How the Cognitive Behavioral Approach helps in treating Anxiety

Apr 15, 20245 min
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Sometimes our thoughts can get so dark that it can feel like, “I don't want to be here in my head!” It gets difficult to track which thought started it all trailed us off to the path of anxiety. With cognitive behavioral therapy (CBT), a psychologist helps you to identify and address the thoughts, emotions, and behaviors that create such anxiety. In CBT, the therapist collaborates with the client to identify patterns and implement changes that promote well-being. First, let’s understand anxiety itself to learn more about how CBT helps with it. 

Anxiety Disorders: The Concern

While everyone faces anxiety about daily life challenges including health, work, relationships, and finances, some people may have chronic anxiety that may feel uncontrollable. A study from 2019 based in the United Kingdom explains the cognitive processes that may be at play in anxiety disorders. These include:

  • Attention bias: When we worry a lot we tend to focus on negative information more than positive. For instance, if I am worried about whether my friends like me, I am biased to remember the one negative remark made about me instead of the three compliments I received that day. 
  • Interpretation bias: Situations seem to be threatening or harmful even absence of such evidence. Think of a time when someone insisted they were not mad at you; is it possible they had a neutral expression but anxiety made you believe they were genuinely upset?
  • Pervasive negative thoughts: Negative or unwanted thoughts pop up repeatedly. It may feel like no matter what or where only these thoughts stay and leave you exhausted.
  • Attentional control difficulties: Difficulty in moving away from these thoughts even though you try. For instance, you may try to notice positive things but an anxious voice always pops up negating any other experience, making you focus only on the negative.

Our anxieties bring with them a lot of information and knowledge that need to be sorted out as helpful or unhelpful. Therefore, CBT techniques are one of the important tools that mental health professionals use to improve anxiety-provoking thoughts and behavioral patterns for the well-being of a person.

Expanding on CBT

Anxiety almost always comes with negative thoughts and fears. Over time, these can become cluttered and affect our lives negatively. There is little room to allow ourselves to sit with our thoughts without feeling scared. In recent years, talk therapies like the Cognitive Behavioral approach to treat anxiety have become prominent. This evidence-based approach allows one to explore their thoughts and recognize what’s helpful to keep and what’s unhelpful to be shelved in the presence of a mental health professional. 

On the one hand, cognitive behavioral approaches help to find and identify patterns, and on the other, they are also the vacuum cleaner coming in to declutter and work through these thoughts. Ideally, you work with a therapist to identify attainable mental health goals and figure out areas that are impacting your life and need improvement.

The modality, as the name suggests, is the product of the marriage between behavioral therapies and cognitive therapies.

  • Behavioral therapies were quite stuck on the observable: “If there’s a stimulus there is likely going to be a response.” For example, if a friend says something hurtful, you immediately say something hurtful back. Here, one behavior elicited the other. 
  • Cognitive therapies wanted to seek the unobservable “If I think the worst about this stimulus, I’m likely going to respond that way.” Let’s assume this friend is usually really nice, and so, the unexpected comment left you upset. Confused, you thought, “Well, damn, they never really liked me anyway, good riddance!” One behavior elicited a thought to provoke another behavior. 
  • The resultant child, Cognitive Behavioral approaches use the best of these to say, “I notice that when I encounter this situation, I specifically think this way, feel a certain way, and act accordingly.” Now, let’s complicate matters a bit more; since this comment was out of turn, you felt hurt and confused but before this, it happened with another friend and you wondered- “why would they both say this to me?” and thus, you would like to get some clarity. You decide to have a dialogue with your friends and see what is bothering them. One behavior elicited a thought and feelings and allowed for trying to find another behavior - different from the usual. 

3 Ways You Can Use CBT to Manage Anxiety

Some common techniques that help to manage anxiety and change behavior under cognitive behavioral approaches:

  • Cognitive restructuring: Maybe you too struggle with some or all of the cognitive processes mentioned in the previous section and tend to overgeneralize resulting in repeatedly feeling, “I knew this was going to happen!” Cognitive restructuring under this approach allows you to carefully look at these processes and identify situations that trigger these patterns. Once identified, your therapist may give you helpful prompts or activities to see if there is a view that may be neglected and may be more helpful for your emotional and mental health.
  • Challenging your thoughts: Not everything we think may be true, yet, in our heads, it all seems undeniable. Challenging one’s thoughts may look like looking at all available evidence, for and against the particular thought, to notice what’s based on facts and what may be just unhelpful. For instance, maybe your anxiety is lying to you and questioning your confidence about the level of preparation for an exam, a good challenge would be: Have you gone through the entire syllabus? Have you made the necessary revisions? If yes, though you may feel anxious, you will have some concrete evidence of what may be true about your preparation.
  • Journaling: Sometimes it gets difficult to unroll the yarn spun by a plethora of thoughts. For the same, your therapist may ask you to keep a “Thought record” that helps you clarify and organize your thoughts. This may also include opportunities for cognitive restructuring and thought challenges on a more moment-to-moment basis. 

Will CBT Help My Overthinking?

In 2019, researchers from the Netherlands analyzed around 69 studies that aimed to measure the effectiveness of different therapies for anxiety symptoms such as rumination or overthinking. They found CBT had anxiety-reducing benefits that lasted at least 12 months.

However, it is only understandable that one feels anxious to try something new after reading about it on the internet! Hence, it makes sense to look for a therapist who works with CBT techniques or specializes in the same before you try something on your own. A therapist is specifically trained to provide you with a safe, trusting, and non-judgmental space for you to unburden and work through the overwhelm that can come when one decides to make a change. 

In conclusion

While it may seem daunting to begin the work, cognitive behavioral approaches are safe to identify negative thinking patterns that contribute to distress and impact well-being. Once identified, a therapist can help you figure out some simple ways to restructure these thoughts for better mental health outcomes. 

  1. American Psychological Association. (2017, July 31). What is Cognitive Behavioral Therapy?
  2. 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.
  3. Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in Clinical Neuroscience, 17(3), 337–346.
  4. Van Dis, E. A., Van Veen, S. C., Hagenaars, M. A., Batelaan, N. M., Bockting, C., Van Den Heuvel, R. M., Cuijpers, P., & Engelhard, I. M. (2020). Long-term Outcomes of Cognitive Behavioral therapy for Anxiety-Related Disorders. JAMA Psychiatry, 77(3), 265.
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Snigdha Samantray
Digital Mental Health Specialist | Clinical Psychologist