Cognitive Behavioral Therapy for Anxiety

Fear is the oldest and strongest emotion of mankind.

  • H.P. Lovecraft

Cognitive behavioral therapy (CBT) for anxiety, and as well depression, is a regularly used treatment approach for symptoms of these mental health challenges. In the medical arena, CBT is often viewed as the “best treatment for anxiety and depression”. CBT is an evidenced-based treatment for anxiety and depression that focuses on the interrelationship of thoughts (cognitions), emotions, physiological and behavioral responses. First wave and second wave CBT for anxiety, worked from the foundation that a person’s thoughts about a situation (appraisal) affect how they feel (emotionally and physically) and this appraisal of a situation drives our behavior. Often, we are “automatically programmed” and don’t even realize we are actively appraising situations and therefore engage in behaviors that may, in fact, be perpetuating or reinforcing our anxiety.  

To understand why Cognitive behavioral Therapy approaches are often seen as the “best treatment” for anxiety and depression, I will offer a brief explanation as to how this therapy works.  Cognitive Behavioral approaches to treating anxiety and as well depression, talk about the role of appraising events in maintaining the anxiety and depression. CBT approaches to anxiety deal with cognitive appraisals of future events and CBT approaches to depressions look at cognitive appraisals of past events.   Cognitive appraisals of situations are individual, meaning two individuals could experience a neutral situation and interpret the situation entirely different – one person may feel threatened by the situation while the other person does not register the situation as a threat. The way I like to think about it is that all people develop a cognitive lens of how they see the world. Individuals, through no fault of their own, often use cognitive distortions in the way they appraise situations. For instance, catastrophizing leads to thinking that something hugely terrible will happen if situation “X” happens. And guess what happens after this appraisal of a situation?  The individual will experience an anxiety response – repeat this pattern and the individual will be at risk of developing depression and/or anxiety symptoms. Traditional, Cognitive Behavioral Therapy for anxiety and depression focuses on interventions at the thought level and behavioral level to break the association between thoughts, emotions, physiology and behavior. Change the thought (appraisal) and the rest of the things will change as well.

Recently, I have become interested in Acceptance and Commitment Therapy (ACT) which is considered a third-wave Cognitive Behavioral Therapy for Anxiety and Depression. ACT says that human beings experience both negative and positive thoughts. The goal in treating anxiety is not to expect that anxious thoughts can be alleviated, but to accept these thoughts and learn diffusion techniques to help get “unhooked” emotionally, physically, and behaviorally from thoughts so that thoughts don’t drive our behavior.  ACT supports value-driven behavior. An individual learns to move towards things that they value to have a meaningful life and away from things that don’t support their values in their life. ACT incorporates the use of mindfulness as a way of unhooking from your thoughts and not attaching to your thoughts. In ACT there is a recognition that thoughts are just thoughts and don’t need to be evaluated as “good” or “bad” but rather is the thought “helpful” to moving you towards a value-driven life.

When discussing CBT for anxiety there are many different approaches that fall under the CBT umbrella. I try to work with individual clients and find the approach that would suit the client. The good news is that anxiety is highly treatable and there are many effective ways to work with it!

I can personally help you if you’re seeking help for anxiety and/or depression, so please contact me today and I will be happy to assist!