CBT for Anxiety

Disclaimer: This blog post is intended for educational purposes only. It does not replace actual counselling and psychotherapy. Furthermore, anxiety treatment is complex and cannot be simplified down to a blog post. This is a broad overview of how Cognitive Behaviour Therapy (CBT) helps with anxiety. CBT with a therapist is more in depth and tailored to each individual person.  

Introduction 

Anxiety can present itself in many ways that cause us distress and get in our way. Sometimes anxiety stops us from making friends or trying something new. It may even go as far as bringing down our confidence, convincing us that others will not like us or that we will fail at new challenges. Anxiety can be a real pain in the... well, you know. 

But anxiety doesn’t just appear as if from thin air. It’s not some magical mystical beast. From early childhood onwards, our experiences shape our views of ourselves, others, and the world. If we’re bullied in school, we may come to believe that others can’t be trusted, and to protect ourselves, we might start avoiding close relationships. This may work well for us in school, helping us to avoid detection from bullies and limit opportunities to be harmed.  

However, when the threat to our safety disappears, these thoughts and behaviours can sometimes remain. In this case, they tend to get in our way rather than help us to stay safe. 

Overview of CBT 

CBT is all about how we think, feel, and react in response to things that happen. In other words, something happens (we spill coffee on ourselves), we experience automatic thoughts about it (“I can’t do anything right” or “everyone is going to laugh at me now”), we experience emotions and feelings related to the thought (embarrassment, disappointment, etc), and we make choices on what to do next based on our automatic thoughts, feelings, and past experiences (skip class to go home and get changed). 

CBT sees our thoughts, behaviours, feelings, and physical reactions (like nausea) as all impacting each other.  

(see our full blog post on CBT for more information) 

CBT’s view of anxiety 

The main idea behind CBT is that it’s not just the situations we face that cause us distress, it’s the meaning we give those situations. 

Let’s say you arrive at work and a coworker walks past without saying hello. Based on our past experiences, our brain will try to make sense of this situation. It makes a quick guess about why they didn’t say hi—and that guess sticks to the situation like a Post-it note on the wall. That Post-it is what we call an automatic thought. 

Let’s try a little experiment. 
Don’t close your eyes yet - read this first. 

Imagine you’re walking into work or school. You pass someone - maybe a receptionist or a classmate - and they don’t greet you like they usually do. What’s the first thought that pops into your head? 

That first reaction is your automatic thought. You might have more than one. Just notice what comes up. Maybe even write it down. 

Now ask yourself: How do I feel in that moment? 
Worried? Hurt? Annoyed? Confused? 
Sit with that feeling for just a second. 
What would you do next?  

There’s no single right answer here. Each of us has different life experiences that shape how we think, feel, and act. For example, one person might think: “I must have done something wrong.” Another might think: “Maybe they just didn’t see me.” 

These two thoughts seem simple, but they lead us in very different directions. The first one puts the blame on you - it assumes you caused the problem. The second one is more neutral and doesn’t assign blame to anyone. 

Depending on which thought you have, your feelings and behaviour may shift dramatically. And that’s what CBT helps us explore, how our thoughts shape our emotional and behavioural responses, and how we can shift them in more helpful ways. 

How does CBT treat anxiety? 

CBT treats anxiety by interrupting this automatic cycle, encouraging us to stop and think about our automatic reaction, and slowly start to change it.  

Our automatic cycle is like a runaway train; if unstopped, there can be chaos. CBT teaches us to slow down and take back control by becoming more aware of our thoughts, feelings, behaviours, and physical reactions.  

How do you become more aware of this automatic cycle? 

CBT is well known for worksheets. We love them!  

A CBT therapist will usually recommend something called a thought record. The purpose of a thought record is to gather data about our automatic cycle. When you find that something has triggered your anxiety, you turn to your thought record and write down as much information as you can about 1) the situation that triggered your anxiety, 2) the thoughts you had during or immediately after the situation, 3) the physical reactions in your body, 4) the feelings you felt, 5) what you did after.  

The more data you have, the better!  

How do you change the automatic cycle? 

Gathering data is just the first step. Now we get to play judge and jury in the court of our mind. The goal is to determine if the thought is accurate or if it might be a little biased. To do this, we need to identify the facts and evidence that both support and contradict the thought.  

For example, if the automatic thought is “nobody likes me,” you would look for evidence that supports that no one likes you, but also evidence showing that people do like you. 

Most likely you will discover that the original thought was not completely accurate and may have been leaning on the negative side. If so, the next step is to create a more accurate thought to replace the original one. Going back to our example, a more accurate thought might be “some people like me and some do not, most people don’t even know me.” 

The purpose isn’t to replace the original thought with something wildly positive like “everyone loves me.” This simply isn’t true, and it won't help us to manage our anxiety in a way that feels validating and in touch with reality.  

Behavioural interventions for anxiety 

There are many behavioural interventions in CBT. In this blog, we will name a few. 

Behavioural experiments 

CBT is a very hands-on, trial and error type of therapy. We’re encouraged to try things and learn from our experience. Behavioural experiments are often used to help us find evidence to support or contradict our automatic thoughts, specifically, thoughts that involve predicting the future.  

For example, let’s say you are worried that if you ask a question during class, people will laugh at you. Using a behavioural experiment, you might try asking a question in class and see what happens.  

It is helpful to work through your behavioural experiment plan with a therapist beforehand to make sure that it is relevant and doable. In other words, the experiment will give you helpful information about your prediction, it feels safe, and only slightly outside of your comfort zone.  

Observations 

If behavioural experiments are too far out of your comfort zone, observation can be helpful. If we look at the same example above, you might decide to keep a record of which questions were asked in class and whether anyone laughed at the person asking the question. Observations allow us to gather valuable information without putting ourselves at risk or pushing ourselves too far out of our comfort zone. 

Acting As If 

This technique can be fun as it involves role-playing and imagination! When we act as if, we embody the thoughts and characteristics of the version of ourselves that we aspire to be. In our classroom example, we would ask ourselves: “what kind of person asks questions during class?” Are they confident? Curious? Brave? What automatic thoughts would they have? Perhaps something like: “my learning is my top priority; asking questions is hard but I want to learn and do well in class.”  

Once we have a good understanding of the characteristics of this person, we start to slowly embody those characteristics ourselves.  

While acting as if is often compared to faking it ‘til you make it, this technique is more than just pretending. Acting as if involves imagining the characteristics of the person we aspire to be, taking small, manageable steps to get there, and debriefing what we learn along the way. A therapist can be especially helpful when using this technique as they can help you plan how you will act as if and process the outcome afterwards.  

Exposure therapy 

Exposure therapy brings us slightly outside of our comfort zone to slowly expose us to the things that trigger our anxiety, gradually working up to the hardest trigger. Many people confuse exposure therapy with flooding - for example, putting someone with a fear of spiders in a room with a tarantula. That’s not exposure therapy. In CBT, exposure is done thoughtfully and step-by-step, never all at once. 

Exposure therapy can be complex and involves a great deal of planning. With a therapist, you will break down the anxiety trigger into small steps and rank order them in terms of how anxiety provoking each one is.  

In our classroom example, we would dig deeper into the fear of asking questions to learn more about it and then determine some small steps that could help them get used to the situation that causes them anxiety. Let’s say our student is anxious any time something draws the other students’ attention to them. Rather than jumping into asking questions in class, we could look at all the different ways that attention can be draw to them, determine how anxiety-provoking each one is, and start by exposing them to the situation that causes the least anxiety.  

Role playing/practicing 

Some anxiety-provoking situations can be practiced ahead of time with the help of a friend or therapist. Role-playing allows us to rehearse these scenarios - often conversations - in a safe, supportive environment. It gives us the opportunity to try out new responses and receive feedback and encouragement. 

Role-playing also helps us apply skills we've been learning in therapy, such as communication tools or coping strategies. Most importantly, it can create a sense of predictability and control, which is especially helpful when facing uncertainty or unfamiliar situations. 

Psychoeducation for anxiety 

Another important part of CBT is helping you understand how anxiety works. Many people have felt anxious but don’t always know what’s happening in their body or brain when they feel that way. 

Psychoeducation takes some of the mystery out of anxiety. It helps explain where the feelings come from and why your body reacts the way it does. This knowledge can be empowering - it can guide you in choosing the right coping tools for the moment. For example, if your heart is racing, a calming breathing exercise might help slow it down. 

Practice makes better, not perfect. 

Unfortunately, we can’t cure anxiety simply by replacing a biased thought with a more accurate one or by embodying the characteristics of the person we aspire to be. Learning to manage anxiety takes practice. We need to repeat the steps above as often as we can to train a new automatic cycle into our brains. Eventually, more accurate, kinder self-talk will become the default mode for our brain and anxiety-provoking situations will be easier to manage and less anxiety-provoking. 

Questions? Concerns? Corrections? Please reach out! Email: alexina@bravemindtherapy.ca