By Tara Bannow • The Bulletin

A number of tools exist for people with anxiety who can’t afford therapy.

1) The Anxiety Disorders Association of America offers a number of tools on its website:

2) The American Psychological Association also offers resources online:

3) OHSU’s Sydney Ey recommends the book, “Facing Panic,” for people who suffer from anxiety. It is available on Amazon.

4) Moodgym out of Australia offers online cognitive behavioral therapy for anxiety. It costs $39 for 12 months of access:

Therapists often help their clients develop tactics to ease the turmoil happening in their minds. Repeat a mantra. Hold a favorite object. Breathe deeply.

When it comes to anxiety disorders, however, that might not be the best medicine. Clinical psychologist Jason Guy Richards said traditional psychotherapy only serves to prolong or even worsen anxiety because it directs people to avoid uncomfortable feelings.

Anxiety specialists like Richards describe theirs as more of a face-your-fears approach. Their clients confront anxieties head on, which usually leads people to recognize their thinking errors.

“We take the fears and have them engage — on purpose — the cognitive-based fears, whether they be images or words,” said Richards, a licensed clinical psychologist. “If they do that repetitiously, it actually burns up the anxious response to the images or words.”

Richards’ counseling practice, the Portland Anxiety Clinic, focuses solely on anxiety disorders. It opened about eight years ago. More recently, Richards and his partner, Jill Davidson, have received numerous inquires from Central Oregon — so much so, they launched a sister clinic in downtown Bend.

“We were getting enough phone calls that we considered the Central Oregon area to be in need of our services,” Richards said. “In fact, people drive down to Portland to see us quite frequently.”

Some evidence suggests the volume of people who need such help is increasing. An estimated 8.3 million Americans suffer from serious psychological distress, and their access to health care services deteriorated between 2006 and 2014, according to an April study published in the journal Psychiatric Services.

Social media and the 2016 presidential election appear to be playing a role. The American Psychological Association’s 2016 annual survey found more than half of Americans reported the election was a very or somewhat significant source of stress. Four in 10 people said political and cultural discussions on social media caused stress.

“It’s not a diagnostic category, Trump anxiety, but I’ve certainly seen that,” said Robert McLellarn, a licensed clinical psychologist in Portland.

A clinic specifically dedicated to anxiety might sound unusual, but there are actually three such freestanding clinics in Portland. Counselors from all three said people with anxiety would be better-served going to an anxiety-specific clinic.

“Somebody who says they do 10 different things, I don’t trust they can do any one of those all that well, frankly,” said McLellarn, who directs the Anxiety and Panic Treatment Center in Portland, which he founded about 15 years ago.

Anxiety specialists like Richards and McLellarn rely on a type of therapy called cognitive behavioral therapy (CBT), which helps people identify mistakes in their thinking and then works to change their behavior by gradually exposing them to the things they’re afraid of.

McLellarn, for example, has a patient who worries increasing his heart rate puts him at risk of having a heart attack, despite having been given a clean bill of health from three cardiologists. The fear keeps him from drinking coffee, exercising or having sex.

“The exposure, the behavioral part is: Go exercise, have some coffee, have sex with your wife and let’s see what happens,” McLellarn said, “And so far it’s going fine. He hasn’t died yet.”

It’s really the difference between helping people cope with their anxiety versus giving them the support to face those fears, said Allison Bonifay, executive director and a therapist with the NW Anxiety Institute in Portland. It’s hard work that requires creativity and a willingness to experiment, she said.

McLellarn agrees traditional psychotherapy can be harmful to people with anxiety. That’s because it devotes a lot of time to examining the origins of certain thoughts. If someone has obsessive compulsive disorder, for example, the therapist might try to learn how the fear of touching a doorknob started. That makes it seem like those thoughts are meaningful, which they are not, McLellarn said.

“From a treatment point of view, these thoughts mean nothing,” he said. “They’re just noise.”

Sydney Ey, a professor of psychiatry at Oregon Health & Science University, disagrees that traditional psychotherapy is harmful for people with anxiety. That’s because research has shown the technique used, whether CBT or traditional psychotherapy, has a smaller effect on patients’ improvement than the relationship between the patient and therapist, she said.

“It’s when you feel like your therapist cares about you and you feel like a level of trust and safety with your therapist,” she said.

That said, Ey agrees that exposure-based therapy is a powerful tool for anxiety because it helps people discover they can handle certain situations, or that their thoughts aren’t as scary as they imagined.

Ey often instructs patients to consider something they probably haven’t: What’s the best thing that could come out of the situation?

“The interesting thing is, people who are really good at worrying, they never ask themselves that question,” she said. “They never say, ‘What’s the best thing that could come out of having to give this talk? Or asking somebody on a date. They never think that way. They’re always thinking about catastrophe.”

Right now, both Richards and Davidson of the Bend Anxiety Clinic split their time between seeing patients in Portland and Bend. They’re looking to hire a new counselor for the Bend clinic.

The Bend Anxiety Clinic does not contract with insurers, so most people would need to pay out-of-pocket for treatment there. But Richards said getting treatment doesn’t just make people with anxiety feel better, it equips them with the skills to take care of it on their own if it comes back in the future.

“In other words,” he said. “We’re not necessarily a long-term therapy.”

—Reporter: 541-383-0304,