In this blog I’ll review the basics of Cognitive Behavioral Therapy (CBT) for anxiety. I’ll go over what you need to know about anxiety and its disorders, simple CBT inspired steps you can take to tackle anxiety, and how to reach out if you need more support.

Cognitive Behavioral Therapy (CBT) for Anxiety: The Basics

Anxiety is a feeling of anticipation of something that might go wrong in the future. Anxiety can show up in many different ways, but it’s often characterized by a combination of cognitive and emotional elements, including excessive worry and emotional responses like tension, nervousness, and restlessness. 

Anxious feelings can range from mild to severe. Cognitive Behavioral Therapy offers an evidence-based approach to managing anxiety, relieving those suffering from anxiety, and improving mental well-being. 

Understanding Anxiety

Anxiety can look different for everyone but there are several components that are central to the experience for everyone. Anxiety is essentially an umbrella term used to describe those uneasy feelings or fears we all experience at some point in life. But what happens when those feelings of “normal anxiety” take over and go beyond a temporary or mild experience?

Anxiety disorders affect millions of people worldwide. Some of the most common anxiety conditions include: 

• • Generalized Anxiety Disorder (GAD): People with GAD tend to have consistent anxiety or fear, which can disrupt day-to-day activities. The state of excessive worry is hard to control and frequent, unlike experiencing occasional or situational stress. An estimated 3.1% of US adults have GAD. 
  • Social anxiety disorder (SAD): More than shyness, SAD is an intense fear of social interactions. Individuals with social anxiety have a persistent fear of being watched or judged by others. An estimated 7.1% of US adults have social anxiety. 
  • Panic Disorder: People with panic disorder have recurring, spontaneous panic attacks. These attacks can happen with or without a trigger. An estimated 2% to 3% of US adults have panic disorder. 
  • Phobias: Phobias are an extreme, irrational fear of a particular object or situation, like heights, spiders, or flying. People will often get highly anxious when exposed to a specific phobia. An estimated 9.1% of US adults have specific phobias. 

Other anxiety disorders include:

• • Selective Mutism (typically seen in young children and sometimes teens)
  • Separation Anxiety Disorder (most often seen in children who struggle when away from their parents or other loved ones)
  • Agoraphobia (fears of having a panic attack when away from home)

Learn more about causes, diagnoses, and treatments for common mental health conditions here. 

What Is Cognitive Behavioral Therapy?

Cognitive Behavioral Therapy was developed in the 1960s by Aaron T. Beck and Albert Ellis to respond to the need for more effective and evidence-based treatments for various psychological conditions. 

This therapeutic approach focuses on how our thoughts, feelings, and behaviors interact and mutually influence each other. 

A core feature of CBT is an emphasis on  identifying and challenging negative thought patterns that contribute to emotional distress, like anxiety. When we break down and dissect these thoughts, we’re essentially “rerouting” our thinking patterns to healthier, more balanced ones.

The Role of Thoughts in Anxiety

CBT treatment usually involves efforts to change thinking patterns. Why is this important? 

Because inaccurate or biased thinking usually exacerbates feelings of fear, worry, and stress. 

Some of the most common anxiety cognitive distortions are catastrophizing, black-and-white thinking (all-or-nothing thinking), and fortune telling (or predicting the future). These common cognitive distortions can cause problems in a few ways.

• • First, negative thoughts can start the anxiety cycle.
  • Second, negative or inaccurate thoughts can maintain the anxious cycle. Repetitive negative thoughts can keep anxiety going long past the first trigger.
  • Third, biased thinking can intensify anxiety. Focusing on catastrophe or worst case scenarios can amplify your anxious response so that it’s out of proportion to the threat you’re facing. 

Anxious thoughts often lead to a chain reaction that only intensifies anxiety. Here’s an example. 

Trigger: Your boss asks you to see them in their office. 

Anxious Thought 1: “I’m in trouble.” “My boss is mad at me.”

Anxious Thought 2: “I’m going to get fired.”

Anxious Thought 3: “I won’t be able to provide for myself or my family.”

What if your boss wanted to tell you you’re doing a great job? Or give you a minor update on a project? Was all that worrying for nothing? Working on changing your thought patterns can break this vicious cycle. 

The Role of Behavior in Anxiety

CBT emphasizes the interactions between thoughts, feelings, and behaviors. Our actions and behaviors can reinforce and intensify anxiety’s emotional and cognitive aspects, perpetuating it. Certain behaviors, like avoidance behaviors, can prevent you from finding healthy ways to cope with fears and anxiety.

Avoidance behaviors happen when a person actively tries to avoid encountering or confronting a specific trigger or stressor. Avoidance can be physical or psychological, like avoiding a social gathering or suppressing thoughts and feelings. People with anxiety disorders, such as social anxiety disorder, specific phobias, generalized anxiety disorder, and agoraphobia, often resort to avoidance as their primary coping mechanism for managing symptoms. The issue is that these behaviors aren’t treating anxiety or its root cause – it’s putting a temporary, quick fix on the real problem. 

CBT and exposure therapy are commonly used to treat avoidance behaviors. They help people confront their fears and learn to manage anxiety and develop coping strategies. Remember, exposure therapy and CBT, in general, are catered to meet the needs of each individual. For reference, someone with SAD may role-play going to a party in a therapeutic setting, while someone with GAD may do daily exercises like setting aside designated “worry time” each day. 

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Not sure what to expect when you begin CBT for anxiety? Therapy can be done one-on-one or in groups with people who have similar issues. CBT is a collaborative approach. Finding a therapist whom you feel comfortable and confident with is critical. 

What to expect during the first session:

• • Your therapist will gather information about you.
  • Expect questions about your current and past physical and emotional health.
  • You’ll talk about your specific anxiety symptoms, their severity, and how they impact your daily life. 
  • The therapist will help determine your best course of action or the goal-setting process. Goals in CBT can be both long-term and short-term. 

What to expect throughout the treatment process:

• • You and your therapist will work together to identify and discuss triggers, situations, or thoughts causing anxiety. 
  • Together, you will explore the thoughts and triggers that provoke your anxiety.
  • Your therapist guides you in recognizing and challenging cognitive distortions (catastrophic thinking, black-and-white thinking) contributing to anxiety.
  • You’ll work with your therapist to develop coping strategies to manage anxiety. 
  • Between sessions, you’ll be assigned homework to practice the coping strategies and techniques you’ve learned in therapy.
  • Throughout therapy, you and your therapist monitor progress toward the established goals.

Techniques and Strategies in CBT for Anxiety

CBT empowers people to understand and manage their anxiety. Treating anxiety with CBT often looks different for everyone. For example, CBT techniques for anxiety may include cognitive restructuring, exposure therapy, relaxation techniques, and behavioral experiments. 

Other techniques or strategies often include things you can do at home, like keeping a thought record or creating a list of anxiety-provoking situations. These at-home assignments are a critical component of CBT for anxiety to reinforce the skills learned in therapy sessions. 

DIY CBT: Self-Help Tips for Managing Anxiety

Check out these at-home cognitive behavioral therapy tips to help ease your anxieties from the comfort of your home. 

• • Tracking Thoughts – What initiates your anxiety? Write triggers, the associated thoughts, and the feelings that come after in a journal. Learn to see patterns.
  • Thought Flexibility – Practice thinking more flexibility. Approach your automatic way of thinking with some curiosity. What are some other perspectives that might be equally valid?
  • Exposure Tasks – Slowly expose yourself to anxiety-provoking situations. Break big fears into smaller steps.
  • Relaxation Skills – Learning and using relaxation skills, like deep breathing, can help reduce anxiety symptoms in the short term. 

These are just a few examples of CBT tips that you can try at home. If self-help strategies don’t work, seek help from a qualified mental health professional. Sometimes it’s helpful to get an outside perspective and some additional guidance to know how to tailor these approaches to your own specific needs.

Common Misconceptions About CBT for Anxiety

Like any therapeutic approach, CBT is sometimes misunderstood. Our therapists and colleagues hear common misconceptions about CBT all the time. Here are some misunderstandings people may have about CBT and the truth behind these claims.

Misconception: CBT only works for people with severe anxiety.

Fact: CBT can be effective for mild to severe anxiety. It can also be used as an early intervention tool to prevent anxiety from worsening.

Misconception: CBT is a quick fix.

Fact: While we may wish this were the case, in reality, CBT is not a one-and-done solution. This kind of therapy usually includes several sessions spanning weeks or months.

Misconception: CBT only focuses on changing thoughts.

Fact: While CBT focuses on modifying thought patterns, it also addresses behaviors and actions contributing to anxiety.

Misconception: CBT ignores the past.

Fact: When needed, therapists may explore past experiences to identify early influences that may be impacting negative thought patterns.

Misconception: CBT is the same for everyone.

Fact: CBT is not a one-size-fits-all solution and won’t work for everyone. However, one of the most promising advantages of this type of therapy is that it can be tailored to meet an individual’s specific circumstances and needs. 

Final Thoughts

According to organizations such as the National Institute for Health and Clinical Excellence (NICE), CBT is the preferred treatment for most mental health issues. This evidence-based, targeted approach effectively manages anxiety disorders, including GAD, SAD, and more. 

If you or someone you know is struggling with anxiety, we’re here to help. Please reach out to our care coordinator at info@anxietyspecialistsofstl.com to schedule a consultation call.