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Anxiety Treatment Options

A Functional, Stepped-Care Approach to Recovery

Written by Gio Arcuri, OT, MSc

Mental Health Occupational Therapist

Course Lecturer, McGill University

Fonder of Clinique Vivago

Anxiety is one of the most common reasons people seek mental health care — but it is also one of the most misunderstood. Many people wonder whether their anxiety is “severe enough,” whether they should try to manage it alone, or whether treatment will actually help.

 

At Vivago, we approach anxiety differently.

 

Rather than asking “What diagnosis fits?”, we ask:

How is anxiety affecting your daily life — and what level of support would help you function better right now?

 

This page outlines evidence-based treatment options for anxiety, organized within Vivago’s three-tier stepped-care model, which adjusts the intensity and type of care to your functional needs, not to labels alone. You’ll find information on psychotherapy, occupational therapy, medication, and interdisciplinary care — all grounded in clinical evidence and real-world application.

 

If you’re unsure where you fit, that uncertainty itself is often a sign that support could be helpful.

Important Medical & Clinical Disclaimer

The information provided on this page is for educational and informational purposes only. It does not constitute medical, psychological, psychiatric, or therapeutic advice.

 

This content is not intended to:

 

  • Diagnose any mental health condition

  • Replace individualized clinical assessment

  • Recommend specific medications or treatment plans

  • Substitute for consultation with a licensed healthcare professional

 

Treatment decisions — including whether to start, stop, or adjust medication — must always be made in consultation with a qualified physician, psychiatrist, nurse practitioner, or other authorized prescriber.

Do I need treatment for my anxiety?

Do I Need Treatment for My Anxiety?

Understanding Fit, Timing, and the “Shoe” Metaphor

Choosing anxiety treatment is about fit.

 

At Clinique Vivago, we often use the shoe metaphor:

 

  • A shoe that is too tight causes pain and restricts movement

  • A shoe that is too loose offers insufficient support

  • A shoe of the wrong shape creates friction, fatigue, or injury

  • The right shoe supports movement without drawing attention to itself

 

Mental health treatments work the same way.

 

A treatment that allows one person to move forward may feel overwhelming, constraining, or ineffective for another — not because the person is “resistant,” but because the fit is wrong for that moment in their life.

 

 

What “fit” means in anxiety treatment

 

Fit depends on:

 

  • How anxiety impacts occupations (sleep, work, school, relationships, intimacy, leisure)

  • The amount of structure, containment, or flexibility you currently need

  • Your nervous system’s capacity right now

  • Past treatment experiences (what helped, what didn’t)

  • Environmental demands and supports

 

Stepped care exists because fit changes over time. Sometimes a sturdier shoe is needed. Sometimes a lighter one. Sometimes a completely different shoe.

 

Anxiety treatment is most effective when it is adapted, not prescribed rigidly.

 

References

Canadian Association of Occupational Therapists. (n.d.). Occupational therapy and mental health practice.

National Institute for Health and Care Excellence. (2020). Generalised anxiety disorder and panic disorder in adults (CG113).

Vivago’s Three-Tier Stepped-Care Model for Anxiety

Vivago uses a simplified, OT-inspired stepped-care framework:

 

 

Movement between levels is non-linear and based on function, not failure.

 

References

Bower, P., & Gilbody, S. (2005). Stepped care in psychological therapies. British Journal of Psychiatry, 186, 11–17.

Canadian Association of Occupational Therapists. (n.d.).

Anxious person chatting with their therapist
Vivago's Stepped Care Model

LEVEL 2 – INTERMEDIATE CARE

Core Psychological Treatment Options for Anxiety

​Cognitive Behavioural Therapy (CBT – Cognitive Behavioural Therapy)

 

 

How CBT works

 

Cognitive Behavioural Therapy is grounded in the understanding that anxiety is maintained by interacting cognitive, behavioural, and physiological processes. CBT intervenes by:

 

  • Modifying threat-based interpretations

  • Reducing avoidance and safety behaviours

  • Facilitating corrective learning through behavioural experiments and exposure

 

CBT does not aim to eliminate anxiety entirely, but to change the meaning and consequences of anxiety responses.

 

 

Who CBT fits best

 

  • Generalized anxiety with worry loops

  • Panic disorder and panic attacks

  • Social anxiety and performance anxiety

  • Anxiety driven by catastrophic thinking and avoidance

 

 

What CBT looks like week to week

 

  • Functional analysis of anxiety triggers

  • Thought and behaviour monitoring linked to daily situations

  • Between-session exposure or experiments

  • Review of learning rather than symptom scores alone

 

 

Common misconceptions

 

  • CBT is “positive thinking” → false

  • CBT ignores emotions → false

  • CBT is superficial → false when properly delivered

 

References

Otte, C. (2011). Dialogues in Clinical Neuroscience, 13(4), 413–421.

Curtiss et al. (2021). Focus, 19(2), 184–193.

 

 

Exposure-Based Therapies

 

 

How exposure works

 

Exposure therapies reduce anxiety by systematically reducing avoidance, allowing the nervous system to learn that feared situations or sensations are tolerable and non-catastrophic. Contemporary models emphasize inhibitory learning rather than simple habituation.

 

 

Who exposure fits best

 

  • Panic disorder

  • Phobias

  • Social anxiety disorder

  • Anxiety driven by fear of bodily sensations or uncertainty

 

 

What exposure looks like week to week

 

  • Collaborative hierarchy development

  • Repeated, planned exposures in real contexts

  • Reflection on prediction errors and learning

 

 

Common misconceptions

 

  • Exposure equals flooding → false

  • Exposure is unsafe → false when paced and clinically guided

 

References

Craske et al. (2014). Behaviour Research and Therapy, 58, 10–23.

NICE (2020).

 

 

Acceptance and Commitment Therapy (ACT – Acceptance and Commitment Therapy)

 

 

How ACT works

 

ACT focuses on psychological flexibility, helping individuals:

 

  • Accept internal experiences without avoidance

  • Defuse from anxious thoughts

  • Act in alignment with values despite discomfort

 

ACT reframes recovery as expanding life participation, not waiting for anxiety to disappear.

 

 

Who ACT fits best

 

  • Chronic or treatment-resistant anxiety

  • Anxiety linked to identity, perfectionism, burnout

  • Individuals exhausted by constant symptom management

 

 

What ACT looks like week to week

 

  • Values clarification

  • Mindfulness and defusion practices

  • Values-based behavioural commitments

 

References

A-Tjak et al. (2015). Behaviour Research and Therapy, 68, 1–16.

 

 

Mindfulness-Based Cognitive Therapy (MBCT – Mindfulness-Based Cognitive Therapy)

 

 

How MBCT works

 

MBCT integrates mindfulness practices with cognitive principles to reduce rumination, threat monitoring, and emotional reactivity.

 

 

Who MBCT fits best

 

  • Anxiety driven by rumination and mental hyperactivity

  • Recurrent anxiety symptoms

  • Individuals open to mindfulness-based practice

 

References

Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2013). Mindfulness-based cognitive therapy for depression. Guilford Press.

 

 

Occupational Therapy for Anxiety

 

 

Occupation-Focused, Evidence-Informed Interventions

 

Occupational therapy addresses anxiety by focusing on how it disrupts daily life, applying evidence-based psychological principles directly to real-world occupations.

 

 

Theoretical foundations in OT for anxiety

 

OT interventions draw from:

 

  • Cognitive Behavioural Therapy-informed approaches

  • Acceptance and Commitment Therapy-informed approaches

  • Exposure-based learning models

  • Sensory integration and sensory modulation frameworks

  • Mindfulness-based cognitive therapy principles

 

 

Core OT interventions

 

Occupation-based exposure

 

  • Exposure embedded in meaningful activities (work tasks, errands, social participation)

  • Focus on participation rather than symptom suppression

 

CBT-informed OT

 

  • Identifying task-specific anxious predictions

  • Behavioural experiments linked to occupations

  • Reducing safety behaviours embedded in routines

 

ACT-informed OT

 

  • Values-based goal setting

  • Supporting engagement despite anxiety

  • Identity and role reconstruction

 

Sensory integration and sensory modulation

 

  • Identifying sensory triggers

  • Regulation strategies to support nervous system stability

  • Environmental adaptations

 

Routine and role rehabilitation

 

  • Sleep-wake restructuring

  • Return-to-work or return-to-school planning

  • Occupational balance restoration

 

 

Who OT fits best

 

  • Anxiety affecting work, school, self-care, or relationships

  • Individuals with insight but limited functional change

  • Anxiety co-occurring with burnout, neurodivergence, or sensory sensitivity

 

References

Brown & Stoffel (2011). Occupational therapy in mental health.

Champagne, T., & Stromberg, N. (2004). OTJR.

CAOT (n.d.).

 

 

Interdisciplinary Care in Anxiety Treatment

 

Anxiety often benefits from collaborative care, depending on context:

 

  • Psychology: psychotherapy delivery and formulation

  • Occupational therapy: functional rehabilitation and exposure in daily life

  • Psychiatry: diagnostic clarification and medication management

  • Social work: psychosocial stressors, family systems, access to resources

  • Sexology: anxiety related to intimacy, performance, desire, or sexual trauma

  • Nursing / primary care: coordination, monitoring, health education

 

Integrated care improves continuity, safety, and functional outcomes.

 

References

Katzman et al. (2014). BMC Psychiatry, 14(Suppl 1), S1.

Psychological Treatment Options for Anxiety
Mindfuless practice for anxiety

Medication-Specific Disclaimer

Medication information presented on this page:

 

  • Is intended to support general understanding of commonly used treatments

  • Does not constitute prescribing guidance

  • Does not replace medical evaluation

  • Should not be interpreted as endorsement of any specific medication

 

Never stop, start, or modify a prescribed medication without medical supervision.

Abrupt discontinuation of certain medications (including antidepressants, benzodiazepines, and other anxiolytics) can result in withdrawal symptoms, rebound anxiety, or other medical risks.

 

If you are currently taking medication and have concerns about side effects, effectiveness, or discontinuation, consult your prescribing clinician.

Medication Treatment Options for Anxiety

Mechanisms, Timelines, Risks, and Clinical Fit Within a Stepped-Care Model

​
 

Medication can play an important role in anxiety treatment, particularly when anxiety significantly interferes with daily functioning, overwhelms nervous system regulation, or limits a person’s ability to engage in psychotherapy and occupation-based interventions.

 

Within a stepped-care approach, medication is not a standalone solution, but rather a tool that may:

 

  • Reduce baseline anxiety intensity

  • Lower physiological hyperarousal

  • Increase tolerance for exposure and daily activities

  • Support engagement in therapy and functional rehabilitation

 

Medication decisions are always individualized and should be made collaboratively with a qualified prescriber. The information below is provided for education and informed decision-making, not self-prescribing.

 

 

Selective Serotonin Reuptake Inhibitors (SSRIs – Selective Serotonin Reuptake Inhibitors)

 

 

How SSRIs work (beyond the basics)

 

SSRIs act by inhibiting the reuptake of serotonin at the synapse, increasing its availability in the brain. However, their anxiolytic effects are not simply due to “more serotonin.”

 

Over time, SSRIs are associated with:

 

  • Modulation of fear and threat circuits (e.g., amygdala–prefrontal connectivity)

  • Reduced hyperreactivity to perceived threats

  • Improved top-down regulation of emotional responses

  • Neuroadaptive changes that take weeks, not days

 

This explains why SSRIs do not provide immediate relief, and why early side effects can occur before therapeutic benefits emerge.

 

 

What SSRIs are commonly used for

 

SSRIs are widely recommended as first-line pharmacological treatment for:

 

  • Generalized anxiety disorder

  • Panic disorder

  • Social anxiety disorder

  • Obsessive-compulsive disorder (with condition-specific dosing)

 

They are often chosen because of:

 

  • Strong evidence base

  • Non-sedating profile

  • Suitability for long-term use when indicated

 

 

What to expect when starting an SSRI

 

Timeline matters — misunderstanding this is one of the most common reasons SSRIs are stopped prematurely.

 

Typical course:

 

  • Weeks 1–2: Possible transient increase in anxiety, restlessness, gastrointestinal symptoms, sleep changes

  • Weeks 3–6: Early stabilization, fluctuating symptom improvement

  • Weeks 6–8+: More consistent anxiolytic effects may emerge

 

Importantly, early discomfort does not predict long-term inefficacy.

 

 

Why stopping SSRIs too early is risky

 

Stopping SSRIs prematurely can lead to:

 

  • No opportunity for therapeutic neuroadaptation

  • Mislabeling the medication as ineffective

  • Increased risk of relapse

  • Withdrawal or discontinuation symptoms if stopped abruptly (e.g., dizziness, irritability, “brain zaps,” flu-like symptoms)

 

From a stepped-care perspective, SSRIs often require supportive interventions (psychoeducation, OT, psychotherapy) during the early phase to help clients tolerate the adjustment period.

 

 

Clinical fit within stepped care

 

SSRIs may be particularly helpful when:

 

  • Anxiety is persistent and generalized

  • Rumination dominates daily functioning

  • Anxiety significantly interferes with sleep, work, or relationships

  • Anxiety limits engagement in therapy or exposure

 

They are not always the right first step when anxiety is situational, mild, or primarily driven by environmental stressors.

 

References

Baldwin et al. (2014)

Katzman et al. (2014)

Slee et al. (2019)

 

 

Serotonin–Norepinephrine Reuptake Inhibitors (SNRIs – Serotonin–Norepinephrine Reuptake Inhibitors)

 

 

How SNRIs work

 

SNRIs increase the availability of both serotonin and norepinephrine by inhibiting their reuptake. Norepinephrine plays a role in:

 

  • Alertness and vigilance

  • Energy regulation

  • Stress responsiveness

 

By targeting both neurotransmitters, SNRIs may influence both cognitive anxiety and somatic symptoms such as tension, fatigue, or pain.

 

 

When SNRIs may be considered

 

SNRIs are often considered when:

 

  • Anxiety overlaps with chronic pain conditions

  • Fatigue or low energy is prominent

  • SSRIs have been ineffective or poorly tolerated

 

 

Risks and discontinuation considerations

 

SNRIs should be tapered gradually. Abrupt discontinuation may lead to:

 

  • Dizziness

  • Sensory disturbances

  • Irritability or rebound anxiety

 

 

Stepped-care perspective

 

SNRIs may support functional rehabilitation when physical symptoms of anxiety are prominent and interfere with occupational engagement.

 

References

Slee et al. (2019)

Baldwin et al. (2014)

 

 

Benzodiazepines

 

 

Short-Term or Situational Use Only

 

 

How benzodiazepines work

 

Benzodiazepines enhance the effect of gamma-aminobutyric acid (GABA), the primary inhibitory neurotransmitter in the brain. This produces:

 

  • Rapid anxiolytic effects

  • Muscle relaxation

  • Sedation

 

 

Appropriate use

 

Benzodiazepines may be used:

 

  • Short-term during acute crises

  • As temporary support while other treatments take effect

  • In carefully selected, time-limited situations

 

 

Risks and limitations

 

  • Tolerance with repeated use

  • Physical and psychological dependence

  • Cognitive impairment and psychomotor slowing

  • Withdrawal symptoms if stopped abruptly

 

 

Why they are not first-line long-term treatments

 

From a functional and occupational perspective, long-term benzodiazepine use can:

 

  • Interfere with learning during exposure therapy

  • Reduce cognitive clarity

  • Limit skill acquisition and autonomy

 

References

National Institute for Health and Care Excellence (2020)

Baldwin et al. (2014)

 

 

Pregabalin (commonly known by the brand name Lyrica)

 

 

How pregabalin works (clinically important distinction)

 

Pregabalin does not act on serotonin or GABA receptors directly. Instead, it binds to the alpha-2-delta subunit of voltage-gated calcium channels, reducing the release of excitatory neurotransmitters.

 

This leads to:

 

  • Reduced physiological hyperarousal

  • Decreased somatic anxiety (muscle tension, agitation)

  • Nervous system calming without cognitive dulling for some individuals

 

 

Why pregabalin is used in anxiety

 

Pregabalin is often considered when:

 

  • Anxiety is primarily experienced “in the body”

  • There is marked restlessness or sensory sensitivity

  • Antidepressants are poorly tolerated

  • Anxiety overlaps with chronic pain or sleep disturbance

 

It is approved for generalized anxiety disorder in some countries and recommended as an option in clinical guidelines when SSRIs or SNRIs are not suitable.

 

 

What to expect

 

  • Faster onset than antidepressants for some individuals

  • Potential side effects: sedation, dizziness, weight gain, edema

  • Requires individualized dosing and monitoring

 

 

Discontinuation considerations

 

Abrupt cessation may result in rebound anxiety or withdrawal-like symptoms. Gradual tapering is recommended.

 

 

Functional fit

 

Pregabalin may be particularly helpful at Level 2 or Level 3 of stepped care when somatic anxiety limits participation in daily activities or exposure-based work.

 

References

Generoso et al. (2017)

National Institute for Health and Care Excellence (2020)

 

 

Gabapentin

 

 

How gabapentin works

 

Gabapentin shares a similar mechanism with pregabalin, acting on calcium channels to reduce neuronal excitability.

 

 

Clinical use

 

Gabapentin is sometimes used off-label when:

 

  • Anxiety presents with prominent physical symptoms

  • Sleep disruption is significant

 

Evidence is less robust than for pregabalin, and use varies by prescriber and context.

 

References

Baldwin et al. (2014)

 

 

Beta-Blockers (e.g., Propranolol)

 

 

How beta-blockers work

 

Beta-blockers block beta-adrenergic receptors, reducing:

 

  • Heart rate

  • Tremor

  • Physical symptoms of anxiety

 

 

Best fit

 

  • Performance anxiety

  • Situational anxiety where physical symptoms dominate

 

They do not address cognitive worry or avoidance patterns.

 

References

American Academy of Family Physicians (2022)

 

 

Medication Within an Occupation-Focused Stepped-Care Model

 

Medication is most effective when:

 

  • Matched to symptom profile and functional impact

  • Given adequate time to work

  • Integrated with psychotherapy and occupational therapy

  • Regularly re-evaluated as functioning improves

 

From an occupational therapy lens, medication is not the endpoint — it is often the bridge that allows people to:

 

  • Re-engage in daily routines

  • Tolerate exposure and uncertainty

  • Rebuild roles and participation

Medication Treatment Options for Anxiety

Finding the Right Level of Support

​Anxiety does not need to reach a breaking point to deserve care. Many people seek treatment not because they are “falling apart,” but because anxiety has slowly narrowed their lives — disrupting sleep, work, relationships, confidence, or joy.

 

Effective anxiety treatment is rarely about a single technique. It is about:

 

  • Fit (the right approach at the right time)

  • Function (how daily life is affected)

  • Flexibility (adjusting care as needs change)

 

A stepped-care approach allows support to meet you where you are, and to evolve as your capacity and functioning change.

 

If you’re unsure what level of care makes sense for you, that question itself is often the first step — and you don’t need to answer it alone.

Frequently Asked Questions About Anxiety Treatment

What are the most effective treatments for anxiety?

 

The most effective treatments for anxiety are evidence-based psychotherapies — particularly Cognitive Behavioural Therapy (CBT) and exposure-based therapies — as well as medication when clinically indicated. For many people, the strongest outcomes occur when psychotherapy, occupational therapy, and (if needed) medication are combined within a stepped-care approach.

 

Research consistently supports CBT and exposure therapy as first-line psychological treatments for anxiety disorders. Medication such as selective serotonin reuptake inhibitors (SSRIs) may be recommended when anxiety significantly interferes with sleep, work, or daily functioning.

 

 

Do I really need treatment for anxiety, or is this normal stress?

 

Stress is a normal response to life demands. Anxiety may benefit from treatment when it:

 

  • Interferes with sleep

  • Disrupts work or school performance

  • Causes avoidance of daily activities

  • Affects relationships

  • Creates persistent physical tension or worry

 

If anxiety is narrowing your life — even gradually — treatment may help restore flexibility and functioning.

 

 

How do I know which anxiety treatment is right for me?

 

The right anxiety treatment depends on:

 

  • How anxiety affects your daily life

  • The severity and persistence of symptoms

  • Whether avoidance patterns are present

  • Your previous treatment history

  • Your current level of functioning

 

A stepped-care model helps determine whether prevention-level support, weekly therapy, or more intensive treatment is appropriate.

 

 

Is therapy or medication better for anxiety?

 

Neither therapy nor medication is universally “better.”

 

  • Psychotherapy addresses thought patterns, behaviours, and avoidance.

  • Medication may reduce baseline anxiety intensity and physiological arousal.

 

For many individuals, combining therapy and medication leads to better functional outcomes than either alone. Mild or situational anxiety may respond well to therapy without medication.

 

 

How long does anxiety treatment take?

 

The timeline varies based on severity and treatment type.

 

  • Cognitive Behavioural Therapy often ranges from 8–20 sessions.

  • Medication may take 4–8 weeks before meaningful improvement.

  • Intensive programs may accelerate progress when weekly therapy is insufficient.

 

Recovery is not linear. Treatment focuses on building flexibility and long-term coping capacity, not just symptom reduction.

 

 

Can anxiety go away without treatment?

 

Mild or situational anxiety sometimes improves with lifestyle changes, stress reduction, or resolution of triggering events. However, persistent anxiety disorders often continue or worsen without targeted intervention.

 

Early treatment is associated with better long-term outcomes and reduced functional impairment.

 

 

What happens if anxiety treatment doesn’t work?

 

If anxiety treatment does not help, the issue is often mismatch, not failure. Possible reasons include:

 

  • Wrong treatment modality

  • Insufficient intensity

  • Untreated trauma or medical factors

  • Poor fit with the clinician

  • Medication discontinued too early

 

A stepped-care framework allows treatment intensity or modality to be adjusted.

 

 

What is exposure therapy, and is it safe?

 

Exposure therapy gradually and systematically reduces avoidance of feared situations or sensations. It is one of the most researched and effective treatments for anxiety disorders.

 

When delivered by trained professionals and paced appropriately, exposure therapy is considered safe and evidence-based. It does not involve forcing individuals into overwhelming situations.

 

 

Do anxiety medications cause dependence?

 

Most first-line anxiety medications, such as SSRIs and SNRIs, are not addictive. However:

 

  • Benzodiazepines can cause dependence if used long-term.

  • Some medications require gradual tapering to prevent discontinuation symptoms.

 

Medication decisions should always be made with a qualified prescriber.

 

 

Can anxiety come back after treatment?

 

Anxiety can fluctuate throughout life, particularly during periods of stress. Effective treatment builds psychological flexibility, coping skills, and nervous system regulation so that anxiety becomes less controlling, even if it reappears.

 

Treatment is about expanding life participation — not eliminating all anxiety permanently.

 

 

When is intensive anxiety treatment necessary?

 

Intensive or semi-intensive treatment may be appropriate when:

 

  • Weekly therapy is insufficient

  • Anxiety severely disrupts work or school

  • Avoidance has become pervasive

  • Panic or shutdown significantly limits functioning

 

In these cases, structured, multi-session-per-week programs may provide containment and momentum.

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