How CBT Helps With Anxious Thoughts

The idea behind CBT

Feeling anxious is a normal part of life, and some anxiety is useful. It becomes a problem when the worry lingers, shows up in many situations and starts to get in the way.

CBT starts from a practical observation: what you think affects how you feel and what you do. The National Institute of Mental Health describes CBT as helping a person become aware of automatic ways of thinking that are inaccurate or harmful, question those thoughts, understand how they affect emotions and behavior, and change self-defeating patterns.

It is not positive thinking, and it is not being told to calm down. It is closer to learning a skill: slowing a fast, automatic process down far enough to look at it.

How an anxious thought takes hold

Here is an ordinary example. Your manager sends a message that says, "Can we talk tomorrow?"

1. 1The thought"I have done something wrong. I am about to lose my job." It arrives instantly and feels like a fact.
2. 2The feelingDread, along with a body that joins in. Anxiety can bring a pounding heartbeat, tension, restlessness and trouble sleeping.
3. 3The behaviorYou reread the message many times, put off other work, or look for a reason to avoid the meeting.
4. 4The loopAvoiding and checking bring a little relief now, but the worry never gets tested, so it comes back the next time.

Working with the thought

In CBT you practice catching the thought and treating it as a guess instead of a verdict. Your therapist may ask questions like these, and over time you learn to ask them yourself.

• What exactly am I predicting will happen?
• What is the evidence for that, and what is the evidence against it?
• Is there another explanation that fits the facts just as well?
• If a friend had this thought, what would I say to them?
• If the worst did happen, how would I cope?

Working with the behavior

Thoughts are half of it. Anxiety also changes what people do, and one common sign is avoiding everyday activities that used to feel manageable. Avoidance makes sense in the moment, yet it keeps your world small.

CBT teaches different ways of behaving and reacting to the things that cause fear. For some people that includes exposure therapy, a type of CBT in which you face a fear in brief, planned steps in a supportive setting, learning to tolerate the distress until the fear lessens over time. The aim is to get back to the things you have been avoiding. You and your therapist decide the steps together, and you are not pushed into anything.

Therapists may also use relaxation and mindfulness techniques, such as breathing exercises and meditation, and may ask you to track emotions and behaviors so you can see how they affect each other.

What sessions are like

CBT is active and collaborative. Early on you and your therapist talk about what anxiety is costing you and what you would like to be different. From there, sessions tend to focus on a real situation from your week: what went through your mind, what you felt, what you did and what you might try next.

A lot of the learning happens in daily life, because that is where anxious thoughts show up. Your therapist may suggest something to practice between sessions, such as writing down a worry and questioning it, or taking one small step toward something you have been avoiding.

It is reasonable to ask a therapist how they will check whether therapy is helping. If you do not feel you are improving after a reasonable time, say so. A good therapist wants to hear it.

What the evidence says, and what CBT is not

The National Institute of Mental Health describes CBT as a research-supported type of psychotherapy and a common choice for treating generalized anxiety disorder. Anxiety is typically treated with psychotherapy, medication or both, and finding the right fit can take some trial and error. CBT is not the only option, and different therapies suit different people.

CBT also does not aim to remove anxiety completely. Anxiety is part of being human. The goal is for worry to take up less room, so that you can do the things that matter to you.

Therapy is ongoing care, not emergency care. If you are in crisis or thinking about harming yourself, call or text 988, or call 911. Locascio Wellness does not provide emergency services. Our crisis resources page has more.

How we can help

CBT is one of the approaches used by members of our team, alongside mindfulness-based, person-centered and solution-focused work. Not every therapist uses every approach, so tell us what you are looking for and we will match you. Our anxiety therapy page explains more, and CBT is also used in depression therapy.

Sessions are online, by secure video, for people who are physically located in Pennsylvania, West Virginia or Arizona during the session. You can book a free 15-minute consultation, and our insurance and fees page covers coverage questions. Anxious thoughts can loosen their hold, and learning how is something many people find worthwhile.