Cognitive Behavioral Therapy (CBT) for Anxiety: What It Is and How It Actually Works

It can be helpful to keep a thought log in between sessions. A thought log is a structured way to document situations, thoughts, feelings, and behaviors, with the goal of recognizing how they interact and influence each other.

Cognitive Behavioral Therapy (CBT) can be used to help you consider different ways of looking at things. Its focus is not on whether your thoughts are right or wrong, but rather, which thoughts are getting in the way of your daily activities, relationships, work, and overall well-being. 

What’s an Unhelpful Thought?

Have you ever found yourself spending a lot of time focusing on the worst case scenario of a situation, even when it’s unlikely?

This might look like believing that making a minor mistake at work will result in you being fired, even if you have a great track record and your employer hasn’t expressed any concerns?

This could also look like worrying that every headache that you have is a sign of a brain tumor, despite consistently keeping up with your annual physicals and not having your primary care provider express any prior concerns about your health.

Ugh, why am I having these thoughts in the first place?

Anxiety is like a biological alarm system that can alert us to potential threats and motivate us to take action to keep ourselves safe. Anxiety can be helpful in certain situations that require enhanced focus and vigilance, like when you are navigating an unfamiliar environment, but it can become unhelpful when it negatively interferes with your daily life.

Okay… so how will CBT help me?

Great question! CBT can help you build awareness around how your thoughts, feelings, and behaviors influence your anxiety symptoms. It involves challenging the accuracy and validity of your unhelpful thoughts.

CBT can also help you develop coping skills. By identifying the types of thoughts that can lead to heightened anxiety, it can become easier to interrupt the thought pattern with a coping skill before symptoms feel unmanageable. 

For phobia-related anxiety, CBT might also include exposure therapy, where you experience gradual and controlled exposure to a feared situation or object. The key being, gradual exposure. Because it can be very anxiety inducing to engage with a fear or phobia in any capacity, it may be helpful to have a therapist’s support to ensure that exposures are being performed safely and effectively—after all, the goal of exposure therapy is to reduce your anxiety, not enhance it. Jumping into exposures that are too hard too soon may result in more fear or avoidance.

In conjunction with cognitive restructuring (identifying, challenging, and replacing unhelpful thought patterns), a behavioral experiment may be used to test out the validity of a negative prediction. For example, someone that experiences social anxiety might try attending a social event and see if the negative outcome they predicted (being ignored) actually happens.

Can’t I just do this at home?

Depending on the frequency, intensity, and severity of your anxiety, it’s totally possible to try CBT at home. 

However, without practice, it can be difficult to recognize and challenge thought patterns, especially ones that are deep-rooted. In some instances, CBT can bring up emotional distress or discomfort, which can lead to feeling overwhelmed or result in further avoidance. 

If you feel like you have strong coping skills in place to manage overwhelming feelings that may arise, and a strong motivation to hold yourself accountable to engaging in consistent practice, then you may be a good candidate to try CBT without the support of a therapist.

What’s Helpful About Doing CBT with a Therapist?

Therapists can help you manage potential discomfort or anxiety that may arise during exposure therapy, behavioral therapy, or other CBT techniques. Therapists can also offer encouragement and accountability to stay on track with your goals/treatment plan.

A therapist can help you set realistic goals, track your progress, and help you make adjustments, as needed. They can also offer support around exploring deeper issues that may be contributing to anxiety symptoms.

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