Everything You Need to Know About Anxiety: How CBT Can Help!

Welcome back to the third and final post in our 3-part series on anxiety, Everything You Need to Know About Anxiety: How CBT Can Help!

In Parts 1 and 2, we learned more about what anxiety is, how exactly it works, and when it becomes a problem, using the Cognitive Behavioural Model of Anxiety as our framework.

Today, we will be discussing how you can experience an improvement in your anxiety with Cognitive Behavioural Therapy (CBT).

How CBT Works

As the name suggests, CBT focuses on the way people think ("cognitive") and act ("behavioural").

The main idea behind CBT is that our thoughts about a situation significantly impacts how we feel (emotionally and physically) and how we behave in that situation. Two people can interpret the same situation in completely different ways.

For example, let’s say two people get invited to a party. The person without anxiety might think, “The party sounds like a lot of fun. I love going out and meeting new people!”. They feel happy and excited, and end up going to the party and having a great time.

The person with anxiety thinks, “I never know what to say or do at parties. I’ll make a fool of myself if I go”. They start to feel anxious and nervous, their heart rate increases, and they feel nausea and sweaty. So, they decide not to go to the party.

It is the meanings we assign to the situation that affect how we feel and act, not the situation itself. It all depends on our perceptions.

For people who struggle with anxiety or anxiety disorders, negative ways of thinking fuel anxiety. When we feel anxious and start to experience physical sensations (nausea, sweating, racing heart), we then usually engage in a behaviour to try and turn down this anxiety so that we can feel better.

However, this behaviour usually ends up making our anxiety worse in the long run (click here for a refresher on how this works), and we get stuck in this vicious cycle of anxiety and avoidance, impacting our ability to function and enjoy our lives to the fullest.

So, how do we work on managing this?

With CBT, the therapist works with the client to change negative and anxious thought patterns, teach relaxation skills, and change problematic behaviors.

The “C” in CBT

We now know that the way we think about things powerfully impacts how we feel and what we do. The “C” in CBT aims to identify, challenge, and change these negative and anxious (and often inaccurate) thoughts and beliefs that contribute to our anxiety. This is called Cognitive Restructuring. The idea is that if you change the way you think, you can change the way you feel (and act).

This involves three steps:

Step 1: Identifying your negative thoughts.

Know what you’re thinking or telling yourself. Paying attention to your thoughts (or self-talk) can help you keep track of the kind of thoughts you typically have and can help you to identify the ones that are contributing to your anxiety. The process of identifying thoughts can sometimes be tough at first. Most of us are not used to paying attention to the way we think, even though we are constantly affected by our thoughts. It usually takes a bit of help and support from a trained therapist. So, try not to get discouraged if this seems difficult for you.

Step 2: Challenging your negative thoughts.

The next step is to start to examine these anxiety-provoking thoughts to see if they’re inaccurate and unhelpful. This involves questioning the evidence for your thoughts and analyzing unhelpful beliefs.

You can ask yourself questions like:

"Is there evidence for my thought, or am I making assumptions?"

"What's the worst that could happen? Is that outcome likely?"

"What's the best that could happen?"

"What's most likely to happen?"

“Am I confusing a possibility with a probability? It may be possible, but is it likely?”

"Will this matter a week from now, a year from now, or five years from now?"

“What would a friend think about this situation?”

This step can be tricky too and is something your therapist can help you with.

Step 3: Replacing negative thoughts with realistic thoughts.

Finally, after challenging a negative thought and evaluating it more objectively, try to come up with an alternative thought that is more balanced and realistic. It’s important for me to emphasize here that the new belief does not need to be full of sunshine, rainbows, and happiness. Sometimes, the best replacement thought is just less negative. Some situations really are scary, and denying that won't do any good. The idea is to think neutrally rather than negatively, and to put fears into perspective. In addition to coming up with realistic statements, try to come up with some quick and easy-to-remember coping statements (e.g., “This has happened before and I know how to handle it”) and positive self-statements (e.g., “It takes courage to face the things that scare me”).

The “B” in CBT

Exposure Therapy

We’ve mentioned safety and avoidance behaviours a few times now. Anxiety isn’t a pleasant sensation, so it’s completely normal to want to avoid the things that make you anxious because this reduces your anxiety in the short term. For example, if you’re afraid of small, enclosed places like elevators, taking the stairs instead will make you less anxious.

But as we know, the problem with avoiding your fears is that you never have the chance to overcome them; avoidance prevents you from learning that the things you fear aren’t as dangerous as you think. So, in this case, taking the stairs prevents you from learning that nothing bad happens when you do take the elevator.

What’s more, avoiding your fears often makes them stronger.

In CBT, the process of facing fears is called exposure – and it’s arguably the most important step in learning to effectively manage your anxiety.

Exposure involves gradually and repeatedly entering feared situations until you feel less anxious. This probably sounds a little scary. This is why we start with situations that only cause you a little bit of anxiety, and we work our way up to facing things that cause you more anxiety.

One of the key factors with exposure therapy is not engaging safety and avoidance behaviours, so that you can learn that nothing bad happens when you do not engage in these behaviours and that you can in fact cope with your anxiety!

The idea is that through repeated exposures, you’ll feel an increasing sense of control over the situation and your anxiety will diminish.

The more you practice, the faster your fears will fade! Having successes and feeling good about your progress is a powerful motivator to keep going.

Behavioural Experiments

Behavioural Experiments allow us to test out the negative predictions we make, as well as the new thoughts and beliefs that we come up with when challenging anxious thoughts.

We do this by designing an experiment where you get to actually test out your beliefs in a real life situation.

For example, you might be worried that everyone will see how nervous you are when giving a presentation at work and that they’ll think you’re a terrible presenter. One way to test this belief is by actually asking your co-workers for feedback after you give the presentation.

The rationale here is that actually experiencing a situation where our negative beliefs are proved inaccurate (and our more realistic thoughts are proved accurate) can result in incredibly powerful learning and a reduction in our anxiety.

Relaxation Techniques

Relaxation techniques, like deep breathing and progressive muscle relaxation, can also be an important part of CBT for anxiety, especially with Generalized Anxiety Disorder and Post-Traumatic Stress Disorder.

That said, we want to be careful to not use relaxation strategies as a safety/avoidance behaviour, but rather as a way to reduce overall levels of anxiety and promote relaxation on a day to day basis.

Next Steps for YOU

If this blog series resonated with you and you are looking for some help in managing your anxiety, or another mental health issue, I offer a complimentary 15-minute telephone or in-person consultation.

We can discuss any questions you might have about whether my therapy services will be a good fit for you. Please feel free to email the clinic at admin@drdarou.com to set up a time that works best for you.

Alternatively, if you are feeling ready to dive in and get started, you can book your first appointment with me at Darou Wellness (click here).

What you can expect in our work together:

• Confidential, non-judgmental, and compassionate care

• Comprehensive assessment of your needs, goals, and strengths

• Collaborative treatment planning rooted in evidence-based models

• Skill-building and development of effective coping strategies

• Home practice on a weekly basis to make sure you feel confident in applying the skills you are learning

I very much look forward to working alongside you on your journey toward wellness!

I regularly blog about mental health concerns, so check back in for more on coping with anxiety, depression, insomnia, emotional difficulties, trauma and general coping and mental wellness.