Cognitive Therapy’s Approach To Anxiety

By: James P. Krehbiel

Many years ago, I was involved in my own personal counseling. I believe that it is important that counselors in practice go through the counseling process for themselves. One particular session happened to be very intense. I was expressing an assortment of conflicting feelings and I left the counseling session in a fog. As I started down a usually familiar street near my home, I lost my spatial compass. I had no idea where I was going and whether the direction was taking me home. Anxiety enveloped me as I grappled with how to regain my sense of direction. I finally pulled into a driveway, stopped my car, and took several deep breaths. As the anxiety subsided, I began to regain some control over my environment. Slowly, I turned around and headed home.

Excessive anxiety is troublesome. For many, it can be an immobilizing experience. Anxiousness can be associated with avoidance and withdrawal, be a factor in relationship difficulties, create painful symptoms, and trigger a rehashing of issues related to our past and future.

I believe that the most successful treatment approach to dealing with anxiety is through the application of Cognitive Therapy. Cognitive Therapy is a very structured, understandable approach to dealing with anxiety. CT is based on the principle that one's spontaneous thoughts, cognitive distortions, and underlying beliefs affect an individual's current behavior.

Spontaneous thoughts are free-flowing expressions of our self-talk triggered by a specific event. For example, if your house is on fire and you are trying to safely leave, you might say something like, "Oh my God, I've got to get out of here — if I don't hurry, I could get killed."

Cognitive distortions are the lenses through which we sometimes perceive reality. For example, if you have been rejected for a date, you might use emotional reasoning by saying, "Being snubbed makes me feel like a dud, and therefore I must be one."

Underlying beliefs are the core assumptions that govern our life. For example, if we grew up in a household where things were abusive, we may have a conception of reality that goes something like this. "It is important to avoid conflict at all costs. If I try to get close to others, I may get hurt."

Anxiety is a reaction to our thinking, beliefs, and underlying assumptions about life. However, it is usually not our primary anxiety that creates our distress. It is our secondary symptoms — or our anxiety about our anxiety that intensifies our symptoms.

Almost everyone experiences anxiety, but not everyone catastrophizes about it. Let's say that you are taking a midterm exam in college. There are several ways you might respond when you open the test booklet and note that there are numerous questions that you are not prepared to answer. First, you might respond by saying, "Oh man, none of these answers look familiar. I don't remember studying this — I'm going to flunk this test. If I fail it, there goes my grade for the semester. Wait until my parents find out, they'll kill me!" Or an alternative, rational response might be, "Gee, I don't understand these first three questions — that's ok, I'll just take some deep breaths, relax and work on the questions that I am familiar with. Then I'll go back and tackle the one's I couldn't answer."

Our manner of self-talk determines the level of our anxiety. When we 'awfulize' about anxiety, it tends to intensify it. When we respond rationally to our anxiety it tends to diminish its effect.

Many people tend to believe that panic or anxiety "appear out of the blue." They may feel confused and perplexed by the sudden emergence of their feelings. Cognitive therapists view anxious feelings as a byproduct of faulty thinking. Teaching others to respond rationally to self-defeating inner thinking is the primary goal of therapy.

Individuals who experience anxious panic attacks are usually troubled by symptoms such as a racing heart, sweating, fear of dying, shallow breathing, and a need to escape social situations. Helping individuals to manage panic attacks takes patience. Assisting them to realize that their panic is time-limited is important. Panic tends to take on a life of its own. Once again, it is important to address the secondary symptoms or the panic over the panic. When people panic, they tend to magnify their symptoms, perpetuating the panic attack. Teaching people to relax into their panic is helpful.

The following are some guidelines for those who experience anxiety and panic:

Cognitive Therapy emphasizes replacing self-defeating thinking with more rational ways of responding to stressors. Identifying goals of therapy, approaching them in a practical manner, and providing homework assignments for people are significant ingredients to Cognitive Therapy's response to anxiety.

James P. Krehbiel is a licensed professional counselor and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. He can be reached at (480) 664-6665 or

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