Cognitive Behavioral Therapy (CBT) is one of the most well validated, time limited and effective forms of treatment for people with mild to severe anxiety problems.
CBT works by helping clients to quickly and effectively identify and change their negative anxiety eliciting thoughts, feelings and behaviors. The goal here is to replace negative thoughts and emotional reactions patterns with more positive and calming thoughts and feelings.
Anxiety problems are defined here in terms of the extent to which the person’s fear or anxiety response significantly interferes with how they function on a day to day basis in typical environments such as home, work or school.
Insurance companies love CBT because it gets lasting results in as few as 5-10 sessions. Therapeutic changes from CBT are skills and research based.
Results are usually as or more effective then drug treatments, which often have undesired side effects. Positive treatment outcomes are not only very strong but they are also long lasting with positive results indicated through 2 and 5 year follow up studies.
The 2 Core CBT strategies in the management of anxiety are: 1) Cognitive Restructuring; and, 2) Relaxation Training.
Changing Your Thoughts to Change Your Emotions
In Cognitive Restructuring the CBT therapist teaches the client how to identify their negative self-talk or the internal speech choices that elicit the client’s anxiety response. Negative self-talk is sometimes referred to as “stinkin-thinkin.”
For example, many people actually think their way into heightened fear or anxiety states that paralyze or compromise their ability to constructively interact with people in social situations. An anxious person who is about to give a public presentation may think negative thoughts to themselves like:
“This is going to be so embarrassing” or “I’m so scared right now…I can’t do this!”
In more serious conditions like panic disorder, people can think thoughts like:
“I’m having a heart attack” or “I’m going to die!”
Strong research in cognitive behavioral therapy has demonstrated very clearly that these kinds of negative thoughts or internal appraisal statements often create negative emotional reactions that can be as intense as those experienced in real situation of threat or danger, that actually happen, sometimes in the real world.
This is because our brains are often unable to distinguish between what’s going on in the real world and what we tell it is going on through the filters or lenses of our thoughts and appraisals. When you change the scary unrealistic appraisals, you change the scary unrealistic emotions like fear and anxiety.
The CBT Journal - Recording Thoughts and Emotions
One of the CBT therapist’s most important teaching and learning tools is the CBT Journal or CBT worksheets. The client brings her journal with her into situations where she becomes disproportionately anxious.
She then records her fear inducing thought statements as close to when they happen in actual situations, so she doesn't forget them later in therapy.
The CBT therapist and client then work on developing alternative, more relaxing and positive self-talk statements for those situations.
In most cases they will also use visualization techniques to practice being in those anxious situations, quickly stopping the negative thoughts and replacing them with more positive self-talk statements or appraisal statements.
In cases involving some phobias (i.e. fear of flying) these "exposure techniques" are taken into the real world. In what's also called "systematic desensitization" the phobic client is gradually exposed to the places and situations that causes their intense fear, while at the same doing cognitive restructuring and self-induced relaxation.
Relaxation Training - Mastering the Relaxation Response
The Cognitive Behavioral Journal also has a section in it for measuring the level of anxiety a person experiences in each targeted situation.
A common strategy applied here is called “scaling” where the client assigns a number on a scale of 1 to 10 to subjectively measure and communicate the emotional intensity of the experience to the therapist. 10 usually represents intense anxiety or even panic. 1 represents a neutral emotional state where the client is not relaxed but not anxious either.
In most cases, the client will also find a 1-10 scale to measure the clients increasing ability to self-induce relaxation through relaxation response training. In this case, 1 represents the lowest level of relaxation and 10 represents the deepest level of relaxation, characterized by measurably decreased pulse, respiration and muscle tension.
The goal of relaxation training is to teach the client how to self-invoke the “relaxation response” on those occasions when she is most likely to become anxious.
The most common evidence-based relaxation training goals are to teach 1) diaphragmatic breathing; 2) systematic muscle relaxation; and, 3) calming meditation practices.
The Relaxation Response is a teachable skill like learning to drive a car or learning to ride a bike. With 1-2 months of daily relaxation practice (20 minutes per day), an anxious person can learn to totally relax their mind and body in just a few seconds, in situations where they really need to.
The relaxation response is used to replace the anxiety response the same way that positive thoughts are used to replace negative thoughts in cognitive restructuring.
Cognitive restructuring and relaxation training work synergistically to transform automatic anxious emotional thoughts and feelings into more controlled, more relaxed thinking and emotional responding .
According to best-practices or evidence-based approaches to the treatment of anxiety, cognitive behavioral therapy is one of the best forms of counseling for anxiety currently available.
Cognitive Behavioral Therapy is practiced by trained Psychiatrists, Clinical Psychologists and Master's level Professional Counselors.
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