How Does a Therapist Treat Anxiety Disorder? An Introduction to CBT Skills
If you are reading this, chances are you already know that symptoms of stress can feel overwhelming, and if untreated can evolve into an anxiety disorder. The good news is understanding the biological roots can be the first step towards success. In this video, ‘Master Your Mind: Essential CBT Skills for Anxiety Symptoms’, Dr. Rosalie Zuniga from Postpartum Wellness and I discuss what information I provide to my clients in the first stages of anxiety treatment. If you want to know about the mind body connection when you experience anxiety symptoms, check out the first part of this video to dive into the biology of stress. If you’d like to try some practical strategies for managing anxiety disorder, you can find more content in the second part. Curious, but not ready to watch the whole video? You can find an overview below.
The Biological Roots of Anxiety Disorders
Anxiety is more than an emotion, it’s an interplay of biology and psychology. The ‘fight, flight, freeze, fawn’ response is a natural instinct we have to stress or danger. This is also known as the ‘stress response’. In the modern world this is not particularly useful. In very few situations this phenomenon may be helpful (if a bear is chasing you). However, when we ruminate about our fears, our brain believes we are actually in physical danger and if it persists can evolve into an anxiety disorder.
Anxiety Symptoms
The symptoms of anxiety can vary but have some specific themes:
Excessive Worry: Constant, uncontrollable worry about everyday things.
Physical Anxiety Symptoms: These can include increased heart rate, sweating, trembling, dizziness, and shortness of breath.
Trouble Concentrating: Difficulty focusing on tasks or making decisions.
Sleep Problems: Trouble falling asleep, staying asleep, or restless sleep.
Avoidance: Avoiding situations that cause anxiety, which can impact daily life and activities.
Panic Attacks: Sudden episodes of intense fear or discomfort, often accompanied by physical symptoms like chest pain or a feeling of choking.
It’s the Thought that Counts
As you have learned, the biological reactioni to specific triggers creates the stress response. It’s just as important to recognize that avoidance of triggers and catastrophizing will feed the belief that we can’t handle our difficult emotions, which leads to anxiety. Below is a helpful equation from Dr. Aaron Beck, the father of Cognitive Behavioral Therapy (CBT)
Dangerous Thinking + Helpless Thinking = Level of Anxiety Symptoms
Dangerous Thinking:
Imagine someone who experiences a setback at work, such as not receiving a promotion they expected. They might engage in dangerous thinking by catastrophizing the situation. For instance:
“I failed, which confirms I’m not good enough. What if people find out? Everyone at work will know I’m incompetent.”
Helpless Thinking:
Helpless thinking involves a belief that whatever the imagined catastrophe is, they will not be able to handle it.
Using the same situation, this person may think, ‘I am so embarrassed and now I have to go to work after this rejection. I’ll be in the bathroom crying all day. I will sit in silence in meetings and I won’t be able to be of any use now because I’ll be a mess. I don’t think I’m going to be able to date because I’ll just keep thinking about how inferior I am.’
CBT in Action:
The video ‘Transform Your Anxiety Symptoms: CBT Skills to Help You Feel Better’ discusses a few interventions, such as ‘Decatastrophizing the Fear (Worst Case Scenario), and the ‘What Ifs’ to examine and test dangerous thoughts.
Although in a stressed state we overpredict dangerous outcomes, the reality is that the worst case can happen. When we anticipate we can’t handle the worst-case scenario our helpless thinking is kicking in. I will ask my clients, ‘How could you cope in a way that is healthy and strong?’ ‘Is there a way you visualize managing the catastrophe in a way you would be proud of?’ My clients who come to me for anxiety treatment in San Diego often will hear me joke that we are not the fragile flowers we believe we are. All humans can survive and thrive under difficult circumstances, and this is a vital understanding to manage anxious thoughts.
Where to Find More Information: Therapy in San Diego
For more details about this insightful session and to explore additional resources, visit Therapy in San Diego and Postpartum Wellness. If you are curious about your anxiety symptoms and wonder if you would benefit from treatment, head to Anxiety Treatment in San Diego – Assessment to see where you land on the anxiety disorder scale.
What are Core Beliefs and Why are they so Important to Our Mental Health?
Core beliefs are deeply ingrained convictions that individuals hold about themselves, others, and the world around them. These arefundamental to one’s sense of self and play a significant role in shaping thoughts, emotions, and behaviors. Core beliefs are often formed early in life through various experiences, interactions, and socialization.
These thoughts tend to be stable over time unless they are consciously challenged and modified. Positive core beliefs contribute to a healthy self-esteem and resilient mindset, while negative core beliefs can lead to self-doubt, low self-worth, and psychological distress.
Examples of core beliefs include:
– I am unlovable and unworthy of affection
– I am worthy of love and respect
– I am incompetent and destined to fail
– I am capable enough
– I am fundamentally flawed and defective
– I am deserving of success and happiness
– Others will always reject or betray me
– Others are generally trustworthy and kind
It’s easy to see how core beliefs serve as the lens through which individuals interpret their experiences and perceive themselves and the world at a subconscious level. These are the ‘roots’ of our psychological tree, and it takes conscious and consistent efforts to change.
In Cognitive Behavioral Therapy (CBT), these core beliefs are a central focus. Cognitive behavioral therapists work with clients to identify and challenge negative core beliefs, replacing them with more adaptive and constructive beliefs. This process, known as cognitive restructuring, helps individuals develop a healthier self-concept and achieve greater emotional well-being.
One exercise I use in my CBT practice is a positive data log:
It’s important to note that the goal is to not convince yourself of the opposite of your core belief, but more of a balanced perception of yourself. ‘I’m good enough’ doesn’t allude to ‘I’m perfect’.
Step 3: List evidence from your recent experiences that contradict or challenge the core belief.
These would be instances where you succeeded, received positive feedback, or felt valued. The more specific the evidence, the more helpful it will be. Additionally, it’s very important to recognize the small pieces of evidence we may be ignoring.
Some evidence may look like this:
– My friend Mark called me to say ‘hi’
– I completed my grocery shopping on my own
– I didn’t get fired today
– Barbara laughed when I made a joke
– A stranger made small talk with me
– My dog was excited to see me when I got home
Last words on Positive Data Logs
Be Patient
Adding to this this positive data log every day can help reinforce useful self-beliefs and challenge negative thinking patterns. This is a long-term practice; we spend our whole lives living through a certain lens, so it takes time to shift. Patience is key here! Many people find that a therapist or other support is vital to stay accountable and also to review and process the evidence collected.
Expect Your Brain to Push Back
It’s natural to find yourself hearing ‘yes but’ after writing down evidence that contradicts our core beliefs. If you find you are having trouble accepting the new evidence, be gentle and remind yourself that you will have time to focus on the opposing data, but for now, you are just collecting some positive information.
Positive data logs are an effective, CBT based method of challenging the unhelpful ways we view ourselves and our world. Used consistently, you can find yourself shifting into a more balanced and rewarding mindset.
Small Steps, Big Impact: Emily’s Story of Reaching Her Dream
Emily had a burning desire to become a renowned painter, but she often felt overwhelmed and anxious by the enormity of her aspirations. She would head to art shows wondering how anyone could reach such recognition. This left her feeling stuck as she continued working her well-paying, albeit unexciting manager position at a Fortune 500 company. Her free time consisted of watching TV, going to the gym, and visiting art museums with good friends. Her life was not dull, but she knew she was avoiding going after what she really wanted.
One Saturday, Emily decided that instead of her normal routine of grocery shopping and cleaning the house, she would focus on doing one thing that aligned with her dream. She grabbed her sketchbook and pencils and went outside to simply draw what she saw around her. No more, no less. After thirty minutes of sketching, Emily felt accomplished. She didn’t worry about creating a masterpiece; instead she had fun with the process of improving her skills one drawing at a time, and gave herself an internal ‘gold star’ for every improvement she made.
As days turned into weeks, Emily’s confidence grew and her anxiety waned. She started experimenting with different techniques and subjects, pushing herself to explore new styles and perspectives. Some days were challenging and overwhelm would creep in, but Emily would just take smaller steps and she noticed her anxiety was more manageable than she anticipated.
Eventually, Emily’s hard work began to pay off. Her sketches caught the eye of a local art gallery owner who offered her a small exhibition space. Excited but anxious, Emily accepted the opportunity.
The night of her art show arrived, and Emily watched people admire her artwork. She felt a sense of pride knowing that each piece represented countless small actions taken toward her dream. Some visitors even expressed interest in purchasing her work, leaving Emily feeling that much more energized.
Years passed, and Emily’s reputation as an artist continued to flourish. She traveled the world, showcasing her paintings in prestigious galleries and sharing her story of how she became so accomplished. Young women would come up to her in awe, asking her how she accomplished such an outstanding reputation. Emily explained that it was the minuscule day to day work that had led her to her achievement. As Emily learned, it wasn’t the height of the ladder that mattered, but openness to understand that small steps and patience are the key to managing the anxiety and overwhelm she had at the beginning.
The Science of Small Steps
BJ Fogg, behavioral researcher and founder of the Behavior Design Lab at Stanford University, asserts that the baby steps we make are the path to success in ‘Tiny Habits: The Small Changes that Change Everything’. “It’s easier to create habits and change than most people think, and it’s faster than most people think,” . “It can even be fun, if you do it in the right way” Bogg states in an interview with NPR.
Most of us have heard the old Chinese Proverb “A journey of a thousand miles begins with a single step”. We can visualize this by comparing two ladders that are the same height but the number of rungs are different. Oftentimes we dismiss our small efforts as ‘not enough’ or a waste of time. However, if one can conceptualize this in terms of two ladders, we can see that this method can not only be easier, more fun and faster, but also make something we believe is impossible entirely possible.
While the idea of big goals may lead to overwhelm and shut down, it’s the small, consistent actions taken towards them that pave the way to accomplish what we never thought we could. By embracing the importance of our tiny efforts, you can make significant strides throughout your journey.
instinct we have to stress or danger. This is also known as the ‘stress response’. In the modern world this is not particularly useful. In very few situations this phenomenon may be helpful (if a bear is chasing you). However, when we ruminate about our fears, our brain believes we are actually in physical danger and if it persists can evolve into an anxiety disorder.
house, she would focus on doing one thing that aligned with her dream. She grabbed her sketchbook and pencils and went outside to simply draw what she saw around her. No more, no less. After thirty minutes of sketching, Emily felt accomplished. She didn’t worry about creating a masterpiece; instead she had fun with the process of improving her skills one drawing at a time, and gave herself an internal ‘gold star’ for every improvement she made.