Day 9: Overview of CBT for Anxiety

When you think about your anxiety and what to do about it, you might not immediately think of therapy. Your initial thoughts might be more of something like, “Just make it stop.” After all, anxiety was historically treated with powerful medications such as benzodiazepines or tranquilizers to blunt the uncomfortable symptoms of anxiety. You might be tempted to simply see your doctor and get a prescription. Medication might help you short term, but it doesn’t do anything to address the triggers and negative thinking that reinforces that anxiety loop. You might consider natural treatments such as herbal remedies or even alternative practices like yoga or acupuncture. And, if you chose any of those options, you would not be wrong. Sometimes medication can be helpful to alleviate severe symptoms. Some people benefit from practices such as yoga, meditation or other mindfulness-based

practice. But you might be missing an important component of anxiety management.

Based on decades of research, the gold standard for the treatment of anxiety is therapy. And not just any therapy. Cognitive Behavioral Therapy or CBT.

CBT is a specific type of therapy that focuses on the relationship between our feelings, thoughts, and behaviors. It is one of the most studied and most popular of the therapeutic approaches and for good reason. It has been extensively studied and found to be highly effective in reducing symptoms for a number of health and mental health conditions. It has been found to be especially effective for the treatment of anxiety.

The underlying foundation of CBT is that each person has the power within themselves to control how they feel about something, how they think about that thing, and most importantly, how they respond to it. Basically, how you think so shall you respond. When it comes to anxiety, when you can change the “how’s”, you can break out of that anxiety loop.

For example, if you’re convinced that having to give a presentation at work is the scariest experience EVER and that you’ll surely forget every word of your speech, you’re likely to feel the sensation of apprehension and fear quite intensely. You’re likely to react more intensely. Your thoughts will be racing and telling you all the reasons you’re going to fail. As you step to the front of the room, your anxiety will be running wild at the first step. The chances of struggling through your presentation or panicking and bolting are high.

On the other hand, if you know you’re going to feel a little nervous and expect it, that first little flip of the stomach will be no big deal. You may barely notice it. When you do, you take a few deep breaths, think “yeah, I know you’re there. I’ve got this” and go up there and knock it out of the park. The intensity of the feelings or sensations may be no different in either scenario. How you view the presentation (the “threat”) and how you handle it makes the difference in how you experience it.

When we engage in negative thinking, we distort our thinking about some situation or event. In other words, those thoughts and accompanying assumptions are inaccurate. CBT calls those kinds of thoughts cognitive distortions.

There are many types of cognitive distortions. One of the most common ones is All-or-Nothing thinking. This type of distortion is when you view things in a very rigid way. Black and white. Good or bad. There is no in-between. You’ll often use “always” or “never”. For example, I’ll never be good enough.

Catastrophizing is another common cognitive distortion. This type of distortion is thinking that if something unwanted happens, it will be the worst thing EVER! You won’t be able to deal. For example: If I have an anxiety attack while I’m speaking in front of the class that would be the worst thing EVER! I would die. I just know it!

And then there’s Fortune Telling. This type of cognitive distortion presumes that you can predict things will not go well. For example, I’m going to have a panic attack right in the middle of my presentation. Maybe you will and maybe you won’t but you’ve already predicted you will with no way of knowing whether that will in fact happen.

Mind Reading is similar to Fortune Telling. This type of cognitive distortion presumes that you can somehow just “know” something without any factual evidence at all. In Mind Reading, you

assume you know what others are thinking about you and you assume it is negative. For example, all my coworkers think I’m weird.

Cognitive distortions can also be directed inward at ourselves. Personalization is a type of cognitive distortion in which you negatively judge yourself. For example, I’m such a loser. I can’t even handle a presentation.

There are others but this gives you the idea of the kinds of things we tell ourselves. And when that happens, our brains believe it. Funny thing about brains…they believe what we tell them. Your brain doesn’t differentiate between reality and the imaginary. It just accepts what it perceives as fact.

So, if your brain continually hears, “OMG I’m going to forget my speech!” “Everyone’s looking at me!” “I can’t do anything right”, your brain will believe you the first time and act accordingly. The brain will send out those pesky neurotransmitters and next thing you know, your heart is racing

and you can’t remember your words. Your “fight or flight” response is triggered and now you’re feeling like a failure. All because of what your brain heard.

The goal of CBT is to take all those negative thoughts and feelings that trigger your anxiety response and change or reframe the way you think. When you change the way you think, you change your responses and your experience. You can choose to act in ways that encourage calm and shut down the feedback loop.

The process of CBT encourages you to challenge your negative thoughts and develop a more positive appraisal of your actions. You can also learn new coping mechanisms to deal with anxiety-provoking situations.

CBT can take many forms. What works best for you depends on your preferences and situation.

You might use Thought Records. Thought records are used as a way to record and track your negative thoughts, feeling, and behaviors. Tracking allows you to discover your patterns of thinking and acting. Once you know your patterns, you can begin to challenge what isn’t working and develop more effective ways of thinking and responding. But, it starts with knowing where you are and what your patterns are.

Another strategy used in CBT for anxiety is Exposure. This technique is most often used in coordination with a therapist trained in this specific treatment. Exposure is most often used with phobias.

Cognitive Restructuring is one of the strategies at the heart of CBT. Once you know your patterns of thinking and responding, you can begin to change them. Cognitive restructuring is the process of modifying problematic thoughts to more positive ways of thinking that can help you change your behavior.

Calming Strategies are also helpful for dealing with anxiety. Left unchecked, anxiety will take over. Calming strategies let you acknowledge the anxiety but send the message, “We are ok. Don’t need you right now.” Practicing mindfulness techniques, positive self-talk, focusing on how feelings will change, and practicing opposite reactions are just a few examples of calming strategies.

Because CBT is a widely popular approach used by many therapists, finding a CBT practitioner is easy. There are also strategies you can try on your own and we will be talking about some of those here.