepsy or depression have reported significant reductions in anxiety symptoms (Chavel, Westerveld, & Spencer, 2003; Rush, George, & Sackeim et al., 2000).

Importantly, vagus nerve stimulation is an invasive approach that is used as an add-on treatment for patients who have not achieved success with CBT and other forms of therapy.

 

Exposure Treatment for Anxiety

exposure therapy for anxietyExposure therapy is a type of CBT that is generally considered the best psychological approach for the treatment of anxiety disorders.

With exposure therapy, the patient is exposed to his/her feared object or situation, such as flying.

Such exposure is typically gradual, with the exposure beginning with less threatening stimuli and gradually working its way toward increasingly feared stimuli (i.e., ‘systematic desensitization,’ Wolpe, 1958).

This graduated exposure therapy is grounded in behavioral psychology (i.e., classical conditioning) with the goal of desensitizing the patient to his/her feared trigger.

An example of graduated exposure therapy is that of an individual with arachnophobia. In this case, the patient might work with a therapist as follows:

The patient first watches a film with giant spiders; the patient then views a large but harmless spider in a glass case across the room; the patient then approaches and looks directly into the glass case, and eventually, the patient works toward actually handling the spider.

Of course, the nature and duration of the arachnophobia exposure therapy will depend upon the patient’s individual symptoms and needs.

If systematic desensitization is used, gradual exposure will also involve relaxation techniques as a way of pairing the feared stimulus with a state that is not compatible with anxiety. Therefore, the arachnophobia patient might experience relaxation training while viewing spider images.

Like CBT, there are different ways in which exposure therapy may be implemented depending upon the client and diagnosis. For example, exposure therapy may be in vivo, as is the case with the live spider. Simulated exposure is a similar technique in which the patient experiences a proxy of the feared stimuli. For example, viewing a film of spiders is a simulated exposure.

Recent technology has provided therapists with the tools to implement more realistic simulations via virtual reality exposure therapy.

In such cases, patients wear headsets in which they experience a highly realistic virtual space. This technique is useful for several anxiety disorders and phobias; for example, military patients with PTSD can use virtual reality to simulate battlefield experiences.

Research studies have shown support for virtual reality exposure therapy in the treatment of anxiety disorders. For example, in a comprehensive meta-analysis, researchers found significant positive effects for virtual reality exposure therapy across outcomes (Powers & Emmelkamp, 2008).

Another type of exposure therapy is termed ‘flooding’ (aka ‘implosion therapy’). With this technique, patients confront their fears via simulated or in vivo exposure that is not gradual. Instead, patients are rapidly exposed to fear-provoking stimuli until they feel less anxious (e.g., a patient with a bridge phobia is taken to a bridge and asked to stand on it until his/her anxiety wanes).

Flooding is based on the idea that, without engaging in avoidance, the patient’s fear will become extinguished (Abramowitz, Deacon, & Whiteside, 2019). Therapists generally prefer gradual exposure over flooding because the latter is intense and may have negative repercussions for patients not prepared for such direct and immediate exposure to feared stimuli.

Other forms of exposure therapy include prolonged exposure, which was designed for the treatment of PTSD. With prolonged exposure, both repeated in-vivo and imaginal exposure are combined to enable the patient to experience trauma without the feared outcomes.

This technique has been widely used for the treatment of PTSD and is considered by many clinicians as the best option for this disorder (Van Minnen, Harned, & Zoellner et al., 2012). This notion is supported by research.

For example, in a meta-analysis examining prolonged exposure among PTSD patients, individuals in the prolonged exposure group experienced better results than 86% of those in control condition (Powers, Halpern, & Ferenschak et al., 2010).

Acceptance-based therapy is another CBT approach sometimes used together with in vivo or simulated exposure therapy. The goal of this relatively new approach is to help patients to increase their willingness to experience anxiety as part of their exposure to feared situations (England, Herbert, & Forman, 2012).

For example, in a study examining the use of acceptance-based exposure therapy for individuals with public speaking phobias, participants received group-based therapy in which they experienced public speaking exposure combined with acceptance-based treatment (i.e., treatment aimed at promoting acceptance of distressing emotions and sensations associated with public speaking; England et al., 2012).

This study indicated that participants who received acceptance-based exposure therapy, which seeks to promote ‘psychological flexibility,’ experienced significant improvements in public speaking confidence, skills, and associated emotions (England et al., 2012).

 

14+ Techniques for Treating Anxiety

If you want to conquer the anxiety of life, live in the moment, live in the breath.

Amit Ray

Along with CBT and other therapist-implemented approaches for anxiety, various additional techniques may help to ease symptoms. Here is a list of ideas:

Mindfulness Approaches involves a type of awareness in which a person pays attention to his/her feelings and thoughts in the moment, and without judgment. It is an open-minded and totally accepting way of responding to thoughts (i.e., cognitions) (Kabat-Zinn, 2005).

Mindfulness techniques may be beneficial to anxiety patients by helping to increase relaxation while removing negative or stressful judgments. Mindfulness may be enhanced by using various approaches, such as meditation, yoga, or deep-breathing exercises.

While mindfulness activities are often add-ons with CBT and other forms of therapy, there is recent evidence supporting their unique benefit for the reduction of anxiety (Blanck, Perleth, & Heidenreich et al., 2018).

Engaging in aerobic exercise also represents a useful way to reduce physiological stress responses and improve mood (Sharma, Madaan, & Petty, 2006). While it may be difficult for an anxious person to find the motivation to exercise, its potential benefits make it worth the effort.

For example, research has indicated that physical activity is linked to reduced anxiety symptomatology, as well as improved cognitive functioning, life satisfaction, and psychological well-being (Carek, Laibstain, & Carek, 2011).

A comprehensive review also has indicated that exercise is beneficial for anxiety disorders, including OCD, GAD, and SAD (Baldwin, Anderson, & Nutt et al., 2014).

In addition, exercise has been associated with reduced anxiety symptoms among sedentary patients with medical conditions (Baldwin et al., 2014).

Exercise is especially attractive because it’s cost-effective and may be performed in a variety of ways (e.g., walking, biking, swimming, running, hiking, etc.). While exercise may not reap the same benefits for anxiety patients as compared to CBT or other psychological approaches, it may enhance the impact of such treatment.

Along with mindfulness techniques and aerobic exercise, here are a variety of things that individuals can do to reduce anxiety:

  • Get involved in a hobby you love (e.g., baking, gardening, reading, painting, etc.)
  • Listen to your favorite music
  • Journal your feelings
  • Take a warm bath
  • Make sure to eat healthy, as junk food can have adverse effects on physical and psychological health
  • Get enough sleep
  • Go out in nature
  • Avoid emotional triggers (e.g., people and places that consistently increase your anxiety)
  • Spend time with animals
  • Organize your home or workspace, as clutter may exacerbate anxiety
  • Watch caffeine and alcohol intake
  • Spend time with family and friends whom you enjoy

 

Techniques for Treating Social Anxiety

Social anxiety (aka social phobia) is a prevalent problem, with over 7% of Americans diagnosed with SAD (Norton, 2012).

Social anxiety may take several forms, such as public speaking phobia, fear of social situations, or fear of meeting new people.

Social anxiety stems from an individual’s fear of adverse judgments or scrutiny from others and the humiliation that follows. As such, social phobia may lead to significant problems within occupational, educational, and social domains, which often results in low self-esteem and loneliness.

The best treatment for social anxiety is CBT, with exposure therapy often recommended.

For example, an individual with public speaking anxiety might work on speaking in front of a few people and gradually work his/her way up to larger groups.

Socially anxious people may also benefit from social skills and relaxation training.

For example, in an in-depth meta-analysis, including 30 studies and 1628 respondents, various social anxiety treatments were investigated (Acarturk, Cuijpers, & van Straten et al., 2008).

Therapy intervention methods included CBT, cognitive restructuring, exposure therapy, social skills training, and applied relaxation training.

The authors found large effect sizes (e.g., high effectiveness) for psychological treatments for SADs, with no differences between treatment types (likely because so many studies used combined treatments). Besides, lower effectiveness was noted for patients with more severe SADs (Acaturk et al., 2008).

In another study, which was randomized with a one-year follow-up, in vivo exposure was compared with virtual reality exposure for the treatment of SAD (Anderson, Price, & Edwards et al., 2013).

Researchers reported significant improvements at 12-month follow-up, with virtual reality therapy functioning equally well as in vivo exposure. Research also has indicated that attentional bias training for SAD is related to significant reductions in social anxiety symptoms (Schmidt, Richey, & Buckner, 2009).

In sum, while SADs often result in severe impairment, there are psychological treatments that have been found to diminish significantly associated symptomatology and to enhance the quality of life for many individuals suffering from social anxiety.

 

9 Useful Worksheets for your Sessions

There are numerous worksheets available online that may be useful for reducing anxiety. Here are several examples:

  1. The Anxiety Workbook: A 7-Week Plan to Overcome Anxiety, Stop Worrying, and End Panic (Cuncic, 2017)
  2. Jane’s Worry Elephant: A Self-help Guide for Kids with Anxiety (Miller, 2019)
  3. The Worry Workbook for Kids: Helping Children to Overcome Anxiety and the Fear of Uncertainty (An Instant Help Book for Parents & Kids; Khanna & Ledley, 2018)
  4. Conquer Anxiety Workbook for Teens: Find Peace from Worry, Panic, Fear, and Phobias (Chansard, 2019)
  5. The 5-Minute Anxiety Relief Journal: A Creative Way to Stop Freaking Out (Peterson, 2019)
  6. The Anxiety and Worry Workbook: The Cognitive Behavioral Solution (Clark & Beck, 2011)
  7. The Generalized Anxiety Disorder Workbook: A Comprehensive CBT Guide for Coping with Uncertainty, Worry, and Fear (Robichaud & Dugas, 2015)
  8. The Anxiety and Phobia Workbook (Bourne, 2015)
  9. Let That Sh*t Go: A Journal for Leaving Your Bullsh*t Behind and Creating a Happy Life (Sweeney, 2018)

 

Helpful Exercises

meditationWhen experiencing anxiety, self-guided mindfulness exercises may help individuals to calm down.

Because such activities may be conducted as needed and without the expense, they represent highly feasible ways to deal with anxiety issues.

While the potential value of self-guided exercise has face validity, stand-alone exercises (i.e., regular exercises performed outside of treatment intervention) rarely have been researched.

However, in a meta-analysis of 18 studies in which stand-alone exercises were examined for the reduction of anxiety and depression symptoms, such exercises were found to be beneficial for the reduction of anxiety (Blanck, Perleth, & Heidenreich et al., 2018).

The stand-alone mindfulness exercises included breathing meditation, sitting meditation, bodyscan (aka ‘progressive relaxation,’ which involves attending to different parts of the body in a gradual format while tensing and then relaxing muscles) and soundscan (e.g., mindfulness that adjusts responses to sounds such that their aversive impact is reduced).

Blanck et al.’s (2018) study is important because it shows that there are positive ways for individuals to deal with their anxiety on their own (e.g., outside of a structured intervention).

Overall, if one is feeling anxious or stressed, various exercises may be easily researched online and applied based on one’s unique interests and needs. Here are some examples:

  • Deep Breathing Meditation
  • Sitting Meditation
  • Bodyscan Meditation (i.e., Progressive Relaxation)
  • Loving-Kindness Meditation
  • Spiritual Meditation
  • Vipassana Meditation
  • Transcendental Meditation
  • Mantra Meditation
  • Walking Meditation
  • Buddhist Meditation
  • Yoga (e.g., Bikram, Vinyasa, Hatha, Hot, & Goat, etc.)

 

A Look at Anxiety Group Therapy + Ideas

Psychological treatment options for anxiety include both individual and group-based therapies.

In his book ‘Group Cognitive-Behavioral Therapy of Anxiety’ (2012), Norton describes effective evidence-based approaches designed to help CBT therapists implement group-based interventions for patients with anxiety disorders.

Norton notes that such group treatment approaches (e.g., exposure, cognitive restructuring, mindfulness, etc.) are useful for all anxiety disorders; hence there is no need to apply separate strategies for specific anxiety disorders (Norton, 2012).

For CBT group therapy to be effective, the group needs to be both cohesive and task-focused; with other key group therapy factors including altruism, imitative behaviors, interpersonal learning, and installation of hope (Yalom, as cited in Whitefield, 2010).

While there is more research examining one-on-one CBT therapy for anxiety versus group therapy (Whitefield, 2010), the latter approach has some advantages, such as:

  • cost-effectiveness,
  • the ability to reach more people,
  • may facilitate the normalization of behaviors (e.g., by seeing that others have the same problems),
  • the acceptance of challenges that are elicited by peers versus the therapist,
  • positive reinforcement by multiple people,
  • exposure situations that are more easily recreated within a group setting,
  • the ability to exercise problem-solving skills by making suggestions to other group members (Whitefield, 2010).

While many individuals with anxiety disorders may benefit from group CBT, there are some people for whom group therapy is likely to be less effective.

Examples of such as individuals include those with comorbid (i.e., co-occurring) psychological disorders (e.g., substance misuse), a more severe and chronic presentation of problems, negative core beliefs, communication problems, interpersonal issues, active suicidal ideation, fear of group environments, and extreme stress and poor relationships (Moorey, as cited in Whitefield, 2010).

Additionally, individuals who lack the motivation to change or fail to comply with treatment (e.g., homework) are also less likely to be a good match for group CBT (Moorey, as cited in Whitefield, 2010).

Research has shown group-based CBT as useful for the treatment of social anxiety-disorders (Butler, Boden, & Olino, et al., 2018; Hedman, Andersson, & Ljótsson et al., 2011).

In addition, preliminary research suggests that large-group CBT classes represent highly feasible and useful approaches for individuals with anxiety disorders (Palay, Wong, & Randall et al., 2018).

In terms of key ingredients for group CBT as a treatment for social anxiety, researchers examined mechanisms for change for two group-based approaches: CBT; and mindfulness and acceptance-based therapy.

Results indicated that mindfulness and acceptance were fundamental mechanisms of change for both group approaches, whereas cognitive reappraisal was more important for CBT (Kocovski, Fleming, Hawley, et al., 2015).

Finally, a qualitative study examined perceptions among individuals with anxiety disorders who achieved benefits following group CBT (Abrahamsson, Nordling, & Michelsen et al., 2018).

Respondents described their anxiety as a lack of security, and noted that creating a securing group environment involved the following themes:

  • sharing with others (e.g., getting to know others with similar problems),

  • knowledge given to participants (e.g., as related to the link between anxiety and thoughts, behaviors, health, and lifestyle),

  • and structure (e.g., how instructors responded to participants’ needs and provided acceptable structures for group members to practice on their own; Abrahamsson et al., 2018).

Overall, if you are dealing with anxiety and feel that group therapy is a good fit for you, there is likely a group that will meet your needs. Once you do some research and find groups that interest you, it is also a good idea to try out several until you find the best fit.

 

A Note on Art Therapy for Anxiety

art therapy for anxiety“…the core process of healing through art involves the cultivation and release of the creative spirit. If we can liberate the creative process in our lives, it will always find the way to whatever needs attention and transformation. The challenge, then, is first to free our creativity and then to sustain it as a disciplined practice” (from ‘Art Heals: How Creativity Cures the Soul,’ McNiff, 2005, p. 5).

There is a certain magic in the act of creating; even young children expressing themselves through art appear not to have a care in the world.

Indeed, the therapeutic benefit in the creation of art transcends age and talent. In fact, there are two important reasons that art therapy is a viable approach for anxious individuals:

  1. because it enables a type of self-expression that goes beyond words; and
  2. because visual representations of anxiety aid in the application of certain types of therapy (Chambala, 2008).

Art therapy also has been described as creating a cathartic release of positive feelings (Curl, 2008). Research supports this idea, as art therapy has been found effective for the reduction of anxiety and other psychological symptoms across multiple populations.

Here are some noteworthy examples:

  • Engaging in art such as coloring mandalas, collage making, and modeling with clay is associated with reduced anxiety among college students (Sandmire, Gorham, & Rankin et al., 2012)

  • Creating art such as ‘healthy image posters,’ greeting cards, and silk wall-hangings are related to reduced anxiety among family caregivers of cancer patients (Walsh, Martin, & Schmidt, 2004).

  • Participation in group art therapy is related to the reduction of symptomatology among adult psychiatric outpatients primarily diagnosed with depressive, anxiety, and adjustment disorders (Chandraiah, Ainlay, & Avent, 2012).

  • Engaging in art therapy (e.g., arts and crafts) is related to the reduction of overall state anxiety among adult cancer patients (Nainis, Paice, & Ratner et al., 2006).

  • Creating art (e.g., drawing nature scenes) is related to reduced levels of perceived stress among Canadian college students (Abbott, Shanahan, & Neufeld, 2013).

  • Making pottery is related to reduced anxiety among elderly nursing home residents (Doric-Henry, 1997).

  • Engaging in art-therapy-based supervision among end-of-life care workers is associated with reduced anxiety and enhancement of emotional awareness and regulation (Potash, Ho, & Chan et al., 2014).

  • Art therapy incorporated into brief CBT among individuals with anxiety disorders is associated with reduced frequency of panic attacks (Morris, 2014).

  • Simply being exposed to visual art is related to reduce anxiety symptoms among psychiatric inpatients (Nanda, Eisen, & Zadeh et al., 2010), a finding which attests to the powerful healing power of art.

 

17 Creative Art and Music Therapy Ideas

The function of music is to liberate in the soul those feelings which normally we keep locked up in the heart.

Sebastian Faulks

Music does have a way of changing moods, whether this means sinking into the angst of the blues or experiencing the upbeat feelings of disco. Because of its ability to affect mood, music therapy has been used to help patients deal with a variety of psychological problems.

Music therapy basically consists of “the monitored use of music to promote clinical change” (Bulfone, Quattrin, & Zanotti et al., 2009, p. 238). Music therapy can be used in multiple ways, such as in combination with CBT or other types of therapy.

Performing music may also foster positive feelings that promote healing. The efficacy of music therapy for the reduction of anxiety is also supported by scientific literature.

For example, music has been found to reduce anxiety among cancer patients receiving chemotherapy (Bulfone et al., 2009; Karagozoglu, Tekyasar, & Yilmaz, 2012), to reduce physiological signs of anxiety among patients receiving mechanical ventilatory support (Korhan, Khorshid, & Uyar, 2011), and to reduce anxiety among patients with Alzheimer’s disease (Guétin, Portet, & Picot, 2009).

Additionally, music therapy is associated with reduced anxiety among individuals with psychiatric disorders (de l’Etoile, 2002; Bibb, J., Castle, D. & Newton, 2015; Bidabadi & Mehryar, 2015).

There are many ways in which we can enhance our moods with the use of music; here are some ideas:

  • Pick music that fits your mood or activity, such as upbeat music for exercise and classical music for relaxation
  • Try meditative music before sleeping
  • Take dance lessons
  • If you are anxious or angry while driving, pick music that will calm your nerves
  • Do not expose yourself to others’ music if it causes stress
  • Use music while creating art as a way of adding inspiration

Similarly, there are several ways in which you might engage in creative art as a way of promoting positive well-being.

Here are a few ideas:

  • Pottery
  • Origami
  • Collage making
  • Painting or drawing
  • Building with Legos or Lincoln Logs
  • Beading
  • Making paper airplanes
  • Scrapbooking
  • Knitting
  • Stained glass making
  • Sewing or quilting

 

Treating Child Anxiety

Treating child anxietyAnxiety affects a high prevalence of children and adolescents (Rapee, Schniering, & Hudson, 2009).

As with adults, childhood anxiety disorders cause significant impairment and are often unrecognized (Walkup, Albano, & Piacentini, 2008).

In their review, Rapee and colleagues (2009) note that childhood anxiety has a negative impact on peer relationships, school functioning, and family processes. Childhood anxiety disorders also commonly occur in conjunction with other psychological diagnoses and have been linked to inhibited temperament (Rapee et al., 2009).

The most common childhood anxiety disorders include separation anxiety, phobias, SAD, GAD, OCD, and PTSD.

As with adults, childhood anxiety disorders are often successfully treated using CBT or skill-focused treatment—both of which are sometimes combined with pharmacological treatment.

For example, in a randomized, controlled study of 488 children with anxiety disorders, CBT, both alone and in combination with antidepressant therapy, was related to significant reductions in anxiety severity as compared to a no-treatment comparison group (Walkup et al., 2008).

Similarly, among children with anxiety disorders, responsiveness to CBT during childhood has been associated with reductions in anxiety during adulthood (Benjamin, Harrison, & Settipani, 2013).

In a study examining the long-term effects of CBT combined with parental anxiety management, children who received the combined treatment were significantly less likely to be diagnosed with an anxiety disorder three years later (Cobham, Dadds, & Spence, 2010).

Interestingly, the combined therapy was significantly more effective than the CBT treatment alone—which makes sense given that psychological symptoms in parents are related to treatment outcomes among children with anxiety (Berman, Weems, & Silverman, 2000).

Along with parental influences, the quality of peer friendships also has been found to predict better CBT treatment responses among kids with anxiety disorders (Baker & Hudson, 2013).

While there is some evidence that children with particular anxiety disorders (e.g., OCD) may benefit from pharmacological treatment (especially selective serotonin reuptake inhibitors, or SSRI’s), quality studies examining the effects of psychotropic medication for the treatment of pediatric anxiety are scarce (Reinblatt & Riddle, 2007).

There is, however, evidence that CBT is an effective treatment for children with anxiety disorders, with long-term benefits often noted (Muris, Meesters, & van Melick, 2002). Moreover, CBT is particularly effective for treating childhood anxiety disorders when combined with family training (Muris et al., 2002).

 

A Note on E-Therapy for Anxiety

With the large numbers of individuals with anxiety disorders who remain undiagnosed and untreated, psychologists have attempted to find more effective ways to provide treatment.

This point is particularly salient concerning anxiety disorders, as the inability to engage in treatment outside the home is often inherent in the disorder itself (e.g., agoraphobia and OCD).

Fortunately, technology has created an avenue in which individuals suffering from anxiety disorders may be reached. By delivering therapist-guided CBT via the computer (aka ‘e-therapy’ or ‘iCBT’), a large number of children and adults may be helped.

For example, in a study examining a 10-week dose of iCBT among participants with GAD, iCBT was associated with significant positive treatment effects comparable to those found for in-person treatment (Robinson, Titov, & Andrews et al., 2010). Similarly, CBT e-therapy has been reported as effective for the treatment of OCD, PTSD, SAD, and GAD (Klein, Meyer, & Austin et al., 2011).

Finally, in a comprehensive review of 26 randomized controlled studies of internet therapy, 23 studies reported positive results for the treatment of depression or anxiety symptoms (Griffiths, Farrer, & Christensen (2010). Preliminary findings for the efficacy of internet-based treatment provides promise for adults and children suffering from the often debilitating effects of anxiety disorders.

 

A Take-Home Message

Anxiety symptoms and clinical anxiety disorders—including GAD, panic disorders, PTSD, specific phobias, SAD, and OCD—are highly prevalent and often debilitating.

Fortunately, these conditions are absolutely treatable. Effective treatment options include CBT, attention bias modification, hypnosis, psychodynamic therapy, and vagus nerve stimulation.

The psychological treatment approach with the most scientific support for anxiety disorders is CBT. Consequently, CBT is often the treatment of choice among therapists specializing in anxiety issues.

CBT may take many forms, with exposure therapy often reported as highly successful for the reduction of anxiety. Exposure therapy may be enhanced with other therapeutic approaches, such as relaxation training and acceptance-based therapy. There is also support for the efficacy of group CBT for the treatment of anxiety, especially when groups are both cohesive and task-focused.

Anxiety disorders are common among children, with the most frequent diagnoses, including separation anxiety, phobias, SAD, GAD, OCD, and PTSD. Research similarly indicates that CBT has long-term benefits for kids, especially when combined with family therapy. Along with CBT, art and music therapy also represent research-based approaches found to soothe an anxious mind.

In addition, there are various things individuals can do on their own to relieve anxiety (e.g., deep breathing, aerobic exercise, meditation, yoga, enjoying a hobby, listening to music, etc.).

Finally, anxiety treatment has been dramatically advanced by technology, with e-therapy (especially iCBT) reaching larger audiences than possible with face-to-face therapy. Overall, given the preponderance of evidence supporting anxiety-focused treatment, those with anxiety disorders or symptoms have much reason to be hopeful about the promise of a tomorrow without suffering.

 

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About the Author

Heather Lonczak holds a Ph.D. in Educational Psychology with a focus on Positive Youth Development. She has published numerous articles aimed at reducing health disparities and promoting positive psychosocial youth outcomes (e.g., academic achievement, cultural identity, mindfulness and belief in the future). Heather is also a children’s book author whose publications primarily center around the enhancement of child resilience, as well as empathy and compassion for wildlife.

Comments

  1. Jill

    How do you find a good iCBT for children?

    Reply
    • Nicole Celestine

      Hi Jill,
      Good question. While I’m not sure what the prevalence of iCBT services for children is (and it will depend somewhat on your country of residence), I’m aware that many face-to-face CBTs are switching to teletherapy as a result of COVID-19. So, a general suggestion I’d make is that if you have trouble finding online child CBT specialists, try doing a more general search for child CBTs and sending out some inquiries about whether they’ve moved online. Hope his helps!
      – Nicole | Community Manager

      Reply

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