Anxiety can feel crippling. It can interfere with sleep, your ability to focus at work, or doing things you enjoy because your mind is worrying. Anxiety can make everything on the inside feel so confusing. You might find it difficult to figure out how to create steps to address the problem or decide where to put your focus so you can move forward. You might feel “all over the place” mentally or you can’t think about anything else because of how worried you are about something you may have no control over.

You may have just one specific thing that you’re anxious about and all you really need is more information, some tools to manage your thoughts and feelings, a plan of action, and some courage to execute it. Or you may have anxiety that really impacts your life in multiple areas and you find it very difficult to get control over your thoughts, even if you believe those thoughts are not rational. And sometimes there are problems that could have really significant consequences if something goes wrong or if you make the wrong choice (even if it’s impossible to know which choice is the right one), and the anxiety that is experienced in response makes it hard to think clearly.

What Doesn’t Work

If you have ongoing difficulty with anxiety, it is usually not helpful when people around you say, “Don’t worry,” or “You worry too much.” This can feel dismissive and limit the opportunity for you to explore your thoughts and feelings and understand why you are this way or why an issue is bothering you so much. Sometimes friends or family try to jump in and solve the problem for you or tell you what to do. This can feel frustrating as it can minimize how difficult the problem really is or can presume you haven’t thought of these things already. At other times, you might feel relief when someone takes over the problem and unburdens you. But the latter usually doesn’t help when this is something you face repeatedly. Sometimes we need another person’s assistance to carry the burden for us or with us, but often, when there are ongoing struggles with anxiety, the need is centered on learning how to effectively solve problems, how to take reasonable risks, developing a sense of trust in yourself (to make the right choice or to be able to handle it if things do go wrong), learning how to tolerate uncertainty, and building confidence to move forward. It also means recognizing that none of us make the “right” choices all the time, even when we’re very diligent and careful. Not only are we all imperfect, but often it’s impossible to know which choice will result in the best outcome because life often presents dilemmas without clear answers. It can be really disappointing to realize that there might be no perfect way forward, but I hope it offers some comfort to know that you are not alone in these kinds of circumstances.

Counseling/Therapy

If you struggle with ongoing anxiety, therapy can be helpful. Different types of therapy can be helpful for different people. If therapy hasn’t helped you in the past, it may not have been the right fit of therapist or the right type of therapy for you, or you may not have been ready for change at that time. If you are looking for a therapist, Psychology Today offers a directory where you can filter by your location and what kind of therapist you are looking for.

Cognitive Behavioral Skills

While most of my work focuses on helping clients understand why they are the way they are, building an internal sense of confidence and trust in oneself, and feeling more effective in relationships, I do integrate cognitive behavioral therapy (CBT) where it can be helpful. Some of my clients with anxiety respond really well to CBT and have really liked the book Feeling Good by David Burns, which provides information about the exercises and activities that can help create change. It’s an older book but a classic. You can see by the many, positive reviews!

Other clients of mine do not feel engaged by CBT and want a space to talk through what is going on for them and to feel heard and supported. They want to understand why they feel the way they do and to sort through things that have gone on in their lives that have impacted them. They want to do this with another person or people (such as in group therapy) because being seen and heard feels important, as does hearing feedback from the other person. Another person can sometimes see something that is being missed or recognize a pattern that is not helpful.

Journaling

Another tool that can help with anxiety is journaling. Clients of mine who sustain a practice of this frequently report back how much it helps them. There are different ways of journaling. You can just “freewrite” whatever comes to mind and get all of your thoughts out on paper. Alternatively, you can identify what the problems are that you are facing, write about possible solutions, write about the pros and cons of each solution and the possible outcomes, and then decide on a plan of action; or if it is an unsolvable problem, you can write how you feel and ways you can cope.

There is also a form of journaling called “Positive Affect Journaling.” This type of journaling helps you to attend to what is working well in your life and research has shown that it does in fact help with anxiety and depression. You write about things like “What is working well?” “What went well today?” “What strengths am I using?” You can view prompts used in a study about positive affect journaling here. Sometimes we focus so much on what is not working, that we miss what is working and what is good, meaningful events that we need to be reminded of. In the study referenced, people journaled 15-minutes a day, 3 days a week. I also find that people gain more benefit from writing by hand than by typing, though typing is better than not doing it at all.

Medication for Anxiety

There is medication for anxiety as well. Medication is not necessary for everyone, but some people find that it really helps them make progress and implement the changes they are trying to make. If someone wants to try medication, I recommend finding a psychiatrist if possible because they are specialists in this area, and in my experience, are often better able to fine tune and attend to what is working and what is not than primary care providers. Primary care providers tend to be more accessible, but psychiatrists tend to be better at monitoring what is going on and have the experience of working with mental health and appropriate medications all day long in their practices.

Individual and Group Therapy

If you are in NYC and interested in in-person therapy, I am happy to help. Counseling can provide some relief for anxiety, unpack and resolve patterns that aren’t working, build greater self-awareness, and offer new skills specific to your needs and circumstances. In addition to individual therapy, I also host an ongoing women’s therapy group for women who would like the support and feedback of their peers in addition to a therapist. If you have any questions about working with me or would like a phone consultation, I would be happy to speak with you. You can email me or call me at 917-689-6530.

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About Melissa King

I am a licensed mental health counselor in New York City with a psychotherapy office in the neighborhood of Murray Hill in Manhattan. Find out more about me here. I'd love to hear from you. Email me if there's a topic you'd like to read about here.

**Information on this site is not intended to replace medical advice and does not constitute a psychotherapeutic relationship with the reader.