Anxious you might have a worry problem? You aren’t alone, especially in New York City. Generalized Anxiety Disorder (GAD), which is really a diagnosis many psychologists believe could be better named Generalized Worry Disorder (GAD) may affect as many as 4-8% of the population. So in NYC that could mean close to 700,000 people are suffering with GAD. Who needs anxiety treatment?
If your worries are excessive, you may have anxiety and physical symptoms, procrastinate from getting things done, avoid potentially fun activities, and you may be doing damage to your relationships by not connecting and enjoying time with those you genuinely like and love.
Fortunately, despite how debilitating Generalized Anxiety Disorder (GAD) can be, it can be effectively treated. First let’s have you answer some questions to see if you are worrying too much for your own good.
- Have worries kept you up at night more times than you would like to remember?
- Do you spend more time and energy worrying about a problem than it would take to address it head on?
- Have obsessive thoughts about doing something the right way kept you from pulling the trigger, moving things forward, or left you with a million untied loops and never finished projects?
- Have you ever been overly fixated on your last interaction with someone and how you want to handle the situation next time?
- Do your worries distract you from your work or prevent you from fully enjoying what should be good times with people?
- Has anyone ever noticed that you are in your head instead of in the room?
- Are you overwhelmed or do you feel exhausted?
- Do your worries and anxiety make you less fun to be around?
- Have you ever been so frazzled by worry/anxiety, that irritation or anger came out?
- Do you procrastinate because you are worried you won’t complete something on time or do a good enough job?
- Are you plagued by the “What if……?”s
- Do you run every scenario in your head to try to figure out the best choice?
- Do you make lists (no, like a lot of lists, you know who you are)?
- Do you ask too many questions of doctors, waiters, etc.?
- Do you double check everything?
- Do you frequently overprepare or overpack?
- Do you spend more time with Mr. Google than your family or friends, looking for certainty?
- Do people come to you for advice because they know you have looked at the research or reviews to find the best carpenter, surgeon, or sushi restaurant?
- Are you afraid to let others do things because they won’t be careful enough?
- Do you run ideas past your appointed board members, hoping a consensus will make decisions for you?
Why You May Need Anxiety Treatment
If you had a lot of affirmative responses to the Worry Test above, it might be worth being screened by a New York Licensed psychologist for Generalized Anxiety Disorder (GAD). To be diagnosed with GAD, you would need to be seen by a professional in person.
The criteria they would be paying attention to would be excessive anxiety and worry more days than not for at least six months, a difficult time controlling worries, and at least three of the following for adults, or only one for children: difficulty concentrating, restlessness, fatigue, irritability, muscle tension/aches, or sleep problems.
If along with those there is significant distress or impaired functioning at work, school, or at home, then the psychologist might give you a diagnosis of GAD.
What are the treatment options for Anxiety in New York City?
New York City (NYC) has many types of services that claim to address anxiety. Many of them could be helpful—but when in doubt, what does science tell us?
Yoga has been the rage for the last few decades in NYC. One national survey indicates that 8% of Americans have tried it. Some yoga advocates believe it can treat anxiety, depression, help you lose weight, improve your complexion, alleviate arthritis, lower blood pressure, prevent heart disease, etc.
Yoga, aside from being effective, has some other critical advantages. The cost can be very affordable, even free. If you have experience, you may even be able to do a yoga routine in your own at home from a YouTube video. Even classes at yoga studios tend to be more affordable than psychotherapy, unless you have an affordable co-pay.
Yoga is also something that you can do when traveling outside of NYC. And similar to psychotherapy, significant improvements in anxiety can be seen in a very short period of time, e.g., 12 sessions. TimeOut New York has listed what it believes to be some of the best yoga studios in NYC. If cost is an issue, here is a list of some of the most affordable yoga studios, some of which are donation based. While New York may be an expensive place to live, price doesn’t have to keep New Yorkers from practicing yoga thanks to these yoga studios.
Behavior Therapy (BT).
In behavior therapy clients actively work with the behavior therapist to establish clear goals. While New York City has been home to psychoanalysts, many New Yorkers seem to prefer this goal oriented, results focused approach to psychotherapy. Techniques like applied relaxation, worry time, assertiveness training, and problem solving can all be used in the treatment of GAD.
Behavior Therapy has been shown to be incredibly effective for anxiety disorders and is effective for GAD. Acceptance and Commitment Therapy (ACT) is one example of a kind of behavior therapy that can be used to treat GAD. Fortunately, New York University (NYU) is now teaching ACT to graduate students, so New York City is gaining more ACT practitioners.
Science supports mindfulness as a powerful way to reduce anxiety and to improve functioning of those who struggle with worries and avoid getting things done. The practice has some real advantages over medications and psychotherapy (that is not to say it should be done instead of those treatments, only considered as an option with your healthcare professional). Meditation and other mindfulness practices can be done from almost anywhere and for free. There are also very few risks or side effects. If you would prefer to learn meditation in a class setting, New York has many options. Two options to try are the Shambhala Meditation Center of New York and the Kadampa Meditation Center New York City.
While few of my clients have ever reported side effects, if you suffer from depression, even though mindfulness can be used to effectively treat depressions, there is also scientific evidence for some people with a significant history of depressive episodes, that it could make things worse. So again, speaking to a knowledgeable psychologist, psychiatrist, or therapist about beginning a practice is a good idea if you have been diagnosed with major depression.
If you decide to take on this practice on your own, research has shown being outside in nature is good for your mental health as well. So why not go for a mindful walk in Central Park? Or find a nice park bench in Bryant Park and focus your attention on a beautiful tree there and meditate? New York City is certainly urban, but there are plenty of opportunities to come into contact with nature, and mindfulness practices can be the perfect way to do that.
Tai Chi and Qigong.
There is evidence that either of these practices can result in small to moderate reductions in anxiety. The research I read calls for more trials, which obviously could demonstrate that they are more (or less) effective. Similar to yoga and meditation, these two practices are affordable and can be easily done at home or while traveling. The Tai Chi Chuan Center offers classes in Bryant Park for free.
Physical exercise has been studied and has been shown to reduce anxiety (and depression). Interestingly the mechanisms of how it reduces anxiety are not perfectly clear to researchers yet, but significant reductions can be found.
Once again, check with your physician to make sure you can safely establish an exercise routine that can reduce your anxiety. And this too is affordable, travels well, and has many other health benefits.
Our guts produce neurotransmitters, lots of them, many of which are related to anxiety. And the Human Microbiome Project (HMP) is feverishly working to better understand the role these bacterial communities have on our health, behavior, and emotions.
What we do know now from a few scientific studies is that there does appear to be evidence that probiotic supplementation reduces anxiety. More research is needed, since there are some inconsistent findings.
In addition to meditation, exercise, and yoga, I also frequently recommend prebiotics to my clients. These foods (e.g., sauerkraut, Kimchi, Natto) are not bacteria, but rather are food to feed the “good” bacteria already in your GI tract. So they bolster the numbers you already have. I eat these on an almost daily basis.
Kava kava (Piper methysticum).
There are a few studies that support the efficacy of kava for reducing both anxiety and difficulty sleeping. There are also studies showing that it does not have a significant effect. While many may think given that it is not a drug, there may not be any harm in trying it, caution is always warranted when taking any supplement or herb. You should consult a physician before using kava to treat anxiety or insomnia.
Many different drugs can be used to treat Generalized Anxiety Disorder (GAD). Some of the most commonly prescribed medications are the selective serotonin reuptake inhibitors (SSRIs) and the serotoninn or epinephrine reuptake inhibitors (SNRIs). Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox, (fluvoxamine), Celexa (citalopram), and Lexapro (escitalopram oxalate) are examples of SSRIs.
Effexor (venlafaxine) and Cymbalta (duloxetine) are two SNRIs that have FDA approval specifically for the treatment of generalized anxiety disorder (GAD). But, SSRIs and SNRIs are both frequently prescribed for many types of anxiety as well as depression. But there are many other drugs that are used to treat anxiety as well.
Cognitive Behavior Therapy (CBT).
This is a collection of therapies with specific techniques aimed at changing behavior and emotional responses. CBT therapists work with clients to identify behaviors and emotional responses that clients want to change.
Together, the client and therapist work to understand what is maintaining anxiety and its accompanying behaviors. They may recognize that avoiding things that might be seen as risky or dangerous is a big problem. They would then be given tools to practice in session and outside of session to reduce the frequency, intensity, and duration of anxiety. Over time, clients get better and better at reducing their anxiety on their own and learn how to reclaim their lives by ending the avoidance behaviors.
CBT has been evaluated in a number of scientific studies and has been shown to be effective for the majority of those suffering with generalized anxiety disorder (GAD).
CBT therapists frequently believe that at least part of the reason anxiety and avoidance behaviors are reduced is by changing the way the anxious client thinks (which distinguishes them from behavior therapists who do not believe thinking causes the anxiety or the avoidance behavior in the first place).
What is important given all of these options, is that your medical professional can explain to you the rationale both in terms of the scientific support for the effectiveness of the particular drug, or drug combination, weighed against the side effects. I believe this is critical to ask all of your clinicians, whether they are prescribing drugs, giving you a massage, or providing Cognitive Behavior Therapy (CBT), what does science say about the benefits and risks of what you are providing?
How can therapy help and Why Cognitive Behavior Therapy (CBT) is the best treatment for Anxiety?
Psychotherapy and medication are the two treatments with the most scientific support for generalized anxiety disorder. There are advantages and disadvantages to both that you want to consider.
Medications, if you have insurance, are typically very affordable and can be quickly obtained simply by seeing a prescribing physician. If you decide medication is an option in your treatment, I definitely recommend seeing a psychiatrist or psychopharmacologist for medication prescribed for anxiety.
While an internist or OB-GYN can prescribe these medications, I prefer my clients to have specialists prescribe and monitor them for anxiety issues. As long as you can tolerate and remember to take the medication, there is not a lot of work you have to do.
In addition some medications are very fast acting (unfortunately, these are the ones that have the potential for addiction), which can be beneficial for someone with acute anxiety.
The first disadvantage is the risk of side effects.
Side effects vary depending on the medication, but can include sexual dysfunction, GI problems, seizure risk, or even increased suicidal ideation, etc. So the side effect profile is something to consider when weighing the pros and cons.
For anxiety, you would typically have to remain on the medication to continue to benefit from symptom reduction. That is not always the case, but it is frequently reported that symptoms return once the medication is stopped if medication is the only treatment someone is receiving.
Psychotherapy, when it is Cognitive Behavior Therapy (CBT) is considered to be one of the most effective treatments for generalized anxiety disorder (GAD). Those suffering with GAD can see benefits of CBT in as few as 12 weeks (while more sessions may add benefits). The benefits typically last once treatment has ended.
CBT clients have “gotten used to” things that used to make them anxious, learned how to think differently, and now possess an understanding for how anxiety starts and is maintained. In addition, they have been given and have practiced using tools to combat anxiety in the future on their own, so they no longer need the CBT therapist.
Even Cognitive Behavior Therapy (CBT) has some real disadvantages that need to be considered. It takes a lot more time and energy than swallowing a pill. While some people like working together with a therapist and find it comforting, it does require exploring your thoughts and feelings and sharing those with another person.
There is evidence that the vast majority of therapists will tell potential clients they practice Cognitive Behavior Therapy (CBT). Unfortunately, many of the therapeutic techniques practiced by these therapists are not in fact CBT and may result in no improvement, little improvement, or in some cases, even make things worse. So finding an expert CBT therapist can be challenging.
Is Anxiety treatment in New York City expensive?
Cognitive Behavior Therapy (CBT) for anxiety in NYC is available. That is the good news. NYC has many psychologists, therapists, mental health counselors, and social workers. Unfortunately, most of the clinicians who have extensive training in Cognitive Behavior Therapy (CBT), and don’t just say that is what they do because they had some classes or a few trainings, are frequently not on insurance panels. That means they do not take in-network insurance. There are of course exceptions.
And for most people finances matter a lot. If you have out-of-network coverage, that means you would be responsible for paying for the session and then your insurance company would reimburse you some percentage of that cost. Reimbursement rates are often between 50-80%. In New York CBT therapists who are well trained and experienced may charge anywhere from $200 to $375.
If you need more affordable effective CBT therapy there are two other options I recommend. You can see a supervised clinician at a much lower rate. These CBT therapists have terminal degrees, i.e., they have graduated with a master’s degree or a doctorate, but have not yet been licensed by New York State. To be licensed they have to log thousands of hours seeing clients while being supervised by a New York State licensed clinician. During this time, they frequently charge much lower rates. While they are not as experienced as a New York State licensed psychologist, technically the supervisor is responsible for the case. Therefore a licensed CBT therapist is overseeing the anxiety treatment. There is a great deal of evidence that supervised clinicians are as effective as licensed therapists at reducing anxiety symptoms. So if they cost less and are comparable, it makes a lot of sense to consider this option.
I also frequently recommend going to university clinics where graduate students are practicing. This is similar in that faculty members supervise them during their clinical training and the costs are often nominal and may be on a sliding scale based on your income.
How to find a good Anxiety therapist in NY
Finding the right CBT therapist for anxiety is the goal. The best psychologist or CBT therapist for you is someone who is well trained in the techniques that are effective for treating anxiety. But he or she also has to be the right fit for your personality. So it is important to understand what professions or degrees are involved in psychotherapy and then to be sure you get along with and trust the particular therapist who has the proper training.
Here is a brief primer on who can provide psychotherapy in New York. It differs by state, but in New York there are a number of professions who are licensed by the state to provide psychotherapy. The number of years of education, type of training, and supervision can vary. Believe it or not in New York, legally anyone, that’s right, anyone even someone who has not completed high school can call him or herself a therapist. So you do want to be sure the person has a New York State license, or is supervised by a clinician who has a license.
New York State Licensed Professionals
Psychologists are doctoral level clinicians. That means they typically have at least five to seven years of training after completing a Bachelor’s degree. They can also do fellowships or other kinds of post-doctoral training beyond the required doctorate necessary to be a licensed psychologist in New York.
They typically have either a Ph.D. or a Psy.D. (but they could also have an Ed.D.). Ph.D.s are trained as clinicians and as scientists who conduct and can interpret scientific research. Psy.D. programs don’t emphasize the production of research as much, but certainly can conduct research. The focus is usually to make sure they can interpret research in order to be clinically effective. But both degrees allow psychologists to conduct research and treat clients. In New York, psychologists are also licensed to do every kind of assessment, including Intelligence Testing, which most other professions cannot.
Psychiatrists are also doctoral level clinicians. The most common degree earned in this profession is an M.D. (but they can also have a D.O.). They also typically receive seven or more years of training (medical school is four years and residency programs can be three or more years after that). And like psychologists, there are fellowships and all kinds of specialized training they could choose to do beyond that. Unlike psychologists in New York, they can prescribe medications to treat mental health issues (nurse practitioners can also prescribe drugs in New York). Many just provide medications for issues, but they can provide psychotherapy as well.
Most medical programs do not focus as much on the production of scientific research as Ph.D. psychology programs do, but many M.D.s do conduct research, and like Psy.D.s they are all trained as clinicians equipped to consume and interpret scientific research in order to stay up to date on the best ways to help their patients.
Social Workers have a master’s degree. That means they have at least two years of training after an undergraduate degree. In New York State, social workers can be licensed to provide psychotherapy as licensed clinical social workers (LCSWs). They can provide psychotherapy for a host of psychological issues.
Mental Health Counselors also hold a master’s degree and similar to social workers the New York Office of the Professions also licenses them to provide psychotherapy in New York. They typically receive two years of training as well and are trained to provide psychotherapy.
Types of Psychotherapy
The type of professional you choose does not determine the kind of psychotherapy you would receive. Here are some therapies that a psychologist, psychiatrist, social worker, or mental health counselor could provide. So you want to think or ask not only about their credentials, but also about their training and reason they use the kind of therapy to treat anxiety.
Cognitive Therapy or Rational Emotive Behavior Therapy (REBT) are two therapies that help people reduce anxiety, primarily by identifying distorted thinking and changing it to more adaptive ways of thinking. These two therapies aim to improve behavior too, e.g., to get people to stop procrastinating or avoiding people. They typically do this by teaching adaptive thinking, which reduces the anxiety that allows clients to engage in healthy behavior because they are no longer as anxious.
Behavior Therapy has lots of scientific support for treating anxiety. Interestingly it does not believe you need to change your thinking in order to get rid of your anxiety. Paradoxically, some of the treatments could even get you to feel anxious now, in order to “get rid” of it for good. But behavior therapists can also use techniques that reduce anxiety through other means, e.g., applied relaxation.
Dialectical Behavior Therapy (DBT) is a form of Cognitive Behavior Therapy (CBT) that uses techniques from both the cognitive therapies and behavior therapies. It was initially developed to help those struggling with suicide and depression, but can be applied to anxiety as well. It provides tools to help people when they are in a panic and to do things like cultivate healthy relationships that may help prevent anxiety from coming up as often.
Interpersonal Therapy (IPT) is a therapy that blends elements from psychodynamic therapy and cognitive therapy. It focuses as the name implies on relationships and has been shown to be effective for depression, but can also be applied to anxiety issues.
Psychodynamic Therapy is the therapy originally developed by Sigmund Freud. Many modern versions now exist. The work may focus on early childhood experiences and relationships within the family in order to explain and treat problems in the present. And anxiety problems may be seen as the ego’s inability to manage an intrapsychic conflict between the id and superego. But many modern dynamic therapies explain anxiety differently. So it is important to ask the therapist to explain his or her specific approach to anxiety disorders.
Now that you understand the professionals and therapies you may encounter, where can you find a therapist?
If you need to use an in-network insurance provider, you can look at a list provided by your insurance company. Unfortunately, many of the best trained clinicians I know do not take in-network insurance. That does not mean there are not competent psychotherapists that do. And the last thing you want is to become more anxious because of the cost of seeing a therapist you can’t afford. So if money is tight, trying someone in-network may be a good place to start. It is just really important that you really ask about his/her training and approach to anxiety. Another option is to use out-of-network coverage if you have it. This means you would pay for the service, but your plan would reimburse you.
Employee Assistance Programs (EAP) are an affordable way to begin the process. Many New York City companies have EAP programs. They often offer some initial short-term therapy for free and then help to find you a referral to a New York State licensed therapist outside of the EAP.
University Counseling Centers are another affordable option. Many New York Graduate Programs offer sliding scale fees for therapy. And there is scientific evidence that for anxiety disorders, graduate students can be just as effective as licensed clinicians, as long as they receive regular supervision and are practicing evidence based treatments. When financial concerns are an issue, I frequently refer people to St. John’s University Center for Psychological Services. And I recommend supervisors there that I personally know utilize empirically supported therapies.
If you decide that in-network insurance, an EAP, or a university center are not for you, you can find a private therapist.
Private Practices in New York City are very common. The first step to see a private therapist would be to compile a list of possible names. If you are comfortable asking friends, family members, or your physician for people they recommend, you can start there. If you prefer others not know you are considering anxiety treatment, you can check with reputable membership organizations for therapists practicing effective anxiety treatments like the Association for Behavioral and Cognitive Therapies, Anxiety and Depression Association of America, or the Association for Contextual Behavioral Science.
Once you have your list of names, a phone call can be very helpful in determining if the therapist is worth meeting. Since you are looking for anxiety treatment it makes sense to ask if the therapist has been trained in Behavior Therapy and/or Cognitive Behavior Therapy (CBT), since these kinds of therapy have the most scientific support to treat anxiety disorders. If the therapist says yes, you can ask “How much training have you had and where was it done?” And then more specifically, “Do you use exposure therapy with clients, and if so what kind?” And then a follow up, “Can you explain what that kind of exposure therapy is and what that would look like for me?” Finally, if they have CBT therapy training, you can ask, “Can you explain how cognitive restructuring works in anxiety treatment?”
A competent CBT therapist who treats anxiety will be able to easily answer these questions for you.
While it is reasonable for therapists to expect detailed explanations to come during therapy sessions, taking five minutes by phone to give a brief explanation should be welcomed. If a therapist becomes defensive or sounds irritated, that is critical information for you to have in deciding if the personality fit makes sense. It also likely indicates a lack of competence, as these are easy questions to answer. With that said, even a warm, compassionate expert therapist with all of the answers has limits, and can’t be expected to spend 30 minutes on the phone with everyone interested in therapy, or they won’t have time to see clients.
So, to be fair, don’t expect them to give away too much time on the call. But they should confidently and empathetically answer your questions, even if the answers are brief. If you select them as a therapist, there will be time in session to be educated about anxiety disorders and how each anxiety treatment works.
If you want more general information on finding a therapist in NYC to treat anxiety or anything else, feel free to contact my practice. One of my staff or I will be happy to answer your questions and help you find the right therapist for you.