Treatment for anxiety falls into four main groupings: psychotherapy, psychopharmacology, combination treatment, and lifestyle modifications. At The Midtown Practice, we have clinicians with expertise in each of these categories. Together, with your input, we will customize a plan that suits your symptoms, medical needs, and personal preference. We have extensive experience working with children, adolescents, and adults who suffer from anxiety.

Psychotherapy, also known as talk therapy or counseling, is the process of speaking confidentially with a credentialed specialist about your emotions, personal life, and the interplay between the two. A therapist can help you gain insight into your feelings and behavior, and help you to develop better ways to manage and cope with your distress. We offer several different types of psychotherapy at The Midtown Practice.

During your initial conversation with one of our clinicians, our first goal is to match you with a therapist who is an expert in treating anxiety, and one with whom you feel comfortable discussing your personal life. Through decades of collective experience, we have developed a series of screening questions to help us identify a clinician who suits you in terms of background, training, and style. Although all of our clinicians are skillful, we understand that personal chemistry is a critical part of forming a good therapeutic relationship. Indeed, research has shown that the strength of the therapeutic alliance is one of the most important determinants of the efficacy of psychotherapy. So our goal is to understand not just the problems you are experiencing but also who you are as an individual. This helps us identify which therapist you will click with, so that you and your therapist can then together develop a customized treatment plan to bring you relief from your symptoms while encouraging psychological growth to face future challenges.

Psychopharmacology, also known as pharmacological therapy or medication management, is the practice of using medication to help with emotional distress, such as anxiety. In recent years there has been an explosion of research in brain science helping us to better understand how nerve cells (neurons) in the brain function, communicate and interact with one another, and how these processes impact mood, affect, and behavior. Most psychiatric medications work on your existing brain chemistry to improve mood, and resolve “neurovegetative symptoms” (such as insomnia, poor appetite, and low energy).

Although medication cannot fix all of life’s problems, sometimes effective psychopharmacology can nonetheless be transformative, or at least can help to “take the edge off” your anxiety and help you live with more ease. Psychopharmacologists at The Midtown Practice are skilled practitioners with expertise in maximizing the benefits of medication and minimizing the possibility of side effects. Our prescribers work collaboratively with you to choose in which situations you might want to use medication and if and when you might want to go off medication.

The types of medication used to treat anxiety tend to fall into two groupings: daily medication and as needed medication.

Daily Medication
If you are suffering from an anxiety disorder that is interfering with your life on a daily basis, we might suggest a selective serotonin reuptake inhibitor (SSRI) or a serotonin and norepinephrine reuptake inhibitor (SNRI). These medications are taken on a daily basis, and work to increase the amount of serotonin and/or norepinephrine, in your brain. In addition to increasing neurotransmitter levels, these medications are also thought to increase the brain’s ability to restructure itself, making it more amenable to new learning. Daily medications can take several weeks for maximum effect. Although these are the most commonly prescribed daily medications, your practitioner might suggest others such as a monoamine tricyclic inhibitor (MAOI) or a tricyclic antidepressant/anxiolytic (TCAs) or mood stabilizers.

As Needed Medications
If your anxiety is episodic and only occasionally severe enough to interfere with your functioning, prescribers at The Midtown Practice sometimes suggest a benzodiazepine. Examples of benzodiazepines include clonazepam (Klonopin), alprazolam (Xanax) or lorazepam (Ativan). Benzodiazepines work by activating the brain’s receptors for a natural neurotransmitter in the brain called GABA (gamma amino butyric acid). GABA reduces brain activity in various neuronal circuits which in turns leads to a reduction of anxiety and muscle tension and sometimes sedation (which can make them useful for insomnia).

Benzodiazepines are very effective in the short term but they may stop working if you take them continuously for more than a few months. This is because your brain adjusts and your body becomes tolerant. When used improperly, benzodiazepines can become physically addictive and cause psychological and physical withdrawal when discontinued.

Combination Treatment
In our experience, anxiety sometimes responds more fully or rapidly to “combination therapy” or a combination of psychotherapy and medication, rather than either treatment alone. Although the choice to combine medication with psychotherapy is always up to the client, such combination treatment often produces substantive relief that allows a person to return more rapidly to a healthier level of functioning, while simultaneously helping a client become available for psychological growth and reflection. We sometimes use the analogy of medication as “training wheels” which may accelerate progress in psychotherapy. When used in this manner, medication temporarily alleviates severe negative emotions, freeing up mental energy which can then be channeled into personal growth and skill building through psychotherapy.