Behavioral Health Cognitive Behavioral Therapy
CBT for Anxiety Disorders
Anxiety is the most common mental health disorder in the world. Almost one-third of adults will experience an anxiety disorder at some point in their lives. Some people hear the word anxiety and think it means a little bit of worry. But anxiety can be highly debilitating and cause serious disruption in your life. Luckily, psychotherapy—particularly cognitive-behavioral therapy (CBT)—has been found to be an effective treatment.
What is Clinical Anxiety?
When we discuss anxiety, we are usually referring to fear and worry. You can also experience physical symptoms including dry mouth, sweating, and nausea. But there is a large difference between being anxious and being diagnosed with an anxiety disorder. We all have some anxiety; we are hard-wired to experience a fight or flight response under stress. Clinical anxiety, however, is a more severe and long-lasting form of anxiety. Think of it as your everyday anxiety multiplied by 10 and seemingly never-ending. If it causes significant impairment in your daily living, then it might be severe enough to qualify as an anxiety disorder. Let’s take a closer look.
Types of Anxiety Disorders
You may not realize that anxiety comes in different forms. The following are common anxiety disorders:
Generalized Anxiety Disorder (GAD): This disorder is what you probably think of when people mention anxiety. GAD involves consistent and unrealistic worry, even when is appears there may be nothing to worry about. It can also involve physical symptoms, such as fatigue, muscle aches, and diarrhea.
Panic Disorder: Have you ever felt like you were having a heart attack but you weren’t? You may have been having a panic attack. Someone who suffers from panic disorder has anxiety attacks characterized by heart palpitations, dizziness, and sweating. They seemingly come out of nowhere and are very scary. And the panic attacks themselves are only part of the problem. People with panic disorder spend a significant amount of time worrying about having another panic attack.
Specific Phobias: Phobias are irrational fears of a specific situation or object. Common ones are fears of heights, flying, and spiders. Panic attacks are common symptoms when people are confronted with a phobic stimulus. People with phobias tend to avoid those stimuli whenever possible.
Agoraphobia: People with agoraphobia have an intense fear of being overwhelmed in public. This may include being in a crowd of people or an enclosed space. For more severe cases, they may fear being in any place outside of the home. As a result, some people with agoraphobia won’t leave their homes.
Social Anxiety: Many people are uncomfortable in social situations. People with social anxiety disorder, though, will avoid social gatherings at any cost. Their worry and self-consciousness when around other people are almost crippling.
Separation Anxiety Disorder: Separation anxiety is usually a disorder of childhood but it can be present in adulthood as well. People with separation anxiety are distressed about separation—or the thought of impending separation—from a caretaker or home environment. Along with anxiety, they may also experience body aches and nightmares. People with separation anxiety may refuse to leave their homes because they fear something bad might happen to their caretakers while they are gone.
Just a quick note. A lot of people believe that Obsessive-Compulsive Disorder (OCD) and Post Traumatic Stress Disorder (PTSD) are anxiety disorders. Although they are comparable in that they involve fear and worry and certain similar physical symptoms, they are not considered anxiety disorders. This is made even more confusing due to the fact that they used to be categorized as anxiety disorders but they now have separate categories in the most recent Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-5). Having said that, CBT is the treatment of choice for OCD and PTSD, as well as anxiety.
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What is CBT?
Cognitive Behavioral Therapy (CBT), as its name suggests, is made up of two main components. One is cognitive and focuses on our thoughts. The other is behavioral and involves how we act. It works under the presumption that thoughts lead to feelings which, in turn, lead to behavior. It helps an individual develop the skills necessary to help themselves. What’s more, it is a relatively brief therapy, aiming to improve symptoms in months rather than years.
The cognitive component of CBT theorizes that distorted thinking leads to maladaptive feelings such as depression and anxiety. Patterns of unrealistic thought bring about heightened anxiety in situations that don’t call for it. People utilizing CBT are taught to think more realistically so their feelings are appropriate for the situation. Therapists call this cognitive restructuring. For example, a person with a phobia may have the thought, “if I fly in a plane, I’m going to die”. This is an unrealistic thought because, statistically speaking, almost no one dies in plane accidents. An individual would be asked to look at the evidence behind their thoughts, challenge it, and come up with a more realistic thought to replace their distorted thought. A more adaptive thought would be: “I’ll probably be okay because less than one percent of people that fly in a plane die”. Thinking more realistically leads to a reduction in anxiety. Just keep in mind, changing maladaptive thinking patterns doesn’t happen overnight.
One of the main tools used to assist in cognitive restructuring is known as a thought record. The thought record is a way to map out the process of replacing maladaptive thinking with more realistic thoughts. It usually includes space to write down the situation, the original thought, a more realistic thought, and the subsequent feeling as a result of more adaptive thinking. The thought record can be used with every anxiety disorder as part of psychotherapy and/or self-help methods
Exposure, Relaxation, and Other Behavior
The other aspect of CBT is behavior. One popular behavioral technique to reduce anxiety is exposure. When utilizing exposure, people expose themselves to the anxiety-provoking stimulus. By facing their fears, they learn to tolerate whatever it is that is giving them anxiety. For example, someone with a fear of needles might take the steps necessary to be injected with a needle. At first, they may just try to cope with being near a needle. Then they can get incrementally closer until it is almost touching their skin. This is a gradual process called systematic desensitization. Eventually, the hope is that they can tolerate being injected with a needle without having a panic attack.
Another common tool to cope with anxiety is relaxation. After all, feeling relaxed is the opposite of feeling anxious. Techniques such as deep breathing, muscle relaxation, and mindfulness, are all used to reduce anxiety with most disorders. Relaxation exercises can be done relatively quickly with a small learning curve.
Finally, many other behavioral changes can help with anxiety. Eating healthily, sleeping well, and exercising are all positive acts. For example, avoiding caffeine is a good idea because it can make you feel agitated and even trigger a panic attack. Regular exercise reduces body tension and helps clear the mind. Sleep has been found to have a bidirectional relationship with anxiety. A lack of proper sleep can cause anxiety and vice versa. Getting a consistent good night’s sleep, by the way, is helpful for almost everything.
Acceptance and Commitment Therapy (ACT) and Dialectical Behavioral Therapy (DBT) are popular treatments that have become more prominent in recent years in the fight against anxiety. They are based on CBT principles but emphasize the acceptance of anxious thoughts rather than focus on changing them.
Does CBT work for Anxiety?
CBT is easily the most well-researched therapy for the treatment of anxiety disorders.
There are hundreds of studies examining its effectiveness.
- In a randomly controlled meta-analysis, CBT was found to be significantly more effective than placebo control groups. CBT was used to treat individuals with generalized anxiety disorder, panic disorder, and social anxiety disorder.
- Another recent study analyzed the long-term effects of CBT on anxiety. Up to a year after treatment, anxiety remained improved in individuals who were diagnosed with generalized anxiety disorder, panic disorder (with or without agoraphobia), social anxiety disorder, and specific phobia.
- CBT is an effective treatment for generalized anxiety disorder (GAD), significantly reducing worry in participants equal to medication and retaining its effects up to 6 months after treatment.
- The American Psychological Association’s division of clinical psychology has concluded that there is strong research support for CBT as an effective treatment for panic disorder.
- CBT has exhibited significant efficacy in the treatment of social anxiety disorder. It is observed that the effect sizes are usually larger in studies that utilized both exposure and cognitive restructuring than those that excluded one or the other.
- Internet-based CBT has also been found to be effective in the reduction of anxiety symptoms. This is especially important because more and more therapy is being conducted online. This may include face-to-face virtual therapy as well as texting and other internet tools. It appears that the effectiveness of CBT principles can transfer to the online medium.
- CBT resources are everywhere. It is easy to find a workbook or worksheet to work on your anxiety with or without a therapist. But does self-help CBT work for anxiety? The short answer is yes. Individuals using self-help resources for anxiety disorders have found a moderate effect in the reduction of anxiety symptoms.
CBT Resources for Anxiety Disorders
There is no shortage of CBT resources for anxiety disorders. Type it in on any search engine and you are going to get an abundance of options. One of the strengths of CBT is that it is readily available for self-help and also as a part of formal psychotherapy.
The following are some recommended resources:
- Workbooks are an efficient way to find many CBT resources in one place. This workbook from Aaron Beck, the godfather of cognitive therapy, has almost everything you need. Looking for a quick solution? Try this well-known workbook that aims to significantly reduce anxiety in seven weeks.
- This webpage from the University of Washington Harborview Medical Center has links to numerous CBT worksheets and anxiety information for therapists and clients alike. And it is free.
- Psychology Tools is not free but they have 137 CBT resources for anxiety, including books, informational handouts, exercise worksheets, and even audio recordings for practicing relaxation and mindfulness.
- Positive Psychology always does a nice job presenting a lot of varied information on a topic. In this post, they present a hodgepodge of information, worksheets, and other resources that help you understand and implement CBT in the treatment of psychology.
- Psychpoint is a site that has worksheets for licensed therapists on every topic. In this case, they provide a comprehensive array of informational worksheets and exercises on anxiety. You can get some for free but they require a paid subscription to access their full library, which is extensive.
- Theraplatform offers numerous anxiety worksheets for mental health providers. These include the 7 Step Anxiety Reduction Model Worksheet, the Anxiety Thought Record, and Quick Tips for Reducing Anxiety. You can also sign up for their mailing list for access to free worksheets, templates, and exercises on a variety of topics.
Anxiety is a common difficulty but it is not to be taken lightly. It can cause heightened levels of distress and avoidance of work and social obligations. At its most serious, it has people fearing for their lives and unable to leave the house. Cognitive-behavioral therapy has been found to be an effective treatment for all anxiety disorders. CBT’s numerous resources make it ideal for self-help as well as more formal psychotherapy. In addition to their CBT worksheets for anxiety, don’t forget to check out the Theraplatform blog for useful information on all things mental health. With some focus and dedication, we can work together to make anxiety a manageable problem.