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Schonbuch-Rabbi-Daniel

Cognitive Behavioral Therapy for Anxiety

If you or your child suffers from panic attacks, obsessive thoughts, unrelenting worries or incapacitating phobias, you or your child may have an anxiety disorder – which does not mean that you have to live with anxiety and fear. Treatment can help, and for many anxiety problems, therapy is a good place to start. Certain types of therapy, such as cognitive behavioral therapy and exposure therapy, are particularly beneficial. These therapies can teach you how to control your anxiety levels, stop worrisome thoughts and conquer your fears.

When it comes to treating anxiety disorders, research shows that therapy is usually the most effective option. That’s because anxiety therapy, unlike anxiety medication, treats more than just the symptoms. Therapy can help you uncover the underlying causes of your worries and fears; learn how to relax; look at situations in new, less frightening ways and develop better coping and problem-solving skills.

As anxiety disorders differ considerably, therapy should be tailored to specific symptoms and concerns. If you have obsessive-compulsive disorder, your treatment will be different from someone who’s getting help for anxiety attacks. The length of therapy will also depend on the type and severity of the disorder. However, many anxiety therapies are relatively short-term. According to the American Psychological Association, many people improve significantly within 8 to 10 sessions.

The leading approaches to treating anxiety today are cognitive behavioral therapy and exposure therapy.

Cognitive behavioral therapy (CBT) is the most widely-used therapy for anxiety disorders. Research has shown it to be effective in the treatment of panic disorder, phobias, social anxiety disorder, and generalized anxiety disorder, among many other conditions. Cognitive therapy examines how negative thoughts, or cognitions, contribute to anxiety while behavior therapy focuses on how you behave and react in situations that trigger anxiety.

The basic premise of CBT is that our thoughts, not external events, affect the way we feel. In other words, it’s not the situation you’re in that determines how you feel, but your perception of the situation.

Imagine you’ve just been invited to a big party. Consider three different ways of thinking about the invitation, and how those thoughts would affect your emotions.

Schonbuch-110813-Chart

 

As you can see, the same event can lead to completely different emotions in different people – it all depends on individual expectations, attitudes, and beliefs. For people with anxiety disorders, negative ways of thinking fuel the negative emotions of anxiety and fear. The goal of cognitive behavioral therapy is to identify and correct these negative thoughts and beliefs. The idea is that if you change the way you think, you can change the way you feel.

Thought Challenging

Thought challenging – also known as cognitive restructuring – is a process in which you challenge the negative thinking patterns that contribute to your anxiety, replacing them with more positive, realistic thoughts. This involves three steps:

1. Identifying your negative thoughts. With anxiety disorders, situations are perceived as more dangerous than they really are. To someone with a germ phobia, for example, shaking another person’s hand can seem life threatening. Although you may easily see this is an irrational fear, identifying your own irrational, scary thoughts can be very difficult. One strategy is to ask yourself what you were thinking when you started feeling anxious. Your therapist will help you with this step.

2. Challenging your negative thoughts. In the second step, your therapist will teach you how to evaluate your anxiety-provoking thoughts. This involves questioning the evidence for your frightening thoughts, analyzing unhelpful beliefs and testing out the reality of negative predictions. Strategies for challenging negative thoughts include conducting experiments, weighing the pros and cons of worrying or avoiding the thing you fear, and determining the realistic chances that what you’re anxious about will actually happen.

3. Replacing negative thoughts with realistic thoughts. Once you’ve identified the irrational predictions and negative distortions in your anxious thoughts, you can replace them with new thoughts that are more accurate and positive. Your therapist may also help you come up with realistic, calming statements you can say to yourself when you’re facing or anticipating a situation that normally sends your anxiety levels soaring.

To understand how thought challenging works in cognitive behavioral therapy, consider the following example: Maria won’t take the subway because she’s afraid she’ll pass out and then everyone will think she’s crazy. Her therapist has asked her to write down her negative thoughts, identify the errors – or cognitive distortions – in her thinking, and come up with a more rational interpretation. The results are below.

Negative thought #1: What if I pass out on the subway?
Cognitive distortion: Predicting the worst.
More realistic thought: I’ve never passed out before, so it’s unlikely that I will on the subway.

Negative thought #2: If I pass out, it will be terrible!
Cognitive distortion: Blowing things out of proportion.
More realistic thought: If I faint, I’ll come to in a few moments. That’s not so terrible.

Negative thought #3: People will think I’m crazy.
Cognitive distortion: Jumping to conclusions.
More realistic thought: People are more likely to be concerned if I’m okay.

Replacing negative thoughts with more realistic ones is easier said than done. Often, negative thoughts are part of a lifelong pattern of thinking. It takes practice to break the habit. That’s why cognitive behavioral therapy includes practicing on your own at home as well.

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