Living With Anxiety? Cognitive Behavioral Therapy For Anxiety Could Be For You

Anxiety is something all people experience in life at one time or another, but not all who experience it will require help with it. There are many situations in life when anxiety is temporary and something that a person is easily able to handle on their own. However, there are also many different types of anxiety disorders that can make it helpful for someone to get help from a therapist. 

If you are struggling with an anxiety disorder, cognitive behavioral therapy (CBT) could be the right option for you. This article will provide a better understanding of what CBT is, how it can help with anxiety, and the different techniques used in this therapeutic approach.

What is an anxiety disorder? 

When most people think of anxiety, they think about being worried about something. This is anxiety on a smaller level. Many things in life can cause us to worry and have a fear of certain situations. However, for some people, the anxiety that they experience gets in the way of their normal daily functions. Prolonged exposure to anxiety can have a serious effect on one’s mental and physical health. Those who experience it are caught in a constant state of uncontrollable worry, dread, and fear which can lead to other mental health challenges such as depression, and physical symptoms as well.

In the field of mental health, there are several different types of anxiety disorders. The main ones that people are familiar with are generalized anxiety disorder and panic disorder. However, there are also additional ones, such as selective mutism, separation anxiety, social anxiety disorder, and phobias about specific things. Also, many people don't realize that obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are anxiety and stress-related disorders. And many mental health conditions are co-morbid with anxiety, including major depressive disorder.

As a result, safety behaviors may be developed, which can become so ingrained that they hinder personal growth and progress. CBT can help patients confront these problematic behaviors by breaking down how they react to particular situations, separating thoughts and feelings from physical reactions, and identifying the warning signs of escalating anxiety.

Are anxiety disorders common?

Adult anxiety disorders are some of the most common mental disorders, and they aren’t reserved only for adults. The Anxiety and Depression Association of America (ADAA) says that "approximately 8% of children and teenagers experience an anxiety disorder with most people developing symptoms before age 21." 

The good news is that anxiety disorders are very treatable, either through in-person treatment or online therapy sessions. There are many kinds of therapy and alternative treatments that are helpful to people that are experiencing symptoms due to anxiety. 

What are the options for treatment?

Along with regular in-person therapy options and psychological treatment that you can receive from a mental health provider, there are also alternative forms of treatment that some people find helpful. Self-care is a big part of alternative treatment. It's important to make sure that you are getting enough sleep, eating the right foods, and taking care of your physical self to help reduce the negative physical sensations that can accompany prolonged exposure to anxiety. Simple changes in your daily routine can make a difference when it comes to your anxiety levels.

Some people also use techniques such as yoga, journaling, acupuncture, art therapy, aromatherapy, deep breathing, mindfulness-based stress reduction, and other applied relaxation skills to treat anxiety, and these may work as both short-term and long-term tools for anxiety. However, in this article, we will focus on a traditional form of therapy that is very effective in treating anxiety disorders.

If you have an anxiety disorder, cognitive behavioral therapy could be a great therapy option for you.

Researchers concluded that CBT therapy was associated with improved long-term outcomes for patients with generalized anxiety disorder, social anxiety disorder, and chronic posttraumatic stress disorder. 

What is cognitive behavioral therapy for?

Cognitive behavioural therapy is a type of psychotherapy or talk therapy that grew out of both cognitive therapy and behavior therapy, hence the name. A CBT therapist who utilizes cognitive behavioral therapy will work with you to lead you through the sessions. Cognitive behavioral treatment may last from 6 weeks to 3 months, depending on the patient and the mental health professional’s recommendations.

Evidence has shown that cognitive therapy is useful for treating symptoms of anxiety disorders. A systemic review of more than one randomized placebo-controlled trial published in J Clin. Psychiatry looked at the efficacy of cognitive therapy for adults. It showed that both cognitive therapy and exposure therapy were useful as social anxiety disorder, generalized anxiety disorder, and PTSD treatments. The meta-analysis found that CBT was an effective treatment for anxiety for a wide range of anxiety disorders.

An additional trial published in the J. Anxiety Disord., found that CBT is effective for treating military-related PTSD symptoms and co-morbid conditions. 

CBT treatments work to help patients change and control their thought process. Because those who are experiencing anxiety tend to have negative thought patterns, cognitive distortions, or racing thoughts that trigger anxiety, the theory behind cognitive therapy is that if the person can learn how to control and change their unhelpful thoughts (through a process known as cognitive restructuring), they will be able to control their anxiety.

Therapists focus on teaching patients CBT skills that will help them cope with their anxiety to learn how to overcome them. Most of the therapy is not going to be focused on talking about the past or where the fears and anxiety are coming from. Instead, it's going to be focused on learning skills that the person can begin to use going forward to improve their situation.

There are a variety of different cognitive therapy techniques, including cognitive restructuring, role playing, response prevention, and exposure therapy. Depending on the therapist, client, and the client’s anxiety symptoms, different modalities may be pursued.

How does cognitive behavioral therapy work?

As stated above, there are several simple steps and cognitive techniques that you will walk through in cognitive behavioral therapy. CBT differs from other types of therapy because therapists typically assign homework to patients so that they will have opportunities to practice the techniques outside of therapy. 

Clinical handbooks for CBT outline the basic definitions, principles, and practices that therapists may apply in their treatment approach. The therapist is going to want to know what your goals are for coming to therapy. This session will help them to identify the best form of cognitive therapy treatment for you.

1. Identifying problems 

The first step in cognitive therapy is for your therapist to help you identify what areas you are struggling with in life. It may be a very specific situation or feared stimuli that you are aware of, like a recent divorce, that is causing you to feel anxious, or it could be that you have dealt with the symptoms as long as you can remember. Compulsive behaviors, obsessive and intrusive thoughts, avoidance behaviors, or social withdrawal are all common examples of anxiety symptoms.

Cognitive therapy may incorporate principles of interpersonal therapy to help the therapist understand how your symptoms may be affected by previous traumas, relationships, or family problems. Interpersonal therapy is a type of psychotherapy that explores how relationships impact mental health symptoms, such as how someone becomes depressed after a breakup. In CBT, problems are broken down into five categories: situations, thoughts, emotions, physical feelings, and actions.

2. Analyzing negative thought patterns

The next step in the process is for you to start to learn and identify the beliefs, thoughts, and emotions you have that are contributing to the problems you are having. Your actions and emotions are going to be impacted by the things you are thinking about. It's important that you become aware of these negative thought patterns so you can learn how to recognize when you are thinking them to interrupt them.

3. Interrupting negative thought patterns

Once you know what thoughts and beliefs you are struggling with, you must start learning how to identify problematic thought patterns and cognitive distortions—and challenging anxious thoughts when you are thinking them. This could include things like journaling to help you become aware of your anxious thoughts during different times of the day and how they are impacting you.

4. Practicing behavioral techniques

Behavioral experiments are one of the most powerful ways to help a patient shift their perspective on a negative belief. During a behavioral experiment, the patient is challenged to put any maladaptive beliefs to the test. Gathering information through experimentation can help the patient and therapist learn more about the negative thinking patterns that may be causing the patient’s anxiety. A therapist may assign a behavioral experiment as homework so they can talk about the results with their client in the next therapy session. 

5. Learning new positive thinking patterns

The final step that is needed to complete cognitive therapy is to learn the helpful thoughts that you need to focus on that will help you transform your behavior. The more you practice using these thoughts, the more it will become a habit for you to think about these things instead of thinking the negative thoughts that were hurting you before. Shifting your cognitive perspective can take practice. CBT therapists may refer to this process of identifying and replacing negative thought patterns as “the three C’s”. The three C’s are “Catch it, Check it, Change it”. 

What is important during CBT?

Another thing that is important to remember is that you need to be willing to do the work that your therapist gives you to do. This may consist of exposure therapy exercises or worksheets that help you understand unhelpful patterns. If you don't do your assigned homework or practice CBT skills, you aren't going to be able to make real progress between your sessions. Don't allow yourself to get complacent with the work. The harder you work, and the more you stick to your plan, the better results you are going to see.

It's also important that you don't expect unrealistic results. Regardless of how great your therapist is, you aren't going to experience immediate results. It takes time to make progress. If you give up early, then you won't have the breakthroughs that you could experience otherwise. It can take several sessions before you start to see any kind of results.

How to find help for anxiety 

If you have anxiety or have been diagnosed with an anxiety disorder, you will want to find a mental health professional who is experienced in treating anxiety disorders. You will also want to make sure that you are looking for a therapist that has the credentials required to be a licensed therapist. It's worth taking your time to do a little research into finding a therapist instead of just working with the first one that you come across.

It's also helpful to look for reviews before starting to work with someone. Ask people that you know have been to therapy to see if they have a recommendation on who you should meet with. If you believe that CBT would be a good form of therapy for you, you can talk to the therapist to see if they agree with you. Remember that if you are working with an experienced and educated mental health provider, then you should trust their instincts and make sure you listen to their thoughts as well as what type of therapy options would work for you.

If you don't have a therapist in your local area to work with, you can also try participating in online therapy. BetterHelp offers affordable online therapy options, and it's easy to get started. You can participate in therapy sessions from the comfort of your home (or wherever you have an internet connection). Whether you are living with generalized anxiety disorder, social anxiety disorder, panic disorder, obsessive-compulsive disorder, or a different anxiety disorder, a therapist can teach you useful cognitive therapy techniques. Through cognitive treatments like cognitive restructuring, you can learn to challenge negative patterns and negative feelings.The most important thing is that you get the help you need to cope with and overcome anxiety.

Below are some commonly asked questions related to this topic:

Can CBT help treat anxiety disorders like GAD, obsessive compulsive disorder, and post-traumatic stress disorder?

Cognitive behavioral therapy, which was developed based on aspects of cognitive therapy and behavior therapy, is a widely used intervention for those living with anxiety disorders and anxiety-related conditions. According to the American Psychiatric Association, cognitive therapy helps people recognize negative thoughts and behavior patterns that trigger anxiety and teaches them to replace those negative patterns with more useful thoughts. As evidenced by a meta-analytic review of studies on the efficacy of cognitive behavioral treatments—many of which were randomized, placebo-controlled trials—CBT is effective for generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, panic disorder, and post-traumatic stress disorder (and chronic post-traumatic stress disorder). CBT can also work for conditions that can be co-morbid with anxiety, like major depressive disorder.

The cognitive distortion (or negative thinking) known as "catastrophizing" is a rational concern for individuals who have been through traumatic events, but it can contribute to chronic post-traumatic stress disorder and make the recovery process feel difficult. Real-life responses to trauma can feel frightening, but it is possible to change one's negative thought patterns by doing the work required in cognitive therapy. 

What are some CBT anxiety techniques?

When it comes to cognitive behavioral therapy (CBT) for anxiety disorders, there are many different types of cognitive techniques that can be used. In one randomized clinical trial, published in the Journal of Consulting and Clinical Psychology, researchers used cognitive restructuring and deep breathing cognitive therapy techniques for managing symptoms of anxiety disorders, including generalized anxiety disorder, social anxiety disorder, and panic disorder. Another randomized controlled trial showed that progressive muscle relaxation could effectively improve quality of life for those living with obsessive-compulsive disorder. Progressive muscle relaxation is a technique in which the person with the anxiety disorder tightens a muscle and then loosens that tension in order to relax.

There is also cognitive processing therapy (CPT), which is a form of cognitive therapy meant to help with PTSD and other trauma-related conditions. PTSD treatments are designed to help manage and reduce symptoms of anxiety resulting from a traumatic memory or event. Emotional avoidance is one example of how PTSD can manifest. People with PTSD may receive temporary relief from anxiety by avoiding triggers, but this can stunt their growth in the long run. Avoidance behaviors reaffirm maladaptive cognitive beliefs that specific actions or memories are dangerous. During cognitive processing therapy, the client learns how their negative thoughts surrounding the traumatic event are leading to avoidance behaviors and negative feelings. The client then tries to change unhelpful patterns through cognitive restructuring.

Exposure therapy, which uses exposure exercises and exposure techniques to decrease the fear tied to a stimulus, is a form of cognitive behavioral therapy that has also been proven useful when it comes to symptoms of different anxiety disorders, such as panic attacks. Exposure therapy works by gradually letting the client interact with the fear in a controlled environment through various exposure techniques. The exposure therapy allows the client to slowly reduce the negative thoughts associated with the stimulus. While it is primarily used for phobias, exposure therapy can also help with panic disorder, social anxiety disorder, and other anxiety disorders. A study published in the Clinical Psychology Review found that exposure therapy was also effective when treating post-traumatic stress disorder.

Another CBT technique that is commonly used is the behavioral experiment. In a behavioral experiment, the client identifies a belief that may be leading to feelings like anxiety, then the therapist sets up a situation in which that belief is challenged. If the individual sees that their belief may not be realistic or warranted, it can be decreased.Some experts have suggested that behavioral interventions could lead to more dramatic changes in cognitive perspective than talk therapy alone, but further research still needs to be done.

There are also pharmacological interventions used to treat anxiety disorders. And, often, psychological and pharmacological interventions will be used simultaneously.

What conditions is CBT therapy effective at treating?

Cognitive behavioral therapy is useful for a number of anxiety-based conditions. A randomized controlled trial found that CBT reduced symptoms of anxiety in participants. Therapists can utilize modalities like applied relaxation techniques to help clients alleviate their anxiety and reduce the uncomfortable physical sensations that come with it. Applied relaxation techniques include deep breathing, meditation, and muscle relaxation, all of which can lessen the effects of stress. A systematic review of the efficacy of applied relaxation techniques for anxiety showed that they were effective in decreasing symptoms.

CBT can also reduce symptoms of anxiety related to a physical health concern. In a study published in the Journal of Clinical Neuroscience, researchers found that anxiety symptoms related to aneurysms were decreased after therapy. In a systematic review of literature, also published in the Journal of Clinical Neuroscience, CBT was found to be effective in decreasing fatigue from multiple sclerosis.