Cognitive behavioral therapy for anxiety

Deborah C. Escalante

Woman talking to a therapist in an office

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Anxiety is the most common mental health condition in the United States, but according to the Anxiety & Depression Association of America, only about 37 percent of people receive treatment.

Anxiety doesn’t have a quick fix. While medications are sometimes necessary and part of a good treatment plan, therapy can also help you work through anxiety. It can help you discover the root cause of your anxiety and the steps you can take to combat it. One treatment option proven to be effective is cognitive behavioral therapy (CBT).

What is CBT?

CBT is a type of therapy that works on negative thought patterns or behaviors in an effort to recognize and restructure them. In other words, CBT can help you change how you approach a situation.

For example, if you’re about to start a new job, you could be feeling several things:

  • Anxious. Because it’s a new environment with new co-workers and processes, you might be feeling anxious. You might think, “I’m never going to be able to catch on” and consider calling in sick your first day.
  • Neutral. You might be feeling neutral because you’ve had other jobs in the past. Work is just work, after all. You might think, “As soon as I’m done for the day, I’m going out for dinner.” You might get off work and go grocery shopping, focused on the rest of your night.
  • Excited. When starting a new adventure and facing new challenges, you might feel excited. You might think to yourself, “I can’t wait to collaborate on that new project.” You might go into the office and start introducing yourself to others.

Beginning a new job can give people different thoughts, feelings, and behaviors. These differences all depend on the personal attitudes, beliefs, and assumptions we have about our circumstances.

When you have anxiety, the negative thought patterns and emotions overshadow the positive ones. Feelings of unworthiness and fear can start to take over. The goal in CBT is to work on changing the way you think. By doing this, you can change how you feel about a situation.

Cognitive behavioral therapy for anxiety

“Anxiety and nervousness are rooted in survival, so feeling anxious or fearful is part of the human experience,” explains Ciara Jenkins, a therapist and licensed clinical social worker at Life On Purpose Counseling & Coaching Services. “Everyone experiences anxiety from time to time at varying degrees. Many times, intense anxiety, fear, or panic is caused by how we think about a certain situation and not necessarily the situation itself.”

Jenkins goes on to say that when you can create space between a situation and your thoughts, feelings, and actions, it can give you the power to handle the situation. It doesn’t hold you back from your goal or make things worse.

“Perception accounts for a lot of our experience. Being able to let go of unhealthy thoughts frees us up to consider other healthier and more factual alternatives, which lead to an improved experience and less intense uncomfortable emotions,” Jenkins adds.

When you have negative feelings and thoughts about a situation, over time it can start to affect your behavior toward it. A child who keeps having negative feelings about going to school may start to come up with excuses not to go.

As time goes on, these behaviors start to become repeating patterns. Using CBT, you can learn to pay attention to those patterns and actively work to change them, along with the feelings tied to them. Given time, it can help to prevent these behaviors from happening in the future.

“CBT helps individuals identify the links in the chain that lead to worse anxiety and depression: the thoughts, feelings, behaviors, and physical sensations that are intimately connected to one another,” says Steven Lucero, PhD, MBA, a clinical psychologist with Brightside. The key, he stresses, is that you can take action to disrupt the spiral of avoiding the situation that causes anxiety.


For instance, let’s say you’re dealing with low self-esteem. Maybe you try to avoid social situations because being around a lot of people is overwhelming and triggers anxiety.

You’re invited out to a group gathering at a restaurant, and you know there will be a big turnout. Your immediate thoughts are, “No way. I’ll have to make small talk. What if people think I’m awkward?”

You might feel nervous, even slightly panicked. At the last moment, you tell the host that you’re not feeling well. You won’t be able to make it.

While this behavior will make you feel better in the short term, it only prolongs the anxiety you feel in social gatherings. The problem is, when you continuously avoid the situations that trigger anxiety and fear, you continue that negative cycle of thoughts, feelings, and behaviors.

In therapy, you work on anxiety in social gatherings. You might:

  1. Begin to learn relaxation exercises that you can use when you get another invitation to go out.
  2. Write down the thoughts you feel when you start to have anxiety.
  3. Work with your therapist to look at your list.
  4. Replace negative thoughts and feelings with ones that are more realistic.

This technique is known as cognitive restructuring or reframing.

“As you see yourself increasingly effective at handling the things that previously led to fear and anxiety, you will be more capable of continuing to act in opposition to the fear,” Lucero explains.

CBT techniques for anxiety

CBT professionals use some common techniques to help you manage anxiety and change your behavior.

Cognitive restructuring or reframing

This involves taking a hard look at negative thought patterns. Perhaps you tend to:

  • overgeneralize
  • assume the worst will happen
  • place too much importance on minor details

Thinking this way can affect what you do and, in some instances, can become a self-fulfilling prophecy.

Your therapist will ask about your thought processes in certain situations so you can identify negative patterns. Once you’re aware of them, you can learn how to reframe those thoughts so that they’re more positive and productive.

Thought challenging

Thought challenging is about considering things from multiple angles, using actual evidence from your life. Thought challenging can help you consider things from a more objective perspective, rather than just assuming that your thoughts are the facts or truth.

Education about cognitive distortions can help a person identify when a cognitive distortion is showing up in thoughts, and that allows them to work to correct the unhelpful thoughts to thoughts that are more balanced and factual,” says Jenkins.

With anxiety, you might have trouble rationalizing your problems. You might feel anxious, but not understand where those feelings are coming from. Or, you might have a fear of something such as social gatherings, but you aren’t sure why.

Behavioral activation

If anxiety is preventing you from doing a certain activity, you can schedule it by writing it in your calendar. This sets a plan in place so you don’t keep worrying about it.

For instance, if you have anxiety about your kids getting sick at a playground, you might schedule a park date with a friend. This will encourage you to move forward and face the situation, armed with the skills you work on in CBT.


Journaling, also called thought recording, helps you get in touch with and bring awareness to your thoughts and feelings. It can also help clarify and organize your thoughts.

You might make lists of your negative thoughts and the positive ones you can swap them out with. Your therapist may encourage you to write down the new skills and behaviors you work on between therapy sessions.

Behavioral experiments

These are commonly used when you’re experiencing catastrophic thinking, which is when you assume the worst is going to happen.

“Just like a scientific experiment, we hypothesize about the potential outcomes of that action, and actually write down what we anticipate will happen and what the fears are of what could happen,” explains Lucero.

You might have a discussion with your therapist about what you predicted would happen and if it actually did. Given time, you’ll start to see your worst-case scenario is unlikely to happen.

Relaxation techniques

Relaxation techniques reduce stress and allow you to think more clearly. In turn, these can help you take back control of a situation. These techniques might include:

  • deep breathing exercises
  • progressive muscle relaxation
  • meditation

These practices don’t take long to do and are tools you can use wherever you’re experiencing anxiety, such as in line to pay for groceries.

How to find a CBT professional

Finding a good therapist can be challenging. While you might feel overwhelmed by figuring out where to start, you *can* find a therapy practice that’s right for you. Here are some things to think about when you’re looking for a CBT professional.

In-person or online

Seeing a therapist in person involves sitting with them in an office setting on chairs or couches. But as more therapists are seeing their clients virtually, practices are offering many more options for online therapy than they used to. You may find you’re more comfortable going in person or in the comfort of your own home.

Some companies such as Online-Therapy actually specialize in CBT. They can include other helpful resources for you, such as workbooks and live sessions in addition to therapy sessions.

Individual or group therapy

You might decide to do individual counseling or have CBT in a group therapy setting. This is where a facilitator, usually a licensed mental health professional, works with a small group of people who are in similar circumstances.

Decide on your preferences

It can be helpful to figure out if there is a type of therapist you may feel more comfortable with.

A good relationship with a therapist is important to your mental health recovery process. Ask yourself:

  • What do you want in a therapist?
  • Do you feel more comfortable with a therapist of a certain gender?
  • Do you want a therapist who is older or younger?
  • Do you want a religious aspect to therapy?

Start your search

You might ask for recommendations from friends and family. Another place to find a CBT therapist is searching online. The website Psychology Today has a database that you can search by state. You can also visit the directory at the National Association of Cognitive-Behavioral Therapists.

Don’t settle

It’s important to feel comfortable with your therapist.

If you aren’t a good match, it’s OK to find another one. Not everyone is going to be a good fit, and different therapists can meet different needs.


Anxiety can be a challenge, but the good news is that you have steps you can take to work through it. CBT is a way to change your negative thought patterns in order to positively affect how you respond to situations.

By finding a therapist with expertise in CBT, you can take steps to manage your mental health. You can then take the skills you learn from CBT and apply them to situations in the future.

Risa Kerslake is a registered nurse, freelance writer, and mom of two from the Midwest. She specializes in topics related to women’s health, mental health, oncology, postpartum, and fertility content. She enjoys collecting coffee mugs, crocheting, and attempting to write her memoir. Read more about her work at herwebsite.

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