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How does Cognitive Behavioral Therapy (CBT) help Anxiety?

Anxiety disorders are very common. One in eight people have an anxiety disorder on any given year1 and one in four people have an anxiety disorder in their lifetime.2 Many more suffer from anxiety that is not intense enough or that doesn't last long enough to be considered a disorder.

Cognitive Behavioral Therapy has been shown to effectively treat multiple types of anxiety disorders, including: panic disorder,3 generalized anxiety disorder (GAD),4 acute stress disorder,5,6 social anxiety disorder,7-9 post traumatic stress disorder (PTSD),10-12 and obsessive compulsive disorder (OCD).13,14 The CBT approach to treating anxiety can be divided into its cognitive and behavioral components.

The cognitive component helps people identify and question the thinking patterns that cause or trigger the feelings of anxiety.15 For example, people that have panic attacks often interpret their symptoms as evidence of having a heart attack or being about to pass out or lose their minds. CBT can help them question the validity of these negative and usually automatic thoughts. It can also help panic attack sufferers to replace those thoughts by more accurate and balanced alternatives, like "I am having a panic attack, I have been told by my doctor that panic attacks are not life threatening. It will go away and I will be OK."

The behavioral component consists of exposure and desensitization.16 With the help of a therapist, patients build up their exposure to anxiety provoking situations, usually right after the patient is induced into a deeply relaxed state. For example, somebody with fear of flying can create a list of activities that goes from seeing pictures of planes, to imagining themselves flying, to going to the airport just to watch planes, to actually flying. The idea behind this approach is that the patient's sensitivity drops. S/he learns from repeated experience not to fear the problematic situation.

  1. 1 Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidty Survey Replication. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Arch Gen Psychiatry. 2005;62:617-627.
  2. 2 Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Kessler RC, Berglund PA, Demler O, Jin R, Walters EE. Arch Gen Psychiatry. 2005;62:593-602.
  3. 3 Cognitive-Behavioral Therapy, Imipramine, or Their Combination for Panic Disorder: A Randomized Controlled Trial. David H. Barlow, PhD; Jack M. Gorman, MD; M. Katherine Shear, MD; Scott W. Woods, MD. JAMA. 2000;283(19):2529-2536
  4. 4 A Randomized Clinical Trial of Cognitive-Behavioral Therapy and Applied Relaxation for Adults With Generalized Anxiety Disorder. Michel J. Dugas, Pascale Brillon, Pierre Savard, Julie Turcotte, Adrienne Gaudet, Robert Ladouceur, Renée Leblanc, and Nicole J. Gervais. Behav Ther. 2010 March; 41(1): 46-58.
  5. 5 Treating acute stress disorder: an evaluation of cognitive behavior therapy and supportive counseling techniques. Bryant RA, Sackville T, Dang ST, Moulds M, Guthrie R. Am J Psychiatry. 1999;156:1780-1786.
  6. 6 Cognitive behaviour therapy of acute stress disorder: A four-year follow-up. Bryant RA, Moulds ML, Nixon RVD. Behav Res Ther. 2003;41:489-494.
  7. 7 Cognitive Therapy vs Interpersonal Psychotherapy in Social Anxiety Disorder: A Randomized Controlled Trial. Stangier et al. Arch Gen Psychiatry 2011;68:692-700.
  8. 8 Social phobia: A comparison of behavior therapy and atenolol. Turner SM, Beidel DC, Jacob RG. J Consult Clin Psychol. 1994;62:350-358.
  9. 9 Cognitive behavioral group therapy vs phenelzine therapy for social phobia: 12-week outcome. Heimberg RG, Liebowitz MR, Hope DA, Schneier FR, Holt CS, Welkowitz LA, Juster HR, Campeas R, Bruch MA, Cloitre M, Fallon B, Klein DF. Arch Gen Psychiatry. 1998;55:1133-1141.
  10. 10 Imaginal exposure alone and imaginal exposure with cognitive restructuring in treatment of posttraumatic stress disorder. Bryant RA, Moulds ML, Guthrie RM, Dang ST, Nixon RD. J Consult Clin Psychol. 2003;71:706-712.
  11. 11 Dresden PTSD treatment study: randomized controlled trial of motor vehicle accident survivors. Maercker A, Zöllner T, Menning H, Rabe S, Karl A. BMC Psychiatry. 2006 Jul 6;6:29.
  12. 12 Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial. Schnurr PP, Friedman MJ, Engel CC, Foa EB, Shea MT, Chow BK, Resick PA, Thurston V, Orsillo SM, Haug R, Turner C, Bernardy N. JAMA. 2007 Feb 28;297(8):820-30.
  13. 13 Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. Foa EB, Liebowitz MR, Kozak MJ, Davies S. Am J Psychiatry. 2005;162:151-161.
  14. 14 Behavior therapy for obsessive-compulsive disorder guided by a computer or by a clinician compared with relaxation as a control. Greist JH, Marks IM, Baer L, Kobak KA. J Clin Psychiatry. 2002;63:138-145.
  15. 15 Anxiety disorders and phobias: a cognitive perspective. Aaron T. Beck, Gary Emery, Ruth L. Greenberg, 2005 edition.
  16. 16 General Principles and Empirically Supported Techniques of Cognitive Behaviour Therapy. William T. O'Donohue, Jane Ellen Fisher. Hoboken, New Jersey 2009.