Cognitive Behavioral Therapy for Anxiety

What is Cognitive Behavioral Therapy?

Cognitive-behavioral therapy is a type of talk therapy that is specifically designed to help people recognize their harmful thoughts and behaviors and learn how to change them. This form of therapy focuses on the present and future of the patient instead of what happened in the past.(1,2,3)

Cognitive-behavioral therapy cannot cure conditions like anxiety and depression, but it can be used to complete other therapies and medications to help improve the patient’s symptoms. Cognitive-behavioral therapy is primarily based on the belief that a person’s emotions, thoughts, and actions are all connected. This means that the manner in which you think and feel about something will have an impact on what you do.(4,5)

However, the core concept of this form of therapy is that these behavior and thought patterns can be changed. Here’s how emotions and thoughts can impact behavior, for either better or worse:

Negative or inaccurate thoughts or perceptions about a situation or self can contribute to emotional distress and mental health concerns like depression and anxiety.

These thought patterns and the resulting distress can sometimes lead to harmful or unhelpful behaviors.

Over time, these thoughts and resulting behaviors can go on to become a pattern that keeps repeating itself.

With the help of cognitive-behavioral therapy, it is possible to learn how to address and change these patterns to help deal with the problems as they arise, thus reducing future distress.

Cognitive Behavioral Therapy and Anxiety

Cognitive behavioral therapy basically helps you change the way in which you approach a particular situation. For example, if you are about to begin a new job this week, you could be feeling and thinking many things, including:(6)

  • Excited: You are beginning a new adventure and ready to face new challenges, so you feel excited.
  • Neutral: You may feel neutral about the situation as you have changed jobs before and believe that work is just work. Work is not the biggest focus in your life.
  • Anxious: You may be anxious about facing a new environment with new co-workers and boss. You might even be thinking about calling in sick the first day.

Situations such as beginning a new job can affect people in different ways. It can give individuals different feelings, behaviors, and thoughts. These differences all depend on personal beliefs, attitudes, and assumptions about the circumstances.(7)

When you have anxiety, the negative emotions and patterns can easily overshadow any positive thoughts and emotions. It is common to have feelings of unworthiness and fear. The goal of cognitive behavioral therapy in people with anxiety is to work on changing how the individual thinks. By doing this, it is possible to change how you feel about a particular situation.

Everyone experiences some level of anxiety from time to time in our lives. We often feel intense fear, anxiety, or panic, and it is caused by how we think or feel about a particular situation, not necessarily the situation itself.

It is necessary to create some space between your thoughts and the situation, feelings, and actions to solve this. This can give you back the power to handle the situation without feeling fear or anxiety. This will prevent the situation from getting worse.(8)

Being able to let go of unhealthy or negative thoughts frees up time and space for us to consider more positive and helpful, and factual thoughts. This improves the mind’s experience and automatically prevents the wave of uncomfortable emotions from taking over. When you have negative thoughts and feelings about a certain situation over a period of time, it can begin to affect your behavior towards it. As time goes on, these behaviors start to form a repetitive pattern. With the help of cognitive behavioral therapy, it is possible to learn to pay attention and recognize these unhealthy patterns and behaviors and actively work to change them. If you continue practicing cognitive behavioral therapy dedicatedly, then with time, it can help prevent these behaviors and thoughts from happening in the future altogether.

Cognitive-behavioral therapy is vital in helping people with anxiety identify the links in the chain that causes their anxiety and depression to worsen. This can include any thoughts, behaviors, feelings, and even physical sensations. The key of such a form of therapy is to let you take action to break the spiral of avoiding the situation that causes anxiety.

An Example of How Cognitive Behavioral Therapy Helps with Anxiety

Example 1

If you have had mild anxiety for many years but find it worsening recently, your anxious thoughts are likely due to things that happen at work or any recent developments in your personal life. Everything might be fine at work or your personal life, and you could still spend your time worrying about what others think of you or dislike you or about how you might suddenly lose your job.(9)

If you visit a cognitive behavioral therapist for help with your anxiety, they will help you identify your negative thought patterns first. They will help you list all the evidence supporting your belief that you will get fired and the evidence against this thought pattern. They will ask you to keep track of these negative thoughts while you are at work. Your therapist will also help you explore your personal relationships and relationships with your co-workers to identify reasons you feel any of them might dislike you. Your therapist will challenge you to continue using these strategies every day at work and in your personal life. You will keep noting down your feelings about your interactions with your boss and co-workers and your loved ones. This will help you identify why you have negative thoughts about why they don’t like you.

As time passes, you will start to realize that your anxious thoughts were due to a deep-rooted fear of not being good enough at your job or in your relationships. Your therapist will help you challenge these fears through CBT by practicing positive self-talk, journaling, and other such helpful techniques to overcome anxiety.

Example 2

Suppose you are having low self-esteem and begin avoiding social situations as being around a lot of people triggers your anxiety and makes you feel overwhelmed. When you get invited to a get-together at a cafe, you know that there will be a lot of people around. So your first thoughts are about what if people think you are awkward and that you will be forced to make small talk. You are likely to feel agitated, nervous, and may even panic. So you let the host know that you are not feeling well and won’t be able to attend.(10)

While you may feel better for having gotten out of this situation in the short term, it will only prolong the anxiety you feel about social gatherings. When you start to continuously avoid situations that trigger your fear and anxiety, you continue to be in a vicious cycle of negative thoughts, emotions, feelings, and behaviors.(11)

When you attend cognitive behavioral therapy for overcoming your anxiety about social gatherings, you may find help with the following:

  • Start to learn some exercises to help you relax.
  • Write down your thoughts whenever you start to feel anxious.
  • Work together with your therapist to look at what you have written down on your list.
  • Replace negative feelings and thoughts with more realistic thoughts.

This technique practiced in cognitive behavioral therapy is known as cognitive reframing or restructuring. At the end of a successfully completed session of cognitive behavioral therapy, you will be more capable of continuing to act despite your fear and become effective at handling things that previously triggered your anxiety.

What are the CBT Techniques Used To Help Anxiety?

Cognitive-behavioral therapists make use of some common techniques that help you manage anxiety and also work towards changing your thought pattern and behavior. Here are some of the commonly used CBT techniques.(12)

  1. Cognitive Reframing or Restructuring

    This technique involves taking a good hard look at your negative thought patterns. You may notice that you tend to overgeneralize, place too much importance on small things, or even assume that the worst will happen. Thinking in this way is bound to affect what you do. Over time, it may even ultimately go on to become a self-fulfilling prophecy.(13)

    Your therapist will work with you to identify your through processes, especially in certain situations, so that you can identify the negative thinking patterns. Once you become aware of this, you can start learning how to reframe or restructure these negative thoughts to turn them into becoming more productive and positive.

  2. Behavioral Activation

    In cases where anxiety begins to prevent you from doing some activity, behavioral activation can help. To start with, schedule this activity by writing it down on your calendar. This allows your brain to understand that a plan has been set in place, so there is now no need to keep worrying about it. Consider this, if you have anxiety about your kids catching something at a playground and becoming sick, you can consider scheduling a park date with a friend. This will help you move forward and face the situation, already prepared with the skills that you worked on during your cognitive-behavioral therapy. (14)

  3. Thought Challenging

    Thought challenging is another cognitive behavioral therapy technique that focuses on looking at things from various angles while using actual evidence from your real life. The technique of thought challenging can help people with anxiety look at things from a more objective perspective instead of just assuming that their thoughts are the fact or truth.

    Being educated about cognitive distortions can help a person identify when a cognitive distortion is taking place in the thoughts, and this allows them to work on correcting the negative or unhelpful thoughts to thinking more balanced, factual, and positive thoughts.(15)

    People with anxiety have trouble rationalizing their problems. You may feel anxious, but you may not understand where these feelings stem from. Or, you may have a fear of something like social gatherings, but you do not know why.

    Thought challenging can help in such situations.

  4. Journaling

    Journaling, also known as thought recording, is another CBT technique that helps people with anxiety. Journaling helps you get in touch with and increase awareness of your feelings and thoughts. This can also help you clarify and organize your thoughts.

    You can make lists of all the negative thoughts you have and then exchange them one by one with positive ones. Your therapist is going to encourage you to write down the new behaviors and skills you are working on during and in between your therapy sessions.(16)

  5. Relaxation Techniques

    Relaxation techniques help people with anxiety reduce their stress levels and also allows them to think more clearly. These techniques can help you feel like you are back in control of a situation. These relaxation techniques may include:(17)

  6. Behavioral Experiments

    Behavioral experiments are usually used when a person is experiencing catastrophic thinking, which is when people with anxiety tend to assume that the worst is going to happen.

    Similar to a scientific experiment, during behavioral experiments, therapists help a person with anxiety hypothesize about the potential outcomes of any action and write down what is likely to happen and what fears are associated with that action.

    You may have a discussion with your therapist about what you predicted would happen and how many times it actually happened. Given enough time at therapy, you will start to see that the worst-case scenario is unlikely ever going to happen.(18)

    These cognitive-behavioral therapy techniques don’t take too long to practice and are helpful tools that you can use whenever you are experiencing anxiety.

Conclusion

Anxiety can be a challenging condition to deal with. But the good news is that there are steps you can take to work through it, and cognitive behavioral therapy is a way to help you put a stop to your negative thought pattern. Such type of therapy can help you react positively to situations. By finding a therapist who is experienced in cognitive behavioral therapy, you can take the necessary steps to manage your mental health.

References:

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  4. Bieling, P.J., McCabe, R.E. and Antony, M.M., 2009. Cognitive-behavioral therapy in groups. Guilford press.
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  8. Kaczkurkin, A.N. and Foa, E.B., 2015. Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in clinical neuroscience, 17(3), p.337.
  9. Zalewska, A.M., 2011. Relationships between anxiety and job satisfaction–Three approaches:‘Bottom-up’,‘top-down’and ‘transactional’. Personality and Individual Differences, 50(7), pp.977-986.
  10. Schneier, F.R., 2006. Social anxiety disorder. New England Journal of Medicine, 355(10), pp.1029-1036.
  11. Schneier, F.R., 2003. Social anxiety disorder.
  12. Anderson, T., Watson, M. and Davidson, R., 2008. The use of cognitive behavioural therapy techniques for anxiety and depression in hospice patients: a feasibility study. Palliative Medicine, 22(7), pp.814-821.
  13. Robson Jr, J.P. and Troutman-Jordan, M., 2014. A concept analysis of cognitive reframing. Journal of Theory Construction & Testing, 18(2).
  14. Hopko, D.R., Robertson, S. and Lejuez, C.W., 2006. Behavioral activation for anxiety disorders. The Behavior Analyst Today, 7(2), p.212.
  15. Wells, A. and Leahy, R.L., 1998. Cognitive therapy of anxiety disorders: A practice manual and conceptual guide.
  16. Hasanzadeh, P., Fallahi Khoshknab, M. and Norozi, K., 2012. Impacts of journaling on anxiety and stress in multiple sclerosis patients. Complementary Medicine Journal, 2(2), pp.183-193.
  17. Eppley, K.R., Abrams, A.I. and Shear, J., 1989. Differential effects of relaxation techniques on trait anxiety: a meta‐analysis. Journal of clinical psychology, 45(6), pp.957-974.
  18. McMillan, D. and Lee, R., 2010. A systematic review of behavioral experiments vs. exposure alone in the treatment of anxiety disorders: A case of exposure while wearing the emperor’s new clothes?. Clinical psychology review, 30(5), pp.467-478.