Cognitive Behaviour Therapy (CBT) For Anxiety: Will It Help Me?
Did you know that your feelings have more to do with what is going on in your head, than anything that is happening outside you?
If you already understand this, then you can skip ahead to the section on using CBT for anxiety, where we talk about ways you can identify and begin to change some of your thinking patterns.
But if you don't quite believe that your thinking is causing much of your anxiety, then read on.
It's not the whole story, because your brain chemistry and energy state can influence your thinking as well. So overcoming anxiety is not quite as simple as deciding to think positive thoughts!
Still, understanding how your thinking influences your feelings is an important part of the puzzle.
It's most likely to be a key part of the puzzle if your anxiety has specific triggers, and you otherwise do not suffer from much anxiety.
If you suffer from GAD – Generalized Anxiety Disorder – and feel some level of anxiety most of the time, then CBT will still help you, but you will probably do best to focus on reducing your overall level of anxiety first – breathing, meditation, herbs and supplements that optimise your brain chemistry.
What is the relationship between your thoughts and your feelings?
Most of the time, it seems to us that our feelings are a direct result of something that happens – an external activating event.
For example, you might feel anxious walking into a room full of people, or looking out over a cliff, or driving in your car (substitute your own anxiety activating event here). By the way, you will probably feel anxious just thinking about one of your anxiety triggers – and your imagined scene now become the activating event. But there are still several missing links between the activating event (the actual or imagined situation) and your reaction to it...
Anxiety has different triggers
Why is one person afraid of a room full of people, and another afraid of spiders, and yet another afraid of flying in a plane?
It has to do with the level of threat that you perceive in that situation – and that will depend on your previous experience with that activating event, the meaning it has for you, your beliefs about it, and your (totally automatic) assessment of the risk to you.
Self-talk that makes you anxious
Here's an example:
Annemarie is driving to the local shopping mall. As she gets closer, she begins to feel more and more anxious – her heart starts to beat faster, she begins to sweat, she has trouble breathing, and she begins to feel dizzy.
Her internal dialogue goes something like this:
“I feel so sick at the thought of going to that mall. I'm going to have another panic attack, I know it!”
“I'm not going to be able to finish my shopping & get home safely. I feel such a fool!”
“Everyone will look at me and know there's something wrong with me.”
…Annemarie remembers the time 2 months ago when she had a panic attack in that shopping centre, and had to sit down because she was afraid of fainting. She remembers how difficult it was for her to get home again, and how afraid she was of having an accident while she was driving in that state.
She just knows it's going to be awful.... catastrophic...
All of this happens in a flash, and it's totally automatic.
CBT – Unhelpful thinking styles
There are several different unhelpful thinking styles that have been identified – thinking habits that do not serve you. Anxiety in particular is often associated with a thinking style called “catastrophising” - the habit of imagining the worst possible outcome.
Catastrophising
Catastrophising is imagining the worst possible outcome of a situation, and believing that it is going to happen for sure.
We can find 3 types of catastrophising that people who suffer from anxiety and panic are particularly good at:
Believing the worst of any physical sensations you experience
For example, if your heart beats faster, you immediately believe you are having a heart attack or a panic attack.
Over-estimating a real risk, eg your chances of suffering a panic attack, or of having a crash in a car or plane
e.g. believing that a panic attack is inevitable once your heart starts beating faster or you begin to feel as though you can't breathe.
Thinking catastrophically about the consequences of a panic attack
eg “If I have a panic attack, everyone will think I'm weird/mentally ill/can't cope..... and that would be unbearably awful.
Usually if you drill down far enough, the feared end result is that you will die in some way....
For example:
Walking into your boss' office...
“She's going to tell me I've screwed up....”
“She's going to tell me I don't have a job anymore....”
…. “then I won't have any money”....
…. “and I can't survive!”
If you believe that you won't survive, it's pretty much the same as being chased by a tiger at close range. Your body goes into high gear emergency mode, only you can't run away to escape the threat.
So what can you do instead?
CBT for anxiety
In essence, the strategy is to identify your dysfunctional thoughts and then challenge them, with questions such as:
- What other ways are there of looking at this situation?
- If I weren't anxious, how would I see this?
- Realistically, what are the chances of that happening?
- How might someone else see this situation?
- If I were giving advice to a friend, what would I say?
This is always a useful process, and I encourage you to play with these questions and find some that work for you and add them to your took-kit.
The problem with this strategy for anxiety – and even more, for a panic attack – is that you have to be in a rational state of mind to do it.
So you need to prepare in advance for situations that are anxiety triggers for you.
The most effective way to use this is to develop one or two or three very simple ways of breaking the escalating anxiety cycle.
This might be as simple as "Stop!"
Or "Remember to breathe..."
Or "I'm safe, everything's ok."
If you are in an escalating anxiety cycle, this is a helpful thing to do - but it won't stop you feeling anxious.
At best, it will take the edge off, and reduce your anxiety to the point where you can engage some other strategy.
Many people do find CBT helpful for anxiety, but for most, it's not a stand-alone technique. This is because anxiety is an emotional state, and while your thoughts do determine your feelings to a large extent, anxiety has a strong biological component. It's generally not possible to talk yourself out of it entirely!
More resources about CBT and anxiety
If you're interested in exploring CBT further, here are some books I recommend (all with lots of 5 star reviews on Amazon, and positive comments by anxiety sufferers as well as therapists):
Change Your Thinking: Overcome Stress, Anxiety, and Depression, and Improve Your Life with CBT
Highly recommended by readers who have used these strategies to deal with anxiety.
Comments: "Simple and easy to use strategies" - 4.7 stars.
Thoughts and Feelings: Taking Control of Your Moods and Your Life
Highly recommended as a very usable self-help book for anxiety - 4.6 stars.
Mastery of Your Anxiety and Panic: Workbook (Treatments That Work)
"Simple to understand and to follow" - 4.7 stars.
Vanessa is a healer and practitioner of natural medicine with a background in clinical psychology.
She has a special interest in natural remedies for anxiety, depression, and other dysfunctions that keep us from living a full and joyful life.