There is a question that many people have when seeking treatment for their anxiety. “Should I see a psychiatrist or psychologist for anxiety?” Answering that question depends on the nature of your anxiety, and the training and specialization of your treatment provider.
When it comes to figuring out who you can talk to about anxiety, the first thing you want to do is make sure that anyone you’re considering does in fact specialize in this area. It is always helpful to ask questions about specialty areas and approach to treatment.
For both psychiatrists and psychologists, you can expect a thorough initial evaluation. In this session, both types of providers will ask you a number of questions for the purpose of giving you an accurate diagnosis and determining the best course of treatment for you.
In deciding when to see a psychologist vs. a psychiatrist for anxiety, it is helpful to review what each type of mental health professional does. There are some areas of overlap, but others that differ.
What do Psychiatrists do for Anxiety?
Most people think of a psychiatrist as someone who prescribes medication. While this is true – a licensed psychiatrist has a medical degree and can prescribe medication – there are still variations in what you can expect when working with a psychiatrist. Here are some examples of what psychiatrists do for anxiety:
Psychiatrists can provide a wide range of medications. The most common first-line medication treatment is usually selective serotonin reuptake inhibitors (SSRIs). Selective norepinephrine reuptake inhibitors (SNRIs), although less commonly prescribed, are also an option. Tricyclic antidepressants are sometimes prescribed for panic disorder. Benzodiazepines, although quick at reducing anxiety symptoms, often have increased dependence, adverse outcomes, and no long-term benefits. There are additional less frequently used medications as well.
Psychiatrists can provide helpful education about different subtypes of anxiety, what contributes to their onset and symptom expression, and adaptive behaviors to address them. Psychoeducation often includes working with patients on forming improved habits and self-care that can improve their anxiety symptoms. Examples include establishing a consistent sleep routine, getting regular exercise, practicing meditation or relaxation exercises, improving diet and nutrition, and engaging in other proactive behaviors that can help reduce anxiety.
This is an area where it pays to be educated as a prospective patient. Many psychiatrists get minimal therapy training in their medical programs. Although they are highly trained in assessing and diagnosing mental health conditions, psychiatrists may not provide any therapy at all. Or, they may offer therapy without the appropriate depth of training necessary to understand and guide a process of therapeutic action.
On the other hand, psychiatrists may have extensive post-graduate therapy training through institutes and continuing education programs. These psychiatrists might be well-regarded experts in providing therapy. Ask a prospective psychiatrist directly about whether they provide therapy, and if so, what approach they follow and the structure (length & frequency) of sessions. Also, keep in mind that you are free to look for therapy with another mental health professional. That’s OK!
In sum, when thinking about the question ‘what do psychiatrists do for anxiety?’, the answer is ‘more than you may think.’ But it is also quite common to just see a psychiatrist for medication management, and that is fine too.
When to see a Psychologist for Anxiety
Psychologists are licensed mental health professionals with a doctoral degree (either a PhD or PsyD) from a clinical psychology or counseling psychology programs. Both types of doctoral degrees take 5-6 years of training to complete. There is some variation between PhD and PsyD programs, but all graduates should have solid clinical training. These programs must meet ongoing national training standards for accreditation.
Of all types of therapists, psychologists tend to have the most specialized training in therapeutic questions, approaches, and interventions. They also tend to have training in specific modalities of therapy, such as individual therapy, group therapy, and couples therapy. Unlike psychiatrists, who take about the same amount of time to get a degree, psychologists’ education and training tends to be more focused on providing therapy. Unlike other therapists – such as licensed clinical social workers (LCSWs) and licensed professional counselors (LPCs) – they have five years of training, as opposed to two. With that said, as in any field, there is variation in the the quality of every psychologist. Sometimes this has to do with who would be a good fit to work with you. Other times, it has to do with the talent of the provider. Again, it pays to ask questions and get a feel for how the psychologist works to see if the fit is right.
Some psychologists specialize in psychological assessment, also referred to as testing. These psychologists get training in administering, scoring, and interpreting tests of psychological functioning. If you are someone who wants a very comprehensive assessment of your psychological functioning, testing is a good example of when to see a psychologist. This is especially the case if anxiety isn’t the only symptoms you may be having. One of the cons about getting testing is that a full psychological test battery can be expensive. So it usually only worthwhile if there are specific and/or difficult questions you have that can’t be answered through a standard ‘interview’ with a psychologist in a first evaluation session. It is also uncommon to get testing just for anxiety symptoms alone.
Let’s now review some common therapeutic approaches for anxiety that psychologists are often trained in. These help explain what a psychologist does for anxiety.
Cognitive-Behavioral Therapy (CBT)
Cognitive-Behavioral Therapy (CBT) is regarded by many as the most effective form of treatment for anxiety. Proponents point to the fact that it has the most empirical support of all treatments in research studies.
The ‘C’ in CBT refers to therapeutic techniques that address unhelpful thinking patterns in anxiety. For example, your therapist may identify patterns of ‘catastrophizing’, or anticipating the worst possible outcomes. This seemingly protective mental pattern can unfortunately have the unintended effect of influencing anxious or worrisome outcomes. When something is often in our mind, that mental focus can sometimes have a role in bringing on the event that we fear. CBT therapists will work on changing mental schemas, or thought patterns, into more helpful ones.
This approach involves identifying and replacing maladaptive thought patterns with new adaptive ones, and then practicing rehearsing the new patterns until they become more second-nature. Different cognitive therapy techniques can be especially helpful with anxiety symptoms that are heavily ‘mentally’ experienced, such as obsessions and generalized worry.
The ‘B’ in CBT refers to therapeutic techniques that treat the behavioral component of anxiety. They help to changes unproductive behaviors that are a part of or contribute to anxiety. Exposure therapy (below) is an example of a CBT approach focusing on behavior.
This is a specialized form of CBT that is very helpful in instances where someone is having a strong physiological response to anxiety (e.g. physical symptoms of anxiety) and/or engaging in behaviors designed to avoid the anxiety (but which inadvertently end up strengthening it). The idea with exposure therapy is to confront your anxiety by getting exposed to it. Exposure therapy is designed to disrupt and change the cycle of fear and avoidance. The more you are exposed to something that causes anxiety, the more used to it you become, and then over time, the less anxious you become. This process helps people ‘extinguish’ the stimulus-response pattern that caused anxiety in the first place.
For example, if I am afraid of flying because I believe the plane will crash, if I have enough situations where I am exposed to flying, it becomes more commonplace and even boring. Lo and behold, I don’t crash, so this no longer becomes something I no longer associate with flying. Maybe now, like most people, I become anxious of being crammed like a sardine into small seats (pardon the real life humor).
There are 3 types of exposure therapy: in-vivo, imaginal, and flooding. In-vivo and flooding exposures take place ‘in real life’. The in-vivo approach is usually a gradual hierarchical exposure designed to build tolerance to exposures. The flooding approach is an ‘all-in’ approach and is more useful when there is extreme fear and avoidance. Imaginal exposure involves using your imagination, or the assistance of A/V technology, to simulate the anxiety-provoking experience. It can be helpful when it is harder to practice real-life exposures. Exposure therapy is especially helpful with behavioral expressions of anxiety, such as with agoraphobia, specific phobias, panic attacks, and compulsions.
Let’s come back to the fear of flying example. What if a person’s fear of flying isn’t really about flying at all? Some anxiety is ‘symbolic’, meaning it represents deeper subconscious themes from formative experiences growing up. Psychodynamic therapy focuses on the role of building insight as a way to understand and shift anxiety. Psychodynamic therapists believe that good rapport, close listening, active questions that stem from therapeutic dialogue, and well-timed interpretations help lead to corrective emotional experiences and deeper understanding for patients. This therapeutic process leads to the reduction of anxiety through insight and growth. Unlike CBT and Exposure, Psychodynamic treatments tend to be moderate to longer-term and are helpful when other therapies have limited results, or the anxiety is part of deeper unresolved issues from childhood.
Mindfulness, Hypnosis & Relaxation
Mindfulness flows out of meditation practice and teaches patients to cultivate mindful awareness in the moment across senses. Mindfulness may or may not be relaxing, but is often breath-centered. Relaxation techniques also use a focus on breathing to build relaxation, and are often combined with guided visualization and sensory experiencing. Hypnosis involves focused attention, imagination, and suggestion. Hypnotic exercises can be very helpful in treating anxiety.
Psychologist vs. Psychiatrist for Anxiety?
Seeing a psychiatrist or psychologist for your anxiety is a personal choice. A lot of it comes down to fit with your provider and a sense that he/she/they has both the skills and personality to help you get the outcome you want. When thinking about what a psychiatrist or psychologist does for anxiety, it’s important to remember that you are not just ‘fixing’ your anxiety. Rather, you are changing your relationship with your symptoms, and more importantly, with yourself.
To this end, while medications can be helpful, especially when symptoms have gotten out of hand, the best approach can often be a combined one featuring therapy and medication. Research shows that medication and therapy are equally effective in reducing anxiety. As a result, you may wish to see both a psychiatrist and psychologist for anxiety. Sometimes, medication is not necessary, and therapy alone provides the necessary relief. As a psychologist, I often recommend therapy as a first approach to treating anxiety, especially when someone has never previously been in therapy.