CBT for Anxiety 

I realised last week that I was a bit wound up and feeling anxious. As a pretty experienced anxiety counsellor, it was easy for me to ‘fix’ – right?

Well, yes and no. I knew what to do; what usually works for me, but I also had to work through a few different strategies for anxiety to find the right one for this situation. Before I dive into my story, let’s look at what works for anxiety.

What strategies or therapies work for anxiety?

One of the best known therapies for anxiety is CBT (Cognitive Behavioural Therapy), which has been extensively researched and found to be effective across a range of anxiety disorders. Working as a counsellor for anxiety, in addition to CBT, I use a lot of ACT (Acceptance and Commitment Therapy), and so this is my go to anxiety therapy. ACT is a form of CBT, often referred to as part of the ‘third wave’ of behavioural therapies. Like classic CBT it has been found through research to be a highly effective treatment for anxiety, and it works on both thoughts and behaviours.  A key part of ACT is the focus on behaviour, on committed action, on getting past unhelpful & unpleasant thoughts and feelings, and doing the things (the Actions, or Behaviours) that are meaningful for us. In essence, ACT and CBT for anxiety help us to get on with life and with doing the things that are important to us, and the things we enjoy.

My favourite ACT strategies are generally grounding strategies, things like the 5-4-3-2-1.

But when I was feeling anxious last week, grounding wasn’t really working. Like many anxiety triggers, what was happening really wasn’t that objectively stressful. I was at home with a sick kid (Brisbane, July 2023 – lots of colds and flus going around!) and I spent a few days chilling with them and watching Lego Masters. After the second day, I was really conscious of all the other things I ‘should’ be doing and got a bit anxious about the time I was spending doing very little. Classic parent dilemma; focus on cleaning or connection?!

 Recognising my anxiety signs (bit jittery, noticing some tension) I tried doing some grounding, but I found that focussing on my surroundings was making me even more aware of all the things that I should have been cleaning and tidying!

So I moved to some of the questioning and thinking strategies that are more associated with classic CBT. There are a few I find particularly helpful, both for myself, and for counselling clients with anxiety. Before I go into too much detail, let’s look at what CBT for anxiety is.

What is CBT for anxiety?

As I mentioned above, CBT is an evidence based therapy that helps with anxiety. CBT counselling helps to identify the thoughts / thinking patterns that underpin anxiety, and challenge them. A CBT counsellor helps you to find anxiety triggers, look at your thoughts and how you react to those triggers, and develop skills to act more effectively in response.

This is essentially the classic ABC of Antecedents – Beliefs – Consequences. It’s not so much the trigger that can lead to anxiety and avoidance, but your beliefs around that trigger – and this is the area that we work in together; helping to notice, question, challenge or reframe those thoughts and beliefs and get a different outcome.

How does CBT for anxiety work in practice?

Anxiety is a fear response; fear of failure is a fairly common concern. For example, the trigger (or Antecedent) might be a test coming up and you notice anxiety about performance; Beliefs that you will fail; it’s too hard; I can’t do this; I always stuff up; etc. And in Consequence you avoid study, and therefore you are more likely to fail and therefore reinforce the idea that you always fail. Or you might avoid the test altogether; deferring it and in consequence prolonging the anxiety.

Working with this, anxiety counselling using CBT would ask about the thoughts and feelings, get to the beliefs and question them, e.g. ‘how likely is it you would fail’. ‘What grades have you been getting in practice tests, or assignments’? ‘What would your teacher or lecturer say about your ability to learn this material’? ‘What would you tell a friend who was worried about this?’ ‘What would actually happen if you got a C instead of a B?’

Something else that CBT for anxiety works on is recognising that thoughts are not facts. Some thoughts are facts – for example if I were to think ‘my name is Louise, and I’m an anxiety counsellor in Brisbane’ yes those are facts. Those are also not generally my thoughts! I’m more likely thinking of “all the things I have to do and there’s not enough time to do them so I’m a failure and I’m a terrible mum and why can’t my kids get on and I must be doing something wrong and everybody else is doing it better and …..”

Hopefully it’s clear that all my above thoughts are not facts; yes there probably are some things I’m getting wrong! But it’s not a fact that everybody else is doing it better, and it’s not a fact that I’m a terrible mum (according to my kids I’m a good mum actually!). With my clients, we go through these sorts of recurring thoughts and notice how many of our thoughts are not facts.

Another thing we work on is recognising cognitive distortions; these are unhelpful (but relatively common) thought patterns that lead to a skewed perception of reality. CBT works on cognitive distortions like personalisation (thinking you’re responsible for things like other people’s moods), black and white thinking, catastrophising, and many more.

The Behaviour part of CBT for Anxiety

As well as working on thoughts or cognitions CBT focuses on behaviours; on actions. In our example about test anxiety, once we have looked at the triggers and the beliefs, we would work on how to approach the test – what active, practical steps to take. What behaviours to work on, for example doing a practice test. Trying short chunks of study. Working with a friend. Doing some timed tests to take the fear of the unknown of exam conditions. We would also look at what obstacles (real or perceived) might come up, and plan how you could overcome them.

Doing things – the Behaviour part of CBT – is really important. Taking small steps and practicing between counselling sessions as well as in sessions is key.

I don’t give clients worksheets or ‘homework’ of that kind; instead what I do is ask them to notice the thoughts and beliefs, and practice the CBT skills for anxiety that we’ve worked on. Then in session we will debrief and find what is working, and how to then build further on that.

In my own example from the start of this blog, feeling anxious about time, and all the things I felt that I needed do, I used one of my favourite ways of questioning my thoughts, and found it really worked for me. The question was “will holding tightly to this thought, this idea that you need to be always busy, and cleaning and tidying, take you where you want to go?” And the answer was no. Big picture, what’s important to me, is my kids. It’s about them being ok and feeling connected. That’s more important to me than a pristine home (which is not a realistic goal for us anyway!). Asking myself if holding tightly to the idea that I should be busy cleaning and tidying was helpful, really let me put that anxiety into perspective. It helped me see that hanging out with my child who wasn’t feeling great, just having relaxed time together, was the ‘right’ thing to be doing just then. It helped me to let go of that worry of all the things that needed done, and focus on what was most important.

And guess what? The cleaning and tidying was still there for me after my little dude had recovered.

PS: if you have any questions about CBT for anxiety please get in touch. Or you can book an appointment if you’d like some counselling for anxiety.

And it’s also important to note that when you’re working with a CBT counsellor or therapist, you should be seeing changes in your behaviour, for example being able to do things you feared before, being able to take small, but ever increasing steps towards things that are difficult, but worthwhile. Regular progress checks are one way that I make sure my clients are heading in the right direction and achieving their counselling goals. We work as a team to try different strategies and adjust or add on new tools as needed.