CBT for anxiety
The CBT definition of anxiety as an overestimation of risk and an underestimation of resources. In other words, anxiety causes us to see greater danger than actually exists and to feel less capable than we actually are. In fact, a person with an anxiety disorder who looks at a list of words will find the threatening words (“death,” “cancer,” “danger”) far faster than a non-anxious person. The anxious brain is always scanning for danger.
Anxiety is often inadvertently maintained and reinforced by avoidance. When we avoid our fears, we actually teach our brain that this experience is too big and too awful, and we can’t handle it. The problem with this approach is that the anxiety gains traction- it begins to look for other ways to make your world get smaller.
Exposure therapy is an essential part of anxiety treatment. We have to teach our brains to unlearn the fear response to experiences. This sounds simple, but the reality is that it is hard work. It is uncomfortable work. We start slow by creating a hierarchy or a simple list of all of the feared experiences and then rank them from hardest to easiest. We start with the easiest items and slowly work our way up to the harder issues- over time, with support and with coping strategies.
CBT for anxiety has excellent supportive research, and is considered the gold standard intervention for anxiety disorders. Of course, as with any intervention, individual success rates vary. There are factors that can lead to a greater chance of success. Numerous studies have demonstrated the efficacy of CBT for the treatment of a multitude of psychiatric diagnoses, including anxiety disorders, bulimia nervosa, binge eating disorder, and depression. And while the evidence supports the efficacy of CBT, there is no guarantee that treatment will work for any one individual. There are, however, things you can do to increase the likelihood of success in CBT. These include:
Motivation. Therapy is hard. It can be tiring, it can stir up uncomfortable feelings and memories, and it requires effort. I am right there with you and helping to make connections and share insights, but you are doing the hardest part. The people who start therapy wanting to do the work and make the changes unsurprisingly see the best outcomes
Homework completion. Yes, there is homework in CBT for anxiety and for depression. The session alone is not sufficient to create change and practice and generalization of knowledge and skills is necessary. Research is clear that CBT participants who complete the outside work in a meaningful way do better in treatment.
Time for the work. CBT involves work in session and out of session. Preparing for each session with your own notes, taking time to think through the situation, and doing the “homework” with care and thought all contribute to a richer experience. Time also includes attending sessions regularly.
