If you have been reading about anxiety treatment, you have probably hit the same question again and again: should you try therapy, or should you ask your doctor about medication? It tends to be asked by someone who is tired, a little frightened by how much the worry has taken over, and hoping to get the decision right the first time.
The honest answer is that this is not really a contest between two options. It is a question of what fits your situation and your capacity right now, and it is one you can revisit later. Here is what goes into that decision, what anxiety therapy actually involves, and how to take a first step.
The short answer: it is usually not either/or
Major treatment guidelines do not crown a winner here. The UK's National Institute for Health and Care Excellence, whose guidance is widely referenced by clinicians internationally, is unusually direct about it. In its guideline on generalised anxiety disorder and panic disorder (CG113), NICE tells clinicians to offer either an individual high-intensity psychological therapy or drug treatment, to explain the benefits and drawbacks of each, and to let the person's own preference guide the choice, on the basis that neither route has been shown to outperform the other.
That is worth sitting with. When a guideline body of that size says preference should decide, the question "which is better?" has no general answer, only a personal one. Your preference is not a tie-breaker for when the evidence runs out. It is part of the evidence.
What the Canadian picture looks like
Statistics Canada's Mental Health and Access to Care Survey gives a sense of how common this crossroads is. In its 2023 release on mental disorders and access to care, the share of Canadians aged 15 and older meeting the criteria for generalized anxiety disorder doubled over a decade, from 2.6% in 2012 to 5.2% in 2022.
The same study looked at what care people received. Among those who met the criteria for a mood, anxiety or substance use disorder in the previous year, about half had spoken to a health professional. Counselling was the most common form of care received, at 43.8%, ahead of medication at 36.5%. Counselling was also what people were most likely to say they still needed and had not been able to get. So if you are weighing this up, you are in ordinary company, and more people land in a talking therapy than on a prescription.
What anxiety therapy actually involves
The first few sessions
The first appointment is a longer conversation, not a test. Your therapist will want to understand what anxiety looks like in an ordinary day, when it started, what makes it louder or quieter, and what you want to be different. Registered Psychotherapists in Ontario do not diagnose, so this is not about being labelled. It is about seeing the shape of the problem clearly enough to work on it, then agreeing on what you are aiming for.
Learning to work with anxious thinking
Cognitive behavioural therapy is the most heavily studied approach for anxiety. It works from the idea that thoughts, feelings and behaviour are linked, so changing how you respond to an anxious thought changes how much power it holds. In practice that means noticing the predictions your mind makes, testing them rather than arguing with them, and deliberately approaching situations you have been avoiding, starting small. Avoidance is what keeps anxiety alive, and structured exposure is how therapy takes that fuel away.
It is also finite. NICE's protocol for CBT for generalised anxiety disorder is usually 12 to 15 weekly sessions of about an hour, fewer if things improve sooner.
When anxiety is not only in your thoughts
For some people anxiety is mostly physical: a body that will not settle, a jaw that will not unclench, sleep that will not arrive. For others it is tangled up with old experiences or a pattern they keep repeating. That is why one method does not suit everyone. Alongside CBT, our team works with somatic and polyvagal-informed approaches for nervous system regulation, mindfulness-based work for people stuck in loops of worry, psychodynamic therapy where the roots run further back, EMDR where trauma is part of the picture, and person-centred therapy where what helps most is room to think out loud. You can read about the different types of therapy we offer, most of it delivered as weekly individual therapy.
Where medication fits, and who to ask about it
Medication is a recognised option for anxiety, and for some people it is what makes everything else possible. It is also outside our scope. Registered Psychotherapists in Ontario cannot prescribe and cannot diagnose, so we are not the right people to tell you whether a prescription would help, which one, or for how long. That conversation belongs with your family doctor or a psychiatrist, who can consider your full medical history.
What we can say is that starting medication does not mean therapy has failed, and choosing therapy first does not mean you are refusing help. Some people use one, some the other, and plenty use both at once, with the prescriber and the therapist each doing their own part. If you are already taking something, that is useful context for your therapist to have.
When you do have that conversation, it is reasonable to ask what the medication is meant to do, how long before you would expect to notice anything, what side effects to watch for, and what stopping would look like. NICE directs prescribers to cover exactly that ground up front, so these are fair questions rather than awkward ones.
What the decision actually depends on
- How much it is affecting daily life. If you are still holding things together, you have room to start with therapy and see. If basic functioning has become difficult, have both conversations sooner.
- What you would genuinely prefer. Not a soft factor. It is what NICE tells clinicians to base the choice on, and it predicts whether you stay with a plan.
- What you have tried before. A poor experience with one therapist, or one medication, is information about that fit, not a verdict on the category.
- Time and capacity. Therapy asks for a weekly hour plus some effort in between, which is a real ask when you are depleted. Better to be honest about that up front.
- What else is going on. Sleep, alcohol, low mood, a thyroid or heart issue, a trauma history. These change the picture and are worth raising with your doctor and your therapist both.
The cost side, plainly
Psychotherapy in Ontario is not covered by OHIP, which catches many people by surprise. Most private insurance plans cover a portion of sessions with a Registered Psychotherapist, so it is worth checking yours before you start. At InnerSight an individual session is $180 for 55 minutes, and the first appointment is a 70-minute initial assessment at $245. We direct bill Sun Life, Beneva (formerly SSQ) and Green Shield. If cost is the obstacle, reduced-fee sessions at $125 are available with select supervised therapists in training.
A few things people get wrong
- "Therapy goes on forever." Many approaches are time-limited and goal-focused, and you review progress as you go rather than drifting indefinitely.
- "Therapy is only for severe cases." Plenty of people come while still coping well, precisely because they would rather deal with it now.
- "Medication is a quick fix." Nothing here is instant, and medication does not do the work of learning new responses to what sets you off.
- "Once you start, you are on it for life." How long treatment continues is a clinical decision made with your prescriber, and a fair thing to ask about at the first appointment.
How to start without deciding everything today
You do not have to settle the therapy question and the medication question in the same week, or pick a lane before you have spoken to anyone. A sensible first move is to book both conversations, one with your family doctor and one with a therapist, then decide once you know what each can offer. You can look through our team of psychotherapists before you reach out.
Frequently asked questions
Can therapy and medication be used together?
How long does anxiety therapy usually take?
Do I need a referral or a diagnosis to start therapy?
Is anxiety therapy covered by OHIP or by insurance?
Can anxiety be managed without medication?
Talk it through before you decide
If you would like to think this out loud with someone who does it for a living, you can book a free 20-minute consultation at no cost and with no obligation to continue. No referral is needed, and you do not need to have made up your mind about medication first. You can also read more about how we approach therapy for anxiety and panic.
Sessions are available at our Woodbridge, Vaughan and Barrie offices and online across Ontario, Monday to Friday from 9:30 am to 8:00 pm and Saturdays from 9:30 am to 5:30 pm. You can also reach us at (905) 553-9507. Conversations with your therapist are private and confidential.