Cognitive Behavioral Therapy (CBT) refers to widely recognized, effective psychological treatments for treating many psychological disorders and, more specifically, is very effective for anxiety disorder treatment. Firmly based on scientific evidence, CBT focuses on the ways that a person’s thoughts, emotions, and behaviors are connected and affect one another. The CBT therapist and the client work together with a mutual understanding that the therapist has theoretical and technical expertise, but the client is the expert on him- or herself. The therapist seeks to help the client discover that he/she is powerful and capable of choosing positive thoughts and behaviors.
(Adapted, by permission, from the Association of Behavioral and Cognitive Therapy website, 2017.)
Our thoughts influence our feelings and actions.
Brief CBT Self-Help Protocol for Anxiety
You might wish to try out CBT as self-help if you don’t feel able or ready yet to engage in therapy but are determined to do what you can to overcome disturbing anxiety and worry. CBT is most effective and precise when executed through dialogue with a skilled therapist with expertise in CBT, but people often find they can benefit from self-help cognitive therapy and behavioral interventions (like focus on the breath) implemented as self-help. If you would like a taste of CBT perhaps you’d like to begin here.
For more information on CBT, or to make an appointment, call David Mellinger, MSW at 818-716-1695.
Brief CBT Self-help for Anxiety, Panic, & Over-worry
This brief self-help protocol is designed to help you reduce disturbing anxiety enough to feel free from its grip. Try to follow this protocol faithfully.
You’ll learn select procedures of decentering, cognitive reappraisal, and overcoming sticky thinking. Decentering is a mindfulness- and acceptance-based CBT technique for enabling a person to “step outside of his or her anxious thoughts and feelings enough to see them as just coming and going, rather than getting carried away by them.” (Goleman & Davidson, 2017, pp. 196-197).
Anxiety is both driven by disturbing, irrational thoughts and perpetuated by getting you caught up in these thoughts and anxious feelings. Cognitive reappraisal techniques will help you notice, identify, and remedy errors in your thinking that contribute to your anxiety – like over-generalization (e.g., “I almost had heat stroke once, so I’m too afraid to go out whenever it’s very hot.”) and catastrophic thinking (e.g., “I keep getting headaches lately. What if I have brain cancer?”). The brief acceptance- and mindfulness-based CBT procedures will help untangle you from the sticky thinking and feelings that keep you caught up in a state of anxiety.
What Can Improve? By following the protocol – acknowledging when you’ve become anxious and pressing the pause button on your upwardly spiraling anxiety – you may discover that nothing really bad is about to happen and expand your awareness of what’s actually going on. Brief, mindful breathing will help you settle your state of mind and abide in the here and now [Mellinger (2017), FTAW Anxiety Workshop]. Clearing the tangle of your anxiety-laden thoughts by taking these steps is like disconnecting the main power from an old house with seriously short-circuited wiring: It opens a window of opportunity to rethink scary thoughts more clearly and less fearfully. Then you can cope well enough and decide what’s best to do next. Here’s how you do it:
> Acknowledge when you’re anxious, worried, or panicky.
> Check your anxiety in the here and now.
> Press the Pause Button.
> Engage in brief, mindful breathing.
> Remedy distinct thinking errors.
> Practice Resilience.
First, acknowledge that you’re feeling worried or anxious. “Acknowledging” means “letting yourself know,” and knowledge is a powerful antidote to fear.
Whenever you’re feeling any form of disturbing anxiety – worry, self-blame, fear of an anxiety attack, a disheartening thought or feeling – simply acknowledge it with a quiet “mental” voice and label it with a simple label, such as “worrying myself sick”, “panic”, ‘’what-if’ thinking“, “dwelling”, or “beating myself up.”
2. Check your anxiety.
Now ask yourself whether there’s really anything to be afraid of right now. Answer either “yes” or “no”.If there seems to be no reason to fear, perhaps what you’ve already accomplished is good enough.If you find you’re still anxious or afraid, then move on to the next step. Try not to get caught up. No need to overthink it.
Next, press the “mental pause button”:
Pause whatever anxiety-driven story or imagining has been going through your mind and, for a few moments, suspend your catastrophic thinking or chaotic, panicky thoughts. A useful visual aid is to look at two fingers that you hold up vertically, parallel to each other – replicating the “Pause Button” symbol in your electronic devices.
This “therapeutic pause” enables you to put on hold the momentum of pressurized anxiety. Stop in your tracks, briefly explore your feelings, and allow the higher-functioning, executive portions of your brain to re-engage in making better sense of things.
4. Engage in Brief, Mindful Breathing
After pausing, as above, and intentionally interrupting the nonstop flow of your thoughts and behaviors, “stop for a few seconds, take three conscious breaths, and move on. . . [Perhaps say “in” to yourself in a quiet mental voice when you breathe in and “out” to yourself when you breathe out.]. Pause and allow this interlude to be a gap in whatever you’re doing. Don’t make it into a project.” [adapted from Pema Chödrön (2009), Taking the Leap.]
The purpose of this brief practice is to create a momentary contrast between being completely self-absorbed and being awake and present. Practice as often as possible, preferably numerous times a day.
Photo credits: “Beach at Night with Moon and Stars” – Ko Li Pe, Thailand. Photo by Piith Hant, 16 April 2013
Brief, mindful breathing is the informal practice of concentration on the breath (COYB), a traditional practice often known as samatha (from the Sanskrit). Formal practice of COYB is a cognitive and behavioral strategy for enhancing our capacity for helpful action to work with disturbing feelings. It trains us to bring our attention to the here and now, steadies our minds, and enhances our awareness when entering or exiting emotionally charged situations. I encourage you to consider formally practicing COYB, because it’s likely to enhance the effectiveness of your brief cognitive-behavioral therapy as self-help. Click here to learn the formal practice of Concentration on Your Breath.
5. Remedy Your Thinking Errors
Don’t believe everything you think:
Thoughts are not facts.
Below are four of the most frequent thinking errors that arise automatically during acute anxiety, panic, and disturbing worry, each with perspectives and remedies for modifying them and relieving your anxiety. Why not study these errors and – as soon as you recognize they’re occurring – try out the remedies? You may find you have the power and skill to choose sensible thoughts over irrational, negative thoughts and gain the upper hand over anxiety.
Common Thinking Errors and Their Remedies
- Dwelling on false solutions to important problems – “If I were better looking, I’d attract someone, and I wouldn’t be alone.” The more we dwell, the more real a notion seems, regardless of whether it’s rational. In this example, the reality of the matter is far more bittersweet and nuanced: Neither beauty, handsomeness, nor cosmetic surgery can curtail aloneness.
- All or Nothing Thinking – “It’s all my fault” is a classic all-or-nothing statement that illustrates looking at things in absolute, black-and-white categories. Your performance was totally good or totally bad; if you are not perfect, then you are a failure. This thinking error does not recognize shades of gray, only black or white. We always, or at least very often, share only a portion of both the blame and the credit with others.