No single therapy is the best one for everyone with anxiety. Cognitive behavioural therapy (CBT) has the strongest research behind it and is usually the first talking therapy recommended. The right choice for you depends on the kind of anxiety you have, how much it affects your life, what you're comfortable with and whether anything else is going on, such as low mood or past trauma.
Anxiety is very treatable. Below, we compare the main therapies, explain where medication fits and set out how to get support in Ireland.
Why CBT is usually recommended first
The HSE describes CBT as one of the most effective treatments for generalised anxiety disorder, and notes that its benefits may last longer than those of medication. A widely cited review in Dialogues in Clinical Neuroscience reached a similar view across anxiety disorders, describing CBT as the psychotherapy with the highest level of evidence. That is a strong reason to consider CBT. It doesn't mean CBT will suit you best, and both how much people improve and how quickly they do so vary.
It helps to separate everyday anxiety from an anxiety problem. Feeling nervous before an interview is normal. Fear, worry or avoidance that hangs around for weeks and gets in the way of your work, relationships, sleep or ordinary plans deserves a proper assessment. You don't need to wait until things reach a crisis, because anxiety is often easier to work with before avoidance becomes a habit.
The type of anxiety matters too. Generalised worry, panic attacks, social anxiety, a specific phobia and anxiety linked to trauma each respond best to slightly different approaches. That is why we always start by understanding what your anxiety looks like before suggesting a way of working.
The main types of therapy used for anxiety
Most of the therapies below have good evidence for at least some kinds of anxiety. The table compares them side by side.
| Therapy | How it works | Often considered for | Important points |
|---|---|---|---|
| Cognitive behavioural therapy (CBT) | Links thoughts, feelings, body sensations and behaviour, then tests anxious predictions | Generalised anxiety, panic, social anxiety, health anxiety | Structured, with practice between sessions |
| Exposure therapy | Planned, gradual contact with what you fear | Phobias, panic, social anxiety, OCD | Paced with you, never forced |
| Acceptance and commitment therapy (ACT) | Making room for anxious feelings while acting on your values | Long-standing worry, anxiety alongside chronic stress or illness | Less about changing thoughts, more about your relationship with them |
| Mindfulness-based cognitive therapy (MBCT) | Combines mindfulness practice with CBT ideas | Recurring worry, anxiety alongside low mood | Often taught in groups and needs regular practice |
| Psychodynamic psychotherapy | Explores how past experiences and relationships shape anxiety now | Anxiety tied to relationships, self-worth or early experiences | Usually longer term and less structured |
| Interpersonal psychotherapy (IPT) | Focuses on relationships, conflict and life transitions | Anxiety linked to grief, role changes or relationship strain | Time-limited and focused |
| EMDR | Reprocesses distressing memories using bilateral stimulation | Trauma-related symptoms and PTSD | Not a general first choice for every kind of anxiety |
Dialectical behaviour therapy (DBT) may also be useful when anxiety comes with intense emotions that are hard to regulate. If you'd like to know more about one of these approaches, we have written separately about acceptance and commitment therapy, and our EMDR page explains how that therapy works with trauma.
Don't choose a therapy only because it's popular. Your diagnosis, how severe things are, anything else you're dealing with, what you've tried before, the therapist's training and your own preferences all matter. Some people want a clear, practical structure. Others want room to understand where the anxiety came from. Either is a reasonable starting point.
How CBT and exposure therapy work
CBT starts from a simple idea: thoughts, body sensations, emotions and behaviour feed each other. Your heart races and you think, "Something is wrong with me." That thought makes you more frightened, the physical symptoms get stronger, and you leave the situation. In CBT, you learn to notice patterns like catastrophising (jumping to the worst outcome), test whether your anxious predictions actually come true and build coping skills you can use in the moment.
Avoidance is what usually keeps anxiety going. Each time you avoid something, you feel relief straight away, and your brain learns that the situation was dangerous. Suppose you dread speaking in meetings. If you stay quiet every time, the fear stays where it is. If you practise in small steps, starting with one comment in a small meeting and working up from there, you get evidence that you can cope.
Exposure therapy builds on this in a planned way. You and your therapist agree a gradual ladder of feared situations, sensations or memories, and you decide the pace together. Nobody is pushed into the most frightening step on day one. Exposure is especially relevant for phobias, panic and social anxiety, but it needs care. Trauma-related symptoms and more complex needs may call for a specialist assessment first, and that is something we will talk through with you.
What happens when you start anxiety therapy
In your first session, your therapist will want to understand your anxiety: when it started, what sets it off, what you avoid, how it affects your sleep, work and relationships, any physical health issues or medication, and what you'd like to be different. They will also ask about your safety. That question is routine and is asked out of care, so please don't read anything into it. Our guide to what to expect in your first therapy session goes into more detail.
From there, you and your therapist agree a plan, including how often you'll meet, whether you'll meet in person or online, and how you'll review progress. Structured approaches such as CBT often include small exercises to try between sessions.
People use the terms loosely, but counselling usually means supportive exploration of what's happening now, and psychotherapy usually means deeper or longer-term work. CBT is a structured form of psychotherapy. In practice there is a lot of overlap. You can explore our counselling and psychotherapy and CBT services to see which feels closer to what you need.
You are entitled to ask any therapist about their qualifications, their accreditation with a professional body such as the IACP, IAHIP or PSI, their experience with your kind of anxiety, confidentiality and their approach. A good therapist will be glad that you asked.
Therapy, medication or both
Talking therapy can be used on its own or alongside medication. Which makes sense depends on how severe your anxiety is, what you prefer, how you've responded to treatment before and what your doctor advises. The review mentioned above reported that combining psychotherapy and medication had relatively strong effects, though only a few studies had tested combinations. That is worth knowing if therapy alone hasn't been enough.
For generalised anxiety disorder, the HSE's treatment guidance describes the main medicines, including two types of antidepressant. Selective serotonin reuptake inhibitors (SSRIs) can take several weeks to start working. Serotonin and noradrenaline reuptake inhibitors (SNRIs) can raise blood pressure. Both can have side effects such as nausea or sleep problems, which often settle within the first couple of weeks. When it's time to stop, your GP will reduce the dose slowly to lower the risk of withdrawal effects, so please don't stop suddenly on your own.
Decisions about medication belong with your GP, a psychiatrist or another qualified prescriber. Your age, pregnancy or breastfeeding, your physical health and any other medicines you take all need individual medical advice. If anxiety stays severe or doesn't respond to treatment, the HSE notes that your GP can refer you to a community mental health team.
If therapy hasn't helped, that isn't a failure on your part. It may be worth checking whether the original assessment still fits, whether your goals were clear, whether you felt comfortable with your therapist, and whether the approach was given enough time. Trying a different evidence-based therapy, or getting input from your GP or a specialist, is a sensible next step.
FAQs
How many therapy sessions does anxiety usually need?
It varies with the therapy, how severe the anxiety is and what you want to achieve. Structured approaches such as CBT are often delivered over an agreed number of weekly sessions, with progress reviewed along the way. Anxiety that is long-standing, linked to trauma or tangled up with other difficulties may need longer, more open-ended work. Your therapist should discuss this with you early on.
How much does anxiety therapy cost in Ireland?
Fees vary by provider, location and whether you meet in person or online. Our current fees are on our prices page, and we keep a low-cost counselling option for people who would otherwise go without. Your health insurance or workplace assistance programme may cover some sessions, so it's worth asking. Publicly funded support is also available through HSE Primary Care Psychology, which your GP can refer you to, or you can refer yourself.
Can I get anxiety therapy online in Ireland?
Yes. Many people find video sessions easier to fit around work and family, and some find it easier to open up from home. You will need a private, quiet space and a reliable connection. As with in-person therapy, check your therapist's credentials and ask what happens if you need urgent help between sessions. We offer online therapy across Ireland, and our comparison of online and in-person therapy may help you decide.
Taking the next step
If anxiety is getting in the way of your life, you don't have to work out the right therapy on your own. Our therapy for anxiety is available in Dublin, in Galway and online, and your GP can also tell you about HSE Primary Care Psychology. When you feel ready, get in touch with us and we'll help you find a therapist and an appointment format that suit you.
If you might harm yourself or can't keep yourself safe, call 112 or 999, go to your nearest emergency department, or call Samaritans free on 116 123. The HSE lists urgent and emergency care options.