Anxiety Treatment in Ireland – Counselling & CBT in Dublin and Online

There are two main treatments for anxiety – talking therapy and medication. If you have anxiety and are considering treatment I shall explain all the options open to you to help you make an informed decision.

I’m Dr Elaine Ryan, a psychologist based in Dublin. I’ve been treating anxiety and related problems for over 20 years. I’ve also had anxiety myself – as a child, and later panic disorder as an adult – so I know this from both the professional and personal sides. I appreciate how daunting it feels when looking for something or someone to help you with anxiety and also that you might be afraid of the treatment itself. I respect that anxiety creates some enormous emotions and feelings, so before I telling you about treatments, let me start by saying that all good therapy teaches you to lower those emotions to get you to a place where you can use your therapy.

If you haven’t already done so I recommend you read my complete guide to anxiety and come back and read about treatments.

Psychological therapy for anxiety

Cognitive Behavioural Therapy (CBT) is one of the most recommended treatments for anxiety in Ireland or indeed anywhere as it is an effective gold standard treatment for anxiety disorders. Gold standard means it is evidence based, where it has been extensively researched and shown to be effective for anxiety, with high success rates.

Exposure Therapy should also be used, often as part of CBT, as anxiety is maintained by avoidance. Exposure therapy is used to help you stop avoiding things in a controlled and safe way.

How I See Anxiety (and Why That Matters for Treatment)

A lot of people talk about anxiety as if it’s a mysterious force that descends on you from nowhere.

Clinically – and from my own lived experience – I see it differently.

Anxiety is an emotion with three main components:

1. What you feel in your body – racing heart, tight chest, dizziness, nausea, tension.
2. What you think – “What if…?”, catastrophising, self?criticism, worries about the future.
3. What you do (or avoid) – cancelling plans, “just in case” behaviours, checking, googling symptoms.

Those components connect into patterns. And patterns can be understood, predicted and changed.

As a psychologist, I don’t think of myself as an anxiety “guru” with secret tricks. I’m someone who is:

• well?trained in evidence?based therapies (especially CBT and exposure?based approaches), which are recommended as first?line treatments for anxiety disorders in national guidelines
• experienced – I’ve sat with people who have had almost every form of anxiety you can imagine
• informed by my own history of anxiety and panic, which keeps me grounded in how it actually feels

Those therapy models give us maps that show how anxiety works in the mind and body. My job in treatment is to:

• spot the specific patterns that are maintaining your anxiety
• explain them in clear, plain English
• teach you practical ways to change those patterns so anxiety no longer dominates your life

You don’t need to become an expert in psychology. You need someone who can break it down and guide you through the steps. That’s what this treatment page – and my work with clients – is about.

Cognitive Behavioural Therapy

Cognitive Behavioural Therapy (CBT) is the main psychological treatment for anxiety disorders worldwide. Large reviews of studies consistently show CBT is effective for conditions like panic disorder, generalised anxiety, social anxiety and health anxiety.

At its heart, CBT focuses on the connection between:

• Thoughts – what you tell yourself about situations (“I can’t cope”, “I’ll have a heart attack in this queue”).
• Feelings – anxiety in the body and emotions (fear, dread, shame).
• Behaviours – what you do in response (avoid, escape, seek reassurance, check).

Over time, certain thought?behaviour loops keep anxiety going, even when you desperately want it to stop.

In CBT for anxiety, we work together to:

• Identify unhelpful thinking patterns – like catastrophising, over?estimating threat, mind?reading others’ opinions, or assuming you “couldn’t cope” if X happened.
• Test those thoughts – using evidence, thought records and real?life experiments to see what’s actually true.
• Change behaviours that maintain anxiety – especially avoidance and “safety behaviours” (things you do to feel safe that ironically keep the fear alive). You can learn how to make your own behavioural experiments for anxiety here.

For example:

• Someone with panic might avoid exercise, in case a racing heart triggers a panic attack. In CBT, we’d slowly reintroduce gentle exercise while showing the difference between normal exertion and panic – so the heart racing no longer signals catastrophe.
• Someone with social anxiety might replay conversations for hours, convinced they sounded stupid. In CBT, we’d challenge those beliefs, look at realistic evidence, and plan graded “experiments” such as intentionally saying something small in a meeting and observing the actual response.

CBT is active and practical. You’ll have things to try between sessions, and we’ll review how they went. It’s not about “thinking positively”; it’s about thinking accurately and behaving in ways that reduce anxiety in the long term. I am going to take some time now and show you what CBT is like and give you some things to try to allow you to get a flavour of CBT.

Imagine Saoirse who has social anxiety and thinks, “If I speak in meetings, I’ll say something stupid, and everyone will think I’m a fool” This negative thought causes Saoirse to feel extremely anxious and avoid speaking up in meetings.

1. Identifying Maladaptive Thought: Saoirse’s therapist helps her identify this automatic negative thought that triggers anxiety.
2. Challenging the Thought: They work together to challenge the validity of this thought by asking questions like, “What evidence do you have that you will say something stupid?” and “Have there been times when you spoke in a meeting and things went well?”
3. Reframing the Thought: Saoirse learns to reframe her thought to something more balanced, like, “I might feel nervous, but I can prepare and contribute meaningfully to the meeting.”
4. Behavioural Change: With this new way of thinking, Saoirse gradually starts to participate in meetings. As she does this, she realizes that her fear of negative judgment was exaggerated, which reduces her anxiety over time.

By changing his maladaptive thinking, Saoirse changes her behaviour (participating in meetings) and her emotional state (reduced anxiety). I’ve make a quick video to explain how CBT works.

How CBT Works for Anxiety

The tenet of CBT is that your thoughts, not events, affect your feelings and actions. For example, if you have to give a speech, your fearful thoughts create anxiety, not the address. ; in other words, your thoughts can create anxiety. CBT helps you see the link between your thoughts and emotions and shows you how to change them.

CBT works for anxiety by addressing the distorted thinking patterns that contribute to your anxious feelings and behaviours. It focuses on identifying, challenging, and altering these negative thought patterns and replacing them with more realistic and balanced ones. Here’s how CBT helps in managing anxiety:

1. Identifying Negative Thoughts:
   • Example: Imagine you have a big presentation at work. Your automatic thought might be, “I’m going to mess this up, and everyone will think I’m incompetent.” In CBT, you learn to recognize this thought as a common trigger for anxiety.
2. Challenging Negative Thoughts:
   • Example: Your therapist might ask you to examine the evidence for and against your belief that you’ll mess up the presentation. You might realize that you’ve successfully delivered presentations before and received positive feedback, which challenges the initial negative thought.
3. Changing Behaviour:
   • Example: Instead of avoiding presentations out of fear, CBT encourages you to confront the situation. You might start with smaller tasks, like speaking up in meetings, gradually building confidence. Over time, this helps reduce anxiety around public speaking.

You can see in the image below a sample CBT thought record that you would typically use to record and change your thoughts and I have included the worksheet in PDF format for you to download.

Key Techniques Used in CBT for Anxiety

Several techniques are employed in CBT to help you manage anxiety:

Cognitive Restructuring:

• Example: Aisling often thinks, “If I don’t get everything perfect, I’ll fail.” In CBT, she learns to challenge this thought by considering more balanced perspectives, such as, “It’s okay to make mistakes; I can learn from them.” You can learn how to use cognitive restructuring techniques in this article.

Exposure Therapy:

• Example: Conor has a fear of flying. In session we gradually confront this fear by first looking at pictures of airplanes, then visiting an airport, and eventually taking a short flight. Each step helps reduce his anxiety.

Relaxation Techniques:

• Example: During stressful situations, Killian practices deep breathing exercises he learned in CBT. By focusing on his breath, he calms his mind and body, reducing his anxiety levels.

Behavioural Activation:

• Example: Aoife feels anxious about going out and often isolates herself. In session I encourage her to engage in activities she enjoys, like joining a book club. By doing so, she feels more accomplished and less anxious.

Benefits of CBT for Anxiety

CBT offers numerous benefits for those suffering from anxiety:

1. Long-term Effectiveness: CBT provides you with tools and strategies they can use beyond the therapy sessions, promoting long-term management of anxiety. I always say in session that they whole idea of CBT is to make me redundant; you should get to a stage where you do not need your therapist and have the tools at your disposal.
2. Skill-building: You learn practical skills to identify and challenge negative thoughts and manage their anxiety independently.
3. Empowerment: By understanding the cognitive-behavioural model, clients feel more in control of their anxiety.
4. Evidence-based: Numerous studies, including those by the American Psychological Association and the National Institute of Mental Health, support the effectiveness of CBT in treating anxiety.

It is a cost-effective treatment.

CBT is a cost-effective treatment option due to the structured nature of the model. It is a short-term model of therapy and has been shown to work, so in theory, you should not have to return and pay for more sessions. This makes it cost-effective if you have to pay for the therapy yourself or for employers or other bodies being billed for treatment.

Also, due to the nature of the model, it can be effectively delivered through self-help books, courses and online, not only adding to its cost-effectiveness but also giving the client more choice in how they wish to receive treatment.

It can be used to treat many types of anxiety disorders.

CBT is an accepted model of therapy for the different types of anxiety disorders, including 

• GAD
• panic disorder
• social anxiety

Depending on your type of anxiety disorder, the model can be tailored to your needs. This is done through the homework that is part of CBT.

During homework, think of yourself as a scientist gathering evidence on your thought processes and behaviours before testing them and changing them.  

The data you collect on your thoughts and behaviours will be unique to you and your type of anxiety disorder, and your therapist will then show you how to change your beliefs or design behavioural experiments that will fit you.

It can help people learn how to deal with their anxiety in the future.

When you fully understand what led to anxiety and, through behavioural experiments, see that you can handle situations that previously led to fear and anxiety, this gives you the confidence to manage stress-provoking problems in the future.

CBT can help you in other areas of your life.

Once you have gone through the process of CBT and understand how your thoughts and behaviours can either help or hinder you, this skill can be applied to many aspects of your life.

As a psychologist, I regularly use CBT not only to help people with anxiety but also to help improved their relationships or as a form of coaching to help with self-development.

The whole idea of CBT is to teach you to be your own therapist and make your therapist redundant. Once you have achieved this, you do not need to return and pay

If you are ready for therapy it is crucial that you not only find someone competent and trained in CBT but also a therapist that has extensive knowledge of anxiety and how to work within the model of CBT and apply it to anxiety.

Finding a qualified CBT therapist is crucial for effective treatment. Here are some tips to help you in your search:

1. Check Credentials: Ensure the therapist is licensed and has specific training in CBT.
2. Ask for Recommendations: Seek referrals from healthcare providers or trusted individuals.
3. Research Experience: Look for therapists with experience in treating anxiety disorders.
4. Initial Consultation: Schedule a consultation to discuss your concerns and gauge if the therapist’s approach aligns with your needs.

Additional Resources for Help

For further information and support, consider the following resources:

1. BABCP: Provides a directory of CBT therapists
2. National Institute of Mental Health (NIMH): Offers information on anxiety disorders and CBT.

In Practice: Another Quick Example of How to Apply CBT

Situation: You get invited to speak at a work event.

1. Old Pattern:
   • Thought: “I’ll definitely make a fool of myself.”
   • Feeling: Fear/dread.
   • Body: Racing heart, tense stomach (overactive amygdala).
   • Behaviour: You find a reason to cancel or avoid.
2. Using the Model:
   • Identify & Challenge: “Is it certain I’ll fail? I’ve spoken up in meetings before without catastrophe.”
   • Physiological Shift: Practice slow breathing for 1 minute, calming the fight-or-flight surge.
   • New Behaviour: You decide to at least attend and share one brief comment.
   • Scientific Backing: Studies show repeating this pattern weakens fear pathways and strengthens confidence pathways in the brain (neuroplasticity).

What to Expect in Anxiety Therapy With Me

Your First Session – Mapping Your Anxiety

The first session is a chance for you to tell your story at your own pace.

We’ll talk about:

• what you’re struggling with now – symptoms, triggers, how anxiety affects your life
• when you first remember anxiety showing up (for many people it goes back years)
• any previous help you’ve had (counselling, medication, courses) and what did / didn’t help
• your goals – what you’d like life to look like if anxiety was no longer in charge

I’ll ask some questions to get a clear picture, but there’s no interrogation and no pressure to share things you’re not ready to. Many people tell me the first session already feels relieving – it’s often the first time they’ve talked honestly about anxiety with someone who really gets it.

By the end of that first appointment, I’ll usually be able to say:

• what type(s) of anxiety you’re dealing with (e.g. panic disorder, GAD, social anxiety, health anxiety, or a mix)
• what patterns I see in your thoughts/behaviours
• an initial treatment plan and how CBT/counselling can help

You’re very welcome to ask questions about the process. Therapy is a partnership; you should feel comfortable with the plan.

Ongoing Sessions – Skills, Practice and Gradual Change

Most people start with weekly sessions. As things improve, we might move to fortnightly.

A typical session might include:

• checking in on how your week has been
• reviewing any anxiety spikes or difficult situations
• discussing how homework / experiments went
• teaching and practicing a new skill (e.g. a breathing technique, a way of responding to a particular thought, planning an exposure step)
• agreeing on a small, doable goal for the coming week

I often sketch out your “anxiety cycle” visually in session so you can see how it works – many clients find that incredibly helpful: “Oh, so when I avoid that situation, it actually confirms the fear… that’s why it’s stuck.”

We then systematically break that cycle:

• adjusting thoughts
• tweaking behaviours
• experimenting with new responses
• gradually facing feared situations

It’s normal for anxiety to rise a bit at points – especially when you’re facing things you’ve been avoiding. We’ll prepare for that and build in support. The whole point is that you’re not doing this alone or blindly; we’ll move step by step with plenty of safety nets.

How Long Does Treatment Take?

There’s no one answer, but to give you a realistic sense:

• for a single, focused anxiety problem (e.g. panic attacks, social anxiety, health anxiety) a structured CBT approach often takes around 8–15 sessions
• for more complex or long?standing anxiety, or when there are other difficulties (depression, trauma, OCD), treatment may take longer

We’ll review progress regularly. You’ll know therapy is working when:

• you can do things you used to avoid
• the intensity and frequency of anxiety drops
• even when anxiety shows up, you feel more confident managing it
• your life feels bigger again (more activities, less fear dictating choices)

Therapy isn’t meant to be endless. The aim is that you build a skill?set and confidence so that you no longer need me.

Medication

As a psychologist, I don’t prescribe, but I often work with clients who take meds concurrently. We’ll monitor how it’s going, and sometimes part of therapy is optimising that aspect (for instance, ensuring you’re not relying on a tranquilizer as a sole solution but using the space it gives you to practice therapy skills). If you want to taper off meds eventually, therapy can assist in providing coping tools to do so smoothly with your doctor’s guidance.

In Ireland, medication for anxiety is prescribed by medical doctors – usually your GP, and sometimes a psychiatrist – not by psychologists. For conditions like generalised anxiety disorder, the HSE notes that medicine is usually considered if psychological therapies and talk treatments have not helped enough.

Common options your GP might discuss include antidepressants such as SSRIs (for example sertraline, escitalopram, citalopram or fluoxetine) and sometimes SNRIs like venlafaxine or duloxetine. In certain cases, other medicines such as pregabalin may be used if SSRIs or SNRIs are not suitable, and benzodiazepines (like diazepam) may be prescribed very short?term during a severe spell of anxiety because of their addiction risk.

Decisions about whether to start, change or stop medication are always made between you and your GP or psychiatrist, taking into account your overall health, other medicines and possible side?effects. My role as a psychologist is to provide evidence?based therapy alongside this – I do not prescribe, but with your permission I’m happy to liaise with your doctor so that therapy and medication work together rather than in isolation.

How to Reach Out

If you’d like to discuss whether anxiety therapy with me is a good fit, you can:

• use the contact form on the Contact page

FAQs About Anxiety Treatment

Q: Do I need a GP referral to see you?
A: No. You can contact me directly. If you’re already under the care of a GP or psychiatrist, I’m happy to work alongside them. If I feel a medical review is needed (for example, if some symptoms need checking), I’ll say so and we can coordinate.

Q: I’ve tried counselling before and it didn’t help. Is this any different?
A: It can be. “Counselling” is a very broad term. CBT and structured anxiety treatment are more specific – we don’t just talk about how you feel; we also map the anxiety cycle and actively experiment with different ways of thinking and behaving. That said, your past experience matters – we’ll talk about what didn’t work before and make sure we do things differently this time. Sometimes previous therapy has lacked a clear focus on anxiety, or hasn’t included enough practical work between sessions. We’ll be very intentional about that.

Q: Will I have to do things that terrify me?
A: We won’t throw you in the deep end. Facing fears (through graded exposure) is part of effective anxiety treatment, but it’s done gradually and collaboratively. We’ll agree each step together. You’ll never be forced to do something you’ve strongly said no to. In fact, most people are surprised to find they feel more in control when they’re facing fears with a clear plan, rather than avoiding things and feeling controlled by anxiety.

Q: Can I do therapy if I’m already on medication?
A: Yes. Many of my clients are on medication prescribed by their GP or psychiatrist. Medication can reduce the intensity of anxiety enough to help you get more out of therapy. Over time, some people choose to reduce or stop medication with their doctor’s guidance once they’ve built strong CBT skills; others prefer to stay on a stable dose. We’ll work with whatever you and your doctor decide – therapy does not depend on being off medication.

Q: Is online therapy really as good as in?person?
A: For many anxiety problems, yes. Research comparing face?to?face CBT and therapist?supported online CBT shows similar improvements in anxiety symptoms when the treatment is delivered properly. Frontiers+1 What matters most is the quality of the therapeutic relationship and the work you do between sessions, not whether the room is physical or virtual. If we start online and you later decide you’d like to try an in?person session (and you can travel to Dublin), we can arrange that.

Q: What if I start therapy and decide it’s not for me?
A: You’re never trapped. You’re free to stop at any time. I do encourage people to give it a fair try (e.g. a few sessions), as anxiety often resists change at first and it can take a little while to feel the benefit. If at any point you feel the approach isn’t right for you, we’ll talk about it honestly. I can adjust what we’re doing, or if you prefer, help signpost you to other services that might suit you better. My priority is that you get the help you need, whether that ends up being with me or elsewhere.