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What we treat

Treating Anxiety

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.

Psychotherapy

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.

Types of Psychotherapy offered at The Midtown Practice

We offer several types of psychotherapy at our practice. These include Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Dialectical Behavioral Therapy, Supportive Psychotherapy, and Psychodynamic Psychotherapy. Your therapist will customize an approach that draws from one or several of these techniques to develop a treatment plan tailored to help manage whatever you are experiencing and achieve an overall improved sense of well being.

Cognitive Behavioral Therapy

The effects of Cognitive Behavioral Therapy (CBT) on reducing anxiety has been well established. The goal of CBT is to help clients identify thoughts that negatively impact mood and produce negative behavioral patterns. Many of us have maladaptive “automatic thoughts” that shape the way we view ourselves and the world around us. These thoughts unknowingly reinforce our anxious emotions and can lead to deleterious self defeating behaviors. CBT therapists will work with you to change these unconscious thought patterns and replace them with more productive rational ones.

Acceptance and Commitment Therapy

Acceptance and Commitment Therapy (ACT) is another treatment offered at The Midtown Practice. ACT has been shown to significantly enhance functioning and improve quality of life in several types of anxiety disorders. ACT starts with the recognition that feeling stuck, and being trapped by negative emotions, is a universal human experience. One overarchinggoal of ACT is to helpclients build more psychological flexibility and resilience in the face of such difficuties. One important technique used in ACT is to develop a great ability to be present, in part through cultivating more mindfulness. Another important component of ACT is working with your therapist to identify what you value and cherish most in life. By committing to identified values and goals, we develop greater capacityto place anxiety and other negative emotions into perspective so that they don’t trap us. ACT helps clients move away from avoidance and other self destructive ways of handling our anxiety while building a more personally meaningful life.

Dialectical Behavior Therapy

Dialectical Behavior Therapy (DBT) is a skills-based therapy that helps individuals learn to tolerate and manage distress, improve interpersonal effectiveness, and manage anxiety in ways that do not lead to damaging behaviors. DBT focuses on appreciating dialectics, or the act of holding two seemingly opposing truths in our minds at once. For example, DBT helps clients recognize that we can simultaneously accept ourselves, while working to change and improve certain aspects of our lives. This treatment often combines individual therapy with didactic groups focusing on life and coping skills. Once a patient has completed DBT therapy, he or she has learned how to identify, tolerate, and manage anxious feelings, and also practiced coping skills with other group members struggling with similar emotions.

Supportive Psychotherapy

Supportive psychotherapy relies heavily on the therapeutic alliance, the relationship between the therapist and the client, to provide validation, empathy, and non judgemental acceptance. In this type of therapy, the clinician takes an active role in helping clients articulate and normalize their emotional experience, while providing techniques and tools to manage anxious feelings outside of sessions.

Psychodynamic therapy

Psychodynamic therapy involves the interpretation of unconscious patterns that result in destructive emotions and behavioral patterns. This treatment is used to gain insight and psychological awareness, while reducing anxiety and other self sabotaging emotions. Often, therapists work with clients to identify early childhood experiences that create anxious feelings, and ways to identify and prevent these patterns from interfering with quality of life and achieving goals.

Psychopharmacology

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.

Lifestyle Modifications

In addition to talk therapy and/or medication treatment, the clinicians at The Midtown Practice recognize that certain habits strongly impact mood and reduce anxiety. Both scholarly research and our own clinical experience show us that maintaining regular physical exercise, sleep, balanced eating habits, and limiting addictive behaviors buildsa strong psychological foundation. Anxiety often worsens when one or several of these factors are neglected. Despite our greatest intentions, many of us have difficulty consistently maintaining healthy habits. Using a non judgemental approach, our clinicians will help identify where you might be neglecting self care, and work on ways to improve your lifestyle and habits when needed.

The clinicians at The Midtown Practice are also trained in the practice of mindfulness, or the practice of being in the present, on purpose, and without judgement. Practicing mindfulness has been shown to help us tolerate and reduce anxiety, improve our relationships, and become more effective at our work and other priorities. When appropriate, your clinician can help you understand how to incorporate the practice of mindfulness into your everyday life.


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