Exploring anxiety
Exploring anxiety

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Exploring anxiety

How does CBT work? What does it involve?

CBT involves working with a therapist to identify negative thinking patterns and behaviours which may be causing difficulties and finding effective coping strategies to challenge these by, for example, changing the way a person feels about a situation to help them to change their behaviour moving forward (Royal College of Psychiatrists, 2013; updated in 2015). This psychological therapy is based on the concept that the way we think about a situation can influence our emotions and subsequent behaviours. If we perceive or interpret a situation in a negative light, then the experience associated with it is likely to lead to negative emotions, which in turn can lead to the development of certain types of behaviours or actions. Negative thinking patterns (or ‘cognitive distortions’ – see Section 4) often start during childhood, and over time, assumptions can be reinforced until as an adult they can frequently interfere with and affect the way an individual feels in their everyday life (see Figure 1).

Figure 1 Model of anxiety based on Beck’s cognitive triad model (Beck, 1976).

If negative interpretations of situations are not challenged, the patterns of thoughts, feelings and behaviours can be repeated as part of a debilitating and unpleasant cycle (see Figure 2).

Figure 2 Anxiety as a perpetual negative cycle.

CBT can help make sense of overwhelming problems by breaking them down into smaller parts, allowing connections and how they affect an individual to become clear. The five main areas of assessment that impact on each other are indicated in Figure 3. For example, how you think about a problem can affect how you feel physically and emotionally.

Figure 3 Five areas of assessment for CBT (based on the Royal College of Psychiatrists, 2013).

CBT can help break the vicious cycle of altered thinking, feelings and behaviour, by helping the individual to recognise and alter their behaviour. CBT can be administered individually by a therapist (usually between 5-20 sessions), within a group, or via a self-help book or online. CBT typically concentrates on addressing current problems, but the therapist may also ask questions about past experiences to understand how these may be affecting the person in the present. Problems are broken down and addressed in separate elements (see Figure 3). Keeping a diary can help identify patterns of thoughts, emotions, physical feelings and actions, and the therapist will work with the individual to explore those that are unhelpful or unrealistic, and how they can be changed through practice by, for example, questioning a self-critical or upsetting thought or an action that would have a negative impact and make the individual feel worse, and replacing these with more helpful ones.

A course of CBT can last a few weeks or up to 6 months. It depends on the nature of the problem and how the therapy works for the individual. It is not a ‘quick fix’, and may not be for everyone, and there is the possibility that symptoms of anxiety may return, so practicing the skills learned (i.e. as part of ‘homework’ outside of therapy sessions) is important and undertaking further courses of therapy may be required. CBT can also be combined with medication (anxiolytic or antidepressant drugs) to treat anxiety. Other psychological therapies include interpersonal therapy (IPT) and psychodynamic psychotherapy. Anxiety may also be managed through mindfulness-based stress reduction and exercise. The NHS UK website [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] also lists a number of mental health apps that may be of interest.


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