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CBT for Anxiety

Written By Dr Elaine Ryan.

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Dr Ryan is a psychologist with over 20 years of experience. She specialises in OCD and anxiety-related conditions and worked in the NHS in the UK before setting up a private practice in Dublin. Dr Ryan obtained her PsychD from The University of Surrey and is a Member of The British Psychological Society, The UK Society for Behavioural Medicine and EuroPsy registered.

Introduction

In Ireland, anxiety disorders are prevalent among the population. According to recent surveys, approximately 7% of Irish adults meet the diagnostic criteria for Generalized Anxiety Disorder (GAD) (Maynooth University) (Irish Practice Nurses). Additionally, broader measures indicate that anxiety affects around 74% of adults to varying degrees, with 48% experiencing anxiety frequently (Aware)?. Cognitive Behavioural Therapy (CBT) is one of the most effective treatments for anxiety, offering practical strategies to manage and reduce symptoms and today I want to explain a bit more about how it works.

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What is Cognitive Behavioural Therapy (CBT)?

Cognitive Behavioural Therapy is a talking therapy that helps you to understand the relationship between your thoughts, feelings, and behaviours. Developed in the 1960s by Aaron T. Beck, CBT is grounded in the belief that changing maladaptive thinking leads to changes in behaviour and emotional state. I shall explain that quickly before moving on.

Imagine Saoirse who has social anxiety and thinks, “If I speak in meetings, I’ll say something stupid, and everyone will think I’m a fool” This negative thought causes Saoirse to feel extremely anxious and avoid speaking up in meetings.

  1. Identifying Maladaptive Thought: Saoirse’s therapist helps her identify this automatic negative thought that triggers anxiety.
  2. Challenging the Thought: They work together to challenge the validity of this thought by asking questions like, “What evidence do you have that you will say something stupid?” and “Have there been times when you spoke in a meeting and things went well?”
  3. Reframing the Thought: Saoirse learns to reframe her thought to something more balanced, like, “I might feel nervous, but I can prepare and contribute meaningfully to the meeting.”
  4. Behavioural Change: With this new way of thinking, Saoirse gradually starts to participate in meetings. As she does this, she realizes that her fear of negative judgment was exaggerated, which reduces her anxiety over time.

By changing his maladaptive thinking, Saoirse changes her behaviour (participating in meetings) and her emotional state (reduced anxiety). I’ve make a quick video to explain how CBT works.

How CBT Works for Anxiety

Cognitive behavioural therapy has been widely researched, shown to be effective and recommended by bodies such as NICE for treating anxiety. As such, CBT is the most commonly used talking therapy for anxiety.

The model is based on two therapies, cognitive therapy and behaviour therapy. Combining these models allows CBT to work by changing what you do or do not do, such as avoidance (your behaviours) and your thought processes ( your cognitions.)

Read more on the principles behind CBT here.

The tenet of CBT is that your thoughts, not events, affect your feelings and actions. For example, if you have to give a speech, your fearful thoughts create anxiety, not the address. ; in other words, your thoughts can create anxiety. CBT helps you see the link between your thoughts and emotions and shows you how to change them.

CBT works for anxiety by addressing the distorted thinking patterns that contribute to your anxious feelings and behaviours. It focuses on identifying, challenging, and altering these negative thought patterns and replacing them with more realistic and balanced ones. Here’s how CBT helps in managing anxiety:

  1. Identifying Negative Thoughts:
    • Example: Imagine you have a big presentation at work. Your automatic thought might be, “I’m going to mess this up, and everyone will think I’m incompetent.” In CBT, you learn to recognize this thought as a common trigger for anxiety.
  2. Challenging Negative Thoughts:
    • Example: Your therapist might ask you to examine the evidence for and against your belief that you’ll mess up the presentation. You might realize that you’ve successfully delivered presentations before and received positive feedback, which challenges the initial negative thought.
  3. Changing Behaviour:
    • Example: Instead of avoiding presentations out of fear, CBT encourages you to confront the situation. You might start with smaller tasks, like speaking up in meetings, gradually building confidence. Over time, this helps reduce anxiety around public speaking.

You can see in the image below a sample CBT thought record that you would typically use to record and change your thoughts and I have included the worksheet in PDF format for you to download.

Thought-RecordDownload

Key Techniques Used in CBT for Anxiety

Several techniques are employed in CBT to help you manage anxiety:

Cognitive Restructuring:

  • Example: Aisling often thinks, “If I don’t get everything perfect, I’ll fail.” In CBT, she learns to challenge this thought by considering more balanced perspectives, such as, “It’s okay to make mistakes; I can learn from them.”

Exposure Therapy:

  • Example: Conor has a fear of flying. In session we gradually confront this fear by first looking at pictures of airplanes, then visiting an airport, and eventually taking a short flight. Each step helps reduce his anxiety.

Relaxation Techniques:

  • Example: During stressful situations, Killian practices deep breathing exercises he learned in CBT. By focusing on his breath, he calms his mind and body, reducing his anxiety levels.

Behavioural Activation:

  • Example: Aoife feels anxious about going out and often isolates herself. In session I encourage her to engage in activities she enjoys, like joining a book club. By doing so, she feels more accomplished and less anxious.

Benefits of CBT for Anxiety

CBT offers numerous benefits for those suffering from anxiety:

  1. Long-term Effectiveness: CBT provides you with tools and strategies they can use beyond the therapy sessions, promoting long-term management of anxiety. I always say in session that they whole idea of CBT is to make me redundant; you should get to a stage where you do not need your therapist and have the tools at your disposal.
  2. Skill-building: You learn practical skills to identify and challenge negative thoughts and manage their anxiety independently.
  3. Empowerment: By understanding the cognitive-behavioural model, clients feel more in control of their anxiety.
  4. Evidence-based: Numerous studies, including those by the American Psychological Association and the National Institute of Mental Health, support the effectiveness of CBT in treating anxiety.

It is proven to be effective in treating anxiety.

CBT is a widely researched model of therapy and has been shown to be effective in the treatment of anxiety, as well as other mental health conditions.

NICE recommends CBT for the treatment of anxiety.

Studies show that CBT can effectively treat anxiety after as few as 8 sessions. 

It is a cost-effective treatment.

CBT is a cost-effective treatment option due to the structured nature of the model. It is a short-term model of therapy and has been shown to work, so in theory, you should not have to return and pay for more sessions. This makes it cost-effective if you have to pay for the therapy yourself or for employers or other bodies being billed for treatment.

Also, due to the nature of the model, it can be effectively delivered through self-help books, courses and online, not only adding to its cost-effectiveness but also giving the client more choice in how they wish to receive treatment.

It can be used to treat many types of anxiety disorders.

CBT is an accepted model of therapy for the different types of anxiety disorders, including 

  • GAD
  • panic disorder
  • social anxiety

Depending on your type of anxiety disorder, the model can be tailored to your needs. This is done through the homework that is part of CBT.

During homework, think of yourself as a scientist gathering evidence on your thought processes and behaviours before testing them and changing them.  

The data you collect on your thoughts and behaviours will be unique to you and your type of anxiety disorder, and your therapist will then show you how to change your beliefs or design behavioural experiments that will fit you.

CBT helps you healthily manage anxiety.

Many people feel anxious but do not seek treatment as they may have learned to cope with their anxiety using methods that do not help them long term.

For example. People may misuse alcohol when out socially to help them deal with their social anxiety or get into the habit of having a nightcap to help them sleep when anxious.

Others might avoid anxiety-provoking situations altogether.

Whilst alcohol and avoidance may help manage the anxiety at the time, they are not healthy coping styles as both hurt you long term. The drinking can get out of control, and you may miss out on things in your life due to avoidance.

For example, a client to see me therapy several years ago never put themselves forward for promotion, even though their boss encouraged them, as they did not want the stress of either the interview or the change if they got the job.

CBT helps you not just cope but get over anxiety without using crutches that are harmful, and the skills you learn can only help in all other aspects of your life. 

It can help people learn how to deal with their anxiety in the future.

When you fully understand what led to anxiety and, through behavioural experiments, see that you can handle situations that previously led to fear and anxiety, this gives you the confidence to manage stress-provoking problems in the future.

CBT can help you in other areas of your life.

Once you have gone through the process of CBT and understand how your thoughts and behaviours can either help or hinder you, this skill can be applied to many aspects of your life.

As a psychologist, I regularly use CBT not only to help people with anxiety but also to help improved their relationships or as a form of coaching to help with self-development.

The whole idea of CBT is to teach you to be your own therapist and make your therapist redundant. Once you have achieved this, you do not need to return and pay

If you are ready for therapy it is crucial that you not only find someone competent and trained in CBT but also a therapist that has extensive knowledge of anxiety and how to work within the model of CBT and apply it to anxiety.

Finding a qualified CBT therapist is crucial for effective treatment. Here are some tips to help you in your search:

  1. Check Credentials: Ensure the therapist is licensed and has specific training in CBT.
  2. Ask for Recommendations: Seek referrals from healthcare providers or trusted individuals.
  3. Research Experience: Look for therapists with experience in treating anxiety disorders.
  4. Initial Consultation: Schedule a consultation to discuss your concerns and gauge if the therapist’s approach aligns with your needs.

Additional Resources for Help

For further information and support, consider the following resources:

  1. BABCP: Provides a directory of CBT therapists
  2. National Institute of Mental Health (NIMH): Offers information on anxiety disorders and CBT.
  3. Read more on anxiety counselling here.