Cognitive Behavioral Therapy for Anxiety Disorders

CBT for GAD Anxiety in London.

When you suffer from panic attacks, unrelenting worries, incapacitating phobia, or obsessive thoughts, it is important to realise that you don’t have to live with it forever. You have choices that you can make to feel better. Therapy is the most effective choice in such cases. Unlike the medications, therapy treats the basic symptoms of the issue. It can help you deal with some underlying issues and worries that can help you sort out your current situation better.

Cognitive Behavioral Therapy (CBT) is the most used therapy for anxiety disorders. Research has shown that it is the best treatment for social anxiety disorder, panic disorder, generalised anxiety disorder, and other similar conditions.

CBT focusses on our perception about the world and the surroundings. It has two main components:

Cognitive therapy focusses on the cognitions, negative thoughts that play a role in anxiety.

Behavioural therapy examines your behaviour and the situations that are triggering your anxiety.

How does Cognitive Behavioural Therapy for Anxiety work?

Cognitive Behavioral Therapy explores factors that make individuals more vulnerable to developing anxiety problems (predisposing factors), factors that may trigger an episode of anxiety (precipitating factors), and factors that increase the likelihood of the problem continuing (perpetuating factors). Events that occur during childhood may increase vulnerability to developing an anxiety problem. For example, overprotective or critical parent styles, neurodevelopmental difficulties, physical illness or bereavements. These events shape our ‘core beliefs’. Core beliefs are our beliefs about others, the world, and ourselves, which are deeply ingrained. Our core beliefs will lead us to hold certain rules or assumptions about how things work. We then develop behaviours or coping strategies based on these assumptions. These will be activated throughout situations in our lives.

Generalised anxiety disorder occurs when the person worries excessively and persistently about a number of things. People who have GAD can anticipate danger and are overly concerned about money, health, family, work, and other normal issues that are not disastrous. They find it very difficult to control their worry. They expect danger when there is no apparent reason to feel that.

How can Cognitive Behaviour Therapy help with GAD?

The best treatment for generalised anxiety disorder is CBT. Studies have shown that CBT is the most effective therapy then all other psychological interventions. CBT teaches the ways of thinking right, behaving well towards certain situations to worry less.

According to NICE, CBT has the best techniques for the purpose of treating GAD. The techniques used in CTB for this treatment are relaxation techniques, mindfulness training, cognitive reconstructing, systematic exposure, and problem-solving training. In all of these techniques, the focus is re-evaluating the thoughts that are causing them to worry persistently. They are taught to use relaxation techniques whenever they are about to have a panic attack.

When is the right time to seek CBT for GAD?

It is diagnosed for treatment when the person fails to control worry for more than 4 months. If three to for of these symptoms are persistent then there is a need for therapy:

• Feeling irritating all the time
• Feeling tyred or weak
• Having trouble sleeping
• Experiencing gastrointestinal problems.
• Have an increased heart rate.
• Difficulty in concentrating
• Breathing rapidly.
• Having a sense of panic, dangers, or doom.

How long does CBT for GAD usually last for?

The treatment plan usually includes insight and re-evaluation of the thought processes. It lets the client know which useless thoughts are triggering these actions. They are taught to control their need to worry about the situations at the moment. Cognitive Behavioral Therapy treatment for GAD can last anywhere from 10-20 sessions depending on the intensity of the disorder.

CBT for Generalised Anxiety Disorder (GAD). A case example.

Here is an example of CBT for generalised anxiety disorder (GAD):

Core Belief: I am helpless. I cannot cope. Others will ridicule me. The world is dangerous.

Assumptions/Rules: If something goes wrong I will not be able to deal with it. I cannot cope.

Coping Strategies: Avoidance.

Situation: Sam is asked to give a presentation at work.

Automatic thought: I can’t do it. My boss will realize that I’m useless and she will fire me.

Emotion: Worried about negative appraisal and possibility of getting fired. Upset.

Behaviour: Fabricate excuse or call in sick.

Cognitive Behavioral Therapy for Generalised Anxiety Disorder

The presentation was the precipitating factor. However, avoiding the presentation means that the worry never goes away and therefore avoidance actually serves to keep the problem going. Therefore, avoidance is a perpetuating factor. Sam has learned that avoiding difficult situations is an effective way of reducing his anxiety, and has also missed an opportunity to see that his worry was unsubstantiated.

Consider if Sam had done this presentation and received positive feedback from his boss and colleagues. This would have removed the concern of getting fired and provided contrary evidence to his belief of being useless. This would make him less likely to fear presentations in the future as he now has had a positive experience. Of course, it is unlikely his anxiety would completely diminish after one presentation. However we would expect that if he were to present regularly his anxiety would reduce substantially.

Within Cognitive Behavioral Therapy we also look at protective factors, which are positive things in the person’s life that may help them to overcome their difficulties. For example, positive relationships, adaptive coping strategies and general interests.