Cognitive Behavioral Therapy For Anxiety

Overview

Anxiety is a natural human emotion, but only up to a certain extent. You may feel anxious before the first day of school, a big exam, a job interview, or a first date. It becomes a problem when it interferes with your daily activities or changes your behaviour towards a situation. Anxiety is the most common mental health issue, affecting around 30% of adults at some point during their lives.¹ Don’t let anxiety affect your mental well-being, performance, or social relationships! There are many options to treat anxiety, and this article aims to unveil an effective type of psychotherapy, called cognitive behavioural therapy (CBT), along with its principles, the therapeutic process, and its benefits. 

Understanding anxiety

Anxiety is often characterised as fear, but even though the terms are used interchangeably, they are not the same. Anxiety is a complex emotion built around apprehension, nervousness, and troubled thoughts. Physical symptoms, such as muscle tension, increased pulse, high blood pressure, rapid breathing (hyperventilation), sweating, trembling, and even digestive and sleeping problems might also appear. Anxiety is an amplified, long-acting response to a future-oriented, not well-defined, danger. Fear is a natural, short-acting, present-oriented response to an immediate, actual threat. Sometimes anxiety is part of life, and it can make you more alert, focused, and prepared for a stressful situation. Anxiety becomes a mental health problem when it affects your thoughts, behaviour, and impacts your everyday life. Your response to a feared trigger is difficult to control, and often exaggerated, making you avoid places or events to remove the source of danger in the future. Generalised anxiety disorder, panic disorder, social anxiety disorder, and specific phobia-related disorders, are some examples of anxiety disorders. Unfortunately, they are not mutually exclusive, you can have more than one disorder at a time.  

What is cognitive behavioural therapy (CBT)?

Cognitive behavioural therapy (CBT) is an effective type of psychotherapy that helps you overcome your problem by aiming to change the way you think, feel, and behave towards it. Focusing on cognition, this therapy is an intervention to how you understand, interpret, and respond to what happens to you. You team up with the psychotherapist in a structured, goal-oriented, time-limited, self-improving journey, to train your mind on how to identify and acknowledge dysfunctional, over-amplified feelings (such as anxiety, fear, angst) and maladaptive behavioural responses (such as avoidance) towards the trigger. CBT helps you learn new ways of thinking about the problem, anchoring you in reality; this approach will improve your feelings and reactions. In time, you become your own therapist, able to identify and modify dysfunctional mechanisms.^2,3

The principles of CBT for anxiety

Pathological anxiety is part of disorders such as panic anxiety, major depression disorder, generalised anxiety disorder, post-traumatic stress disorder, obsessive-compulsive disorder, specific phobias, substance abuse, chronic pain, hypochondria and schizophrenia. CBT has methods to use in each anxiety disorder, but there are two most commonly used methods called exposure therapy and cognitive therapy.^2,4  

Cognitive therapy works on the interconnection of thoughts, feelings and behaviour. Distorted thoughts create negative feelings; negative feelings ignite the negative thinking. This thought sequence influences behaviour, and a vicious “anxiety cycle” is born. Your therapist will train you to identify inaccurate thinking patterns. By analysing and understanding all the details of the thought-feeling-behaviour association, you can change the way you think, and break the anxiety cycle.^4,5

Exposure therapy is a behavioural exercise that targets your trigger-response association. Anxiety occurs when a safe trigger from the environment activates an emotional response to danger, causing a normal event to feel like a harmful one. Therefore, the sense of immediate danger makes you avoid the trigger. By avoiding further exposure to the trigger, you prevent your mind from learning new associations regarding the feared event and your emotional response to it. Therefore, the anxiety pattern is reinforced every time you avoid the situation. So, exposure therapy aims to break your irrational, trigger-response association, by using exercises to help you get exposed to the situation. Confronting the trigger, your brain learns new associations regarding the event and, in time, makes the fear decrease.⁴ 

The therapeutic process

What to expect from CBT? This type of psychotherapy is a structured, predictable, time-limited, goal-oriented, engaging collaboration with your therapist. At the beginning, you usually fill in an initial assessment that helps the therapist understand your case, diagnosis, and develop a treatment plan. Then you both agree upon a structure and an “agenda” for your treatment. You might set the sessions on a weekly basis (depending on your needs). One session lasts around one hour, focusing on a goal. During the session, depending on the therapeutic technique used in your case, you can examine the depths of your struggle, understand your underlying mental mechanisms, feelings and behaviours, try different exercises to approach the problem and progressively improve your response. You need to actively engage in the process, trust the therapist, commit to the journey, and even do your homework between sessions. You might need to do some reading, keep a diary, or other assignments. Exposure therapy lasts about 10 sessions and cognitive therapy up to 20 sessions.^4,6,7

Benefits of CBT for anxiety

First of all, CBT is considered to be the gold-standard treatment in psychology. Therefore, this type of psychotherapy is the most studied, researched, and up-to-date, being a relevant option to treat anxiety disorders, due to the wide availability of disorder-specific methods.⁸

Secondly, nowadays CBT can be delivered both online and face-to-face. The online treatment accessibility may improve adherence. Although convenient, the online version of therapy seems to be less effective than the classic, in-person option.⁹ 

Thirdly, studies show that, even though anxiety symptoms improve after only a few sessions, results are superior when the treatment lasts longer than 20 sessions and is delivered in person, not online. The extended treatment duration also improved the patients’ quality of life.⁹ 

Is CBT right for you?

You should consider what CBT implies, before committing to it. The therapy relies on establishing an efficient therapeutic relationship in order to obtain results. If you think you might have difficulties in setting up this connection, maybe this type of therapy isn’t for you. Furthermore, your active participation in this treatment is paramount. Fully engaging in the process can be challenging. You might experience powerful and stressful emotions and experiences during the exercises, you might need to find your inner courage to fulfil your assignments and also show commitment to do your homework between sessions. These are some points to keep in mind while considering whether CBT is right for you.⁷

• Where can I find more information?
• How can I find a therapist in the UK, or around the world?

Myths and misconceptions

Unfortunately, there are some common myths and misconceptions about psychotherapy. 

“Therapy is for the weak or mentally ill”, is a stigma-bearing misconception. Committing to CBT takes a lot of courage, because you need to share your feelings and thoughts, and confront your fears, which only a strong person does. Psychotherapy is an effective tool in mental disorders, but it is also beneficial to anyone who is in need of support or help in a particular struggle. Stress, anxiety, losing a loved one, or going through a big change in your life, are common situations in which people reach out to a therapist. And this should be a normal thing to do, and talk about, not something to hide because of a fear of being judged. 

“The psychotherapist can prescribe medication”, is also false. Only the psychiatrist, who is a licensed medical doctor, can prescribe pharmacotherapy for mental health disorders. Studies show that the medication used in psychiatry, known as psychotropic agents (such as antidepressants), are more effective when used in combination with psychotherapy for anxiety and depressive disorders, than when the only treatment given is medication. The use of CBT combined with medication is also effective in preventing a relapse.^10,11

Summary

CBT is an effective method to treat anxiety. You need to actively engage and commit to the process in order to achieve results. Your therapist will help you achieve the skills to be able to break the “anxiety cycle” and improve your quality of life. The focus of the therapy is the link between thoughts, feelings, and behaviour. Two of the most commonly used methods are cognitive and exposure therapy. Cognitive therapy deeply explores and helps you to understand your thoughts and feelings, and exposure therapy focuses on learning exercises to stop avoiding the triggering situations. CBT empowers you to improve your response and even overcome the anxiety. Sometimes, CBT can be used in combination with psychotropic medication to fight anxiety disorders. But you don’t have to wait until anxiety becomes unmanageable and affects your everyday life. Reach out to a psychotherapist to open up about your struggle so that  together you can find the best approach to your problem. 

FAQs

How can CBT help with anxiety? 

CBT aims to break the anxiety cycle of negative thoughts, strong and uncomfortable feelings, and dysfunctional behaviour. You team up with your therapist, to develop the skills to overcome your struggle. 

How long does CBT take to treat anxiety?  

Anxiety is usually treated during 20 sessions of CBT, but each person has individual progress and different needs, so the process can vary. 

When is CBT not appropriate? 

Because CBT requires active engagement in the process, and setting up an efficient therapeutic relationship with the therapist, some people suffering from severe personality disorders, or those with intellectual disabilities, might benefit from other specialised treatment methods instead.