Solution-Focused Brief Therapy (SFBT)
- Focuses on the future and solutions rather than the past and problems. Instead of dwelling on the causes of anxiety, SFBT emphasises what the client wants to have instead of anxiety.
- It adopts a resource model, viewing clients as having strengths and resources to cope with anxiety, rather than a deficit model that sees the client as damaged. SFBT explores how clients have managed anxiety in the past (finding exceptions) and focuses on building hope and describing a preferred future without anxiety.
- Techniques include future-oriented questions (e.g., “What will be the best result of our session today?”), finding strengths and resources, and finding exceptions to anxiety. Questions like “How did you manage to sometimes feel safe and have control over your life?” aim to highlight existing coping mechanisms.
- SFBT can be combined with traditional approaches, including biological treatments, by focusing on positive descriptions of recovery. SF conversations are often more lighthearted.
Cognitive Behavioral Therapy (CBT)
- Traditional CBT approaches anxiety using a pathology model with the aim of reducing distress through problem-solving. It often involves diagnosis before treatment.
- CBT’s cognitive models emphasise an overdeveloped sensitivity to threat. A basic tenet is the cognitive specificity hypothesis, suggesting that anxiety involves the perception of threat and an underestimate of coping abilities.
- Treatment focuses on helping clients better assess the risk in feared situations, decrease avoidance, and confront feared situations to test negative predictions. Techniques include cognitive restructuring to evaluate and modify unrealistic thinking, and behavioural experiments.
- CBT may also address core beliefs underlying anxiety. It operates within a mastery and control framework, aiming to help clients control their thoughts and emotional experiences (symptoms).
- Exposure therapy is a core component, designed to counteract avoidance by promoting approach behaviours and facilitating corrective emotional learning.
Acceptance and Commitment Therapy (ACT)
- ACT views struggles with anxiety as an example of more general human problems stemming from normal psychological processes, rather than a disease. It is a process-based approach focusing on the underlying processes of suffering.
- A key concept in ACT is experiential avoidance, defined as attempts to avoid, suppress, or alter unwanted private events (thoughts, feelings, sensations, memories). ACT posits that these control efforts are often the problem, not the solution.
- Instead of aiming to reduce anxiety, ACT seeks to help clients accept anxiety and commit to living a valued life despite its presence.
- Techniques include acceptance (allowing anxiety to be without struggle), mindfulness, cognitive defusion (loosening the grip of thoughts), and values clarification and committed action towards those values.
- ACT recontextualises CBT techniques like exposure within an acceptance and mastery of experiencing framework, focusing on changing the client’s response to their experiences, not the content itself. Creative hopelessness is used to highlight the unworkability of past control efforts.
Neuro-Linguistic Programming (NLP)
- NLP suggests that anxiety has an inherent structure and focuses on reprogramming the mind’s responses to different situations.
- It offers adaptive techniques that encourage understanding and handling anxiety symptoms rather than hiding or escaping them.
- Techniques include identifying anxiety triggers, reframing anxiety triggers, accessing solutions and resourceful memories, and setting relaxation anchors.
- NLP challenges the traditional medical model that solely relies on medication, arguing that it often only addresses symptoms without getting to the root cause.
Other Psychotherapeutic Approaches
- Traditional psychotherapies (including psychoanalytic, client-centered, and CBT) generally apply the pathology model, aiming to reduce distress using problem-solving. They often focus on the client’s theory of change.
- Client-centered therapy is mentioned as a traditional approach.
- Psychotherapy in general is described as a talking treatment that helps people understand and come to terms with the reasons for their anxieties. It can be individual or in groups.
Compassion Focused Therapy (CFT)
- CFT adds the creation of an inner sense of kindness, support, and encouragement to the process of overcoming anxiety.
- It builds upon principles of exposure by encouraging a compassionate approach to difficult feelings like anxiety, using a warm inner voice to calm anxiety by engaging a different emotion system.
- CFT suggests a ten-step plan to tackle anxiety, which includes examining why one wants to face anxiety.
Mindfulness-Based Approaches
- Mindfulness exercises can be helpful for internal avoidance in anxiety.
- Mindfulness-Based Cognitive Therapy (MBCT) is an example of a newer-generation behaviour therapy.
- Mindfulness helps people detach from their thoughts and add compassion to their experiences. However, it is crucial that mindfulness is not used as another control strategy for anxiety.
HeartMath
- The HeartMath solution addresses emotions directly, using techniques to access the power of the heart to change habitual anxiety patterns.
- Techniques like Cut-Thru aim to release accumulated anxieties by transforming cellular patterns.
Body-Based Therapies
- Body-based therapies like Somatic Experiencing or sensorimotor psychotherapy can help address the physical aspects of panic response and restore resilience, particularly if anxiety relates to trauma.
General Considerations
- Many sources note that anxiety disorders are responsive to psychotherapeutic treatment. Often, a combination of therapy and medication provides the most sustained response for most psychiatric disorders.
- It is important to identify the individual’s anxiety cycle to plan how to break it.
- A common theme is that going to war with anxiety often makes things worse.
- Understanding the root cause of anxiety is considered crucial for lasting relief, rather than just applying techniques to manage symptoms.
- Recognising the different ways anxiety manifests (e.g., cortex-based vs. amygdala-based) can help tailor more effective strategies.
In summary, therapeutic approaches to anxiety range from focusing on changing thoughts and behaviours (CBT), to accepting difficult emotions and committing to values (ACT), to exploring solutions and strengths (SFBT), to retraining the mind’s responses (NLP), and to incorporating compassion and body-based techniques. The understanding of anxiety has evolved from a focus on deficits and pathology to include the role of avoidance, the importance of acceptance, and the potential for leveraging existing strengths.