Counselling for Mental Health: How is Anxiety Therapy Practiced?
As a psychotherapist in London my practice clinic sees a diverse mix of individuals seeking counselling for mental health. Despite this diverse mix, of those who come to my clinic, anxiety is consistently the most common concern of which people seek mental health support. Luckily a skilled anxiety therapist will be able to quickly and efficiently treat anxiety. Here is a brief guide to evidence-based anxiety treatment that I think both professionals and clients can learn more from.
Understand the Prevalence and Impact of Anxiety Disorders.
The best anxiety therapists will not only be aware of the prevalence of Anxiety, but they will have a deep understanding of its impact on people and their lives. It is extremely important to have empathy and be sensitive to the clients struggles. People are best assisted if they feel listened to and understood because it will keep them engaged and less likely to drop out. At the same time the therapist should be confident and able to offer a detailed clinical analysis and treatment plan in which to work with the client towards recovery and treatment; this should be agreed in collaboration.
Assessment and Case Formulation.
Your therapist will begin by conducting a comprehensive assessment. The assessment process should include conducting a clinical interview. Good assessment will gather a detailed history of the persons challenges and symptoms, during which, the process should feel natural and not too ridged. You could also use self-report questionnaires in this stage to assess the severity and type of anxiety. In developing the formulation, the therapist will identify the clients specific anxiety symptoms and triggers. They will understand the contributing factors like thoughts, behaviours and emotions and create a treatment plan based on this information.
Recognise the Common Symptoms and Characteristics of Different Anxiety Disorders.
Your therapist might will first work with you identify the type of anxiety you are experiencing. Anxiety can often fall into one of the below categories.
Generalized Anxiety Disorder (GAD).
Panic Disorder and Agroaphobia.
PTSD.
Social Anxiety Disorder.
Specific Phobias.
Obsessive-Compulsive Disorder (OCD).
Once there is a better understanding of the disorder then we can assess the best methods to treat the anxiety as different approaches can work better in different presentations. General methods that can be used in treatment of anxiety include both cognitive interventions and behavioural interventions.
Cognitive Interventions
Therapist can use cognitive restructuring, by identifying and challenging distorted thinking patterns.
Replace irrational thoughts with balanced and realistic thoughts.
Often therapist will ask client to keep thought records which they can analyse and reframe.
Socratic questioning should be used to help clients find their own path towards positive beliefs and assumptions in replacement of the negative.
Behavioural Interventions
Exposure therapy is commonly used to gradually and systematically expose to feared situations. You may develop exposure hierarchies with your therapist.
Relaxation techniques can be taught such as breathing exercises and progressive muscle relaxation.
Behavioural experiments are a great way to test out beliefs thorough real life situations.
Engagement and exploration of enjoyable and other activities like social or physical can reduce avoidance and stress.
Treating Generalised Anxiety Disorder (GAD)
Is characterised by excessive worrying.
Psychoeducation can take place with the client around worry and the cycle of worry and intolerance of uncertainty.
It may be beneficial for the client to schedule “worry time” to contain the worry.
Problem solving techniques can be used to challenge realistic concerns and a sense of positive problem-solving orientation can be reinforced with client.
To help clients tolerate uncertainty they can gradually be exposed to uncertain situations to build resilience.
By practicing positive coping strategies, the individual may further increase tolerance for uncertainty
Treating Panic Disorder and Agoraphobia
You will learn about the panic cycle initially in psycho-education session.
You will then begin to normalise the physiological sensations of panic.
Exposure to panic sensations can take place in a controlled environment. (interoceptive exposure)
Further exposure to feared situations in-vivo will then gradually help the client to change perceptions about danger and the environment.
Treating Social Anxiety Disorder
Systemic desensitisation can be implemented which may first include creating a hierarchy of fears.
A gradual exposure phase may then take place exposing to feared situations or objects.
Beliefs can start to be challenged about feared situations and perceptions.
Behavioural experiments can further show abilities for problem solving in social situations.
Progress can be made towards more challenging exposures.
Treating Specific Phobias
Systematic desensitisation: creating gradual exposure through hierarchies.
Exposure to feared objects and situations.
Begin with less evoking situations and progress.
Treating Post Truamatic Stress Disorder
Create a safe therapeutic environment as a foundation for therapy.
Build trust and rapport.
Trauma Focused CBT as an evidence-based practice.
Prolonged exposure to traumatic memories.
Cognitive processing therapy to reframe traumatic beliefs.
Narrative exposure therapy to process the trauma story.
Maintenance and Relapse Prevention.
After working with your therapist on some of the techniques and strategies above in Mental health counselling, you will likely notice your anxiety lessen and perhaps go away completely. However, it is important to learn how to maintain your new mental wellbeing. You can work on a number of things with your therapist such as:
Developing a relapse prevention plan.
Identifying potential triggers.
Exploring and learning strategies to manage triggers.
Encourage ongoing practice of cognitive and behavioural skills.
Learn to manage setbacks and develop setback plans.
Conclusion
The above is an example of how your therapist could treat anxiety using evidence-based practice as laid out in the National Institute for Health and Care Excellence (NICE) guidelines in the UK. Professionals might go about treating such anxiety disorders in alternative methods according to their training. This CBT focused approach is common among clinical mental health counselling professionals yet is not the only way to treat such disorders. Many psychotherapists including those at my London psychotherapy clinic will be trained to use these techniques as well as others if the client requires alternative approaches. Is it important to note that some individuals may not feel better from just CBT techniques and benefit from deeper work that incorporate psychodynamic approaches for example.
If you would like to talk to a therapist, feel free to arrange a free consultation using this link. Our service can also provide anxiety counselling online at discount prices.
