A wonderful thing is happening in the world: stigma around mental health and anxiety is decreasing while access to various mental health supports is increasing. But having so many options can be both a blessing and a curse. Maybe you’re ready to take the leap and try out some therapy to manage your anxiety, but you’re overwhelmed by all the different types available. That is why I created this guide to the best therapy for anxiety, based on my own experience with anxiety, my work in the field of mental health and current research.
Breaking Down the Brain
To figure out the best therapy for anxiety and why it is effective, it’s important to understand your brain. Don’t worry, I’m not about to quote a boring textbook at you. Instead, I’m going to (over)simplify the brain in the way that helped me to better understand it, and I’ll even throw in some pretty colours (as seen in the illustration below).
The Reptilian Brain
The human brain is made up of three main sections. The first of these sections to develop is at the very bottom of the brain (i.e., the light pink portion) and is called the brain stem. This is the part of our brain in charge of keeping us alive. To do this, it controls many relevant bodily functions, such as our breathing and our heart rate. The brain stem works very instinctively, so we refer to this part as our Reptilian Brain.
The Emotional Brain
Moving on up to the middle portion of the brain (i.e, the yellow and purple chunks), we have the limbic system. This section of the brain houses the parts that deal with our emotions, so we call it the Emotional Brain. We will come back to this section of the brain later, when we look at why anxiety happens.
The Rational Brain
Finally, at the top of our brain (i.e., the pretty turquoise part) are the frontal lobes. This is the part of our brain that develops last in life. Previous research suggested this part was fully developed at age 25, while newer research suggests it is still developing into our 30s and 40s (and maybe even later!). We call this part the Rational Brain because it is in charge of our thoughts, language and logical thinking.
What Causes Anxiety in the Brain
To determine what the best therapy for anxiety is, it’s important to understand what is happening in the brain when anxiety happens. To do this, we are going back to the Emotional Brain, and a specific part in this section of the brain called the amygdala.
The amygdala essentially acts as our threat detector. It is constantly scanning our environment for any signs of danger, real or perceived. Because the thing is, the amygdala doesn’t really care if there’s actually a grizzly bear in the room with you or you just received a vague e-mail from your boss asking if they can talk to you. It will prepare your brain and body the same way for both of those scenarios.
When the amygdala picks up on a supposed threat, it sets off a chain reaction of safety protocols. These involve shutting down your Rational Brain (because why would we need access to logical thinking when faced with stress?) and allowing your Emotional and Reptilian Brains to call the shots. This results in your body being prepared to fight the perceived threat, run away from it, freeze or give into the threat. And it doesn’t matter whether you are actually in imminent danger here. All that matters is that your amygdala thinks there’s even a tiny chance that you are.
Enter anxiety. If you are one of the lucky people born with an increased tendency towards anxiety, your amygdala has been nominated for the overachiever of the year award. Because when we experience more stress and anxiety, the amygdala tends to err on the side of caution and perceive way more things as a threat to our safety.
Types of Anxiety Therapies
I swear we’re getting closer to the best therapy for anxiety, so bear with me a little longer and it will all make sense! Sound like a plan? Great. So, there are actually two general categories of mental health therapies: top-down approaches and bottom-up approaches. Here’s a quick overview of these two types of therapeutic approaches:
Top-Down Therapies
Top-down approaches focus primarily on thoughts and target the Rational Brain. Their general premise is that if we can change how we think, we can change how we feel. Examples of top-down therapy approaches include cognitive-behavioural therapy (CBT), solution-focused therapy (SFT) and dialectical behavioural therapy (DBT).
Bottom-Up Therapies
Bottom-up approaches focus primarily on body sensations and emotions by targeting the Emotional Brain and the Reptilian Brain. These approaches are guided by the idea that a calm body achieves a rational mind. Examples of bottom-up therapies include somatic experiencing, eye movement desensitization reprocessing (EMDR) and expressive arts therapy.
So What Is the Best Therapy for Anxiety?
The goal of this post is not to say that one type of therapy is better than another. Rather, it is to explain how to make all types of therapy more effective for treating your anxiety. With that in mind, remember how I said that our Rational Brain is shut down when our amygdala picks up on a (most likely fake) threat to our safety? This could explain why more traditional talk therapies (or top-down approaches) may not always be the best first line of attack for managing anxiety.
Top-down therapies rely on the Rational Brain being online to be effective. When we are anxious, there’s a good chance that this part of the brain is on a coffee break. What we do know is that top-down therapeutic work will be most effective when a client is grounded in a state of safety. We also know that we cannot think our way to safety; but if we can calm our body and nervous system, we can once again access our Rational Brain.
Here’s an interesting statistic (at least to a nerd like me): 20% of the communication between our brain and nervous system goes from the brain to the nervous system. But a whopping 80% of that communication goes from the nervous system to the brain! I think that’s a strong argument for targeting our nervous system first to calm anxiety faster, before moving on to working with our thoughts.
And the Winner Is…
To summarize, the best therapy for anxiety is an integrative approach that, as I once heard someone refer to it, goes through the side. In other words, it will start with the use of more bottom-up techniques to help you regulate your nervous system before moving on to some top-down techniques, which will now have a better chance at being effective.
Luckily, there are so many different bottom-up and top-down techniques and strategies that therapists can use to help you manage your anxiety. So when you feel ready to look for a therapist, be sure to ask them about these. And in the meantime, if you’re looking for a resource that covers both bottom-up and top-down strategies, check out my book Anxious and Empowered as a good place to start!
Conclusion
The anxiety healing journey is going to look very different for everyone, so I cannot tell you the specific therapeutic modality that will be the right fit for you. What I can conclude based on my personal experiences and my work with anxious clients is that the best therapy for anxiety is one that considers the body and nervous system as well as the brain and our thoughts.
One final thing to keep in mind when embarking in therapy for your anxiety: the most effective therapy will be the one you do with someone you feel comfortable with. Not every therapist is going to be a good fit for you, and that’s okay. It may take some patience and trial and error, but finding a therapist that you vibe with makes all the difference. Happy searching!
PS – want to learn more about anxiety and the nervous system? Check out these posts:
