Seeking psychological treatment for an anxiety disorder (e.g., panic disorder, social anxiety disorder, obsessive-compulsive disorder) can be a confusing process as types of therapy for anxiety can vary widely and it can be hard to know which type would best suit your needs.

According to the American Psychological Association’s list of  research-supported psychological treatments, cognitive-behavioral therapy, often including a exposure therapy component,  is a first-line treatment for most anxiety disorders. The Association for Behavior and Cognitive Therapies and the International OCD Foundation both have a number of helpful guidelines for your anxiety therapist search including a searchable database to find therapists in your area, key words to look for in a prospective anxiety therapist’s profile, and questions to ask your prospective therapist to help you make your decision.

Finding a therapist, making the initial appointment, and the anticipation before the initial appointment can involve some unique challenges for you if you are already experiencing high levels anxiety. Here are some of the challenges that are commonly reported at the beginning of therapy:

Tolerating Uncertainty.  It is understandable to be nervous about starting therapy as there are a lot of unknown variables: Will we be a good match? Will therapy work? How long will it take for me to see changes? We take risks and tolerate unknowns on an everyday basis, but these risks can become more difficult to accept when we experience high levels of fear or anxiety. A major goal of anxiety treatment is to learn to tolerate some uncertainty and take risks so you can live the life you want to live. Making the commitment to try anxiety treatment despite fear of the unknown is an important first step.

Disclosure. If you suffer from social anxiety, making the decision to talk to a complete stranger about yourself and your symptoms can be terrifying. Even if social anxiety is not a primary problem, you may have been accustomed to hiding your symptoms out of shame or embarrassment and talking about them out loud is the last thing you would want to do. Letting your new therapist know that you experience discomfort when speaking about your presenting problem can be helpful in setting the pace of the initial session. Additionally, it may be helpful to “practice” speaking about your anxiety with someone you trust as it will get progressively easier with practice.

All-or-nothing Thinking. Some thoughts that may come up at the beginning of therapy include, “I have to have the perfect therapist/treatment or I will not get better,” or “I have to do treatment in exactly the right way or it will not work.” Is it even possible to find a “perfect” therapist or to do treatment perfectly? These thoughts can create additional anxiety and are examples of all-or-nothing thinking, which is the tendency to see things in extremes when the reality is actually somewhere in the middle. Your therapist can help you identify when these thoughts are coming up for you so you can practice less extreme, more realistic alternative responses that will help you stay motivated in treatment.

Anxiety treatment involves a lot of hard work and initial uncertainty, but making the commitment to actively work on your anxiety can result in tangible and long-lasting improvements.