What’s the Best Therapy for Anxiety? A Closer Look at CBT, ACT, and EMDR

Anxiety doesn’t always show up as a racing heart or spiraling thoughts. Sometimes it looks like spending too much time or energy on trying to control or manage your anxiety.  Sometimes it’s constant muscle tension or a mind that just won’t turn off, even when everything seems fine. If anxiety is getting in the way of how you want to live, therapy can help. But with so many treatment options out there, where do you start?

Let’s walk through the evidence-based therapies that are most effective for anxiety—and how to know what might be right for you or someone you care about.

Cognitive Behavioral Therapy (CBT) for Anxiety: The Gold Standard

Cognitive Behavioral Therapy is one of the most well-established, well-studied treatments for anxiety. In CBT, the focus is on identifying patterns of thinking and behavior that fuel anxiety and then learning practical ways to shift them.

CBT is especially effective because it offers tools that are both evidence-based and easy to apply in daily life. You’ll learn to recognize unhelpful thinking (like catastrophizing or all-or-nothing thinking), gradually face feared situations, and build coping strategies rooted in your values and goals rather than fear.

How effective is CBT for anxiety?

CBT is considered a first-line treatment for a wide range of anxiety disorders, including:

• Generalized Anxiety Disorder (GAD)
• Social Anxiety Disorder
• Panic Disorder
• Specific Phobias
• Obsessive-Compulsive Disorder (with exposure and response prevention)

A meta-analysis by Hofmann et al. (2012) found that CBT is highly effective for anxiety, with large effect sizes across multiple conditions. Treatment benefits often last well after therapy ends—especially when clients practice skills outside of sessions.

 

Acceptance and Commitment Therapy (ACT) for Anxiety: A Mindful, Values-Driven Approach

Acceptance and Commitment Therapy (ACT) focuses on helping you change your relationship to your thoughts. ACT teaches psychological flexibility—your ability to stay present, open up to and move through difficult feelings, and take actions that reflect your values.

Instead of trying to eliminate anxiety altogether (which often backfires), ACT helps people learn to carry anxiety differently. You’ll practice noticing anxious thoughts without getting hooked by them, and take meaningful steps toward what matters most—even with anxiety along for the ride.

How effective is ACT for Anxiety?

ACT is effective for a wide range of anxiety presentations and is particularly helpful when:

• Anxiety is chronic or intertwined with life transitions
• You’ve tried to “get rid of” anxiety with limited success
• You struggle with avoidance or perfectionism
• You want therapy that incorporates mindfulness and values-based living

A review by Ruiz (2010) showed ACT to be comparably effective to CBT for anxiety, with added benefits in long-term psychological flexibility and quality of life.

 

Can EMDR help Anxiety?

Eye Movement Desensitization and Reprocessing (EMDR) is best known as a treatment for trauma, but it can also help reduce anxiety—especially when the anxiety is rooted in past experiences.

In EMDR, clients recall distressing memories while engaging in bilateral stimulation (often eye movements or tapping). Over time, this process helps the brain reprocess painful events, reducing their emotional intensity and associated anxiety.

EMDR may be particularly useful for:

• Anxiety rooted in past trauma
• Performance anxiety or phobias
• Medical or situational anxiety with known triggers

Although more research is still emerging, studies like Faretta (2013) have shown EMDR to be effective for panic disorder and phobias, and it can be a useful adjunct to CBT or ACT, especially when trauma is part of the picture.

 

Which is the best therapy for anxiety for you?

There’s more than one “right” answer when it comes to therapy for anxiety. All three of these therapies are grounded in research and can be adapted to your specific symptoms, history, and goals.

CBT may be the best starting point for learning immediate tools.
ACT is a great choice for building long-term flexibility and values-based living.
EMDR may be a fit when anxiety stems from unresolved past experiences.

You don’t have to figure it out alone. A therapist can help determine the best approach based on your unique experience.

At Dallas CBT, we specialize in evidence-based treatments for anxiety, including CBT, ACT, and EMDR. If you’re wondering where to begin, we’re here to help you take the first step.

 

References

Faretta, E. (2013). EMDR and CBT in treatment of panic disorder: A comparison. Journal of EMDR Practice and Research, 7(3), 121–131.
Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440.
Ruiz, F. J. (2010). A review of Acceptance and Commitment Therapy (ACT) empirical evidence: Correlational, experimental psychopathology, component and outcome studies. International Journal of Psychology and Psychological Therapy, 10(1), 125–162.

Deciding that it’s time to start therapy and looking for a therapist can already be vulnerable tasks. Now layer on the added stress of wondering whether they’ll truly see you—your identity, your story, your experience—not as something to diagnose, fix, or tiptoe around, but as real, worthy, and whole. For individuals in the LGBTQ+ community, therapy can be a space of powerful healing—but it must feel safe and affirming.

If you’ve ever found yourself scanning bios for keywords like “LGBTQ+ affirming” or “identity-inclusive” or searching for other clues that a therapist will be a fit, this post is for you.

What Does “LGBTQ+ Affirming” Really Mean?

An affirming therapist doesn’t just have the right education and training—they actively work to understand and celebrate the nuances of LGBTQ+ identities. That includes being trauma-informed about the impacts of heteronormativity, homophobia, transphobia, and systemic marginalization, and being clinically competent in treating anxiety, depression, trauma, and identity-related stressors that may be wrapped up in all of it.

Signs a therapist may be affirming include:

• They name LGBTQ+ populations explicitly in their bio
• They’ve actively sought out training and experiences with the LGBTQ+ community
• They acknowledge the role of social stigma in mental health.
• They are open to discussing identity, gender, and sexuality without pathologizing or tiptoeing.
  
  

Acceptance and Commitment Therapy for LGBTQ+ Therapy

At Dallas CBT, one of the supportive therapy models we use when working with LGBTQ+ individuals is Acceptance and Commitment Therapy (ACT). ACT helps you get unstuck from rigid self-stories so you can move toward what really matters to you.  

Here’s how ACT supports LGBTQ+ identity work:

1. Defusion (Unsticking) from harmful narratives

Many LGBTQ+ clients carry messages that were never theirs to begin with—internalized shame, inherited fear, perfectionism, or invisibility. ACT helps you notice these stories for what they are: thoughts, not truths. Instead of arguing with them or believing them blindly, you learn to hold them lightly.

2. Values-based living

ACT invites you to reconnect with your own core values. Not what society expects. Not what your family demanded. But what you want your life to stand for—whether that’s authenticity, creativity, connection, or anything else. Identity exploration is about discovering and living in alignment with who you are.

3. Psychological flexibility

ACT isn’t about feeling good all the time—it’s about becoming flexible in the face of pain. That’s especially helpful when navigating minority stress or living in environments that don’t always understand you. With ACT, you learn to stay grounded in your truth while still showing up fully in your life.

How to Find an LGBTQ+ Affirming Therapist

Finding the right therapist is part research, part intuition, and part trial and error. Here are a few tips to help with your therapist search:

1. Use filters on directories like Psychology Today, Therapy Den, or Inclusive Therapists to search for “LGBTQ+ affirming” or identity-competent clinicians.
2. Read between the lines. Do they name LGBTQ+ populations directly? Do they use inclusive language? Do they list modalities like ACT or trauma-informed care?
3. Ask directly. It’s okay to email or ask in a consult:
   “What’s your experience working with LGBTQ+ clients?” or
   “How do you integrate identity work into therapy?”
4. Trust your sense of safety. You should generally have a strong sense that your therapist cares about you and is on your team.  Therapists are human and make mistakes, but the relationship should be strong enough to hold any minor blips in the road. 

You Deserve More Than Just “Welcoming”

Your best bet is to find a therapist who has made identity work and LGBTQ+- related concerns central to their work.  That is not to say you cannot find an incredible fit in a therapist without this specialty– it is definitely possible, because so much rides on the strength and authenticity of the connection between the therapist and the client.

If you’re in Texas and looking for LGBTQ+ affirming therapy or want to learn more about how ACT can support identity work and emotional wellbeing, reach out to our team at Dallas CBT.  We will connect you with therapists who are committed to working within LGBTQ+ communities and who will help you step more fully into who you are.

Ready to start? Reach out for a consultation. We’d be honored to walk with you.

How To Speak Up: Therapy To Help You Overcome Fear of Public Speaking

It starts with a racing heart. Maybe a dry mouth. A sudden foggy brain where your perfectly prepared words used to be. If you’ve ever felt paralyzed before speaking in a meeting, presenting in class, or even introducing yourself at a social event, you’re not alone. Fear of public speaking—sometimes called glossophobia—is one of the most common fears. And for some, it’s more than just nerves—it’s a form of social anxiety that shrinks their life and their career goals.

As daunting as it may seem, this fear is able to be overcame– we see it all the time.  Exposure-based Cognitive Behavioral Therapy (CBT) can help you work through this anxiety in a practical and effective way. 

What’s Really Going On When You’re Afraid to Speak?

At the root of the fear is often a deeply human concern: the fear of being judged, humiliated, or seen as inadequate. Our minds can run wild with “What ifs”—What if I mess up? What if my voice shakes? What if people think I’m stupid? What if my mind goes completely blank?

These fears can become sticky. Your brain learns to associate public speaking with danger, and it begins to sound the internal alarm (your fight-or-flight response) even before you open your mouth. Over time, you might avoid speaking situations altogether, or tolerate them under certain conditions (e.g., you have to over-prepare for days, you must speak last, you must be drunk).  Avoidance provides short-term relief—but reinforces the belief that speaking is unsafe. That avoidance loop is how anxiety takes hold and grows.

How CBT and Exposure Therapy Break the Social Anxiety Cycle

CBT doesn’t just help you cope—it helps you change your relationship with fear. One of the most powerful CBT tools for social anxiety is exposure therapy, a method that helps retrain your brain to see feared situations as manageable rather than catastrophic.

Here’s how CBT works for fear of public speaking:

• Gradual Exposure: You won’t be thrown onto a TED Talk stage on Day 1. Instead, therapy starts with smaller, manageable steps—like reading aloud to your therapist or practicing a short speech. As you gain confidence, the challenges increase.
• Cognitive Restructuring: While you’re working through exposures, your therapist helps you identify and reframe the anxious thoughts that show up (“If I mess up, it means I’m a failure” becomes “Everyone makes mistakes; it doesn’t define my worth.”)
• Behavioral Experiments: You’ll test your fears in real time. What actually happens when you say “um” during a sentence? When you pause to collect your thoughts? These experiments help you update your brain’s predictions with actual data.
• Skills and Tools: You’ll learn practical strategies to ground yourself—like breathing techniques or posture shifts—and how to use your attention effectively when you’re speaking.

Does Therapy for Fear of Public Speaking Work?

Yes—decades of research support exposure-based CBT as a gold-standard treatment for social anxiety, including fear of public speaking. Meta-analyses (e.g., Acarturk et al., 2009; Mayo-Wilson et al., 2014) show that CBT leads to significant and lasting improvements in anxiety, self-confidence, and quality of life. Importantly, the change doesn’t just happen in your head—it often shows up in your body, too. Over time, the physical symptoms (heart rate, sweating, shakiness) begin to ease as your brain learns there’s no real danger.

You don’t need to become a fearless, spotlight-loving extrovert to overcome public speaking anxiety. You just need to learn how to be with the fear instead of ruled by it– and to get back in the driver’s seat of your own life.

Therapy can help you stop running from discomfort and start moving toward your values—whether that’s leading a meeting, advocating for your ideas, or giving a wedding toast with confidence.  

We believe your voice matters, and want to help it be heard.  Our therapists specialize in anxiety and offer both individual and group therapy for social anxiety and fear of public speaking.  Reach out to our office for more information. 

Facing the Fear: How Exposure Therapy Really Works

There’s a cruel irony in anxiety: the more we avoid what scares us, the scarier it becomes. You dodge a feared situation once, feel temporary relief, and your brain celebrates: “Avoidance worked! Let’s do it again.” Before you know it, your world is shrinking and the anxiety is growing.

Enter exposure therapy—a therapy approach built on the tried-and-true idea that the only way out of fear is through it.

Exposure therapy comes in many variations, and decades of research indicates it’s the most effective treatment for many anxiety-related disorders and Obsessive Compulsive Disorder (OCD).

What Is Exposure Therapy?

Exposure therapy helps people systematically and gradually confront the things they fear—whether those fears are about a situation, a thought, a memory, or a physical sensation. The goal isn’t to traumatize or overwhelm. It’s to teach the brain over time: “This isn’t dangerous, and I can handle it.”

Think of it like re-training your threat detection system. Anxiety disorders are often the result of a hyperactive alarm system—one that rings at full volume even when there’s no fire. Exposure therapy helps your brain re-organize what it considers to be a threat.  

How Exposure Works: The Mechanisms Behind the Method

So how does this actually work on a neurological level?

1. Extinction Learning: In classical conditioning terms, exposure therapy helps reduce the association between a feared cue and the perception of danger. When you face a fear (on purpose) without the dreaded outcome occurring, your brain learns a new association: feared thing = safe.

2. Habituation: With repeated exposure, the emotional intensity of fear responses tends to decrease. Your body learns not to overreact. That pounding heart or sweaty palm no longer screams emergency—it becomes a familiar, manageable signal.

3. Inhibitory Learning: Instead of just unlearning fear, exposure helps you form a new memory that competes with the fear memory. You’re not erasing old learning—you’re building stronger, more flexible alternatives.

4. Self-Efficacy: Perhaps most importantly, exposure therapy builds confidence. Clients often say: “I didn’t think I could do that—but I did.” That shift changes everything.

The Evidence Is Strong

Exposure-based therapies have been studied extensively and consistently rank among the most effective treatments for anxiety-related conditions.

• Exposure Therapy For Phobias and Panic Disorder: Exposure therapy (especially interoceptive exposure for panic) is a gold-standard treatment (Craske & Barlow, 2007).
• Exposure Therapy For PTSD: Prolonged Exposure (PE), developed by Edna Foa and colleagues, has shown remarkable efficacy in helping individuals confront trauma memories and regain control (Powers et al., 2010).
• Exposure Therapy For OCD: Exposure and Response Prevention (ERP) for OCD is the gold standard treatment, according to research. Clients are exposed to anxiety-provoking thoughts or situations without engaging in compulsions. Over time, the obsession loses its grip because the brain learns: “I can tolerate uncertainty. I don’t need to neutralize it.” Studies show that ERP significantly reduces obsessions and compulsions—even in treatment-resistant cases (Foa et al., 2005).
• Exposure therapy for Social Anxiety: Exposure has been shown to be highly effective for social anxiety disorder, particularly when combined with cognitive restructuring—helping individuals reduce avoidance and build confidence in social situations. 
• Exposure Therapy for Generalized Anxiety Disorder (GAD): Exposure techniques targeting worry triggers and uncertainty (especially imaginal exposure) can reduce anxiety severity and improve tolerance of distressing thoughts.

Types of Exposures

Not all exposure looks the same. Here’s a breakdown of the different types, each tailored to specific challenges:

1. In Vivo Exposure

Facing feared situations or objects in real life. For example, someone with a driving phobia might gradually work up to driving on a highway.

2. Imaginal Exposure

Used when the feared stimulus isn’t accessible or is internal (e.g., memories, thoughts, images). Clients vividly imagine the feared scenario to reduce avoidance and emotional reactivity.

3. Interoceptive Exposure

This involves deliberately triggering physical sensations associated with panic (e.g., dizziness, shortness of breath) to reduce fear of the sensations themselves.

But Isn’t Exposure…Horrible?

This is the biggest myth. Yes, exposure can be uncomfortable—but not intolerable. Therapists work collaboratively to build a hierarchy so that clients gradually work their way up to more feared situations. The goal is empowerment, not suffering.

In fact, most clients describe exposure therapy as surprisingly liberating. Once avoidance loses its hold, people begin to reclaim their lives.

Get support from Exposure Therapists at Dallas CBT

Exposure therapy isn’t about white-knuckling your way through fear. It’s about learning—emotionally, cognitively, and physically—that fear doesn’t have to rule your life. It’s an act of courage, yes—but also an act of healing.

If you’re struggling with OCD, panic, trauma, or phobias, exposure therapy might be one of the most helpful tools on your path forward.  And if you’ve tried everything else and nothing’s worked? It might be time to face the fear—in a safe, guided, evidence-based way.

Therapists at Dallas CBT specialize in exposure therapy for anxiety disorders and OCD.  Call us to schedule an appointment for help on your recovery journey.

References
Craske, M. G., Kircanski, K., Zelikowsky, M., Mystkowski, J., Chowdhury, N., & Baker, A. (2008). Optimizing inhibitory learning during exposure therapy. Behaviour Research and Therapy, 46(1), 5-27.
Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S., Campeas, R., Franklin, M. E., … & Tu, X. (2005). Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. American Journal of Psychiatry, 162(1), 151-161.
Powers, M. B., Halpern, J. M., Ferenschak, M. P., Gillihan, S. J., & Foa, E. B. (2010). A meta-analytic review of prolonged exposure for posttraumatic stress disorder. Clinical Psychology Review, 30(6), 635-641.
Craske, M. G., & Barlow, D. H. (2007). Mastery of your anxiety and panic: Workbook. Oxford University Press.

How do I stop overthinking and procrastinating?

Get to a next best step once you realize you are overthinking and procrastinating. Overthinking often breeds inaction. It’s a key maintaining factor in the process of procrastination. Here’s a personal example. I’ve been overthinking this blog post for 3 to 6 weeks. On the one hand, I’ve got ideas, but on the other, it just didn’t feel right. Maybe I hadn’t “figured it out.” Maybe something else.  Regardless, I was stuck and procrastinating.

Like, I’m capable of forming coherent thoughts at times, but on the other hand, I haven’t written one down…

What angle do I want to take?  What’s the purpose?  Will this or that be the most impactful? What is the the best approach?

 

Pause.

 

Overthinking may present itself in a couple of ways, but the behavioral pattern of thinking (and thinking and thinking) without action is present in many mental health disorders, and just at a basic human level. It’s a common cognitive response to anxiety and a method of trying to control an experience that often leads to good old-fashioned procrastination. Overthinking, especially when it leads to difficulty with planning, organization, and task completion, can also be a sign of executive dysfunction.  ADHD and anxiety are commonly linked to executive dysfunction– our brains just don’t do what we’d like them to all the time.

 

Why do I get stuck overthinking? 

Overthinking is self-reinforcing while not actually helping you move forward.Why is it so easy to get stuck in the pattern of overthinking and procrastinating? It’s likely because the pattern reinforces itself.  It feels good to overthink at times (e.g., “I’m almost there, I’ve almost cracked the code, if I can just think a little more”), or maybe it feels just less bad (e.g., “I’m scared of BLANK consequence, but maybe I can figure out a way around”), and sometimes less bad is enough to reinforce it. For me, overthinking feels like “I’m making progress,” which reinforces it positively, but also keeps me from having to do the thing that is stressful about writing: actually writing.

 

Try this to stop overthinking.

If you even think you might be overthinking, take a brief pause.  90 seconds.

Use a present-moment-focused skill (being in the present moment) like a breathing exercise for 90 seconds, and just try to be for that period.

There are other options here, of course, but this is my favorite first step in many cases.  For others, it may be 90 seconds of gentle physical movement, 90 seconds of sunshine, 90 seconds with a cold compress on your head.  Work with your therapist to identify what works as a pause for you.

Next, decide if you need one or two more rounds of a present-moment skill, or, if you’re ready, try one action.

 

Take an action; aka, what’s a next step? 

Identify something that would be a next best step. “Next best” here means something you’ll probably have to do anyway, even if it’s not the perfect next step. Just a next action that may help. Devote 5 minutes to DOING it. It doesn’t have to be perfect, it just has to be.

After this, devote another 5, or if you’re feeling it, 10 minutes to either this or another next best step. Once you need a break, take a brief 3 to 10 minute one, then try another 5 minutes.

If you need a longer break, take something that most would call a reasonable break, but commit to what time you’ll get re-started.

 

A real-life example: 

My favorite intervention with creative types who are stuck in writer’s block, for example, is: “Write a BLANK Story.” For perfectionists, it’s often “Write a BAD Story.”  For a Mr. or Ms. Smarty-pants Perfectionism, it’s “Write a DUMB Story.”  Write a quick stream-of-consciousness story.  The only point is to actually WRITE SOMETHING.  Engage in the behavior. That’s a next best step.

Get it done. We will do this with our clients in session (called body doubling), or we’ll do it separately and trade next week if that’s helpful.  The story doesn’t have to be long, but let’s agree to writing something that is a meaningful word count for that person.

Once you’ve done it, don’t focus on the product.  Try to hold the end product lightly and find appreciation for the action you took. What was it like to write?  What was it like to write without caring about the product?  Can we try it again next week, but as “Write a story you only kind of like with a beginning, a middle, and an end?”

 

Overthinking is common and easy for all of us to get stuck in.  Try a next best step once you can accept that you may not think your way out of the problem.