Cognitive Therapy for Anxiety

Farid Alsabeh, TLLP

Farid is a Temporary Limited Licensed Psychologist in MichiganRead full bio

Millions of us experience anxiety each year, and the effects are both distressing and debilitating. Chronic unease, apprehension, and avoidance keep us from participating fully in life — and when our attempts to overcome our anxiety fail, we inevitably experience a sense of helplessness.

Cognitive therapy, developed by psychiatrist Aaron Beck in the 1960s, has consistently been shown to decrease the frequency and strength of anxious thoughts. With a calmer mind, we can start to lead a life based on our values and aspirations, not our worries and doubts.

What is Cognitive Therapy?

Cognitive therapy is a kind of mental health treatment that transforms your thoughts and assumptions about yourself, others, and the world. To understand how it does so, we first have to understand how the mind acts as an information processing system.

Like any other part of our body, our mind has developed over millions of years to help us survive and adapt to our environment. One of the most important functions it has developed is to take information from our environment, interpret it, and use it to change our behavior in useful ways.

For example, we may as children witness somebody being stung by a hornet. Our mind will take this information, interpret it as a sign that hornets are unsafe, and then begin to produce negative thoughts about them. In turn, this will influence our behavior: we will be cautious around them, and try our best to avoid them.

This is an example of an adaptive use of our mind’s information processing system. However, when we become chronically anxious, this system becomes distorted. As a result, it gets in our way instead of helping us, causing distress and interfering with our daily lives.

The following changes happen to the anxious mind’s information processing system:

• Hypervigilance: being overly attentive to potential dangers. The anxious person will see threats everywhere, even where they might not exist.
• Selection: choosing information about dangers. The anxious person will tend to emphasize information in their environment that confirms their perception of threats.
• Overinterpretation: taking dangers too seriously. The anxious person will overestimate both the likelihood and potential severity of threats (this is also known as catastrophizing).
• Increased access: being quicker to think about themes of danger. The anxious person will have memories and facts readily available to support their perception of threats.

This is where cognitive therapy steps in. Cognitive therapy treats anxiety by undoing these distortions to our information processing system, which have been acting as the cause of our anxiety. As a result, a person will begin to perceive a less threatening world.

Cognitive Therapy Techniques

The techniques of cognitive therapy are all aimed at changing how our body and mind react to perceived threats in our environment. This involves several distinct processes.

Expanding bodily awareness.

The word ‘anxiety’ comes from a Latin word related to constricting or pressing. As the origin of this word suggests, there are bodily experiences associated with anxiety.

One of the first steps towards treating anxiety is becoming more aware of its moment-to-moment physical manifestations. Does your breathing become more narrow? Is there a tightness in your chest? Do your muscles feel more tense?

As we become more familiar with how our body reacts to anxiety, we can take steps to mitigate the response. But we can also use this information to identify the scenarios and experiences that cause us anxiety in the first place.

Expanding thought awareness.

Just as we become more aware of how our body participates in anxiety, we must also become more aware of how our mind does. This means becoming more aware of the beliefs, scenarios, and underlying assumptions behind our anxiety.

For example, we may become anxious after a certain interaction at work. In response, we start to explore what thoughts are behind this anxiety, and this reveals that we worry most about people’s negative perception of our perceived incompetence. This information will help us more adequately apply the cognitive techniques.

Cognitive challenging.

Once we’ve identified the thoughts that underlie our anxiety, the next technique is to take active steps to change them. After repeatedly challenging these thoughts, they become less automatic, allowing us to control and shift them.

One effective cognitive challenging technique is to pause and reflect when experiencing anxiety. By asking ourselves about the specific scenario that’s causing our worry, we can begin to uncover the underlying thoughts and beliefs that are contributing to our anxiety. Once we have identified these thoughts, we can start to evaluate them against the reality of the situation. By examining the evidence and considering alternative perspectives, we can challenge and reframe our negative thought patterns, leading to a more balanced and constructive perspective. This technique can help to reduce anxiety and improve our overall well-being.

Exposure

The final technique in cognitive therapy is to directly confront situations which are known to evoke anxiety. Although this may at first appear intimidating, it can be done slowly, with small-scale exposures being done before taking on larger challenges.

This technique has many benefits. The first is that it reduces your adverse reaction to the feared situation, because by experiencing and surviving it, you teach your body that the situation isn’t as threatening as you thought. The second is that you improve your sense of self-efficacy, as you learn that you’re able to take action despite your anxious thoughts and feelings.

Cognitive Therapy Goals

The main goal of cognitive therapy is to transform our minds from rigid, irrational, egocentric processors of information, to flexible, adaptive, and helpful processors of information.

In general, this involves four separate processes:

Accurately estimating probability of threats.

Notably, this doesn’t mean that we falsely reassure ourselves that negative outcomes won’t occur. But it means having a more realistic understanding of their likelihood, so that we can act in a more informed way.

Accurately estimating the severity of the threats.

Just as we gain a realistic understanding of the likelihood of events, we also become realistic with regards to their negative outcome. Is the feared outcome really as catastrophic as we think it would be? What are some potential alternatives to the worst-case-scenario?

Cultivating our ability to cope.

The level of threat posed by a situation is determined not only by the nature of the threat itself, but also by our capacity to effectively respond to it. By strengthening our coping mechanisms, we convince ourselves that we can be resilient to threats, and they start to carry less weight.

Developing rescue factors.

If our ability to cope represents an internal source of support, then rescue factors are external sources of support. These may include family members, friends, or a supportive work environment. Improving our access to these resources, and developing ways to rely on them, bolsters our ability to make it through difficult times.

Cognitive Therapy Exercises for Anxiety

After learning about the principles and techniques of cognitive therapy, you may be wondering what exercises could be helpful for managing your own anxiety. What are some effective strategies that you can implement to challenge and reframe your negative thought patterns, reduce your symptoms, and improve your overall well-being?

Thought recording

One of the first steps in gaining a foothold on our anxiety is to be aware of the thoughts that are behind it. Once we’ve gotten used to the process of exploring the thoughts behind our anxiety, we can start to do it systematically by using a thought record.

A thought record is exactly what it sounds like: a written record of the thoughts that we have at particular times. Having a note in our phone, for example, allows us to write down what thoughts we’re experiencing, for example in the following way:

Date: 11/14

Time: Morning

Anxiety score: 6/10

Underlying thoughts: “I won’t get anything done today;” “It’s gonna be crowded at the gym today.”

Over time, this technique allows us to find patterns in the nature of our thoughts and how they contribute to our anxiety. This understanding will be the first step in actively challenging our thoughts instead of accepting them at face value, which can significantly improve our overall anxiety.

Imaginative rehearsal

Imaginative rehearsal is the process of vividly imagining how we might cope through a distressing situation. Oftentimes, our anxiety is made worse by the fact that we project worst-case scenarios into unknown situations. Imaginative rehearsal is a process that allows us to increase self-efficacy, reduce anxiety, and improve performance by mentally preparing for the situation ahead of time. By repeatedly visualizing oneself successfully navigating a challenging situation, individuals can build confidence and reduce feelings of uncertainty or fear.

For example, a person whose anxiety has caused them to avoid public spaces may practice imaginative rehearsal by imagining themselves navigating a public space. They will explore the bodily sensations and thoughts that occur to them, anticipate any distortions in thinking that are likely to occur, and brainstorm the internal and external resources they could use to successfully navigate the situation.

Conclusion

Anxiety is an incredibly burdensome state of mind. Not only is it uncomfortable, but it prevents us from leading a rich and fulfilling life. It results from distortions to our mind’s information processing system, which can make the world seem like a more threatening place than it actually is. Thankfully, cognitive therapy techniques and exercises can help us to shift these biases so that the world feels safer and we feel more confident in our ability to navigate it.

If you’re ready to take the first step in treating your anxiety, consider finding a therapist who specializes in cognitive therapy.