Cognitive behavioral therapy (CBT) was first developed in the 1960’s by Aaron Beck, a psychiatrist, who noticed that certain types of thinking which he labeled “automatic negative thoughts,” were at the root of many of his patients’ emotional problems.This led to his hypothesis that since thoughts precede feelings, and feelings lead to action, if you change the way you think, your feelings and actions will change as well. Since then, CBT has grown in popularity, and is today recognized as a proven form of therapy that is considered the gold standard for treatment of anxiety disorders.
In short, cognitive behavioral therapy is an intensive, short-term, skills-focused treatment option that requires active participation as you work with your therapist to learn how to identify and correct the destructive thought patterns that are negatively impacting your behavior and feelings. It encompasses a wide variety of tools and techniques that may be combined in various ways to best meet your specific needs.
Regardless of which CBT method(s) your therapist uses, however, the treatment process will always involve three basic steps—identifying the distorted thought patterns that trigger your anxiety and that are negatively impacting your emotions and behavior, challenging these thoughts, and then reframing them in a more realistic way.
How Cognitive Behavioral Therapy Works
The cognitive behavioral therapy procedure is not a quick fix. It is a very structured treatment option that will require a lot of hard work on your part. In order to reach the ultimate goal of being able to automatically recognize your distorted thoughts the moment they pop into your mind, and reframe them before they have the chance to get the better of you, you have to retrain your brain.
Retraining your brain requires a lot of repetitive, consistent practice. It does not happen overnight. Your therapist will give you homework assignments to complete between sessions which may take several hours of your time to complete. It is important to know that the degree of success you can expect to experience will be proportionate to your willingness and commitment to put forth the necessary effort for change to occur.
Step 1. Identifying the thought.
At the core of unhealthy anxiety is a mistaken appraisal of danger that causes perceived threats to be exaggerated, in turn leading to overwhelming feelings of distress that often result in avoidance behaviors.
The first step toward recovery is to learn how to identify and recognize these unbalanced thoughts. Your therapist will help you do this by asking a series of questions such as what kinds of things trigger your anxiety, what situations you feel most anxious in, how you respond to them, and how your reactions to your distressing thoughts are affecting your life.
Step 2. Challenging the thought.
Your mind can be so adept at using cognitive distortion to deceive you into believing something is real that isn’t, that recognizing inaccuracies in your thought patterns can be tricky.
Your therapist will show you how to do it as, together, you challenge each thought identified in step one. You will learn to question whether there actually is any evidence to support it or whether you are making assumptions, catastrophizing, overgeneralizing, personalizing, ignoring the positive, or only seeing one side of the situation.
Step 3. Reframing the thought.
Once you have learned how to identify your faulty thought patterns, your therapist will help you find new ways of looking at the things that trigger them. Your therapist will demonstrate how you can replace a distorted belief with a more balanced and realistic alternative.
For example, you are walking along the street and see someone you know walking toward you. You say hello, but he or she keeps walking and doesn’t respond. Your automatic response might be, “He must be mad at me,” or “She doesn’t like me and is trying to avoid me.”
Instead of jumping to conclusions, you could reframe those thoughts with more realistic ones such as, “Perhaps her mind was on other things and she didn’t notice me.” This approach can calm your anxiety.
Approaches in Cognitive Behavioral Therapy for Anxiety
These are the most popular types of CBT used to treat anxiety.
Avoidance is a self-defeating strategy that may provide short-term relief, but will actually only intensify your feelings of anxiety and make them worse. Exposure therapy, on the other hand, is a systematic desensitization technique that helps you progressively face your fears by confronting them in a safe, controlled setting.
Under the guidance of a trained CBT therapist, you will gradually build up your comfort level to where you can ease your way into the situations you have been avoiding. Depending on the severity of your symptoms, your therapist may start you out with something only mildly threatening, such as an imagined or virtual exposure to a trigger, and then as you become able to handle that, work up to real life situations in small incremental steps.
Gradually, with repetition, your fear and avoidance behavior will diminish, confidence in your coping abilities will increase, and you will be able to face the dreaded event without feeling distressed.
Guided discovery is a process your therapist may use to help you reflect on how you tend to process information. It can show you how you can break out of your negative thinking cycle.
Your therapist will help you expand your thinking by contrasting your underlying assumptions with more realistic alternate perspectives. You will be asked to answer questions that challenge your beliefs such as what evidence exists to support your assumptions, what evidence does not support them, what else can you assume, what alternate ways of looking at this situation are there, and why.
As you learn to see things from a different, more balanced perspective you may not have considered before, it will enable a shift to take place in your emotional reactions as well.
Writing down your thoughts can help you recognize a cognitive distortion or negative thought pattern even if at first you weren’t sure what was causing your anxiety. Your therapist may ask you to keep a journal in which you list negative thoughts you had between sessions, as well as alternate positive ones you could choose from.
As you practice journaling on a consistent basis, you’ll likely start noticing distorted thought patterns more quickly. Journaling is also a great way to keep track of your progress so you can see how far you have come.
Group therapy is sometimes used to complement and enhance individual CBT therapy. It provides you with an opportunity to practice the skills you are learning in your individual sessions, in a non-threatening setting, before testing them out in real life.
Playing out possible scenarios that cause you anxiety can help lessen the fear and increase confidence. For example, if you are dreading going into an interview, your therapist may have you enact a mock scene with him or her taking on the role of the interviewer.
With your therapist, you will analyze it to see how your anxiety affects your demeanor, and what you could do differently next time. In this way you can work out any self-defeating behavior ahead of time and be prepared to respond more positively by the time you actually get to the interview.
Relaxation and stress reduction techniques
Relaxation techniques such as grounding, deep abdominal breathing, progressive muscle relaxation, and/or mindfulness, can help diminish the physical symptoms produced by your anxiety, reduce stressful feelings, and increase your sense of control when facing an anxiety-producing situation.
Christian Counseling for Anxiety
Christian counseling involves a combination of biblical principles and clinical intervention. If you have questions or would like to set up an appointment, please contact me or one of the other faith-based counselors in our online counselor directory today. We would be happy to help you manage the challenges you face, as well as support and encourage you along the way.
Andrea Brandt, Ph.D., M.F.T. (June 3, 2019). 3 Steps to Treat Your Anxiety Using CBT, Psychology Today.
Ann Pietrangelo (December 12, 2019). 9 CBT Techniques for Better Mental Health, Healthline.com.
Kendra Cherry (November 5, 2021). What Is Cognitive Behavioral Therapy (CBT)? Verywell Mind.
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