CBT treatment plans for anxiety

In this article, we will learn about the treatment plan for CBT and also understand its developmental process. 

What is the treatment plan in CBT to help with anxiety?

CBT is a proven method to help with anxiety. CBT follows a certain treatment guideline to help the client recover. 

• Analyzing the triggering events with the help of techniques such as thought monitoring or journaling. 
• Identification of negative thoughts that lead to anxiety. 
• Challenging and replacing that negative thought with the help of cognitive restructuring. 
• Helping the clients get used to their feared situation or object by slowly increasing their tolerance through continuous exposure. 
• Assisting the client in overcoming the symptoms associated with anxiety attacks through various relaxation techniques. 
• Assigning homework to the client so that the client can practice their newly learned coping skills and techniques in real-life situations and help them prevent from relapsing. 
• Once it has been ensured that the client is capable of handling things on their own only then the treatment is terminated.

How does CBT help with treating Anxiety?

Cognitive-behavioral therapy (CBT) is one of the most widely used and effective therapy to treat mental health disorders such as depression, schizophrenia as well as disorders such as personality, mood, eating, and anxiety disorders. 

In anxiety disorder, it has been proven very effective in treating generalized anxiety disorder as well as a social anxiety disorder. 

CBT is a short-term treatment that helps in developing skills to modify and replace cognitive distortions that are harmful to your psychological well-being. The therapist aids in changing dysfunctional thoughts and ideas with functional thoughts and ideas to bring about positive change in a person’s attitude and behavior. 

According to Cognitive Behavioral Therapy our thoughts, emotions, and behavior are interconnected and influenced by each other. If our thoughts are negative and maladaptive then they lead to unpleasant emotions and distress, and this emotional distress accompanied by distorted thinking can lead to maladaptive behavior and consequences. It is almost like a vicious cycle that keeps repeating itself over and over.  To break this vicious cycle CBT employs a three step process. 

3 steps of CBT

Understanding and identifying negative thoughts

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. Because these events will help in identifying our negative thoughts. 

For example,  a person ended up falling three-step on stages while performing and now has fear of being embarrassed on stage again.

The negative thoughts arising out of this situation could be:

• I am a useless person
• I cannot even perform properly
• I am a pathetic artist
• I should quit performing
• Everybody will laugh at me

We need to identify such events that left a lasting impact on us. By trying  to recollect the thoughts and emotions that were revolving in our mind during that event we can reach the NATs (Negative Automatic Thoughts) 

Challenging the negative thoughts with evidence

To challenge our negative thoughts we require sufficient evidence against them. Unless we provide concrete evidence it is very difficult to change these maladaptive thoughts as the person truly believes them to be true. To provide proof against those ideations the therapist may ask questions like:

“What makes you think you are a bad performer?

“What are the reasons that suggest that you cannot perform well in the future?

“Tell me about the instances when people appreciated your talent and complimented you?

“How do you feel when you are performing and people appreciate you?

When the therapist prods the client to think carefully about the situation they can easily conclude that though they experienced a bad incident in the past it should not necessarily govern the rest of their life. In this case, the therapist can help the client understand that though there was one bad performance there were times when they performed well as well. Just because they had one bad performance does not mean that they are not good as an artist. There are ups and downs in everyone’s field and life and they can learn from this experience to do better in the future.

Replacing the negative thoughts with practical and positive thoughts

It is necessary to understand that the thoughts used for replacement are not too extreme or unrealistic. For example if a person has the negative thought, “I am the world’s worst performer”, then this thought shouldn’t be replaced with, “I am the world’s best performer”. The thought should be practical and genuinely believable by the person. So rational thoughts could be utilized such as,

“I am a good artist who can do better if I worked harder and practiced more”

“I have reached till here with my efforts and I, can go further with more efforts and developing my skills”

“I may not be a great artist but I attempt to be by developing my skills”

The thoughts should be practical as well as positive and encouraging. These thoughts help in boosting the person’s confidence and morale and help them get back on the right track.

Vital Techniques in CBT for Anxiety

Anxiety Psychoeducation

Everyone doesn’t need to be aware of the causes of the anxiety or its symptoms. Some people might be aware of their phobias of particular objects or things or situations but some people might feel anxiety without knowing its cause or triggers. In such instances, it is important to help them identify their fears. Also, the therapist needs to assist the client in learning more about anxiety, its nature, and its symptoms so that they can deal with it better in the future. 

Exposure Therapy / Systematic Desensitization

Exposure therapy is based on the concept of confronting your fears to overcome them. Here the client is slowly exposed to their fears continuously and slowly eased into the situation to increase their tolerance. It is with the intention to make the person realize that being exposed to their fears does not necessarily create negative consequences for them and they are not dangerous. Once they are exposed to them and survive that encounter unscathed slowly over time their fears are lessened and they overcome their anxiety. 

Relaxation Skills

Relaxation techniques are very effective in alleviating anxiety symptoms. There are various types of exercises that have proved to be helpful.

Deep Breathing exercises: They have proved to be very useful and are found to provide calming effects. 

Progressive muscle relaxation: PMR is a  type of technique where muscles are contracted and relaxed systematically to release stress and pain relief.

Visual Image relaxation: A person can visualize a calm scenario that feels peaceful and content in this technique. This helps in the alleviation of stress.

How is the treatment plan created in CBT?

Every treatment plan is designed to the needs of the particular client to cater to their requirements. The treatment plan consists of various systematic steps. These steps help in forming a viable treatment plan.

Step 1 

Objectives

It is important to know your objectives or concerns about the treatment. It is necessary to discuss with the client to understand what will be the aim and direction for the treatment. 

Setting of goals

It is imperative to set goals beforehand and work towards achieving them. The client certainly would have certain expectations and visions regarding their treatment. They will help in the setting of the goals. 

Planning of interventions. 

Once the goals are decided and the disorder is assessed and analyzed. The interventions are planned according to the severity of the issue and the needs of the client. Since every treatment plan is unique the interventions planned for the treatment may vary from case to case. 

Following are some of the interventions utilized in treating  

Anxiety

Journaling

Journaling is an important technique to keep records of one’s emotions and thoughts. This helps us in finding the patterns in our thoughts and behaviors.  

Finding the Cognitive Distortions

By finding the harmful cognitive distortions we can attempt to eliminate them therefore t is necessary to become aware of these thoughts and fight them. 

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 harm harm 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 try 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 and response prevention

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. 

Interoceptive exposure

This technique is utilized to treat panic and anxiety issues. In this technique, the client is exposed to their feared bodily sensations to provide a reaction. With the help of this method, the unhelpful ideations associated with their fears are awakened and brought forth. Also, the client is subjected to these sensations without any interference and disturbance is that there is no distraction or avoidance on the client’s part. Through this process, the client can understand that while the symptoms of panic and anxiety are very unpleasant and uncomfortable they are not dangerous or insurmountable. We can handle them if we develop enough tolerance. 

Conclusion:

In this article we learned how to create a treatment plan for anxiety and the various aspects that are included in the treatment plan. 

Frequently Asked Questions

What are the 5 steps of CBT?

The five important steps in CBT to change your Thinking are :

Step One – To create a List

Step Two – Self-recording and monitoring of thoughts

Step Three – Forming alternate thoughts to replace dysfunctional thoughts

Step Four – Reading the list regularly 

Step Five – Noting dysfunctional thoughts and replacing them 

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.  

Can you do CBT over the phone?

Telephonic counseling has been for years to help those who are unable to access counseling online. These days due to the pandemic countless people are unable to access counseling and require help. In such scenarios, telephonic counseling makes a big difference in helping them with their issues. 

How do I choose a therapist for anxiety?

You can contact your local hospital, mental health clinics, or counseling clinics for professionals to help you with anxiety. Nowadays various websites help you with finding suitable healthcare professionals for your needs. But it is important to check and ensure that the professional you have chosen is reliable and has the suitable experience to handle your concern. 

What professionals help with anxiety?

For any mental health disorder like anxiety, professionals such as psychiatrists, psychologists, and other mental health professionals such as counselors can help. These professionals help in diagnosing as well as treating mental health disorders with the help of appropriate treatment methods such as psychotherapy and medications. 

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/

Mindful anger | psychology Today. (n.d.). Retrieved December 27, 2021, from https://www.psychologytoday.com/us/blog/mindful-anger

Therapist Aid. (2016, April 29). Treating anxiety with CBT (guide). Therapist Aid. Retrieved December 27, 2021, from https://www.therapistaid.com/therapy-guide/cbt-for-anxiety