The top therapeutic interventions for anxiety

Curious about therapeutic interventions for anxiety?

If you’ve noticed a general increase in clients seeking support for anxiety or anxiety-related issues, you are not alone.

In fact, studies, including the 2022 National Health Interview Survey (NHIS), have shown that anxiety levels have been increasing in US adults over the past several years.

Fortunately, there has also been an increase in cutting-edge research on the most helpful interventions for anxiety, helping to sharpen our understanding of how anxiety works and the best ways we can support our clients in overcoming anxiety.

In this article, I will highlight the top interventions for anxiety disorders therapists should have in their toolkits.

I will also provide concrete anxiety therapy techniques, including examples and actionable tools you can use right away.

Psychoeducation

Out of all of the therapeutic interventions for anxiety, psychoeducation is the most important. It provides the foundation for all other techniques to really take hold.

Psychoeducation can cover many different aspects of a client’s anxiety, including:

• Informing clients how the sympathetic nervous system works (e.g., flight, fight, or freeze response).
• Explaining to patients that their uncomfortable symptoms are not dangerous, especially panic attacks and intrusive thoughts.
• Normalizing the role of avoidance while also informing clients how this inadvertently fuels their anxiety.
• Providing a clear rationale for each of the therapeutic interventions for anxiety you use.

When using interventions for anxiety with apprehensive and anxious clients, I always inform them that knowledge is power, and the key to overcoming their anxiety is to learn its nuanced tricks and traps.

Our anxious clients need to feel a sense of agency and empowerment in their therapeutic journey.

To help with this, I like to tell them, “I’ll never ask you to do anything that you are not 100% clear on the reasoning behind or that you don’t think will be helpful.”

If you disagree with my reasoning or explanations, I want you to feel free to let me know, and don’t hesitate to push back against anything I am saying.”

In my experience, this goes a long way to helping clients feel agency in their treatment and keeping myself accountable.

Cognitive defusion

When driven by anxiety, it’s too easy for people to become intertwined with their scary and catastrophic thinking.

When people see thoughts as fact or as predictive of bad things happening, they engage in those thoughts even more.

This over-engagement in thoughts ends up perpetuating their anxiety while continuing to take them out of the present moment.

A core component of Acceptance and Commitment Therapy (ACT), cognitive defusion interventions provide a powerful way to reduce the impact anxious thoughts have on clients.

Cognitive defusion entails helping our client step back and see thoughts as thoughts rather than thoughts as our lived reality or something that needs our immediate attention.

There are many different tools to foster defusion, but some of my favorite include:

• Prefacing an anxious thought with “I notice I’m having the thought that…”
• Thanking the mind for a thought (e.g., “Thanks for the scary thought, Brain.”
• Singing the scary thought to a tune (e.g., Happy Birthday; camp town races) or thinking of it in a silly voice (e.g., Yoda, Daffy Duck, Darth Vader).
• Imagining placing thoughts on balloons and watching them float around

Exposure therapy

When clients are anxious, it’s natural for them to avoid triggers or try to appease their anxiety in some way.

While this can offer temporary relief, avoidance will perpetuate anxiety in the long run.

Exposure therapy is one of the therapeutic interventions for anxiety that has the most significant evidence base for its effectiveness. It enables clients to identify the ways anxiety is limiting their lives and then strategically face their fears in bite-sized and manageable ways.

When clients can face their fears, they quickly learn that they are much more powerful than their anxiety makes them think they are.

You can find out more about the ins and outs of exposure therapy here.

Radical acceptance

Carl Jung wisely noted, “What we resist will persist.”

Anxiety is our brain telling us there is something wrong, so it’s only natural to resist it.

Fighting against anxiety can take many forms, both subtle and obvious.

Common ways our clients try to resist anxiety include mentally trying to “figure it out” or “solve it,” using substances to gain temporary relief, avoiding anxiety-causing events or situations, or even “white knuckling,” which is when a person relates to their anxiety as an enemy within.

Unfortunately, most attempts to fight and resist anxiety backfire, leading to even more anxious distress in the long term.

Radical acceptance is one of the interventions for anxiety that targets this process directly.

This skill set teaches our clients how to make space for their anxiety with curiosity and openness.

If clients can learn to invite their anxiety while dropping the fight, it will lose much of its power.

A list of therapeutic interventions to help foster radical acceptance include:

• Exploring with clients the consequences of struggling with anxiety
• Metaphors highlighting the paradoxical nature of control (e.g., holding a beachball underwater)
• Practicing observing uncomfortable thoughts and feelings in session, without any attempts to make them go away

Mindfulness

Jon Kabat-Zinn, one of the world’s leading experts in mindfulness, defines it as the process of paying attention to the present moment in a way that is non-judgemental and with curiosity, on purpose.

Out of all of the therapeutic interventions for anxiety, mindfulness is the one that has received a surge of recent attention in the psychological literature on cutting-edge anxiety interventions.

Due to its growing evidence base, even the more traditional CBT for anxiety protocols have been incorporating mindfulness into their protocols.

Mindfulness skills aim to teach our clients how to notice when their attention is hijacked by anxious narratives and to bring themselves back to the present moment gently.

The mechanisms of mindfulness include helping clients become aware of their inner and outer states, changing their relationship with thoughts and feelings, and being able to experience the richness of living in the present moment.

Diaphragmatic breathing

The breath plays a vital role in our experience with anxiety and can be an essential element in many of the therapeutic interventions for anxiety.

When anxious, our bodies will hyperventilate, making our breaths more shallow (often noticeable as rapid chest movements).

Due to shallow breathing, we are not able to expel as much carbon dioxide from our body, which can lead to anxiety-inducing physiological symptoms, including dizziness, tingling, rapid heartbeat, muscle tension, and much more.

Fortunately, diaphragmatic breathing is a powerful antidote to anxious, shallow breathing.

When we breathe with our diaphragm (the large muscle sitting right below the ribcage), we can lower the intensity of uncomfortable symptoms caused by hyperventilation.

Below, I’ll outline the most important steps of diaphragmatic breathing.

However, it’s important to explain to clients that the goal of this intervention isn’t to get rid of anxiety, as that will add more unhelpful resistance (see the “radical acceptance” section above).

The goal of breathing is simply to “take the edge off” of intense discomfort in service of allowing our clients to practice additional therapeutic interventions for anxiety, such as radical acceptance and mindfulness.

• The pacing of diaphragmatic breaths should be long, slow, and smooth.
• The exhale should be slightly longer than the inhale. Many people enjoy a 4-second in-breath and a 6-second out-breath, but it may take some experimentation to find what’s right for you or your client.
• Direct clients to breathe in through their nose and out through their mouth. Pursing their lips will help keep their out-breath long and smooth.
• Have clients focus on expanding their belly outwards with the inhale and contracting their belly inwards with the out-breath.
• I like to have clients imagine a balloon in their stomach. When they breathe in, they can imagine the balloon inflating with oxygen. And, when they breathe out, it deflates.
• Clients can put their hand on their belly for some biofeedback to feel the tactile sensations of the bellow moving with their breath.

Cognitive restructuring

When our clients are anxious, it’s common for their thoughts to be distorted in many ways.

Simply put, thinking clearly is hard when our brains are in survival mode!

Some of the most common cognitive distortions in anxiety include catastrophizing (worst-case scenario thinking), black-and-white thinking (e.g., “If I don’t do this perfectly, I will fail”), and emotional reasoning (e.g., “because it feels scary and dangerous, that must mean it is”).

As a core tenet of CBT for anxiety (one of the most highly researched therapeutic interventions for anxiety), cognitive restructuring is the act of helping clients point out various flaws or errors in their thinking and come up with new, more helpful, and accurate ways to think.

Cognitive restructuring can target both surface-level worries and fears and more profound core beliefs people may hold about themselves.

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