Anxiety Technique: Cognitive Behavioural Therapy (CBT)

What is it?

Cognitive behavioural therapy (CBT) is used as a technique to help with many mental illnesses. It can be done with a specialist or on your own. “Cognitive behavioral therapy helps you become aware of inaccurate or negative thinking, so you can view challenging situations more clearly and respond to them in a more effective way.” It can help you cope with specific thoughts or challenges (Mayo Clinic Staff, 2013a).

Our thoughts, feelings, and behaviours are closely related to one another. When we think something, we often feel something which then often effects our behaviour.

Example:

Thought – I’m going to fail this driving test.

Feeling – Anxious, frustrated, stressed

Behaviour – I don’t do it because of my negative thoughts and feelings, therefore, I can’t drive yet.

CBT helps you change negative thinking patterns to help make you feel better and to help change your behavior.

Example:

Thought – I can’t wait to be able to drive after I pass my driving test.

Feeling – Excited, confident

Behaviour – I do the test and pass it.

“Cognitive behavioral therapy may not cure your condition or make an unpleasant situation go away. But it can give you the power to cope with your situation in a healthy way and to feel better about yourself and your life” (Mayo Clinic Staff, 2013b).

Cognitive distortions

Cognitive distortions are negative thoughts and views on how we view/think about our world, ourselves, and others. There are many different categories on these types of thoughts. These categories include:

“Fortune telling: Thinking that I ‘know’ how a situation is going to turn out without having any evidence

“Mind Reading: Thinking that I ‘know’ what someone else is thinking

“Catastrophizing: Imagining worst-case scenario

“All-or-Nothing Thinking (also known as black-and-White Thinking): Seeing things as either black or white, with no gray or middle ground; things are either wonderful or awful, with nothing in between; terms such as ‘always’ or ‘never’ are typical

“Mental Filter: Focusing on the negative details of an event or situation, without seeing the full picture

“Personalizing: Blaming myself as the sole cause of an event or situation

“Jumping to Conclusions: Reaching conclusions (usually negative) using only small amounts of evidence

“Overgeneralizing: Taking isolated incidents and making broad generalizations; seeing a single negative situation as a pattern of failure

“Magnifying or Minimizing: Making a big deal of the negatives and understating the positives

“Discounting the Positives: Similar to minimizing: receiving a compliment or praise and discounting it

“Labeling: Using negative self-talk, such as I’m a loser or I am an idiot

“Should-Statements: Using rigid rules or statements, such as ‘I should be able to do this,’ rather than focusing on the actual situation

“Emotional Reasoning: Using emotions as truths; for example, ‘I feel like a loser; therefore, I must be a loser'” (Roberts, Sylvia, & Reilly-Harrington, 2014).

These are just some that I found in a book I had about bipolar, but they work for anxiety too. If you want more anxiety-directed ones, just google search. There’s tons of sites that have them.

How to change your thinking

Now we have to change these thoughts and turn them into something positive or remove the thought completely. How? I’ll take this step by step, along with my own example.

Step 1: Write down the situation. What/who/where/why/when/how?

Example: I am in the bathroom, having a panic attack because I have to write a big exam in a half hour.

Step 2: Write down your automatic thoughts. What negative thoughts are you having regarding the situation?

Example: I can’t do this. I’m going to fail the test.

Step 3: Write down how much you believe that thought (0-100%).

Example: 80%

Step 4: Write down all the cognitive distortions/errors that you are experiencing.

Fortune telling, catastrophizing, labelling

Step 5: Write down at least 3 emotions that you are feeling and rate their strength from 0-100%.

Example: Frustrated – 80%, nervous – 80%, pressured – 65%

Step 6: “What is the objective evidence that my thought is true?” Is there any facts? If so, write them down.

Example: No evidence

Step 7: Write down some alternatives that might explain the situation.

Example: I’m just nervous

Step 8: Write down what you would tell a friend if he/she had this thought.

Example: You can do this. Just try your best.

Step 9: “What is the effect of this thought on my mood? Are there any benefits? Are there any costs?” Write them down.

Example: It can either motivate/pressure me to try my best, or I might not do as good as a job because I’ll want to rush through it. I don’t know.

Step 10: Write down what’s the worst that could happen if your automatic thought turned out to be true. Also include what’s the best that could happen, and the most realistic outcome.

Example: I fail my test, but that doesn’t necessarily mean I fail the course or that I’m a failure.

Step 11: Write down how much you believe your automatic thought now (0-100%). Has it changed?

Example: 50%

Step 12: Write down at least 3 emotions that you are feeling now and rate their strength from 0-100%.

Example: Anxious – 70%, determined – 70%, frustrated – 55%

Step 13: Last but not least, write down a more balanced or healthier thought.

Example: I can do this. I will try my best.

(Roberts, Sylvia, & Reilly-Harrington, 2014)

You could choose to write all the steps out or do this in your head. Eventually, you may become a pro and do it automatically whenever you think a negative or anxious thought.

Warning: Depending on the severity of the situation, this exercise may emotionally exhaust you. You may become frustrated or start to cry, but that’s ok! If you’re a really emotional person, consider doing this with a friend or specialist.

References

Mayo Clinic Staff. (2013a). Cognitive behavioral therapy: Definition. Mayo Clinic. Retrieved from http://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/basics/definition/prc-20013594

Mayo Clinic Staff. (2013b). Cognitive behavioral therapy: Results. Mayo Clinic. Retrieved from http://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/basics/results/prc-20013594

Roberts, S., Sylvia, L., Reilly-Harrington, N. (2014). The Bipolar II Disorder Workbook: Managing Recurring Depression, Hypomania, and Anxiety. Oakland, CA: New Harbinger Publications

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