Anxiety & CBT

Signs of anxiety

“If I take this exam, I will probably freeze, forget everything and make a fool of myself!”

“I haven’t heard from X. What if something happened? What if they were in an accident? What if they don’t like me anymore? What if I did something and they hate me? What if... What if... ?”

“I’d better think about what might go wrong in (specific situation).”

“If I think about (something that scares me), I’ll break down.”

These are some examples of thoughts that people with anxiety often have. Anxiety is the fear of some kind of danger. It most often is not a real or physical danger. This sense of danger (or threat) is often paired with physical symptoms. These include shaking, increased heart rate, nausea, shortness of breath, sweating, dizziness, and muscle tension.

How does anxiety work in the body?

Think of feelings as messengers in the body. They transfer messages to us to motivate us, protect us, guide us.

Emotions communicate information and motivate us for action. Anxiety tells us that we’re facing a challenging situation and provides us with the physical energy to meet that challenge. Everybody experiences some degree of anxiety, which can be helpful. For example, having anxiety before a big presentation at work will likely motivate you to prepare more thoroughly, hopefully leading to a better performance.

Anxiety can also be problematic when it’s disproportionate to the situation. People who suffer from disproportionate anxiety have certain characteristics in common. They perceive situations or experiences as dangerous in some way and predict negative or threatening outcomes.

As long as they can avoid certain situations or experiences, they experience temporary relief from anxiety. In the long run, though, avoidance keeps the anxiety disorder going. People think, “If I hadn’t been able to avoid this, then something bad would have happened.”

Sometimes, anxiety is helpful. It may spur us to work a little harder or to be careful in a risky situation. But people who suffer from excessive anxiety do not have an accurate view of their situation. They may anticipate a threat to their well-being when there is little likelihood that it will occur.

When anxious people are facing a challenge, they tend to exaggerate the difficulties they face and dwell on the potential consequences of a negative outcome. At the same time, they tend to underestimate their own ability to cope with whatever they fear might happen. In other words, they overestimate the likelihood that a threatening situation or experience will occur and they overestimate how severe or intense it will be. They also underestimate their ability to cope effectively.

To make matters worse, when severely anxious people become intensely aware of their own unpleasant physical and emotional reactions, they may begin to dread and fear the symptoms themselves even more than the situation that triggers them. The more upset they get, the more intense their symptoms become, and they become involved in a self-perpetuating spiral of increasingly intense emotional and physical suffering.

How does cognitive behavioural therapy (CBT) work?

In the following example, you may notice the way in which anxiety-related thinking can have a negative impact. A lonely high school student wants to talk to classmates to make friends. But every time she has the opportunity to do so, anxious thoughts show up: “They’ll see how nervous I am. They’ll think I’m stupid and awkward.” As these thoughts flood her mind, her throat tightens, her mouth goes dry, and she thinks she won’t be able to say a word. She copes by sitting by herself and does not try to start a conversation.  She then thinks, “I’m a loser,” and is likely to continue avoiding talking to classmates in the future.

CBT teaches you to recognize the mistakes in your thinking about what would happen if you dared to act in a way that aligns with your values. Through therapy, you will learn to apply your reasoning skills and powers of observation to situations in your life that are leading to anxiety. Like a scientist, you will learn how to test your ideas to determine how realistic they are. When you reduce the distortions and inaccuracies in your thinking, you will decrease your anxiety and develop a more helpful approach to dealing with situations you fear.