Cognitive Behavioural Therapy (CBT) is a short-term, focused, and goal-oriented treatment. It has strong evidence supporting its use for anxiety disorders.
What is it about CBT that makes it effective? CBT is based on Beck’s cognitive therapy. This idea says that our thoughts and perceptions affect our feelings and behaviors.
Some key elements include:
- Cognitive Specificity Hypothesis: Individuals with anxiety disorders tend to catastrophise – expecting worst-case scenarios. When we feel anxious, we often overestimate the likelihood and severity of threat of the feared outcome. CBT targets these unhelpful thinking patterns through cognitive restructuring by finding counterevidence and alternative, more adaptive ways of viewing feared situations.
- Addressing safety behaviours: People with anxiety often engage in safety-seeking behaviours (actions to avoid or prevent feared outcomes), which provide short-term relief but maintain anxiety long-term by preventing learning that feared catastrophes are unlikely or tolerable. CBT works to identify, reduce, and eliminate these behaviours, often through graded exposure to feared stimuli or situations.
- Exposure and response prevention: Anxiety often persists because of avoidance of feared objects or situations. By avoiding the feared situation, this reinforces the belief that these situations are justifiably scary and teaches us that we are unable to face them.
Exposure therapy is an important technique in CBT. It involves facing feared situations step by step. This helps reduce our anxiety. It also teaches us that the feared situation can be managed.
How do I know if CBT would suit me?
Determining whether someone is a good candidate for CBT to treat anxiety involves severalconsiderations:
1. Diagnosis:
The individual should meet diagnostic criteria for an anxiety disorder (e.g., Generalized Anxiety Disorder, Panic Disorder, Social Anxiety Disorder, Specific Phobias, Agoraphobia). However, individuals who experience anxiety symptoms without a formal diagnosis can still benefit from CBT if these symptoms are significantly impacting on their daily functioning.
2. Willingness and Motivation:
Any effective therapeutic modality requires the client to be motivated and willing. CBT requires individuals to confront their fears in a safe and controlled way and for homework tasks to be completed between sessions in order for progress to occur. These may include monitoring worried thinking patterns, practicing relaxation techniques and completing graded exposure tasks of feared situations.
3. Cognitive and emotional capacity:
CBT requires a certain level of insight and cognitive ability to identify and challenge unhelpful thoughts. Individuals need to be able to identify their worried thinking in order these to be explored during cognitive restructuring and for insight to develop in relation to their feelings and behaviours.
In practice, a thorough biopsychosocial assessment including clinical interviews, observation, and standardized rating scales will help establish suitability. Psychoeducation regarding the CBT model can also gauge the client’s understanding and readiness to engage in treatment. CBT is generally effective when the client is willing to learn and practice new thinking and behavioural strategies, is able to tolerate anxiety during exposure exercises, and has adequate cognitive functioning to participate in therapy tasks.
Summary
CBT for anxiety is based on the idea that unhelpful thoughts and behaviors keep anxiety going. By changing these thoughts, reducing avoidance, and facing feared situations, anxiety can be lowered effectively.
