I do not ask you to take my word for any of this. Further down this page you can read the research I base my anxiety practice on, including the therapies that work, the cautions worth knowing, and the ones that underperform.
If anxiety has been running in the background for a while, it helps to see its actual shape, how much is worry, how much is physical tension, and how much is low mood underneath it. The DASS-21 is a short, private questionnaire that measures all three over the past week and gives you tailored next steps for each.
I do not ask you to take my word for any of this. Further down this page you can read the research I base my anxiety practice on, including the therapies that work, the cautions worth knowing, and the ones that underperform.
If anxiety has been running in the background for a while, it helps to see its actual shape, how much is worry, how much is physical tension, and how much is low mood underneath it. The DASS-21 is a short, private questionnaire that measures all three over the past week and gives you tailored next steps for each.
I do not ask you to take my word for any of this. Further down this page you can read the research I base my anxiety practice on, including the therapies that work, the cautions worth knowing, and the ones that underperform.
If anxiety has been running in the background for a while, it helps to see its actual shape, how much is worry, how much is physical tension, and how much is low mood underneath it. The DASS-21 is a short, private questionnaire that measures all three over the past week and gives you tailored next steps for each.
Can anxiety be part of something else like ADHD, OCD?
What is anxiety treatment with Dr Rick Smith?
Will my anxiety ever go away?
How do you treat anxiety?
For parents: what’s the parent’s role in treatment?
What does anxiety look like in teens and adults?
Can anxiety treatment be done online?
General FAQs
ADHD
Anxiety
OCD
Screen Time
School Refusal
Defiant Behaviour, PDA, ODD
Parenting Support (SPACE Model)
Procrastination
Performance Psychology
Executive Coaching for Burnout
Substance Use
Can anxiety be part of something else like ADHD, OCD?
What is anxiety treatment with Dr Rick Smith?
Will my anxiety ever go away?
How do you treat anxiety?
For parents: what’s the parent’s role in treatment?
What does anxiety look like in teens and adults?
Can anxiety treatment be done online?
Evidence Library
Treating Anxiety
What the research shows about the therapies that treat anxiety, and the cautions worth knowing.
The overall picture
Anxiety disorders are among the most treatable conditions in mental health, and the evidence points clearly to two front-line options: cognitive behaviour therapy built around exposure, and the SSRI and SNRI antidepressants. In the largest and best-controlled comparisons, individual CBT produces large improvements and is the single most effective treatment for social anxiety, while SSRIs are the medication of choice when someone prefers not to do therapy or needs more than therapy alone. Acceptance and Commitment Therapy (ACT), which helps a person make room for anxious feelings and act on their values rather than fighting the anxiety, is also well supported: across dozens of trials it beats placebo and usual care and performs on par with established CBT. For children and adolescents the same pillars hold, and combining them works best of all: in the landmark childhood trial, CBT plus sertraline outperformed either on its own. Parents matter too; parent-based work that reduces accommodation can treat a child's anxiety even without the child in the room. Two cautions run through the evidence. Benzodiazepines relieve anxiety quickly but are a poor long-term bet: tolerance, dependence, rebound anxiety on stopping, and interference with the learning that makes exposure work mean they can worsen the course rather than fix it. And the therapies with the weakest support, interpersonal, psychodynamic and EMDR, consistently underperform CBT and often fail to beat placebo. The practical message is consistent: start with an exposure-based therapy, CBT or ACT, add or substitute an SSRI when needed, and combine treatments for children with more severe anxiety.
A note on scope: this library is here to help you evaluate the psychological therapies. The medication studies are included for honest context, because weighing therapy properly means seeing the whole evidence map. I support medication where it helps, but prescribing decisions sit with a doctor or psychiatrist, not with a psychologist.
How to weigh these studies. Not all evidence is equal. From strongest to weakest: network meta-analysis (pools dozens of trials) > meta-analysis > large randomised trial (RCT) > small pilot trial > observational study. Each card shows its study type, and you can sort by strongest evidence first.
What works least: EMDR, interpersonal and psychodynamic therapy
Mayo-Wilson et al.; Bandelow et al. · Lancet Psychiatry; Int. Clin. Psychopharmacology
At a glance
The weakest options for anxiety, clearly behind CBT and often no better than a dummy treatment.
For parents
Not every therapy is equal for anxiety. Interpersonal therapy, psychodynamic therapy and EMDR consistently come out as the weakest performers, well behind exposure-based CBT, and in the best controlled comparisons they do not reliably beat a placebo. They are not the place to start for an anxiety disorder; exposure-based CBT is.
One-to-one CBT is the single most effective treatment for social anxiety; an SSRI is the best medication.
For parents
This is the definitive comparison for social anxiety. Individual CBT came out on top by a clear margin, and along with the SSRI antidepressants it was one of the only treatments that beat a genuine placebo. The message is direct: start with individual CBT, and if someone declines therapy, an SSRI is the best-evidenced medication.
2014 · Network meta-analysis (medication finding) · Within 101-trial network
SSRIs and SNRIs: the medication of choice for anxiety
Mayo-Wilson et al. (SSRI/SNRI finding) · The Lancet Psychiatry
At a glance
The best-evidenced medication; slower than a sedative, but it treats the disorder rather than masking it.
For parents
When someone prefers medication, or needs it alongside therapy, the SSRI and SNRI antidepressants are the best-evidenced choice. In the strongest controlled comparison they were one of only two treatment classes, along with individual CBT, that clearly beat a placebo pill. They work more slowly than sedatives but treat the disorder rather than just masking it.
2014 · Network meta-analysis (safety appraisal) · Across the trial evidence
Benzodiazepines: fast relief, poor long-term bet
Mayo-Wilson et al.; Bandelow et al. · Lancet Psychiatry; Int. Clin. Psychopharmacology
At a glance
Fast relief, but they can lead to dependence, worse anxiety later, and can undercut therapy.
For parents
Benzodiazepines (such as diazepam or lorazepam) calm anxiety quickly, which is why they feel effective. But they are a poor long-term solution and can make anxiety worse over time. The body adapts, so higher doses are needed for the same effect; stopping brings rebound anxiety that can be worse than the original; and because they blunt the very feelings exposure therapy works with, they can undermine the lasting gains that CBT produces. They are best reserved for short-term or occasional use.
ACT works well for anxiety even in a group, so more people can be helped.
For parents
A newer and larger look focused on ACT delivered in groups. For anxiety it produced a medium-to-large improvement, clearly better than waiting for treatment. This matters for access: ACT works in a group format as well as one-to-one, so more people can be helped.
James, Reardon, Soler, James & Creswell · Cochrane Database of Systematic Reviews
At a glance
CBT roughly triples a child's chance of shedding the anxiety diagnosis compared with no treatment.
For parents
The most thorough review of CBT for anxiety in children and teenagers. Compared with no treatment, CBT roughly tripled the chance of losing the anxiety diagnosis. It was less clearly better than good routine care, which is a fair and honest nuance, but against waiting or no treatment the benefit is solid.
Bandelow et al. · Int. Clinical Psychopharmacology
At a glance
Both medication and CBT produce big improvements. Anxiety responds well to treatment.
For parents
The largest single synthesis of anxiety treatments, covering panic disorder, generalised anxiety and social anxiety. Every established treatment, medication and therapy alike, produced large improvements. Medications showed the biggest raw changes, and cognitive behaviour therapy was the strongest of the psychological treatments. The takeaway is that anxiety responds well to proper treatment.
Acceptance and Commitment Therapy (ACT): as effective as CBT
A-Tjak et al. · Psychotherapy and Psychosomatics
At a glance
ACT, the approach I use, beats doing nothing and works about as well as CBT.
For parents
ACT is the approach I work in. Rather than trying to argue anxious thoughts away, it helps a person make room for difficult feelings and keep moving toward what matters to them. Across the trials it clearly outperformed doing nothing, a placebo, and usual care, and it worked about as well as established cognitive behaviour therapy. It is a genuine evidence-based option, not an alternative to the mainstream but part of it.
2008 · Meta-analysis of placebo-controlled RCTs · 27 placebo-controlled trials
CBT versus placebo across the adult anxiety disorders
Hofmann & Smits · Journal of Clinical Psychiatry
At a glance
CBT clearly beats a dummy treatment across the anxiety disorders.
For parents
A clean test of the core question: does CBT beat a placebo for adult anxiety? Across the well-controlled trials, it clearly does. The benefit was strongest for OCD and weakest for panic disorder, but CBT held up as an effective treatment across the range of anxiety conditions.
Coaching the parent alone worked as well as treating the child directly.
For parents
A landmark for worried parents: a treatment delivered entirely to the parent, with the child never seeing a therapist, worked as well as treating the child directly. Supportive Parenting for Anxious Childhood Emotions (SPACE) teaches parents to stop accommodating the anxiety and respond supportively instead. It gives families a real route in when a child refuses therapy.
2008 · Randomised controlled trial · 488 young people
The landmark childhood anxiety trial (CAMS)
Walkup et al. (CAMS) · New England Journal of Medicine
At a glance
For children, therapy plus medication worked best; either one alone was still clearly effective.
For parents
The most important trial in childhood anxiety. It compared CBT, an SSRI (sertraline), both together, and a placebo, in children with separation anxiety, generalised anxiety or social phobia. Combining therapy and medication worked best, but CBT alone and medication alone were both clearly effective and both well ahead of placebo.
Dr Rick Smith, is a dual-doctorate clinical psychologist in Hong Kong specialising in ADHD, OCD, anxiety, executive functioning, and performance psychology. He works with adults and adolescents in his Central Hong Kong practice and online.
Dr Rick Smith, is a dual-doctorate clinical psychologist in Hong Kong specialising in ADHD, OCD, anxiety, executive functioning, and performance psychology. He works with adults and adolescents in his Central Hong Kong practice and online.
Dr Rick Smith, is a dual-doctorate clinical psychologist in Hong Kong specialising in ADHD, OCD, anxiety, executive functioning, and performance psychology. He works with adults and adolescents in his Central Hong Kong practice and online.
