CBT for Anxiety, by Brianna Sculley, LCSW

Brianna Sculley, LCSW, our resident Cognitive Behavioral Therapy (CBT) expert, developed a 4-part series on CBT interventions! In this first installment, learn how CBT helps with anxiety, a very common psychological problem that gets exacerbated in times of stress.

Brianna writes, "If you struggle more than you think you should with worry and anxiety, you might be wondering how CBT can help you. People with anxiety often ruminate on negative thoughts that aren’t likely rooted in the present and may not even be rooted in facts. Then, it can affect your mood and behavior in ways that do not line up with the facts. The cycle can feel extremely frustrating and hard to manage.

CBT tackles these kinds of thinking problems and analyzes the way they negatively affect emotions and behavior. Then new thoughts based on facts are incorporated to help change our thinking, feelings, and behaviors.

When anxiety is high, our perceptions are naturally distorted as our neurological arousal system, specifically the sympathetic nervous system, is set off and produces rapid changes in our body to gear us up for fight or flight. Our brain is certain there is a threat. Trying to talk ourselves out of our beliefs or "get perspective" in these moments can truly feel impossible!

Thankfully, CBT strategies can help to alleviate these distressing thoughts, and with enough time and practice, you can develop and use these truly effective techniques strategically and on your own.

Let's take an example. Say you text a friend and they do not send a text in return, triggering thoughts that they do not like you, or "I am unlikeable". You may also notice that this is a common assumption and one you make with multiple friends and colleagues. This thought naturally increases worry and distress, and if the thought occurs frequently, you are likely to be in a lot of anguish. Unchallenged, these thoughts may lead you to erroneously conclude your worst fears, making you feel even more miserable AND you may even act on your conclusions by withdrawing from your friends (flight) and unnecessarily isolating yourself, or confronting your friends for rejecting you (fight) and causing unneeded relationship trouble.

Use these 4 CBT steps to help you:

Step 1 - Identify Your Negative Thoughts
Take the time to identify negative thoughts that you dwell on. These beliefs might make you feel insecure, unworthy, or fearful. Think about the origins of these thoughts. Did you receive a lot of criticism or rejection as a child, or did you suffer a significant loss or abandonment? In the example above, the frequent thought is "I am unlikeable," or "people don't like me".

Step 2 - Challenge Cognitive Distortions
Come up with a list of examples from the past that confirm or debunk this thought. Chances are you have many more examples in your life proving your fear is wrong. A majority of these thoughts that are exacerbating your anxiety do not pass the reality test. A CBT therapist can walk you through “reality testing” if you need extra help.

Step 3 - Replace Problematic Thoughts with New Ones
You have figured out which thoughts are rooted in anxiety. You have determined that many of them are not based on any real evidence, and now you are ready to establish healthier thought patterns. With the above example, replace "People do not like me" with “I am a good friend and have a good time when I'm with friends. I feel liked in their presence and they show interest in me. People often get busy and overlook texts. I have even overlooked texts from time to time with good friends." These new thoughts likely won't sink in right away – but as you focus and commit to adopting new beliefs that align more closely with reality, you’ll find relief from your anxiety.

Step 4 - Generalize by Practicing Reinforcing & Encouraging
Like learning any new behavior, you must practice in order to achieve mastery. Use these techniques often. Don't forget to reward yourself for your efforts and apply good old reinforcement to give your efforts an extra boost. Keep encouraging yourself along the way! You can do this! In time, you will become a thoughts and emotions master. And as always, we believe in you!”