Anxiety: who to see and what helps

Anxiety · Kitchener, Waterloo & Cambridge

Anxiety becomes a disorder when the worry, the physical tension and the avoiding are persistent and severe, and they start to run your days. For generalized anxiety, the kind this page is mostly about, Canada’s clinical guideline calls cognitive behavioural therapy (CBT) an effective first-line treatment that works as well as medication. CARESPACE counsellors are Registered Psychotherapists and Registered Social Workers, they offer CBT, and a counsellor is your first visit.

What anxiety is

Ordinary anxiety is occasional, mild and brief. In an anxiety disorder it comes more often and more intensely, and it can last for hours or days. One in three adults will have an anxiety disorder in their lifetime.

Generalized anxiety disorder (GAD) is the form most people mean when they say “I have anxiety”. It is excessive worry on more days than not, for at least six months, about a number of things at once, such as work or school, and the worry is hard to control. About 6 in 100 people have it at some point in their lives.

Several narrower conditions have pages of their own, because the treatment differs:

• Panic disorder. Sudden panic attacks that come unexpectedly and keep returning.
• Social anxiety. The fear is about social situations and being judged, not about many subjects.
• Phobias. Marked fear of one specific object or situation.
• Health anxiety. The worry keeps coming back to being ill.
• OCD and intrusive thoughts. Unwanted thoughts answered with rituals. OCD is no longer classed as an anxiety disorder.
• Stress. Stress, fatigue and feeling out of control can set off anxiety symptoms, but stress is not itself an anxiety disorder.

Symptoms of anxiety

• Worry about many things that you find hard to stop or control
• Feeling restless, keyed up or on edge
• Tiring easily
• Difficulty concentrating
• Irritability
• Muscle tension
• Trouble sleeping
• A pounding or faster heartbeat, shallow breathing, trembling, sweating, dizziness or nausea
• Stomach problems
• Avoiding situations, or leaning on small “safety behaviours” to get through them

School and work are the usual subjects. In a region with two universities, a college and a large tech sector, that often means grades, co-op placements and performance reviews.

How CARESPACE helps with anxiety

Counselling & Psychotherapy

In CBT for anxiety you learn to identify and question anxious thoughts, you face what you have been avoiding in planned steps, and you practise between sessions. CARESPACE counsellors offer cognitive behavioural therapy (CBT). CBT for an anxiety disorder should come from a professional with training in CBT specific to anxiety disorders, which is what Ontario’s standard asks for, so ask for that when you book; if nobody suitable is available, ask a physician or nurse practitioner for a referral.

See the psychotherapists who treat anxiety →

More about cognitive behavioural therapy (CBT) →

Nurse Practitioner

For anxiety, a Nurse Practitioner can carry out the assessment described above, look for a medical cause, and prescribe and monitor medication. In Ontario the role is authorized to diagnose, to order and interpret tests, and to prescribe.

See our nurse practitioner team →

Personal Training

The exercise evidence for generalized anxiety is one randomized trial of weightlifting or aerobic exercise added to other treatment, and CAMH calls exercise matched to your health and fitness level a promising addition. A personal trainer can build that program. Treat it as an addition to CBT or medication, not a replacement.

See our personal training team →

Other services people ask about

Naturopathic medicine. Trouble sleeping is one of the symptoms of generalized anxiety, and a Naturopathic Doctor can assess and help with sleep problems. On herbal and over-the-counter products the sources are cautious: there is potential for interactions and a lack of evidence to support their safe use, and the herbal industry is unregulated. Talk to a pharmacist, physician or nurse practitioner before taking one.

Massage therapy, mental performance and acupuncture. Massage therapy and mental performance coaching are not assessed for generalized anxiety in any of these documents, so there is no evidence to report. For acupuncture, a systematic review of four studies concluded there was insufficient evidence to determine whether it works.

Where most people start

With a counsellor. See a physician or nurse practitioner first if nobody has looked for a physical cause, or if you want to talk about medication.

How your team works together

Counselling carries most of the treatment for anxiety. A prescriber handles the diagnosis and any medication, and exercise is an optional addition. If a prescriber starts or changes a medicine, tell your counsellor: anxiety and sleep can get worse for a while at the start.

Browse by service: counselling, nurse practitioner and personal training.

What to expect at your first visit

Your first visit is with a counsellor, who works to understand your concern and comes up with a plan. You may be asked about:

1. The worry. What it tends to be about, how many days a week it is there, and when it started.
2. Your body and your sleep. Tension, a racing heart, stomach trouble, how you are sleeping.
3. What you avoid or put off. And what you do to get through the things you cannot avoid.
4. What else is in the picture. Caffeine, alcohol, medicines and supplements, and any treatment you have tried.

You leave the first visit with a plan.

Anxiety treatment in Kitchener, Waterloo and Cambridge

Kitchener. Counselling in Kitchener and Personal Training in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Counselling in Waterloo, Nurse Practitioner in Waterloo and Personal Training in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Counselling in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

What causes anxiety

Usually several things together.

• Family history. Anxiety disorders are more likely in people who have a relative with one.
• Life events. Stressful or traumatic experiences.
• Health. A painful long-term condition such as arthritis, and some medical conditions that produce anxiety symptoms themselves.
• Substances. Stimulants, caffeine included, are the substances most often linked to generalized anxiety and panic symptoms. Alcohol and unregulated drugs can create or increase anxiety.
• Avoidance. It brings relief in the moment, but when feared situations are avoided, the fear is strengthened.

How anxiety is diagnosed

In Ontario, communicating a diagnosis is a legal act reserved for specific regulated professions, among them physicians, nurse practitioners and psychologists. A full assessment establishes which anxiety disorder it is, how severe it is, how much it interferes with your life, and what else is present, such as depression or a physical condition. Where a medical condition is behind the anxiety, treating that condition most often reduces it. Counselling at CARESPACE is with Registered Psychotherapists and Registered Social Workers, who do not diagnose or prescribe.

Ontario Health’s quality standard describes anxiety disorders as underdiagnosed and undertreated.

What the evidence says about treating anxiety

• Where this comes from. Canada’s 2014 guideline for anxiety disorders, the UK’s guideline for generalized anxiety (NICE, 2011, since amended) and Ontario Health’s 2020 quality standard. “First-line” and “offer” are firm recommendations and “consider” is a weaker one; the wording reflects how confident the panel was, not only the quality of the trials.
• CBT is a first-line treatment. It is as effective as medication, and its benefits were still present one to three years after treatment ended.
• A course of CBT is short. Typically 12 to 15 weekly one-hour sessions. Pooled research found programs of fewer than eight sessions as effective for anxiety symptoms as longer ones, and internet-based CBT did significantly better than a waiting list. Group and individual therapy appear equally effective.
• Applied relaxation: the guidelines differ. The UK recommendation is to offer either CBT or applied relaxation. In Canada, more recent studies are read as showing that applied relaxation has limited efficacy.
• Medication is the other main option. In the UK the choice between therapy and medication is based on your preference, and the medicine offered is an SSRI, with sertraline considered first. Canada’s first-line list includes several SSRI and SNRI antidepressants and pregabalin. There is no current evidence to support routinely combining CBT with medication.
• Benzodiazepines and antipsychotics. The UK position is firm: do not offer a benzodiazepine for generalized anxiety except as a short-term measure during crises, and do not offer an antipsychotic in primary care. Canada lists benzodiazepines as second-line and usually only for short-term use, because of side effects, dependence and withdrawal. If you take one now, talk to the prescriber before changing anything.
• Exercise, meditation and herbal products. In one randomized trial, adding resistance training or aerobic exercise brought significant improvement. Open-label studies suggest meditation and yoga-based treatments may be useful. Herbal preparations cannot be widely recommended, because the products are poorly standardized. The Canadian guideline’s summary for all of these: they may be useful for some people, and more data are needed. Bright light therapy is not recommended.

What a doctor may offer

Medication for anxiety comes from a physician, nurse practitioner or psychiatrist. The UK guideline asks prescribers to explain that anxiety, agitation and sleep can get worse at the start, and that a medicine that works should be continued for at least a year because the likelihood of relapse is high. It also asks them to warn people under 30 that SSRI and SNRI antidepressants are associated with an increased risk of suicidal thinking and self-harm in a minority of that age group. If that happens to you, use the crisis numbers above and tell the prescriber.

What you can do at home

The NHS in the UK suggests these for generalized anxiety:

• Try a recommended self-help book, online tool or course.
• Try not to avoid the situations that make you anxious.
• Practise calming breathing exercises, or try yoga or pilates.
• Exercise regularly and get enough sleep.
• Eat a healthy diet, with regular meals.
• Cut back on coffee, tea, cola and energy drinks, because caffeine can disrupt sleep.
• Do not use alcohol, cigarettes, gambling or drugs to relieve anxiety.

Outlook

CAMH puts it plainly: anxiety is not an illness with a cure, because worry and fear can arise for anyone, but anxiety disorders are treatable and early treatment helps. Ask your counsellor, before your sessions end, how to handle a return of symptoms.

When it is an emergency

Call 911 right away if you have any of these signs of a heart attack:

• Chest discomfort: pressure, squeezing, fullness or pain, burning or heaviness
• Sweating
• Discomfort in the neck, jaw, shoulder, arms or back
• Nausea
• Shortness of breath
• Light-headedness

Women can have a heart attack without chest pressure. They may have shortness of breath, pressure or pain in the lower chest or upper abdomen, dizziness, light-headedness or fainting, upper back pressure or extreme fatigue. Several of these are also symptoms of anxiety, and nobody at CARESPACE can tell the two apart.

When depression occurs alongside an anxiety disorder, the two in combination increase the risk of suicide.

If you are thinking about suicide, or you do not feel safe, do not wait for an appointment: use the numbers below.

If you are in crisis or thinking about suicide, help is available right now.

• Call or text 9-8-8, the Suicide Crisis Helpline, at any hour.
• Call Here 24/7 at 1-844-437-3247 for addictions, mental health and crisis services in Waterloo Region, at any hour. here247.ca
• Call 911 or go to the nearest emergency department if you or someone else is in immediate danger.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

Common questions

How long does CBT for anxiety take?

A typical course is 12 to 15 weekly sessions of about an hour.

Do I need medication for anxiety?

Not necessarily. CBT is as effective as medication for generalized anxiety, so the choice can rest on what you prefer. A decision about medication is made with a physician, nurse practitioner or psychiatrist.

Does caffeine make anxiety worse?

It can. Stimulants, caffeine included, are the substances most often associated with anxiety and panic symptoms. The NHS advice is not to drink lots of coffee, tea, cola or energy drinks.

Can CBT for anxiety be done online?

Yes. CBT by videoconference or guided over the internet is recognized in Ontario alongside in-person sessions. Ask when you book how a counsellor offers theirs.

Is there anxiety counselling in Cambridge?

Yes. CARESPACE offers counselling in Cambridge as well as in Kitchener and Waterloo. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• Katzman MA, Bleau P, Blier P, et al. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry, 2014.
• National Institute for Health and Care Excellence (UK). Generalised anxiety disorder and panic disorder in adults: management (CG113), 2011, with later amendments.
• Ontario Health. Anxiety Disorders: Care in All Settings (quality standard), 2020.
• Rector NA, Bourdeau D, Kitchen K, Joseph-Massiah L, Laposa JM. Anxiety Disorders: An Information Guide. Centre for Addiction and Mental Health (CAMH), 2024.
• NHS (UK). Generalised anxiety disorder (GAD), reviewed October 2024.
• Heart and Stroke Foundation of Canada. Emergency signs (signs of a heart attack).
• College of Nurses of Ontario. NP Practice Resources (what Nurse Practitioners are authorized to do), viewed November 2026.
• College of Psychologists and Behaviour Analysts of Ontario. The Controlled Act of Communicating a Diagnosis (registration guidelines, section H), viewed November 2026.
• 9-8-8: Suicide Crisis Helpline. 988.ca.
• Here 24/7 (addictions, mental health and crisis services, Waterloo Wellington). here247.ca.

Related conditions

• Panic Attacks & Panic Disorder
• Social Anxiety
• Health Anxiety
• Stress
• Depression

Ready to book?

Book online with a counsellor, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

Find your practitioner