There are so many interesting explanations for anxiety. Most successful treatments have relaxation training as an important component. My question is...is this Generalized Anxiety? If he does have Generalized anxiety, then he is most likely to benefit from a combination of (1) 16 to 8 muscle group to cue controlled relaxation combined with (2) a heavy emphasis on the cognitive component and (3) "worry exposure". The first question in developing a treatment plan with the anxious person is determining what THREAT is fueling the sympathetic arousal. Tackle the distortions associated with the threat cognitively - while at the same time expose him to the worry without allowing him to avoid (negative reinforcement) the negative affect & physical sxs. This will involve teaching others around him (i.e., "supportive" others) to compassionately NOT reassure him or allow him to engage in any distracting "temporary" relief. The ritual behaviors (look & you'll find them) he engages in to brielfy decrease his anxity are very similar to the more obvious compulsions of the OCD-suffering patient. Like the OCD pt, these behaviors only serve to perpetuate the disorder. Successful anxiety Tx always seems to involve attacking the THREAT via Sx control(relaxation), distortion control and exposure (prolonged & moderately arousing) w/ response prevention (no reassurances). This Tx is so obvious with someone with the other "extreme" forms of anxiety. It is often difficult for clinicians to realize that common & understandable stressors can be the source of a major disorder. Finally, I would be looking more at myself as a clinician for the stagnation and not so quickly attribute resistance or noncompliance with the patient. If he continues to show up for treatment when you expose him to his own worry - then he's truly motivated. I personally find OCD easier to tx , at times, than generalized anxiety - GOOD LUCK!