Cognitive Behavioral Therapy for Anxiety in New York City

The Life at Your Best Plan offers individual and group therapy for anxiety, using a clinically proven approach combining cognitive and behavioral therapy to reduce and manage anxiety symptoms. An overwhelming body of evidence recommends cognitive-behavioral therapy as the most effective psychotherapy for anxiety symptoms. Newsweek calls cognitive behavioral therapy “…the gold standard for treating anxiety disorders” (February 24, 2003). For anxiety, the type of therapy you choose makes a dramatic difference


Generalized anxiety involves excessive anxiety and worry for most days during a period of at least six months. The worry is difficult to control, causing distress, and may include: edginess, easily tiring, difficulty concentrating, irritability, muscle tension, and difficulty sleeping.

The most common symptoms include tension, jumpiness, unsteadiness, fright, and the inability to relax. Cognitive functioning is impaired by concentration difficulties, apprehension about losing control, fear of being rejected, inability to control thinking, and confusion.

Secondary symptoms include emotional outbursts and hypersensitivity, reduced sexual and interpersonal activity, perfectionism, hyper-vigilance, and exaggerated startle response. A central manifestation of generalized anxiety is anticipatory anxiety. Many studies have concluded the relative effectiveness of cognitive and behavioral therapy for generalized anxiety (Durham and Allan, 1993). Most patients who receive cognitive-behavioral therapy show significant and consistent improvement (Roth and Fonagy, 1996).


Attacks of panic are periods of intense fear or discomfort developing suddenly, beginning with cardiac symptoms and difficulty breathing, and peaking within 10 minutes. A full panic attack usually lasts under 10 minutes, but can continue up to 30 minutes. The panic stems from misinterpretations of physical symptoms.

The three types of panic are:

  1. Unexpected or un-cued with no apparent trigger
  2. Situational bound or cued attacks, in anticipation of or on contact with specific stimuli
  3. Situational predisposed attacks usually associated with specific triggers

Cognitive therapy, combined with behavioral interventions and sometimes medication, has been found to be more effective than other therapeutic interventions. Research has shown that 75 to 90 percent of people with panic were panic-free after cognitive treatment. Medication alone may relieve symptoms of panic for approximately 70 percent of respondents, but without cognitive therapy, relapse rates are far higher (near 100% when medication is withdrawn).

Elimination of the panic symptoms alone may not be enough, as low self-esteem and interpersonal difficulties are common among people who suffer panic attacks. The prognosis for treatment with cognitive behavioral therapy is excellent, with over 80 percent of patients panic free after fifteen sessions of treatment (Craske and Barlow, 1993). Anxiety symptoms become manageable so they do not escalate to panic.


A reaction to an extreme stressor that has caused or threatened death or severe injury defines Posttraumatic Stress Disorder (PTSD). Extreme stressors include terrorist attacks, rape, combat, automobile accidents, and natural disasters, among others. The trauma may involve direct experience, observation, or vicarious experience with the stressor.

Post-traumatic stress may include one of the following:

  • Great fear and helplessness in response to the traumatic event
  • Persistent re-experiencing of the event (dreams, recollections, or intense distress at reminders of the event)
  • Loss of general responsiveness (feeling detached from others, believing one’s life is foreshortened, dissociating from or being unable to recall major aspects of the traumatic experience)
  • Sleep disturbances, anger or irritability, severe startle responses
  • Difficulty concentrating due to the stressor that is severe enough to cause significant distress or impairment

Additional symptoms may include shame, survivor guilt, lack of interest in usual activities (e.g., sex), inability to identify emotions, mistrust of others, withdrawal from close relationships, difficulty self-soothing, fear of losing control or going out of control, and psychosomatic symptoms. Symptoms of post-traumatic stress persist for more than a month, and, without treatment, may last for many years after the trauma. Edna Foa reports a 91 percent rate of significant improvement after treatment combining exposure and stress inoculation training, a cognitive-behavioral approach (1995).


Phobias are persistent, unwarranted, and disproportionate fears of an actual or anticipated stimulus. Examples are snakes, heights, flying, being alone, speaking in public, elevators, dentist’s offices, dogs, thunderstorms, injections, blood, or unusual objects such as balloons or stairs with openings between the treads, etc. These involve an unhealthy way of coping with that fear. Panic or extreme anxiety may result when the stimulus is confronted. People with phobias are generally aware of their unreasonable reactions, but feel powerless to change them.

Phobias result from illogical thinking, over-generalizing, selective perception and negative views of the self and world. Cognitive-behavioral therapy is structured, directive, and focuses on the symptom itself. Once the phobia is identified, skills and techniques are used to gradually face the fears and adaptively cope with the feared stimulus. The prognosis for phobia treatment is generally excellent, with 70 to 85 percent of patients showing significant improvement (Emmelkamp, 1994; Maxmen and Ward, 1995).


Social Anxiety, also known as Social Phobia, involves a persistent fear of humiliation or embarrassment in social or performance situations. Physical symptoms of blushing, perspiration, hoarseness, and tremor may be common with social anxiety. Examples include eating in public, taking tests, attending parties or social gatherings, writing while being observed by other people, speaking in public, performance anxiety (e.g., during sex), and being interviewed.

As a result can lead to underemployment, lower rates of relationships, and panic attacks when exposed to the feared situations. The prognosis of treatment with cognitive-behavioral therapy is excellent, with an average of 90% of social anxiety patients improving through treatment. Group therapy is the most effective treatment for social anxiety.


An anxiety about being in places or situations from which escape might be difficult or embarrassing, or which help might not be available (cars, barber shops, supermarket checkout lines, crowds). Agoraphobia is the most common type of Phobia. People with agoraphobia express fear of loosing control and having a limited-symptom attack (loss of bladder control, chest pains, or fainting). You may restrict travel or refuse to travel without a companion. Agoraphobia usually develops later than other phobias, in the late twenties or thirties.

The agoraphobic person becomes dependent on substances to cope with the anxiety, or become dependent on a significant person. Cognitive-behavioral treatment involves gradually exposing the patient to the feared situations after skills and techniques are developed to successfully cope with the feared stimulus. Prognosis is good, with two-thirds of agoraphobic patients improving functioning and reducing symptoms, and maintaining gains (Barlow and Waddell, 1985).


Obsessions are recurrent, intrusive thoughts, images or impulses. Compulsions are repetitive, purposeful, driven behaviors or mental acts to reduce anxiety or avoid a feared circumstance. Thoughts or behaviors may be excessive and unreasonable. Obsessions and compulsions are chronic, but may wax and wane in response to stressors. The four patterns of obsessive-compulsiveness are listed below.

  1.  Obsessions focused on contamination. Examples are washing, avoiding objects viewed as carriers of germs and disease.
  2. Obsessive doubts that lead to time-consuming or ritualized and repetitive checking of appliance or door and window locks.
  3. Obsessions without compulsions. These are usually thoughts of sexual or violent acts that are horrifying to the person
  4.  A powerful need for symmetry or precision. This causes the need for extreme slowness for even routine activities like eating and dressing.

Common compulsions include counting, hoarding, repeating, ordering, asking for reassurance, and touching in a ritualistic fashion. The results of research for obsessive-compulsiveness consistently recommend behavioral therapy as the primary therapeutic intervention, combined with cognitive therapy to reduce intrusive thoughts and ruminations and avoid relapse. Medications can accelerate treatment, such as anafranil or the SSRIs (prozac, luvox, etc). Realistic cognitive-behavioral therapy goals are for a significant improvement in decreasing symptoms, as OCD is a chronic but manageable condition, which can make a significant difference in a person’s enjoyment and continue in life.


Richard Friedman, M.D., writes in the August 27th, 2002 issue of The New York Times that psychoanalysis rarely works for obsessive-compulsive disorder. Cognitive-behavioral therapy and the S.S.R.I.’s (e.g., prozac) can be highly effective in treating OCD. Brain imaging shows that patients responding to medication or cognitive-behavior therapy showed virtually the same changes in their brains over a 10 week period toward normal function. Learning can clearly change the structure and function of the brain.

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