Cognitive Behavioral Therapy for Anxiety

According to the National Institute of Mental Health, anxiety is a common diagnosis in the United States where 31% of the population experiences an anxiety disorder at some point in their life. The goal of CBT for anxiety is to target the root cause of excessive fear or worry depending on what object or situation is their source of anxiety.

Individuals with anxiety experience preoccupation with their thoughts, overwhelming feelings of worry, and increased autonomic arousal. Triggers for anxiety can range from general distress over daily tasks to particular phobias such as agoraphobia, a fear of being alone in an unknown or crowded space with an inability to escape.

Anxiety disorder symptoms include physical and mental effects:

• Excessive feelings of fear and worry
• Restlessness
• Fatigue
• Irritability
• Muscle tension
• Sleep and concentration difficulties

Anxiety affects how individuals navigate their life tasks to the point of debilitating their daily routines. CBT aims at reframing the cognitive framework behind these thoughts to reduce the physical and psychological anxiety response.

To accurately diagnose anxiety, healthcare providers need to explore whether their client is comorbid with other prevalent disorders like depression or post-traumatic stress disorder before attempting a CBT treatment plan for anxiety.

Dr. Goldstein-Piekarski, Dr. Williams, and Dr. Humphreys are Stanford faculty from the psychiatric department and they reveal in A Transdiagnostic Review of Anxiety Disorder Comorbidity that anxiety disorders have a 60% comorbidity rate with another anxiety disorder or a depressive disorder. In this research, scientists highlight the disorders with the greatest comorbidity rates, which comprise social phobia disorder and major depressive disorder, major depressive disorder and specific phobias, as well as major depressive disorder and generalized anxiety disorder.

The National Alliance on Mental Illness shares that 40 million adults in the United States hold an anxiety disorder diagnosis. CBT is one of the leading treatments for the most prevalent anxiety disorders and rarer anxiety disorders, such as:

• Generalized Anxiety Disorder (GAD): Individuals with generalized anxiety disorder tend to worry about daily events like their health, school performance, finances, or workplace performance. They feel circumstances are out of their control in these situations, which results in physical and psychological harmful effects.
• Separation Anxiety Disorder (SAD): Separation anxiety disorder is most frequently diagnosed in children under the age of 12 but also occurs in adults. To qualify as SAD in children, the feelings of anxiety from separation must last for four weeks. Adults need to feel fear, anxiety, or avoidance for a period of 6 months to receive a diagnosis. Not all adults who are diagnosed with separation anxiety disorder were diagnosed with the disorder as children.
• Social Anxiety Disorder (SO): Social anxiety disorder is also known as social phobia. Individuals with social anxiety fear situations where they are exposed to possible scrutiny or fear their behavior will lead to public humiliation or shame.
• Panic Disorder (PD): Panic disorder is a condition where an individual experiences recurrent unexpected panic attacks, which include feelings of intense fear or discomfort.
• Specific Phobias: The most common phobias include claustrophobia, agoraphobia, a fear of animals, and a fear of natural disasters and environments like heights, fires, or earthquakes.
• Selective Mutism: Selective mutism is a rarer anxiety disorder and typically emerges in younger school-aged children when social situations tend to increase. 

Traditionally obsessive-compulsive disorder and posttraumatic stress disorder also fall into the anxiety disorder classifications. Within the last decade, the DMS-5 reclassified the disorders into separate divisions of obsessive-compulsive and related disorders or trauma- and stressor-related disorders. The American Psychological Association identifies exposure and CBT therapy as effective forms of therapy for anxiety.

Practitioners educate their clients with a variety of techniques when they introduce CBT as a therapy treatment:

• Socializing the patient
• Identifying and categorizing distorted automatic thoughts
• Challenging automatic thoughts
• Identifying maladaptive assumptions
• Challenging maladaptive assumptions
• Identifying dysfunctional schemas
• Challenging dysfunctional schemas
• Problem-solving and self-control
  

Socializing the Patient

The first technique in CBT is to prepare the patient for what CBT entails. Researchers and healthcare providers refer to this step as socializing the patient. During the initial intake session, set expectations for what clients want to achieve with their treatment. Some individuals may seek to lessen triggers to their phobias, while others hope to learn skills to manage their daily anxieties. This stage is where treatment providers decide whether their client is suitable to receive CBT and receptive to CBT techniques.

Dr. Stanley Brodsky, Ph.D., is a professor emeritus at the University of Alamaba and coordinator of the psychology-law program who leads a course on Therapy with Reluctant Clients in partnership with CONCEPT Professional Studies. For effective therapy treatment, mental healthcare providers are able to use specific techniques such as avoiding asking questions and making assertive observations to encourage productive behaviors in disinclined clients.

Automatic Thoughts & Maladaptive Assumptions

Automatic thoughts and maladaptive assumptions arise from a cyclically negative cognitive pattern. These thoughts and beliefs are difficult to control as they interject intrusively into clients’ daily thought processes. With a therapist, individuals with anxiety are able to learn when to interrupt these patterns and challenge them with newfound skills. Individuals who utilize CBT techniques begin to recognize the start of negative thoughts or maladaptive assumptions. Then, they are able to target the origin of their feeling and behavior healthily. 

The Stress & Development Lab at Harvard University identifies catastrophizing, overgeneralizing, and jumping to conclusions as several examples of negative automatic thoughts. Body scan meditations, journaling, and paced breathing are a few options to redirect anxious thoughts and behaviors. 

Dysfunctional Schemas, Problem-Solving & Self-Control

Schemas are the way individuals understand the world, and individuals with anxiety reinforce their negative schemas. CBT aims to target a client’s dysfunctional schemas with problem-solving and self-control techniques. For example, exposure therapy is a form of treatment where individuals with anxiety face their triggers to desensitize their fear to the stimulus. This treatment falls under the CBT branch and challenges clients’ perceptions of their understanding and known psychological frameworks. Gradually, over a period of time and exposure, the individual should experience a lessened or unreactive response to the stimuli than their typical psychological and physiological reaction. 

Self-regulation is an essential technique that provides clients with the solution to soothe themselves and intervene in their dysfunctional schemas. Dr. Jerrod Brown, Ph.D. educator and researcher with four master’s, will lead an upcoming live course with CONCEPT Professional Studies on Behavioral Health Aspects of Self-Regulation Deficits. 

For additional intervention strategies, Dr. Lynn C. Waelde, Ph.D. and professor at Palo Alto University, presents a course on Inner Resources for Stress: Mindfulness for Self Care. Every client prefers a particular approach to self-soothing, so explore and present clients with a range of techniques.

Ultimately, anxiety techniques aim at recentering how individuals with anxiety view themselves, their relationships, and their world. CBT, a form of psychotherapy, and pharmacology are the two most frequently chosen treatment options for anxiety disorders. Not every client will be comfortable with turning to medication as a solution to their anxiety, so talk therapy such as CBT is a preferred treatment choice. CBT is successful at treating a variety of anxiety disorders because the treatment provides clients with immediate skills to intervene when anxious behavior and thoughts occur.