When you need support: The best therapy for depression and anxiety

Anxiety and depressive disorders can interfere with daily life, sometimes causing intense sadness, hopelessness, fear, or worry. These feelings tend to get worse when left unaddressed, but several types of evidence-based therapy can be used to improve symptoms. Cognitive behavioral therapy (CBT) is typically considered the gold standard for treating anxiety and depression, and many online CBT therapists specialize in addressing these disorders.

Anxiety: Background

Many people experience anxiety during stressful life events such as giving a presentation or taking an exam, for instance. However, individuals with anxiety disorders may experience excessive worry or fear about daily occurrences. Sometimes, anxiety disorders consist of persistent worry (common in individuals with generalized anxiety disorder), or they may include peaks of intense fear or terror (known as panic attacks). 

Anxiety disorders constitute the most common mental disorders in the United States. The American Psychiatric Association estimates that around 30% of adults experience an anxiety disorder at some point during their life. Some common anxiety disorders include: 

• Social anxiety disorder
• Panic disorder
• Specific phobias
• Generalized anxiety disorder
• Separation anxiety disorder

The symptoms of anxiety may vary depending on the specific disorder but could include:

• A sense of impending danger
• Increased heart rate
• Restlessness
• Hyperventilation 
• Trouble thinking about anything other than the source of the worry 
• Sweating, clammy hands, or patchy skin
• Difficulty controlling worry
• Avoidant behaviors
• Gastrointestinal distress

Several factors may contribute to the development of an anxiety disorder, including life experiences, genetics, and medical conditions. Chronic stress, other mental health conditions, and substance use can increase your risk of developing an anxiety disorder. 

Depression: Background

While many people feel sad occasionally, depressive disorders are often characterized by persistent sadness and other symptoms that last for at least two weeks. Depression is one of the most common mental health conditions in the United States. In 2020, nearly 15 million US adults experienced at least one major depressive episode. There are several types of depressive disorders: 

• Major depressive disorder (MDD) is the most common depressive disorder. Around 21% of adults develop MDD at some point in their lives. 
• Persistent depressive disorder (PDD) is a form of mild to moderate depression that lasts for an extended period (often two or more years). 
• Premenstrual dysphoric disorder (PMDD) is depression that occurs when premenstrual syndrome (PMS) symptoms co-occur with mood symptoms. Typically, PMDD improves after your period starts, but it may still interfere with daily life. 
• Seasonal affective disorder (SAD) is a type of depression that is related to seasonal changes. Often, SAD develops during the fall and resolves during the spring.
• Peripartum depression, formerly called postpartum depression, occurs during pregnancy or after childbirth. People of any gender can experience peripartum disorder.  
• Bipolar disorder is a psychiatric disorder characterized by extreme mood swings from emotional highs to depressive lows. In some cases, the depressive lows may meet the diagnostic criteria for major depressive disorder. 

Symptoms can vary, but common signs of a depressive disorder include:

• A persistent sad, low, or empty mood
• Feeling hopeless or pessimistic
• Frequent crying
• Ongoing irritability or restlessness
• Angry outbursts
• Loss of interest in things you used to enjoy 
• Difficulty concentrating or making decisions
• Sleep disruptions
• Social isolation
• Physical symptoms, including gastrointestinal symptoms, headaches, and other unexplained chronic pain
• Changes in eating habits, which may lead to weight loss/gain
• Thoughts of self-harm or suicide

Though the cause of depression is unknown, researchers believe risk factors for depressive disorders include genetics, brain chemistry, medical conditions, other mental health conditions, stressful life events, and certain medications. 

The link between depression and anxiety

Individuals with this comorbidity are more likely to experience severe symptoms, greater disruption of daily activities, and a higher risk of suicide. The reason for high rates of co-occurrence is not fully understood, though researchers theorize that personality traits, genetic predispositions, or overlapping symptoms may play a role.

Types of therapy for depression and anxiety

Many forms of talk therapy can be effective for both depression and anxiety. Here are some of the most common types of therapy used for clinical or subclinical anxiety and depression: 

• Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) combines cognitive therapy and behavioral therapy to help clients identify automatic thoughts, question them, and then reframe them. This type of talk therapy is often considered the gold standard of psychotherapy. 

Common therapeutic strategies used during CBT include psychoeducation, cognitive restructuring, exposure therapy, relaxation training, and behavioral activation. Unlike some forms of psychotherapy, CBT typically requires only 6-20 sessions. The shorter duration of treatment can be attributed to CBT’s goal—to teach clients to assess their own thoughts and behaviors and apply learned skills outside of therapy sessions. 

• Dialectical behavioral therapy

Dialectical behavior therapy (DBT) is a type of talk therapy adapted from CBT. The focus of DBT is acceptance and healthy coping skills for people who experience intense emotions that are difficult to manage. In addition to anxiety and depression, DBT can effectively address borderline personality disorder, posttraumatic stress disorder, binge eating disorder, and suicidal thoughts. 

Unlike cognitive behavioral therapy, DBT typically takes six months or longer. It often involves developing coping skills, including mindfulness, distress tolerance, interpersonal skills, and emotional regulation. 

• Interpersonal therapy

Interpersonal therapy (IPT) is a type of psychotherapy that focuses on social relationships and how they impact mental health. Though it’s most often used to address depression, some research suggests that IPT may be helpful for anxiety.

IPT techniques often focus on: 

• Examining social support
• Determining attachment style and communication style
• Evaluating interpersonal challenges 

For individuals diagnosed with a depressive disorder, IPT can be an effective alternative to CBT and/or pharmacotherapy. For people with problematic relationships that trigger or contribute to depression, IPT may be particularly beneficial. IPT is generally used as a short-term therapy over 12-16 sessions, though the number of sessions needed may vary based on diagnosis and symptom severity.

• Psychodynamic therapy

Psychodynamic therapy (PDT) is a traditional type of talk therapy that focuses on evaluating the past to understand present challenges. Unlike other types of therapy, which tend to evaluate present feelings and thought patterns, PDT may be a more open-ended and explorative long-term therapy. 

PDT is considered generally effective for depressive disorders and some types of anxiety disorders, though it’s most effective for borderline personality disorder. 

Is online therapy effective?

Research published in 2017 supports that online CBT can effectively address and manage many psychiatric disorders, including depressive disorders, generalized anxiety disorder, social anxiety disorder, panic disorders, phobias, substance use disorder, bipolar disorder, and obsessive-compulsive disorder. Additionally, the study determined that this type of therapy can be more cost-effective compared to in-person CBT and more accessible for people living in rural areas. 

For individuals with anxiety and/or depressive disorders, online therapy may be less intimidating than in-person therapy as well. Platforms like BetterHelp can match most people to a licensed therapist in as little as 48 hours, so you can get started shortly after you decide to try therapy. 

Other treatment options

In addition to talk therapy, there may be other options to help manage symptoms of anxiety and depression, including the following: 

• Lifestyle changes: Getting enough sleep, engaging in moderate physical activity, practicing mindfulness and meditation, and following a nutritious diet can help you cope with anxiety and depression. 
• Medications: Pharmacotherapy is frequently used to treat anxiety or depression. Medications including Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), or Benzodiazepines may be prescribed by your doctor to help manage anxiety or depression symptoms. 
• Transcranial magnetic stimulation (TMS) : TMS may be recommended for individuals who have not experienced symptom relief from therapy, medications, and other interventions. 

While these options may provide some symptom relief on their own, they’re not typically recommended as a replacement for psychotherapy.