CBT for Anxiety



State anxiety = the feeling that accompanies an event and then passes when the event is over.
Triggers flight-or-fight response.
Most ‘threats’ today are not life-threatening, but our body doesn’t know that.
High arousal does not help us in most instances.

Trait anxiety = an inherited predisposition towards anxiety


Common threats that induce anxiety :

Physical safety                (walking alone at night, pathology test)

Material wellbeing           (financial debt; losing job, running business)

Self – esteem                 (going for job interview, performing)

Social safety                   (confronting someone, being disapproved of)


Effects of Anxiety :

Thoughts :   Thoughts can make us feel anxious. And also, anxiety can influence our thoughts. (Example: feeling nervous about a dinner party may affect how you then interact with people.)

Body :   Flight-or-fight response : heart rate, pulse, sweating, dizziness etc. These can cause more anxiety, leading to panic attack (the anxiety cycle)

Behaviour: Appropriate tension can enhance performance. Anxiety impairs performance, makes us agitated, startle response, and may cause us to seek avoidance behaviour (eating, drinking, smoking etc.)

Escape responses : substance abuse, addictions. Avoiding anxiety provoking situations, leading to narrowing of life experiences.


Patterns of Thinking that lead to Anxiety

Holding on to worrying thoughts
Need for approval
Need for control

Worry     (the ‘What If?’ syndrome)

Possibility of something bad happening : loss, injury, rejection, failure, shame. 

Holding on to worrying Thoughts

Magical thinking: that worrying will prevent the thing from happening. May come from past experience where after worrying, the thing did not happen.

Preparing for the worst : I’ll either be relieved, or will have prepared myself.

In fact gives us unnecessary suffering and keeps us from enjoying events. 


Overestimate probability of bad thing happening

Exaggerate negative consequences if it does happen

Perfectionism (belief that performance must be perfect)

Leads to anxiety over :

Expectation of extremely high standard

Procrastination   (difficulty getting started)

Difficulty finishing (not good enough yet)

Concern with small flaws


Lack of self-congratulation

Downgrading of our achievements

Need for Approval

Belief that we are not good enough / flawed, so seek external approval and validation.

Leads to anxiety over :

Taking social risks

Being assertive

Confrontations and conflict

Hypersensitivity to perceived slights & rejections

Fear of our performance in front of others

Need for Control

Appropriate taking of control of challenging situations can make us feel good about ourselves. Excessive need for control has opposite effect – anxiety and frustration.

Controlling behaviour tries to make our world safe and predictable, so things will not go wrong :


Things we cannot have control over, we need to :

Let go
Trust things will work out
Tell ourselves we will be able to cope even if they don’t work out
Let go of the need to fix everything.




De-catastrophise   (Bring problem back to its correct perspective.)

  1. Recognizing that the feared situation is unlikely to happen. Over 90% of the things we fear never eventuate.
  2. Consider consequences if it did, & recognize that you would cope. Even when feared event happens, the consequences are usually not as bad as we predict.
  3. Sometimes difficult situations that we fear actually have some positive consequences.


Risk Assessment     (Analytic exercise to shift perspective to the wider view)


  1. Define the thing that you are worried about
  2. Rate your feelings of anxiety on scale of 0 to 100%
  3. What are the worst possible consequences of this situation?
  4. Rate the likelihood that these consequences will happen, 0 to 100%
  5. Are there factors that make them unlikely to happen?
  6. Realistically, what is most likely to happen?
  7. What thoughts can help you to keep things in perspective?
  8. What actions can you take?
  9. Realistically, what is the likelihood that the worst possible thing will happen?
  10. Re-rate your feelings of anxiety, from 0 to 100%


Weigh up the Evidence   (WORKSHEET)

  1. Catastrophic thought
  2. Evidence for
  3. Evidence against
  4. Alternative, balanced thoughts


Coping Statements      

Find your own coping statement, something that expresses your hopeful impulse. If necessary, post it up in visible places :

It’s out of my control – let it go                                                 Relax!

I did my best. The rest is out of my hands                                 This too will pass

NMP! (Not My Problem!)                                                          Wait and see

Whatever happens, I always manage / cope                            One day at a time

It’s not life threatening, it’s not that important

I have the right to screw up occasionally

It’s a pain in the neck, but it’s not awful

This won’t matter in five years time

Let go and relax – it’s really not so bad

In the big world picture, it’s really not so important




Exposure therapy         (easing gradually into desensitizing yourself)

Confronting your fears = behavioural disputing

  1. Step by step (baby steps)
  2. Visualizing yourself in the feared situation before doing it physically


Problem Solve

If the situation allows some action on our part to fix or improve things, work through a problem-solving process. Identify what things you have some control over, do a risk assessment, make a list of the issues involved and what could be done about each issue.


Coping Imagery

Visualize yourself in the feared situation, and visualize yourself coping really well, being strong, assertive, efficient, confident, etc. Particularly useful for feared future events.

Give the exercise full attention : lie down and relax, evoke scene with full senses, visualize, and monitor relaxed muscles. Repeat regularly.


Distraction      (when no action is possible, ie, waiting)

Plan an event, go to the movies, play cards, computer games, puzzles, crosswords, listening to music, etc.


Deep Relaxation Techniques

Reverses the physiological symptoms of flight-or-fight response associated with anxiety. Slows heartrate, blood pressure drops, less oxygen use.

Progressive muscle relaxation : work through the major muscle groups from feet up to head. Can involve tensing & then releasing.

Meditation : mental stillness through focus on an object (mantra)

Calming visual imagery (visualization) : find your most effective scenery

Breathing exercises :

diaphragm breathing

Slow breathing with a pause after in-breath

Rhythmic breathing. 1. in & count to 10, out thinking ‘relax’. 2. in 1,2,3,4 and out 1,2,3,4, thinking ‘relax’ after each out-breath. Repeat step 2 10 times.

AUTHOR’S NOTE:  I recommend Dan Siegel’s approach to meditative exercises. He hasWheel of Awareness constructed a powerful meditation exercise, which can be downloaded from his website, under “Resources”. It is called The Wheel of Awareness and is linked to his work and research in Interpersonal Neurobiology.  Link:http://www.drdansiegel.com/resources/wheel_of_awareness/




Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s