Cognitive-behavioral therapy for anxiety (A complete Guide)

In this article, we will provide the answer for, “how does cognitive behavioral therapy treat anxiety?” and also explore its unique attributes. 

How does Cognitive Behavioral therapy treat Anxiety?

Cognitive Behavioral therapy is a fourth-generation behavioral therapy that achieves behavior modification by altering cognitive functioning. It is one of the leading treatments for anxiety as it aims to reduce anxiety by remodeling the factors and thought processes that trigger anxiety and fears. 

3 steps of Cognitive Behavioral Therapy For 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 


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.

Anxiety and the Symptoms

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. In an article published online, “Anxiety Therapy in London”, the author has explained the complexities and myths associated with anxiety.  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.


Symptoms of anxiety can be different for every individual, But there are a few common anxiety symptoms. 

  • Accelerated Breathing
  • Increased heart rates
  • Excessive Sweating
  • Increased blood pressure
  • Tingling sensations
  • Body and muscle aches
  • Nausea
  • Fatigue
  • Dizziness

Causes of Anxiety

Common causes of anxiety are:


Genetics always has been a significant cause in the development of many disorders. Sometimes, being prone to anxiety is passed through our genes. Genetics does play a role in acquiring anxiety disorders as well.

Environmental Factors: 

Our surroundings and the environment in which we grow up have a lot of influence on our thought processes. Certain traumatic events can lead us to become fearful or worried about them. 

Chemical Imbalance:

The imbalance in the chemicals that regulate our mood can affect our anxiety levels.

Hyperactive Amygdala: 

Amygdala is the part of the brain that controls the fear responses in our body. If a person has an overactive amygdala, then they might experience a heightened level of anxiety.

Anxiety And Its Cycle

Anxiety follows a vicious cycle that keeps repeating itself over and over. Let us consider for a moment a person who has stage fright has to deliver a speech. The person would feel fearful of the upcoming event and get carried away by negative thoughts. These thoughts would then cause a surge of unhelpful emotions, ultimately giving rise to bodily reactions that further exacerbate his condition. 

Then the person either might not show up to the event due to fear or fall sick. Even if he does attend the event, his health and mental state would be in poor condition and affect his performance. Thus the cycle would repeat itself. Therefore it is crucial to break this cycle to get rid of anxiety.

Interventions in Cognitive Behavioral Therapy For Anxiety?


It often happens that people are not aware of the anxiety they are suffering from. They are entirely in the dark about their triggers, symptoms, or even responses. In such cases, it is essential to psychoeducate them to be well equipped to tackle their anxiety. Also, there are various types of anxieties, and their emotional responses or triggering events differ. Thus it is essential to identify the kind of anxiety the person is suffering from and provide treatment accordingly.

Emotion regulation

When a person is experiencing anxiety, they often experience symptoms upon getting triggered by an event. These symptoms can serve as a warning sign, and if immediate action is taken, the symptoms can be avoided from getting severe. To prevent the symptoms from worsening, some special skills or techniques can be utilized to help calm down the emotions the person is experiencing.

Facing your fears

Prolonged exposure to events, objects, or anything that sparks fear can help reduce our anxiety. But it has to be gradual and also rational. Facing the fear of stage fright by making a speech is rational but facing the fear of poisonous animals by touching them is irrational. 

Relaxation techniques

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.


Throughout the article, we learned and understood the causes, symptoms of anxiety, and the complex processes and strategies that Cognitive Behavioral therapy employs to deal with anxiety.

Frequently Asked Questions

Can anxiety cause weird sensations?

Yes, anxiety can cause bodily sensations, such as increased heart rates, sweating, tingling, or stomachache. It depends on the person experiencing it, as different people can react to the same type of anxiety.

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 Cognitive Behavioral Therapy on myself?

Yes, you can. CBT is one of the few therapies available that can easily be administered if one follows the proper course of action and guide. There are many worksheets and exercises of CBT available online that are self-administered to help people deal with their issues on their own.

Can Cognitive Behavioral Therapy Be Harmful?

Cognitive Behavioral Therapy is a very beneficial and effective therapy. There are no harmful side effects associated with CBT. However, CBT has many exercises that a person has to follow. These exercises focus on changing oneself and facing one’s fears which can be distressing to a person. But all the activities and plans are for the client’s benefit and are not intended to cause any harm.

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.

Can CBT make anxiety worse?

CBT focuses on challenging unhelpful negative thoughts, fears, and worries to replace them with positive thoughts. To achieve this, the individual has to confront those fears, which may cause anxiety to spike during that initial period. But doing such things is necessary for the successful implementation of the therapy. So even if there are chances of anxiety getting worse for a brief period, it is part of the process and would only be helpful in the treatment.


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.

Self Help – Cognitive-Behavioural Therapy (CBT). (2019, March 6). Anxiety Canada.

Therapist Aid. (2016, April 29). Treating Anxiety with CBT.

Therapy Central. 2021. Anxiety Therapy in London | Take control back with Therapy Central. [online] Available at: <> [Accessed 22 October 2021].