Anxiety

Cognitive behavioral therapy (CBT) is the most widely-used therapy for anxiety disorders. Research has shown it to be effective in the treatment of panic disorder, phobias, social anxiety disorder, and generalized anxiety disorder, among many other conditions.

CBT addresses negative patterns and distortions in the way we look at the world and ourselves. As the name suggests, this involves two main components:

Cognitive therapy examines how negative thoughts, or cognitions, contribute to anxiety.

Behavior therapy examines how you behave and react in situations that trigger anxiety.

The basic premise of CBT is that our thoughts—not external events—affect the way we feel. In other words, it’s not the situation you’re in that determines how you feel, but your perception of the situation. For example, imagine that you’ve just been invited to a big party. Consider three different ways of thinking about the invitation, and how those thoughts would affect your emotions.

Situation: A friend invites you to a big party

Thought #1: The party sounds like a lot of fun. I love going out and meeting new people!

Emotions: Happy, excited

Thought #2: Parties aren’t my thing. I’d much rather stay in and watch a movie.

Emotions: Neutral

Thought #3: I never know what to say or do at parties. I’ll make a fool of myself if I go.

Emotions: Anxious, sad

As you can see, the same event can lead to completely different emotions in different people. It all depends on our individual expectations, attitudes, and beliefs. For people with anxiety disorders, negative ways of thinking fuel the negative emotions of anxiety and fear. The goal of cognitive behavioral therapy for anxiety is to identify and correct these negative thoughts and beliefs. The idea is that if you change the way you think, you can change the way you feel.

Thought challenging in CBT for anxiety

Thought challenging—also known as cognitive restructuring—is a process in which you challenge the negative thinking patterns that contribute to your anxiety, replacing them with more positive, realistic thoughts. This involves three steps:

  1. Identifying your negative thoughts. With anxiety disorders, situations are perceived as more dangerous than they really are. To someone with a germ phobia, for example, shaking another person’s hand can seem life threatening. Although you may easily see that this is an irrational fear, identifying your own irrational, scary thoughts can be very difficult. One strategy is to ask yourself what you were thinking when you started feeling anxious. Your therapist will help you with this step.
  2. Challenging your negative thoughts. In the second step, your therapist will teach you how to evaluate your anxiety-provoking thoughts. This involves questioning the evidence for your frightening thoughts, analyzing unhelpful beliefs, and testing out the reality of negative predictions. Strategies for challenging negative thoughts include conducting experiments, weighing the pros and cons of worrying or avoiding the thing you fear, and determining the realistic chances that what you’re anxious about will actually happen.
  3. Replacing negative thoughts with realistic thoughts. Once you’ve identified
    the irrational predictions and negative distortions in your anxious thoughts, you can replace them with new thoughts that are more accurate and positive. Your therapist may also help you come up with realistic, calming statements you can say to yourself when you’re facing or anticipating a situation that normally sends your anxiety levels soaring.
    1. Replacing negative thoughts with more realistic ones is easier said than done. Often, negative thoughts are part of a lifelong pattern of thinking. It takes practice to break the habit. That’s why cognitive behavioral therapy includes practicing on your own at home as well. CBT may also include:
    2. Learning to recognize when you’re anxiousand what that feels like in the body
    3. Learning coping skillsand relaxation techniques to counteract anxiety and panic
    4. Confronting your fears(either in your imagination or in real life)