What’s the Best Treatment for Anxiety?

Summary: The best treatment for anxiety depends on two things: the type of anxiety and the severity of the diagnosis. In general, an effective treatment plan for anxiety includes a combination of medication, psychotherapy, and lifestyle changes.

Key Points:

Six types of anxiety disorder are common among adults in the U.S.: generalized anxiety disorder (GAD), social anxiety disorder (SAD), separation anxiety, agoraphobia, panic disorder (PD), and specific phobias.
Effective medications include antidepressants and anxiolytics.
Effective modes of psychotherapy include cognitive behavioral therapy (CBT) and its derivatives.

Why Finding the Best Treatment for Anxiety Matters

Millions of people in the U.S. have anxiety that reaches a clinical threshold. That means their anxiety is more than typical worry, and symptoms cause some level of disruption on most days. In other words – and this is oversimplifying – anxiety makes life more difficult.

Statistics show the following prevalence of anxiety among adults in the U.S.:

3 out of every 10 receive an anxiety diagnosis at some point in their lives.
2 out of every 10 have anxiety so severe it affects typical functioning every day.
Only 4 out of every 10 diagnosed with anxiety get effective, evidence-based treatment.

That’s about 70 million people with anxiety, 45 million people with severe anxiety, and only 28 million getting the treatment they need. What people with anxiety need to know is this:

Untreated anxiety can escalate until the disruption is so severe its debilitating, but anxiety at any level of severity is highly treatable and responds well to appropriate evidence-based therapeutic modes.

In 2023, a group of researchers conducted a comprehensive meta-analysis – meaning a study that analyzes the results of all the relevant studies to date on a topic – on the most effective psychotherapies for generalized anxiety disorder (GAD). The results of that meta-analysis can help us answer the question at we pose in the title of this post: what is the best treatment for anxiety?

Talk Therapy for Anxiety: What Works

Before we answer that question with results from the study, we’ll quickly review the approaches we know work from the other two core components of anxiety treatment, medication and lifestyle changes.

Evidence shows the most effective medications for anxiety include:

Antidepressants such as selective serotonin reuptake inhibitors (SSRI) and selective noradrenaline reuptake inhibitors (SNRI).
Anxiolytics such as benzodiazepines, prescribed most often for panic attacks or short-term symptom relief

Evidence shows that effective lifestyle changes for anxiety include:

Mindfulness-based meditation, such as mindfulness-based stress reduction (MBSR), effective up to three years post-treatment
Physical activity/exercise, effective for the short-term relief of anxiety symptoms, but not as a standalone treatment

Now let’s look at the results from the meta-analysis on the most effective psychotherapies for generalized anxiety disorder (GAD).

Best Treatment for Anxiety: Psychotherapies

Overall:

Cognitive behavioral therapy (CBT)
Recent variations of CBT, called third-wave CBT

Short-term:

New types of cognitive behavioral therapy (CBT):
- Acceptance and commitment therapy (ACT)
- Mindfulness-based cognitive therapy (MBCBT)

Long-term:

Standard CBT

In this study, short-term meant effectiveness at the end of the study period, and long-term meant effectiveness at three- and twelve-months post-treatment.

In general, we can think of CBT as an approach that helps people identify patterns of thought that cause problems, known as cognitive distortions, and then learn how to replace those disruptive patterns of thought with helpful, productive patterns through a process called cognitive restructuring.

Similarly, we can think of ACT as augmenting the core CBT approach with a focus on seeing and accepting the world as it is in the here and now and deciding to act in accord with personal goals and values, and understand MBCBT as core CBT + principles of mindfulness and MBSR.

With those concepts in mind, the results of the study show us that present-centered approach found in mindfulness-based CBT derivatives are most effective for acute, short-term relief, while the cognitive restructuring associated with standard CBT is most effective for long-term relief of generalized anxiety symptoms.

How this Helps Our Patients

The clinical evidence in this study supports a comprehensive, holistic, all-of-the above approach that we embrace. For patients with symptoms of GAD, we now have a solid core of research that tells us that MBCBT, MBSR, and ACT, all of which use CBT + mindfulness to address short-term symptoms, can offer short-term relief, while the work of cognitive restructuring associated with standard CBT can consolidate progress made early in treatment, and offer long term relief from symptoms of GAD.

That’s a logical treatment progression that makes intuitive sense to us, which we can apply in our work immediately, because these tools are readily available, and our clinicians are well-versed in both CBT and mindfulness concepts. In fact, many of us use these techniques in similar sequence already, because its effective – and now we have the evidence to back up what we understand through experience.

Angus Whyte

Angus Whyte has an extensive background in neuroscience, behavioral health, adolescent development, and mindfulness, including lab work in behavioral neurobiology and a decade of writing articles on mental health and mental health treatment. In addition, Angus brings twenty years of experience as a yoga teacher and experiential educator to his work for Crownview. He’s an expert at synthesizing complex concepts into accessible content that helps patients, providers, and families understand the nuances of mental health treatment, with the ultimate goal of improving outcomes and quality of life for all stakeholders.