CBT for Anxiety
The CBT triangle is often used to visually depict the connection between someone’s thoughts, feelings, and behaviors. While Cognitive Behavioral Therapy can assist with various internalized beliefs, it is exceedingly common for anxious thoughts (located at the top of the triangle) to serve as the catalyst for someone seeking therapy.
CBT is viewed as the gold-standard treatment for anxiety disorders. In fact, research shows this modality is up to 74% effective for people with anxiety. Evidence suggests that it’s possible to see lower levels of anxiety after just 8 sessions of CBT.
Concepts such as trigger identification, cognitive restructuring, and behavior modification help individuals simultaneously talk and work through feelings of unease in a measurable way. This article breaks these aspects of CBT down so you can understand how they can be used to manage symptoms of anxiety.
Trigger Identification
Along with anxious thoughts, people may come to their therapist with specific situations they don’t feel they can navigate on their own. It can be especially difficult to see how these problems affect you in the moment, as emotions may run high and you may feel the heat to respond promptly. However, your therapist can help you slow down the pace, look for patterns, and shed light on problems that may lead to greater feelings of anxiety.
These are called triggers. An example of a situation-based trigger is being in crowded spaces or public gatherings and experiencing feelings of being threatened and overwhelmed, which lead to physical symptoms of anxiety. Triggers aren’t exclusive to situations. Thoughts and other (possibly more complex) emotions can also fuel anxiety. Similarly, beliefs such as self-doubt or worst-case assumptions can lead to feelings and bodily sensations associated with anxiety. As you can see, identifying triggers is an important first step in CBT. This process sets the tone for you and your therapist to positively shift your thinking to avoid anxiety.
Cognitive Restructuring
The next step in managing anxiety with CBT involves adjusting one’s thoughts and beliefs so that they don’t cause (or worsen) emotional distress. This is called cognitive restructuring – or the process of challenging negative thoughts to develop healthier responses and a more positive outlook. This may be done in several ways. Some therapists guide their patients in exploring all potential explanations in a certain situation. For example, instead of feeling anxious as a result of being hurt that a friend forgot your birthday, your therapist might urge you to consider alternative reasons for this oversight – such as your friend having a bad day, dealing with a busy schedule, or not having access to their phone for the day.
Examining the evidence is another way to help restructure your thoughts. This is particularly salient for changing negative beliefs. Let’s say you are grappling with this continual thought: “I am not doing as well as I need to in my math class this semester.” If your therapist is walking you through examining the evidence, they will sit down and look at the facts of the situation with you. By reviewing your grades, it will become quite easy to see whether this statement is true or not. While you may have certain standards for yourself, getting above-average or even average grades shows that you are doing well enough to pass the class and move on to the next step. This can serve to manage symptoms of anxiety by adopting a more realistic way of thinking.
Behavior Modification
This step involves taking those new beliefs and more manageable emotions, folding them into one, and using them to inform your actions. This may involve different communication (e.g. responding differently to people when in a situation you’ve identified as a trigger), improved self-care (e.g. taking time out to manage your emotions during times of stress), or structuring your day in a way that is overall less overwhelming for you. In the best case scenario, behavior modification will encompass a bit of each area.
Behavior modification may include any of the following, depending on your circumstances and preferences:
● Activity scheduling
● Symptom tracking
● Journaling
● Mindfulness
● Setting goals
● Deep breathing techniques
● Yoga
● Tai chi
● Qi gong
● Progressive muscle relaxation
● Guided imagery
● Visualization
● Thought stopping
● Scheduling worry time
● Self-massage
● Biofeedback
● Meditation
● Listening to music
● Coloring or drawing
● Doing a craft project
● Teaching yourself a new skill
As we’ve mentioned, some of these may be immediately helpful when practiced during moments of high anxiety. Others may be more fitting when integrated into your daily routines and schedules. Regardless of what each CBT aspect looks like, they each play an important role in the management of anxiety and similarly distressing mental health concerns. Ultimately, your sessions will vary based on your needs, preferences, and the progress you make over time.
Homework
This last step is one of the most general, but also the most pivotal. The effectiveness of CBT hinges on your ability to take what you’ve reviewed during therapy and put it into practice. Sometimes this means placing yourself in certain situations (as per therapist recommendation, of course) and using the strategies you’ve learned. Other times, homework may involve journaling to work through your feelings or thoughts in much the same way as you would alongside your therapist.
Either way, your therapist will offer guidance as to the specific techniques they would like for you to turn into habits. This not only helps you cope with feelings of distress in the moment, but instills a greater sense of control for the long-term – which is the key to overcoming anxiety.
Don't wait to put these powerful techniques into practice. Contact East Side CBT today to get started with a therapist who will guide you every step of the way.
References:
Hirsch, C.R., Beale, S., Grey, N., & Liness, S. (2019). Approaching cognitive behavior therapy for generalized anxiety disorder from a cognitive process perspective. Frontiers in Psychiatry, 10. DOI=10.3389/fpsyt.2019.00796
Stewart, R. E., & Chambless, D. L. (2009). Cognitive-behavioral therapy for adult anxiety disorders in clinical practice: A meta-analysis of effectiveness studies. Journal of Consulting and Clinical Psychology, 77(4), 595-606.
Kerslake, R. (2024). Everything You Need to Know About Cognitive Behavioral Therapy for Anxiety. Retrieved from https://www.healthline.com/health/anxiety/cbt-for-anxiety
Curtiss, J. E., Levine, D. S., Ander, I., & Baker, A. W. (2021). Cognitive-Behavioral Treatments for Anxiety and Stress-Related Disorders. Focus (American Psychiatric Publishing), 19(2), 184–189. https://doi.org/10.1176/appi.focus.20200045