5 Cbt interventions for anxiety

In this article, we will answer the question, “what are the different types of interventions utilized in CBT?”

What are the different types of interventions utilized in CBT?”

• Identifying Cognitive Distortions
• Cognitive restructuring, 
• Exposure or desensitization of fear, 
• Roleplay
• Relaxation and visual imagery, etc.
• Journaling/thought recording and monitoring (Evaluating and analyzing thoughts through self records)

These are just some of many intervention strategies used in CBT for anxiety

What are CBT and Anxiety?

Cognitive Behavioral Therapy is based on the concept of changing negative thought patterns into positive thought patterns to decrease psychological distress. CBT helps in challenging our negative thought processes and replaces them with positive reinforcing thoughts. Cognitive Behavioral Therapy proposes that our thoughts, feelings are related to each other. Even if one component out of three is affected, it impacts the other two components as well. So if we are going through an adverse situation, it would impact our thoughts and feelings.

Following are the  steps in which CBT best helps to deal with 

Anxiety 

Understanding and identifying negative events or situations in life

The events occurring in our lives impact our thoughts and feelings in the present and the future. To avoid or overcome any issues, we first need to identify the events that caused the changes in our thought processes. We need to identify such events that left a lasting impact on us. These events could be an elocution competition where you were required to speak in front of a huge crowd. Perhaps your performance was not up to the mark, and it left an impression on your mind. Try to recollect the thoughts and emotions that were revolving in your mind during that event. Relive that event now and attempt to understand how that makes you feel even today.

Identifying Automatic Negative Thoughts.

The most crucial step is to identify NAT (Negative Automatic Thoughts), which hinder our development by creating mental distress in our minds. They are thoughts such as, “I am hopeless,” “I cannot do it,” “I am unlovable,” etc. These thoughts pop automatically in our minds (hence the name negative automatic thoughts). We are often accosted by such thoughts when we are going through a distressing situation or an event. 

To identify these thoughts, we need to think back to a situation that left us feeling down. It could be anything, such as feeling socially anxious in large crowds. Try to recollect what were the emotions you were experiencing at that time. 

Also, try to pinpoint the thoughts that were associated with these negative emotions.

If the thoughts were for, eg., “I am worthless, and so one would like me” or “I am not good enough,” these thoughts can be identified as negative. 

Challenging the Negative Thought Processes

Now comes the essential step of negating the negative thoughts and replacing them with positive ones. This could be done by rational analysis of those thoughts. If we have the thought, “I am not good enough,” then we should ask the question of “What makes us think that?” We should find evidence to support this unhelpful thought. Most of the time, we think of such thoughts without really thinking about the reasons behind them. But when we start to raise questions and reason, we realize that we have little evidence to support such thoughts.

Thus with three simple steps, cognitive behavioral therapy helps us navigate the unhelpful thinking processes.

Types of Anxiety

Anxiety is our body’s biological reaction to events that cause psychological distress. Anxiety experienced in moderation is quite normal and even beneficial as it helps us become aware of the danger. But when we start experiencing excessive fear, stress, or worry that hinders and affects our lives, then that is classified as an anxiety disorder.  There are various types of anxiety disorders; some of them are listed below:

• Social Anxiety Disorder (SAD): This type of anxiety creates fears of social events and interaction. 
• Generalized Anxiety Disorder (GAD): People experience excessive worry over situations and that are common but out of their control
• Panic Disorder: When anxiety becomes excessive, some people suffer from unexpected panic attacks that could be severe and dangerous.
• Obsessive-Compulsive Disorder (OCD): Individuals suffering from OCD commit compulsive behaviors due to unwanted thoughts that keep disturbing their state of mind.
• Post-traumatic Stress Disorder (PTSD): Traumatic events leave a lasting impact on a person’s psyche. At times people develop stressful responses when that traumatic memory is triggered. People who have suffered or witnessed violence or suffering often get diagnosed with PTSD.
• Other Anxiety Disorder: Anxiety: Anxiety disorders are not limited to just the above-listed disorders. Various other specific disorders impact a person’s mental health. Phobias such as Claustrophobia, Hypochondria, or Agoraphobia are some of the other known anxiety disorders.

CBT interventions for anxiety

Cognitive Restructuring

One of the most crucial aspects of CBT treatment is cognitive restructuring. Cognitive restructuring refers to the process of eliminating harmful, negative thought processes and replacing them with positive and helpful thoughts. Maladaptive cognitions have an adverse impact on our behavior and emotions hence it is necessary to identify and modify them. By doing so we can achieve positive effects on our feelings, emotions, and behaviors, thereby alleviating our anxiety in the process. 

Thoughts such as “I can never be good enough” or “The world is a scary place”

Can be replaced with “I am worthy and can do well if I tried hard” or “The world has both positive and negative aspects and I can choose to focus on the positives”. By trying to change our way of thinking and perception we can change the way we perceive our fears and conquer them.

Exposure Technique

By facing our fears we can become immune to their negative influence on us over time. But the exposure has to be systematic and consistent. Confronting our fears without taking proper measures can lead to harmful consequences. In this technique a person is gradually eased into the situation they are afraid of or detest. Constant exposure decreases the impact as the person comes to terms with the fact that the situation or the object of their fear might be scary but they can still survive after facing it. For example, a person with a social anxiety disorder is exposed to events or situations where they have to interact with people. Though the amount of interaction and number of people will be controlled and minimum, at least initially. 

Role Play

In role technique, a hypothetical situation, that might generate fear within the person, is enacted. Through this method, the client gets used to the situation and has a chance to understand what their possible reaction could be if such an event were to occur in real life. It also prepares them to face such situations in the future by simulating them in a controlled environment. For example, a person with acrophobia (fear of heights) the client could be asked to role-play and enact a situation where they have gone on trekking. By enacting and imagining the situation it provides the client with a rough idea as to how their reaction would be to the situation and how prepared they are if such a situation were to happen in real life.

Relaxation 

Breathing Exercises and PMR (Progressive muscle relaxation) are some of the best ways to combat the physical symptoms of anxiety. Also once we have calmed our physical symptoms it helps in relaxing our emotions and moods as our feelings, behavior, and physical symptoms are all interconnected according to Cognitive Behavioral Therapy. Breathing exercises could be simple exercises wherein we are required to take in and release deep breaths. In PMR all the muscles in our body from the top of our head to the tip of our toe are contracted and relaxed to release the tension accumulated in our body. 

Visual Imagery

Visual imagery technique is a very innovative method of not only relaxing one’s mind but also exposing oneself to perceived threats through imagination. Through this technique, we can expose ourselves to our fears without putting ourselves at real risk. But we can feel the emotions or feelings that would be generated in the real-life scenario.

Suppose a person is afraid of enclosed spaces and is wary of facing this fear in reality. They can imagine themselves being in a closed room or space. By using this method they will undergo the emotions they normally experience while being in their feared situation. Through consistent use, they might become used to that scenario or at least be able to think about it without being paralyzed into shock. 

Journaling and thought records

Journaling is a great method of getting acquainted with one’s thoughts and ideas. Writing is a time-honored way of getting in touch with your thoughts.

It also helps us keep track of our emotions to trigger events and analyze them unbiased at a later time when we aren’t heavily influenced by our feelings or emotions. Journaling is an exercise that needs to be maintained regularly for it to be effective. All the anxious thoughts and worries can be poured into the journal to be analyzed with a calm mind at a later point of time.

Conclusion 

We explored the various intervention strategies available in CBT to deal with anxiety and also learned about the characteristics of CBT and anxiety

Frequently asked Questions

What are the Disadvantages Of CBT?

• CBT is a structured and systematic therapy that requires the commitment and time of the client. It doesn’t show results in just one session, and it also requires the client to put effort into changing themselves. Hence it can be a hassle for some.
• CBT takes time to show results. Clients cannot stop the therapy after just one or two sessions. So it is time-consuming as well.
• CBT makes the client confront their negative thought processes, which they usually tend to avoid. This can generate unease and emotional distress in some people.
• As the name suggests, CBT is a cognition-based therapy that requires a lot of analysis and rational thinking. Therefore this could be difficult for people with intellectual disabilities or people suffering from severe mental health issues.
• CBT believes that changes in our belief system tend to create an impact on our psychological well-being, but it disregards the effect of past stimulants or events that can have an effect. These events could be unhappy childhood memories or even traumatic past events.

How can I do CBT on myself?

CBT can be conducted upon self requires extreme patience and time to master. A person can try a few of the techniques in CBT such as confronting negative thoughts with evidence, relaxation techniques, and various other types of activities to ground themselves in the present and reconfigure their thought process. 

Can anxiety be cured?

Unfortunately, anxiety is not completely curable. But it is not a very big issue as its problematic aspects can be kept under control with the help of proper treatment. There are many techniques and exercises available that can be utilized to keep the anxiety in check. 

How long does it take for CBT to work for anxiety?

It could take anywhere between 6 and 24 sessions. Also, if the anxiety is severe and deep-rooted, it might require more sessions than usual.

Can I do CBT online?

Yes CBT can be accessed online with the help of either video calling or even chat messaging systems. It has been observed that online counseling provides almost the same results as face-to-face counseling and research backs it with evidence that people are likely to recover just as well with this method.  

References

25 CBT techniques and worksheets for cognitive behavioral therapy. PositivePsychology.com. (2021, December 14). Retrieved December 27, 2021, from https://positivepsychology.com/cbt-cognitive-behavioral-therapy-techniques-worksheets/

Raypole, C. (2020, August 31). Thought-stopping: Outdated or helpful? Healthline. Retrieved December 19, 2021, from https://www.healthline.com/health/mental-health/thought-stopping

Mayo Foundation for Medical Education and Research. (2019, March 16). Cognitive behavioral therapy. Mayo Clinic. Retrieved December 27, 2021, from https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610

Pietrangelo, A. (2019, December 12). CBT techniques: Tools for Cognitive Behavioral therapy. Healthline. Retrieved December 27, 2021, from https://www.healthline.com/health/cbt-techniques

Gillihan, S. J. (2016b). Retrain Your Brain: Cognitive Behavioral Therapy in 7 Weeks: A Workbook for Managing Depression and Anxiety (1st ed.). Althea Press.

How Cognitive Behavioral Therapy Can Treat Social Anxiety Disorder. (2021, September 1). Verywell Mind. https://www.verywellmind.com/how-is-cbt-used-to-treat-sad-3024945