CBT FOR ANXIETY

"My life has been full of terrible misfortunes, most of which never happened" – Michel de Montaigne

"Essentially a tool kit for the anxious mind" – US writer Brad Stulberg, who lives with anxiety, on CBT (1)

WHAT IS AN ANXIETY DISORDER?

Anxious woman. — Persistent anxiety can be exhausting and debilitating.

Anxiety disorders are the most common mental health problem. As a cognitive behavioural therapist, I see the effects of anxiety every day: it is easily the most common problem reported by clients at Kinsale CBT.

Anxiety is a normal part of life and we all know what it's like to feel anxious – exam stress, awaiting medical results, starting a new job, becoming parents. However, when anxiety is persistent and severe, it becomes debilitating. Managing anxiety is crucial because anxiety can be very gripping, interfering with our day-to-day life and our relationships. In these instances, anxiety has become a clinical problem, what we call an anxiety disorder, requiring treatment and management.

There are many different categories of anxiety. These include social anxiety, panic disorder, agoraphobia, generalised anxiety disorder (GAD), obsessive compulsive disorder (OCD), specific phobias, health anxiety (hypochondriasis), and post-traumatic stress disorder (PTSD).

ANXIOUS THINKING PATTERNS

Anxious feelings and thinking patterns. — Decades of research show that anxious thinking patterns are best tackled with CBT.

There are certain thinking patterns common to anxiety.

Worrying tends to be repetitive and ruminative (going over things again and again, replaying negative events, etc). With anxiety, it's typical to overestimate the likelihood of something bad happening. For example, someone with panic disorder might worry, "if I have a panic attack, then I could get a heart attack (and die)".

People often catastrophize or awfulize, predicting worst-case scenarios while also underestimating their coping abilities. For example, a person with social anxiety might worry that others will judge them harshly if they see they are anxious.

Individuals often misinterpret the meaning of physical symptoms, worrying that when anxious they might become totally out of control.

Anxious thoughts are typically future-oriented with a person anticipating ‘what if…’ scenarios.

OTHER FEATURES OF ANXIETY

Anxiety disorders share other common features.

An intolerance of uncertainty, needing to know things 'for sure'.

Anxiety is a reaction to the perception of threat, whether this threat is real or imagined.

The anxiety felt by people is associated with feelings of uneasiness, apprehension and dread.

Behavioural avoidance is very common to anxiety, i.e., avoiding situations which provoke anxiety. These behaviours might be obvious or subtle. For example, avoiding social situations would be described as obvious avoidance behaviour. Using alcohol to numb and escape painful feelings would be considered more subtle avoidance behaviour. Avoidance behaviours maintain or worsen anxiety and prolong mental health difficulties.

Physical symptoms of anxiety can include palpitations or accelerated heart rate, sweating, trembling or shaking, feelings of dizziness or light-headedness, derealization (feelings of unreality) or depersonalization (feeling detached from oneself), cold chills or hot flushes, impaired attention and concentration & restlessness.

CAUSES OF ANXIETY

Anxious old man by lake. — Anxiety runs in families and is often passed down from parent to child.

PREDISPOSING FACTORS

These factors, present from early on in childhood, can increase the risk of the development of an anxiety disorder.

Family history of anxiety (genetic predisposition).
Temperamental style.
A particular thinking style.
Early trauma e.g., early parental separation or unstable living conditions in childhood.

PRECIPITATING FACTORS

These are factors which can contribute to the first onset of an episode of anxiety.

A traumatic event (motor vehicle accident or mugging).
Unpleasant and uncomfortable physical symptoms associated with a medical condition (e.g. migraine, thyroid problem).
Experience of someone else suffering a serious medical condition (e.g. parent having a heart attack).
Unremitting pressure & work stress.

CBT AND ANXIETY: TREATMENT

Anxiety-free woman kicking water. — CBT relies on tried-and-trusted techniques to help people overcome their anxiety.

You will most likely be referred for cognitive-behavioural therapy (CBT) by your GP, who is most people’s first port of call. Research confirms CBT is by far the most successful psychotherapy for the treatment of anxiety.

To manage anxiety, you must first understand that it is maintained by a number of factors. These include cognitive/thinking biases, positive beliefs about worry ("worry keeps me safe", "worry shows I care"), intolerance of uncertainty ("I need to be sure") and overly cautious behaviours. CBT is psycho-educational: it helps you explore the counterproductive nature of your worrying thoughts and cautious behaviours, showing how they influence how you feel and act.

In therapy, practical treatment interventions will be set out and tailored to your needs. These include learning to identify and challenge unhelpful and negative thoughts (cognitive restructuring) as well as detaching from safety behaviours (behaviours developed to minimise anxiety) which do not serve you. We will also set out gradual exposure-based approaches which can offer you dramatic results, helping you to manage and overcome your fears and anxiety. We will also incorporate acceptance and mindfulness techniques to ensure you can learn to make lasting change. These life skills can prevent against future relapse.

We know from neuroscience that we can literally rewire our brains with CBT, a process known as neuroplasticity. As CBT expert Dr Harry Barry pointed out in an Irish Examiner interview, “you are not doomed to be anxious for the rest of your life” (2).

References

(1) – https://www.outsideonline.com/2279856/anxiety-cant-be-trained-away

(2) – http://www.irishexaminer.com/lifestyle/features/dr-harry-barrys-techniques-for-an-anxiety-free-life-420329.html

General anxiety disorder (Gad)

Obsessive-compulsive disorder