Challenging Thoughts to Lower Anxiety: How Cognitive Behavioral Therapy (CBT) Works
What is Cognitive Behavioral Therapy (CBT)?
Cognitive Behavioral Therapy, or CBT, is the most widely-used form of treatment for anxiety. A large amount of research has been done to demonstrate the effectiveness of CBT for anxiety disorders, including post-traumatic stress disorder (PTSD), generalized anxiety disorder, obsessive compulsive disorder, social anxiety disorder, panic disorder, and specific phobias.
CBT addresses the negative thought and behavioral patterns that are a part of anxiety. The basic premise of CBT is that our thoughts affect the way we feel. Another way to put it is that it’s not the external situation, but rather our perception, that causes us to feel a certain way.
In February, I wrote about a crucial component of CBT – awareness. This is an important first step that I talk about with my clients, because without awareness, we aren’t able to identify the irrational (and oftentimes automatic) thoughts that cause us to feel anxious.
After we are aware of our thoughts, then we are able to challenge those thoughts. The fancy term for this is “cognitive restructuring,” but which I will refer to as “thought challenging.” Thought challenging is identifying our negative thoughts, then replacing those thoughts with more positive, rational thoughts.
With anxiety, external events are often perceived in a distorted way. For those who experience anxiety, events tend to be interpreted as more personalized, dangerous, and negative than they actually are. For instance, for someone with social anxiety, going to a party can seem very scary. Thoughts such as “they don’t like me,” “everyone is looking at me,” “so-and-so thinks I’m stupid” cause feelings of anxiousness.
For someone who does not experience social anxiety, these thoughts are easy to identify as irrational. However, for the socially anxious person, these thoughts are so automatic and feel so true that it’s hard to see that they’re irrational in the first place, which is why first having the awareness to identify our own irrational thoughts is so important.
After building an awareness of our automatic thoughts, we are then able to evaluate those thoughts and challenge them. This is often done in session with a therapist trained in CBT. What this process looks like is challenging the “proof” of these thoughts. This can take some time, especially with thoughts that are strongly ingrained and automatic. But eventually, one is able to see that the thoughts are irrational, and can then replace the irrational thoughts with more rational, accurate thoughts.
An Example of Thought Challenging
Let’s take the example of Fred (made up person), who experiences test anxiety and therefore avoids studying for his exams. In session, we’re able to identify that Fred’s irrational thoughts are “I’m going to fail,” and subsequently, he jumps to “I’ll never graduate college” (which by the way – these common types of thoughts are also known as ‘predicting the worst,’ which I’ll talk about more in future blog posts):
Negative thought #1: “I’m going to fail”
More realistic thought: “I pass nearly all of my exams, so it’s very unlikely I will fail”
Negative thought #2: “I’ll never graduate college”
More realistic thought: “I work hard and have all As, Bs, and Cs in my classes, I will get through college and graduate.”
See how in these examples, Fred finds evidence of why his thoughts are irrational? He hardly ever fails tests, and even though college is hard, he is passing all his classes and he’s a hard worker. By identifying the irrational thoughts, challenge those thoughts, and replace them with more rational, positive thoughts, Fred feels less anxious before his exams and therefore instead of avoiding studying, he’s able to study feeling more calm and confident in himself.