Anxiety disorders, including Panic Disorder, Specific Phobias, Social Anxiety Disorder, and Generalized Anxiety Disorder are the most common mental disorders in the United States (see https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders). They impact individuals of diverse racial/ethnic, sexual orientation, gender identity, and socioeconomic sociocultural groups (note: notable mental health disparities exist that we will discuss in other articles). Cognitive Behavioral Therapy (CBT) is a behavioral therapy utilized by psychologists and other mental health providers to treat anxiety disorders among children, teens and adults. CBT is utilized as a short-term, present-focused, and goal-oriented therapy
(see https://beckinstitute.org/get-informed/what-is-cognitive-therapy/). CBT was founded on various principles that emerged from clinical studies and experiments. When implemented by a trained provider, CBT can be modified in a culturally competent and affirming manner with diverse sociocultural groups.
Cognitive Model
The cognitive model that guides the ‘cognitive’ part of CBT therapy proposes that external situations trigger automatic thoughts or images that stem from core beliefs, or strongly held assumptions about oneself, others, and the future. If someone holds unhelpful core beliefs and thought processes, then automatic thoughts and images are triggered. These unhelpful automatic thoughts and images can lead to unhelpful emotional, behavioral, or physiological responses that can subsequently develop into disorders over time (e.g., Generalized Anxiety Disorder, Panic Disorder, Agoraphobia).
Oftentimes, if core beliefs and automatic thoughts are not fully consistent with the big picture, it is because unhelpful thought processes reinforce the core belief. In CBT, these unhelpful thought processes are called ‘cognitive distortions,’ and they are specific ways of looking at world and situations. A common cognitive distortion is ‘black-and-white thinking’ or ‘absolutist’ thinking, which means viewing situations or people in extremes (i.e., either good/bad, perfect/failure, etc).
Behavioral Model
The ‘behavioral’ component of CBT is also imperative to consider. As discussed here, the Two-Factor Theory of Fear and Avoidance (Mowrer, 1951) purports that some individuals experience anxiety in the face of specific environmental stimuli, leading to avoidance of those feared stimuli. Avoiding the anxiety reinforces more avoidance, which also leads to increases in fear and anxiety over time. Thus, the ‘behavioral’ component targets this avoidance of feared stimuli through Exposure and Response Prevention Therapy. ERP is a subcomponent of CBT designed to lessen the impact of the ‘fear memory’ or ‘fear structure.’ This therapy attempts to extinguish the panic and other physiological reactions connected to a specific stimulus or stimuli. One of the key differentiators of ERP from Exposure Therapy in general is that a ‘relaxation’ or ‘coping skill’ component is removed when completing exposures (Böhnlein et al., 2020), which makes ERP more effective.
In CBT and ERP, both cognitive and behavioral interventions are highly recommended for fully treating anxiety disorders. In essence, both types of interventions address the thoughts, emotions, physiological responses, and behaviors contributing to anxiety disorders. Typically, it is helpful to begin with the behavioral component in order to generate increased self-efficacy, or belief in oneself, in facing the feared stimuli. This would include creating a hierarchy of fears collaboratively with a therapist. A hierarchy of fears would include exposure exercises ranked from least anxiety-provoking to most anxiety-provoking.
An example of a cognitive intervention would be using thought record sheets to challenge unhelpful assumptions and automatic thoughts. Thought record sheets allow individuals to identify their cognitive distortions and challenge them with evidence.
In sum, CBT incorporating both cognitive and behavioral interventions can fully treat the underlying facets of anxiety disorders. First, I recommend finding a suitable provider, as discussed here. The promising news is that CBT and ERP treatments have been found to be effective with children, teens, and adults.
References
Böhnlein, J., Altegoer, L., Muck, N. K., Roesmann, K., Redlich, R., Dannlowski, U., & Leehr, E. J. (2020). Factors influencing the success of exposure therapy for specific phobia: A systematic review. Neuroscience and biobehavioral reviews, 108, 796–820. https://doi.org/10.1016/j.neubiorev.2019.12.009
Mowrer, O. H. (1951). Two-factor learning theory: summary and comment. Psychological Review, 58(5), 350–354. https://doi.org/10.1037/h0058956
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