How does cognitive behavioral therapy help with anxiety

Cognitive behavioural therapy (CBT) can help you make sense of overwhelming problems by breaking them down into smaller parts.

In CBT, problems are broken down into 5 main areas:

situations
thoughts
emotions
physical feelings
actions

CBT is based on the concept of these 5 areas being interconnected and affecting each other. For example, your thoughts about a certain situation can often affect how you feel both physically and emotionally, as well as how you act in response.

How CBT is different

CBT differs from many other psychotherapies because it’s:

pragmatic – it helps identify specific problems and tries to solve them
highly structured – rather than talking freely about your life, you and your therapist discuss specific problems and set goals for you to achieve
focused on current problems – it’s mainly concerned with how you think and act now rather than attempting to resolve past issues
collaborative – your therapist will not tell you what to do; they’ll work with you to find solutions to your current difficulties

Stopping negative thought cycles

There are helpful and unhelpful ways of reacting to a situation, often determined by how you think about them.

For example, if your marriage has ended in divorce, you might think you’ve failed and that you’re not capable of having another meaningful relationship.

This could lead to you feeling hopeless, lonely, depressed and tired, so you stop going out and meeting new people. You become trapped in a negative cycle, sitting at home alone and feeling bad about yourself.

But rather than accepting this way of thinking you could accept that many marriages end, learn from your mistakes and move on, and feel optimistic about the future.

This optimism could result in you becoming more socially active and you may start evening classes and develop a new circle of friends.

This is a simplified example, but it illustrates how certain thoughts, feelings, physical sensations and actions can trap you in a negative cycle and even create new situations that make you feel worse about yourself.

CBT aims to stop negative cycles such as these by breaking down things that make you feel bad, anxious or scared. By making your problems more manageable, CBT can help you change your negative thought patterns and improve the way you feel.

CBT can help you get to a point where you can achieve this on your own and tackle problems without the help of a therapist.

Exposure therapy

Exposure therapy is a form of CBT particularly useful for people with phobias or obsessive compulsive disorder (OCD).

In such cases, talking about the situation is not as helpful and you may need to learn to face your fears in a methodical and structured way through exposure therapy.

Exposure therapy involves starting with items and situations that cause anxiety, but anxiety that you feel able to tolerate.

You’ll be exposed to an item or situation for a length of time and frequency recommended by your therapist.

After the first few times, you’ll find your anxiety does not climb as high and does not last as long.

You’ll then be ready to move to a more difficult situation. This process should be continued until you have tackled all the items and situations you want to conquer.

Exposure therapy may involve spending 6 to 15 hours with the therapist, or can be carried out using self-help books or computer programs. You’ll need to regularly practise the exercises as prescribed to overcome your problems.

CBT sessions

CBT can be carried out with a therapist in 1-to-1 sessions or in groups with other people in a similar situation to you.

If you have CBT on an individual basis, you’ll usually meet with a CBT therapist for between 6 and 20 weekly or fortnightly sessions, with each session lasting 30 to 60 minutes.

Because exposure therapy sessions include time to expose you to the item or situation causing you anxiety, they will usually last longer.

CBT therapy may take place:

in a clinic
outside – if you have specific fears there
in your own home – particularly if you have agoraphobia or OCD involving a specific fear of items at home

Your CBT therapist can be any healthcare professional who has been specially trained in CBT, such as a psychiatrist, psychologist, mental health nurse or GP.

First sessions

The first few sessions will be spent making sure CBT is the right therapy for you, and that you’re comfortable with the process. The therapist will ask questions about your life and background.

If you’re anxious or depressed, the therapist will ask whether it interferes with your family, work and social life. They’ll also ask about events that may be related to your problems, treatments you’ve had, and what you would like to achieve through therapy.

If CBT seems appropriate, the therapist will let you know what to expect from a course of treatment. If it’s not appropriate, or you do not feel comfortable with it, they can recommend alternative treatments.

Further sessions

After the initial assessment period, you’ll start working with your therapist to break down problems into their separate parts. To help with this, your therapist may ask you to keep a diary or write down your thought and behaviour patterns.

You and your therapist will analyse your thoughts, feelings and behaviours to work out if they’re unrealistic or unhelpful and to determine the effect they have on each other and on you. Your therapist will be able to help you work out how to change unhelpful thoughts and behaviours.

After working out what you can change, your therapist will ask you to practise these changes in your daily life. This may involve:

questioning upsetting thoughts and replacing them with more helpful ones
recognising when you’re going to do something that will make you feel worse and instead doing something more helpful

You may be asked to do some “homework” between sessions to help with this process.

At each session, you’ll discuss with your therapist how you’ve got on with putting the changes into practice and what it felt like. Your therapist will be able to make other suggestions to help you.

Confronting fears and anxieties can be very difficult. Your therapist will not ask you to do things you do not want to do and will only work at a pace you’re comfortable with. During your sessions, your therapist will check you’re comfortable with the progress you’re making.

One of the biggest benefits of CBT is that after your course has finished, you can continue to apply the principles learned to your daily life. This should make it less likely that your symptoms will return.

Online CBT

A number of interactive online tools are now available that allow you to benefit from CBT with minimal or no contact with a therapist.

Some people prefer using a computer rather than talking to a therapist about their private feelings. However, you may still benefit from occasional meetings or phone calls with a therapist to guide you and monitor your progress.

Find out more:

self-help therapies
Every Mind Matters: self-help cognitive behavioural therapy (CBT) techniques

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What is CBT?

CBT is a type of therapy that works on negative thought patterns or behaviors in an effort to recognize and restructure them. In other words, CBT can help you change how you approach a situation.

For example, if you’re about to start a new job, you could be feeling several things:

Anxious. Because it’s a new environment with new co-workers and processes, you might be feeling anxious. You might think, “I’m never going to be able to catch on” and consider calling in sick your first day.
Neutral. You might be feeling neutral because you’ve had other jobs in the past. Work is just work, after all. You might think, “As soon as I’m done for the day, I’m going out for dinner.” You might get off work and go grocery shopping, focused on the rest of your night.
Excited. When starting a new adventure and facing new challenges, you might feel excited. You might think to yourself, “I can’t wait to collaborate on that new project.” You might go into the office and start introducing yourself to others.

Beginning a new job can give people different thoughts, feelings, and behaviors. These differences all depend on the personal attitudes, beliefs, and assumptions we have about our circumstances.

When you have anxiety, the negative thought patterns and emotions overshadow the positive ones. Feelings of unworthiness and fear can start to take over. The goal in CBT is to work on changing the way you think. By doing this, you can change how you feel about a situation.

Cognitive behavioral therapy for anxiety

“Anxiety and nervousness are rooted in survival, so feeling anxious or fearful is part of the human experience,” explains Ciara Jenkins, a therapist and licensed clinical social worker at Life On Purpose Counseling & Coaching Services. “Everyone experiences anxiety from time to time at varying degrees. Many times, intense anxiety, fear, or panic is caused by how we think about a certain situation and not necessarily the situation itself.”

Jenkins goes on to say that when you can create space between a situation and your thoughts, feelings, and actions, it can give you the power to handle the situation. It doesn’t hold you back from your goal or make things worse.

“Perception accounts for a lot of our experience. Being able to let go of unhealthy thoughts frees us up to consider other healthier and more factual alternatives, which lead to an improved experience and less intense uncomfortable emotions,” Jenkins adds.

When you have negative feelings and thoughts about a situation, over time it can start to affect your behavior toward it. A child who keeps having negative feelings about going to school may start to come up with excuses not to go.

As time goes on, these behaviors start to become repeating patterns. Using CBT, you can learn to pay attention to those patterns and actively work to change them, along with the feelings tied to them. Given time, it can help to prevent these behaviors from happening in the future.

“CBT helps individuals identify the links in the chain that lead to worse anxiety and depression: the thoughts, feelings, behaviors, and physical sensations that are intimately connected to one another,” says Steven Lucero, PhD, MBA, a clinical psychologist with Brightside. The key, he stresses, is that you can take action to disrupt the spiral of avoiding the situation that causes anxiety.

Examples

For instance, let’s say you’re dealing with low self-esteem. Maybe you try to avoid social situations because being around a lot of people is overwhelming and triggers anxiety.

You’re invited out to a group gathering at a restaurant, and you know there will be a big turnout. Your immediate thoughts are, “No way. I’ll have to make small talk. What if people think I’m awkward?”

You might feel nervous, even slightly panicked. At the last moment, you tell the host that you’re not feeling well. You won’t be able to make it.

While this behavior will make you feel better in the short term, it only prolongs the anxiety you feel in social gatherings. The problem is, when you continuously avoid the situations that trigger anxiety and fear, you continue that negative cycle of thoughts, feelings, and behaviors.

In therapy, you work on anxiety in social gatherings. You might:

Begin to learn relaxation exercises that you can use when you get another invitation to go out.
Write down the thoughts you feel when you start to have anxiety.
Work with your therapist to look at your list.
Replace negative thoughts and feelings with ones that are more realistic.

This technique is known as cognitive restructuring or reframing.

“As you see yourself increasingly effective at handling the things that previously led to fear and anxiety, you will be more capable of continuing to act in opposition to the fear,” Lucero explains.

CBT techniques for anxiety

CBT professionals use some common techniques to help you manage anxiety and change your behavior.

Cognitive restructuring or reframing

This involves taking a hard look at negative thought patterns. Perhaps you tend to:

overgeneralize
assume the worst will happen
place too much importance on minor details

Thinking this way can affect what you do and, in some instances, can become a self-fulfilling prophecy.

Your therapist will ask about your thought processes in certain situations so you can identify negative patterns. Once you’re aware of them, you can learn how to reframe those thoughts so that they’re more positive and productive.

Thought challenging

Thought challenging is about considering things from multiple angles, using actual evidence from your life. Thought challenging can help you consider things from a more objective perspective, rather than just assuming that your thoughts are the facts or truth.

Education about cognitive distortions can help a person identify when a cognitive distortion is showing up in thoughts, and that allows them to work to correct the unhelpful thoughts to thoughts that are more balanced and factual,” says Jenkins.

With anxiety, you might have trouble rationalizing your problems. You might feel anxious, but not understand where those feelings are coming from. Or, you might have a fear of something such as social gatherings, but you aren’t sure why.

Behavioral activation

If anxiety is preventing you from doing a certain activity, you can schedule it by writing it in your calendar. This sets a plan in place so you don’t keep worrying about it.

For instance, if you have anxiety about your kids getting sick at a playground, you might schedule a park date with a friend. This will encourage you to move forward and face the situation, armed with the skills you work on in CBT.

Journaling

Journaling, also called thought recording, helps you get in touch with and bring awareness to your thoughts and feelings. It can also help clarify and organize your thoughts.

You might make lists of your negative thoughts and the positive ones you can swap them out with. Your therapist may encourage you to write down the new skills and behaviors you work on between therapy sessions.

Behavioral experiments

These are commonly used when you’re experiencing catastrophic thinking, which is when you assume the worst is going to happen.

“Just like a scientific experiment, we hypothesize about the potential outcomes of that action, and actually write down what we anticipate will happen and what the fears are of what could happen,” explains Lucero.

You might have a discussion with your therapist about what you predicted would happen and if it actually did. Given time, you’ll start to see your worst-case scenario is unlikely to happen.

Relaxation techniques

Relaxation techniques reduce stress and allow you to think more clearly. In turn, these can help you take back control of a situation. These techniques might include:

deep breathing exercises
progressive muscle relaxation
meditation

These practices don’t take long to do and are tools you can use wherever you’re experiencing anxiety, such as in line to pay for groceries.

How to find a CBT professional

Finding a good therapist can be challenging. While you might feel overwhelmed by figuring out where to start, you *can* find a therapy practice that’s right for you. Here are some things to think about when you’re looking for a CBT professional.

In-person or online

Seeing a therapist in person involves sitting with them in an office setting on chairs or couches. But as more therapists are seeing their clients virtually, practices are offering many more options for online therapy than they used to. You may find you’re more comfortable going in person or in the comfort of your own home.

Some companies such as Online-Therapy actually specialize in CBT. They can include other helpful resources for you, such as workbooks and live sessions in addition to therapy sessions.

Individual or group therapy

You might decide to do individual counseling or have CBT in a group therapy setting. This is where a facilitator, usually a licensed mental health professional, works with a small group of people who are in similar circumstances.

Decide on your preferences

It can be helpful to figure out if there is a type of therapist you may feel more comfortable with.

A good relationship with a therapist is important to your mental health recovery process. Ask yourself:

What do you want in a therapist?
Do you feel more comfortable with a therapist of a certain gender?
Do you want a therapist who is older or younger?
Do you want a religious aspect to therapy?

Start your search

You might ask for recommendations from friends and family. Another place to find a CBT therapist is searching online. The website Psychology Today has a database that you can search by state. You can also visit the directory at the National Association of Cognitive-Behavioral Therapists.

Don’t settle

It’s important to feel comfortable with your therapist.

If you aren’t a good match, it’s OK to find another one. Not everyone is going to be a good fit, and different therapists can meet different needs.

Takeaway

Anxiety can be a challenge, but the good news is that you have steps you can take to work through it. CBT is a way to change your negative thought patterns in order to positively affect how you respond to situations.

By finding a therapist with expertise in CBT, you can take steps to manage your mental health. You can then take the skills you learn from CBT and apply them to situations in the future.

Risa Kerslake is a registered nurse, freelance writer, and mom of two from the Midwest. She specializes in topics related to women’s health, mental health, oncology, postpartum, and fertility content. She enjoys collecting coffee mugs, crocheting, and attempting to write her memoir. Read more about her work at herwebsite.