The Effects of Cognitive-Behavioral Therapy (CBT) for Reducing Anxiety

If you’re struggling with an Anxiety Disorder, particularly Generalized Anxiety Disorder (GAD), then you might want to consider trying Cognitive-Behavioral Therapy – or as it is more commonly referred to: CBT. If you are looking for counseling in the San Diego area, for your Anxiety Disorder, CBT can be very beneficial. In fact, CBT is one of the most popular types of therapy for Anxiety, among other psychological disorders. I will briefly outline the basics of CBT using some examples throughout so that you have a better understanding of what exactly this type of therapy is like.

Cognitive-Behavioral Therapy is exactly what it sounds like. In CBT, there are 3 components: Cognitive, Emotional and Behavioral. CBT is founded on the premise that if you can change your problematic thinking or negative thought patterns, your emotions and behaviors will subsequently change also. It sounds pretty easy, right? While the concept of CBT is rather straightforward, it doesrequire a lot of work on your part. For example, CBT commonly employs “homework” for you to complete before and after therapy sessions. This “homework” usually consists of things like keeping a Thought Record (which I will describe in detail later on), multiple times per day. Overall, CBT is relatively short in duration, with about 10-12 weekly therapy sessions that last about 1 hour each. However, you only get out of it what you put into it. By this, I mean that the harder you work at changing your thought patterns and re-framing negative thoughts, the bigger the change will be in your overall behavior and emotions. Therefore, the more “homework” you complete in between therapy sessions, the better off you will be at the end of it all.

We all experience negative thoughts about ourselves from time to time, however, people with Anxiety Disorders often have cognitive distortions more often than someone who doesn’t have an Anxiety Disorder. Cognitive distortions can include things like catastrophic thinking (predicting the absolute worst is going to happen), polarized thinking (“black or white”, “all or nothing” thinking), and overgeneralization (making a general conclusion based on a single incident). For example, a catastrophic thought could be “I’m going to completely screw this whole thing up. Everyone’s going to laugh at me” As you can see, catastrophic thinking is envisioning the worst case scenario and making things out to be a lot bigger than they actually are. A polarized thought could be something like “Bad thingsalways happen to me!” or “My co-workers never listen to me!” Notice the absolutes in these phrases, specifically the words “always” and “never”. People with this type of cognitive distortion tend to think in black or white terms, where there is no middle ground or grey area. Finally, an example of overgeneralization is “This happened to me before so it will probably happen again”. When we over-generalize, we are basing our future on events of the past. While this is common among most people, we have to realize that our past does not always predict our future.

Some other common cognitive distortions that you may identify with are as follows:

Discounting the Positive: In these situations, we tend to ignore the positive aspects of a situation or simply discount them, as though they aren’t important. For instance, saying things like “Anyone could have done that” or “That wasn’t my best work, I could have done better”.

Personalization: We are attributing ourselves as causal agents, or as being personally responsible for something that is likely beyond our control. For example, upon hearing that your child needs extra help in one of her classes at school, you may think: “It is my fault that she is having such a hard time with this class. I should have been at home more to help her with her homework. I shouldn’t be out working when my child obviously needs me. I’m a bad mother”.

Emotional Reasoning: We experience reality as a reflection of our emotions. We think based on things like: “Where there is smoke, there must be fire”. For example, “I feel that, so it must be true”. More specifically, “I did not get that joke and now I feel really stupid, so I must be stupid”.

There are indeed several other types of cognitive distortions, but I generally find that these are the most common. These distortions in thinking are problematic, because they allow us to view the world and our surroundings in a negative light. We predict the worst possible outcome in every situation. We believe that there is no way out. We constantly feel defeated because our thoughts are basically telling us that there is no other way to feel. I’m sure you can begin to see how this could negatively affect someone over time and take a toll on his/her daily life. If you are constantly thinking negative thoughts, you are going to feel and behave negatively. This is where CBT comes in. If we can help you to change your negative thought patterns, by re-framing the situation and looking for evidence that both supports and debunks your negative thought, then we can help you come to a more realistic way of thinking. Maybe a terrible event is looming…or maybe it isn’t. Re-framing your “automatic” thought from something negative to something realistic is the key in CBT. A common misunderstanding of CBT is replacing negative thoughts with positive ones. While of course we like to encourage positivity in counseling, we do not hold the belief that every situation and every event in life is a positive one. That is not realistic either! Sometimes bad things really do happen, and sometimes these things are beyond our control. Believing that everything is “peachy” is not a healthy way to live life either. However, having a realistic outlook on life’s events and situations is more appropriate. That’s why our goal in CBT is to help you re-frame your automatic, negative thoughts into more realistic ones. Here’s a quick example to help illustrate what I’ve said so far:

Automatic Thought: “I’m going to fail this upcoming exam.”

Emotions: Anxious, worried, fearful, nervous, scared, and sad.

Now we would ask you to find support for this automatic thought of yours about failing an exam, as well as evidence against this thought. This will help you to come up with a more realistic, or “balanced” thought. For instance:

Evidence Supporting:
1) I have not studied enough.
2) I find this course very difficult.
3) The exam is tomorrow and I’m too sleepy to be able to study well enough.

Evidence Against:
1) I have never failed an exam before.
2) I have taken several other “difficult” courses before and passed them.
3) I once wrote an exam on no sleep whatsoever and ended up getting an A.

As you can see, this example shows the person’s automatic thought (“I’m going to fail this upcoming exam”), and then attempts to find evidence to both support the automatic thought, and to counter the automatic thought. Once you have come with up some evidence “for” and “against” your automatic thought, you can create a balanced, more realistic thought, such as:

“I may feel like I’m unprepared for tomorrow’s exam, but I have never failed an exam in the past and I have taken a lot of difficult courses in the past and done well in the end.”

As time-consuming as this is, writing this out and the very act of creating a Thought Record tends to greatly decrease a person’s anxiety. Once you’re able to see your thought on paper and find evidence to support and counter it, you are better able to re-frame your thinking into something a bit more realistic. As you can see, our example of a “balanced” thought it not necessarily a “positive” thought – rather, it is a realistic thought: you may or may not pass the exam, but evidence from your past shows that you have been in similar situations before and done well, so maybe you won’t fail after all.

While CBT does take some training, since you literally have to teach yourself to catch an automatic, negative thought while it’s occurring and then examine it closely and re-frame it by finding evidence for and against this automatic thought, it will soon become second nature to you. After several weeks of practice, both in and out of therapy sessions, you will begin to catch yourself in the midst of an automatic thought, successfully identify the cognitive distortion you are making, and re-frame the thought into a more balanced and realistic one. At first it will be a lot of work, since you will have to fill out Thought Records and do lots of “homework” to learn about CBT and the cognitive distortions you commonly employ, but eventually you will reach a point where you no longer have to write everything down. You will then be able to quickly do a mental Thought Record to reduce or relieve your anxiety. It does take practice and a lot of hard work, but if you are serious about making a change in your life, contact me at my San Diego office today for a free  consultation. I have helped many people over the years overcome their debilitating anxiety symptoms using the techniques of CBT, and with your commitment, I can help you as well by teaching you the necessary tools and skills required to combat your anxiety.  Call me at 858-481-0425 for more info.

Copyright ©2012 Jan Rakoff. All Rights Reserved.

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