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:
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.
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.
Remedy this error by honestly evaluating the negativity of your actions on a range from 0 to 100; recalling any neutral and positive actions, and then taking a few moments to correct your perspective (from David D. Burns (1989), The Feeling Good Handbook. New York: Penguin, 1989.)
- Catastrophizing – Catastrophizing is the essence of disturbing anxiety – potent, irrational thinking that arises “automatically” when our vital concerns or values seem jeopardized. Catastrophic thinking can make us feel like major upheavals or personal disasters are in the works and activate our instinctive “fight, flight, or freeze” reaction – despite the absence of solid evidence that a catastrophe actually will Ask yourself earnestly, “Where’s the evidence?”
- Wild Ride in the Mental Time Machine – Much anxious disturbance involves irrational fear of future plans and events. When we travel through time in our thoughts, it’s very easy to have wrong emotional reactions when we aren’t in the Here and Now. Deliberately return yourself to the present. Breathe in, pay attention, breathe out, pay attention – gather yourself and experience this moment mindfully. For now, just acknowledge and accept what really is. This isn’t a time to judge yourself.
Has the practice you just completed reduced or relieved your disturbing anxiety? Having just completed it, to what extent do you feel “back to yourself”? Does this kind of treatment give you more hope of overcoming troubling anxiety, panic, or worry?
If this treatment seems to help, try to utilize it consistently – whenever you feel disturbingly anxious or notice familiar patterns of anxiety disorder – such as when you’re stirred up by intense worry, panicky feelings, or sudden shyness. After you’ve finished working with yourself, take note or journal about helpful insights, new perspectives, or notably useful ways of coping that would be good to bear in mind.
For more information about CBT and anxiety therapy, or to set up an appointment, call me – David Mellinger, MSW – at 818-716-1695.
Association of Behavioral and Cognitive Therapy website (www.abct.org), December 31, 2017.
David D. Burns (1989). The Feeling Good Handbook. New York, NY: Penguin Books.
Pema Chödrön (2009). Taking the Leap. Boston, MA: Shambala Publications.
David I. Mellinger (2017). Protocol of the FTAW (Fundamentals of Treatment of Anxiety Workshop).
David I. Mellinger & Steven Jay Lynn (2015). Anxiety Smarts: Cutting-Edge Strategies for Overcoming Anxiety and Worry. Unpublished manuscript.