Cognitive Therapy's Treatment of Anxiety

James Krehbiel

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Excessive anxiety is troublesome. For many, it can be an immobilizing experience. Anxiousness can be associated with social avoidance and withdrawal, can be a factor in relationship difficulties, can create painful symptoms, and can trigger a need to rehash issues related to our past and future. Anxiety triggers the “fight or flight” response, ramping up our sympathetic nervous system.

I believe that the most successful treatment approach to dealing with anxiety is through the application of Cognitive Therapy. Cognitive Therapy is a very structured, practical, and understandable approach to dealing with anxiety. CT is based on the principle that one’s spontaneous thoughts, cognitive distortions, and underlying beliefs affect an individual’s current behavior.

Spontaneous thoughts are free-flowing expressions of our self-talk triggered by a specific event. For example, if your house is on fire and you are trying to safely leave, you might say something like, “Oh my God, I’ve got to get out of here – if I don’t hurry, I might get killed. ” Cognitive distortions are the lenses through which we may view reality. For example, if you have been rejected for a date, you might use emotional reasoning by saying, “Being snubbed makes me feel like a dud, and therefore I must be one – I’ll never get a date. ” Underlying beliefs are the core assumptions that govern our life. For example, if we were raised in a household where emotional abuse was present, we may experience a reality that goes something like this. “It is important to avoid conflict at all costs. If I try to get close to others, I may get hurt – I better keep my distance. ”

Anxiety is a reaction to our thinking, beliefs, and underlying assumptions about life. However, it is usually not our primary anxiousness that creates our distress. It is our secondary symptoms – or our “anxiety about our anxiety” that intensifies our symptoms.

Almost everyone experiences anxiety, but not everyone catastrophizes about it. Let’s say that you are taking a midterm exam in college. There are several ways you might respond when you open the test booklet and note that there are numerous questions that you are not prepared to answer. First, you might respond by saying, “Wow, none of these answers look familiar. I don’t remember studying this – I’m going to flunk this test. If I fail it, there goes my grade for the semester. Wait until my parents find out, they’ll kill me!” Or an alternative, rational response might be, “Gee, I don’t understand these first three questions – that’s ok, I’ll just take some deep breaths, relax and work on the questions that I am familiar with. Then I’ll go back and tackle the one’s I couldn’t answer before. ”

Our manner of self-talk determines the level of our anxiety. When we ‘awfulize’ about anxiety, it tends to intensify it. When we respond rationally to our anxiety it tends to diminish its effect. Rationally responding to anxious thoughts is critical to minimizing the effect of anxiety.

Many people tend to believe that their panic or anxiety “appear out of the blue. ” They may feel confused and perplexed by the sudden emergence of their feelings. Cognitive therapists view anxious feelings as a byproduct of faulty thinking. There is no mystery to it. Teaching others to respond rationally to self-defeating self-talk is the primary goal of therapy.

Individuals who experience anxious panic attacks are usually troubled by symptoms such as a racing heart, sweating, fear of dying, hyperventilating, and a need to escape social situations. Helping individuals to manage panic attacks takes understanding and patience. Assisting people to realize that their panic is time-limited is important. Since panic tends to take on a life of its own, it is important to address the secondary symptoms or the “panic over the panic. ” When people panic, they tend to magnify their symptoms through self-defeating thinking, perpetuating the panic attack. Teaching people to relax into their panic is helpful.

The following are some guidelines for those who experience anxiety and panic:

  • Anxiety is time-limited. It is comforting to know that it always diminishes in its impact over time.

  • Don’t fight with your anxiety. It only makes things worse. Lean into your anxiety, embrace it, and it will subside.

  • Schedule a “worry time. ” Go into a quiet room, relax and try to expose yourself to your anxieties. Try to bring on your symptoms and you will find that it is difficult to do.

  • If you have a tendency to panic, create an exit strategy. Plan a way to remove yourself from anxious situations to bring relief.

  • Refocus your attention away from your anxiety. For example, when people experience panic attacks that involve a racing heart, I might encourage them do jumping jacks to demonstrate that there is nothing physically causing their symptoms. This strategy actually lightens the situation and their symptoms.

  • If you are anxious, chunk things down into smaller parts. People tend to feel overwhelmed when they look at the entire picture. Rather than clean the entire house, pick a specific task such as shredding a few unnecessary documents.

  • Stay in the present. Don’t rehash your history or anticipate your future. Worrying about your future or history serves no useful purpose. You can’t control it anyway.

    Cognitive Therapy emphasizes replacing self-defeating thinking with more rational ways of responding to stressors. Identifying goals of therapy, approaching them in a practical manner, and providing homework assignments for people are significant ingredients to Cognitive Therapy’s response to anxiety.

    James P. Krehbiel is a licensed professional counselor and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. He can be reached at (480) 664-6665 or

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