Cognitive Behavioral Therapy for Anxiety


Cognitive Behavioral Therapy for Anxiety
Cogito ergo efficio (I think, therefore I do–if I remember my high school Latin correctly.) Rene Descartes never said this, but maybe this is because he lived before cognitive behavioral therapy (CBT).

CBT is both new and yet predates Rene Descartes. It is new in that it is the merger and evolution of behavior modification or therapy (pioneered by B.F. Skinner) and cognitive psychology (pioneered by David Meichenbaum). It is old because it is the realization that what we think influences how we feel and what we do. It is old because it is as old as rational thought itself.

It is old also because it uses the Socratic method and is heavily influenced by Stoicism (that it is best to live in accordance with nature, and that a departure from this–errors in judgement–will result in destructive emotions and behaviors). It is as old as the Ancient Greeks, the harbingers and masters of rational thought.

Since then, it has been used to treat disorders of sleep, substance abuse, eating, personality, mood and psychosis. The U.K. health agency has studied it extensively and states that it is effective for schizophrenia, OCD (obsessive compulsive disorders), depression, eating disorders such as anorexia and bulimia, anger management, the above-mentioned substance abuse (both drug and alcohol) and sleep problems (including insomnia), relationship problems, and habits–even involuntary ones such as facial tics.

They say that it can be used as therapy in even physical health problems such as arthritis and IBS (irritable bowel syndrome). It can not correct the actual underlying cause, but CBT can enhance a person’s reaction to or perception of the problem. The U.S. military uses it as a form of suicide prevention and as a treatment for PTSD (post-traumatic stress disorder).

Long before I became interested and engaged in health (both mental and physical) and its treatments, I had heard that people with phobias (such as arachnophobia–a fear of spiders) would be confronted with the source of their fears (a spider) and then gradually be brought closer and closer to it. This is a form of CBT and this approach is also used to treat various types of anxiety and panic disorders.

For a system that is based on rationality, logic and reality it seems peculiar to me that there does not seem to be a consistent and uniform method concerning CBT in treating such disorders. (Or maybe I am just misinterpreting such information which, itself, is a “cognitive distortion” to be described later–perhaps I, myself, can benefit from CBT.)

The Basics

Let me describe the details in a four step process. I shall emphasize what I feel is the most helpful and useful, but also incorporate variations of the description.

Observe your thoughts / identifying maladaptive thoughts and beliefs / know what you are thinking or telling yourself / re-label.

Throughout the day, we often think things that have no relevance and no relation to what we are doing. Throughout the day, we often do things without thinking, or do things while thinking about other things. One tip to correct this is to do something like washing your hands and to think of nothing but what you are doing and what is happening. Of course, you must not do this while you are driving. It has often been said that if you actually thought about driving while you are driving then you would not be able to accomplish that and/or get into a horrific accident.

Relabeling is the realization that a thought is a thought. For example–and relating to anxiety–is that if you feel anxious in social situations then realize that your thoughts about it and understand it for what it is: a false alarm, with little or no basis in reality.

Again, CBT is based on the Socratic method, so ask yourself questions: Is the thought or belief secondary to another thought or belief? How much do I truly believe it, and why? Does this thought affect my life negatively? Am I prepared to work on this immediately, or later, or should there be some intermediary steps?

Look for cognitive distortions / challenging maladaptive thoughts and beliefs / identify the thoughts that make you feel bad / reattribute

10 popular cognitive distortions

1) All-or-nothing thinking
2) Should and must statements
3) Personalization, or believing that everything (including other’s behaviors) revolves around you
4) Catastrophizing
5) Magnification or minimization, or emphasizing the negative and ignoring the positive
6) Overgeneralization
7) Mind reading, or believing that you know what others are thinking or saying
8) Tunnel vision, or being like a horse with blinders on
9) Labeling, or stating something as being true before knowing more about it
10) Emotional reasoning, or letting feelings overrule facts

Thought Transformation

I could probably write an article or even a book on any one or all of these distortions (although there could be some cognitive distortions in that sentence). Regardless, my wife is extremely religious and loves Jesus. At the same time, she frequently says that she hates all human beings (partly for what they did to Jesus, partly for what they are doing now, and for other reasons). She also had some friends when she was a child who did some childish pranks on her, and now she says that she does not want to have friends because they will just betray you.

In short, she hates people and does not want friends, and yet she wonders why people are not friendly towards her. My wife also misinterprets my supposed body language. She will say something, and I will “look” or “appear” a certain way, and she will be upset that I am “angry” when, in reality, I have no such thoughts.

In reattribution, you recognize that you are not your (bad or counter-productive) thoughts, feelings and behaviors. Again, if you are a person who is anxious in social settings then you are not socially anxious; you are simply a person with socially anxious thoughts and feelings. You will still be a person–and most likely a better person–if you do not have social anxiety.
Some questions that you can ask yourself are What evidence is there that this thought is true/not true? What would I tell someone whom I loved if she/he were in this situation and had these thoughts? If this thought or feeling is true then what is the worst/best thing that could happen?

Deal with the cognitive distortions / behavioral activation / develop an alternative thought / refocus
Identify which distortion is most applicable to you and is resulting in the most hardship (or, in the case of my wife, take one distortion at a time). Observe your thoughts (see above) and record when a distortion takes place and under what circumstances.

Try to find the underlying cause of the counter-productive thought or feeling; the possible side effects or retaining this thought, and rethink or rephrase the thought in a better way. Finally, become stoical (again, intrinsic to CBT) and become detached from the thought. Realize that you can not control all of life’s hardships (especially those caused by the actions of others) but that you can control how you perceive or view these hardships and obstacles.

In refocusing, when you think that you are becoming socially anxious, realize (refocus) this as simply being a thought about anxiety, and then focus on something else. This is, as things often are, easier said than done. CBT recommends that you wait a period of time–preferably 15 minutes–before acting upon the thought, after which your initial reaction will hopefully have vanished and you will accomplish something more productive.

Ask yourself: Are there any activities or hobbies that I used to enjoy but have stopped doing? Are there any interesting activities that I would like to begin? Are there things in my life that I would like to change? If so, then what can I do about them that I have not already tried?

Make this a new habit / problem solving / revalue
This is one of the rare things that are easier done than said. There have been numerous studies that show that CBT can rewire the brain so that new (and presumably better) things can be thought, felt and acted upon.

There is a wonderful mnemonic device called SOLVED to help you accomplish this. SELECT a problem that you would like solved; OPEN your mind to all options; LIST the possible pros and cons of each option; VERIFY the best choice; ENACT the plan; DECIDE if the plan worked (do some follow-up, and if it did not quite work then tweak it or adopt another option.

Of course, the rationally, logically and realistically best choice may be to go to a professional and experienced therapist. After all, I am not a CBT professional or therapist but I am certain that this will work wonders for your feelings behaviors of anxiety. You can use this article as a guideline, and to be aware of it when you do see a professional. Whenever I want to find anything anywhere, I go to the “Local” tab at Google+. You can search for “cognitive behavior therapy” in your area to find such a therapist.

Having said all of this (or perhaps because I have said all of this), it may not be for everyone. People who view the process and the professional to be collaborative, safe and trusting are far more likely to derive benefit and productive results from the treatment. People who do not may not be as fortunate. (Although people who do not have that view can change professionals, or change their view with CBT.)

In short, it may be much like hypnotism. It is well known that people who do not believe that they can be hypnotized are in fact, not able to be hypnotized. You can only get what you put in.
Know thyself!