Cognitive behavioral therapy exercises for anxiety
Anxiety Disorders, according to the latest research, is one of the most common illnesses in the United States of America. Every year 40 million adults report suffering from symptoms of anxiety.
Anxiety disorders develop from a culmination of factors such as an individual’s genetics, brain chemistry, life events, and personality.
Cognitive behavioral therapy exercises for anxiety is a popular and effective therapeutic approach to help an individual manage his/her symptoms.
Psychology Today, a renowned psychological magazine defines Cognitive Behavioral Therapy (CBT) “As a form of psychotherapy that treats problems and boosts happiness by modifying dysfunctional emotions, behaviors, and thoughts.
Unlike traditional Freudian psychoanalysis, which probes childhood wounds to get at the root causes of conflict, CBT focuses on solutions, encouraging patients to challenge distorted cognitions and change destructive patterns of behavior.”
This therapy technique is based on the principle that one’s thoughts, attitudes, and beliefs affect one’s behavior to a great extent and that mental disorders like anxiety and depression can effectively be dealt with, by changing one’s negative thought processes.
Cognitive Behavioral Therapy compares our thinking pattern to a pair of glasses that enables us to view the world in a specific way. If our thinking is positive we will have a positive outlook on life and if our thinking is negative we will have a negative view of the world.
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According to the founder of cognitive behavioral therapy, Dr. Aaron T. Beck “The perceptions and interpretations of a depressed person are distorted, causing him/her to engage in “cognitive errors” such as a negative mindset, jumping to conclusions, catastrophizing and thinking only in black and white “.
Beck noted that these thoughts came automatically to the individual causing him/her to believe them as absolute truths instead of distortions, leading to mental disorders like anxiety, depression, phobias etc.
Cognitive behavior therapy exercises for anxiety focuses on modifying these negative thought patterns by challenging them against reality.
When an individual replaces these negative and harmful thoughts with positive thinking, their anxiety and distress levels considerably reduces allowing them to function normally.
According to psychologist- Grohol (2016) these inaccurate thoughts and belief systems that reinforce negative behaviors, thought patterns and emotions are called Cognitive Distortions.
These distortions alter our vision from the truth and are experienced by all human beings at some or the other point in their lives. When these distortions take over an individual’s thought processes it leads to mental disorders like anxiety attacks, extreme feelings of despair, hopelessness, and doom.
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There are 15 types of distortions that affect one’s thought processes and are the major causes of anxiety.
- Filtering: Filtering refers to the distorted thinking of an individual who chooses to dwell only on the negative happenings of their life, ignoring all the positive occurrences.
- Even though a lot of good may happen in the person’s day the individual may choose to focus only on the negative happenings thus increasing one’s level of anxiety.
- Polarized or Black and White thinking: As the name suggests, this distortion is all about thinking in black or white, with no grey shades in between for e.g. If a student is weak at a particular subject he/she may believe “that they are a failure and will not be able to succeed in their life” even though in reality they may be good in other subjects. This kind of thinking leads to a sense of despair eventually increasing one’s sense of anxiety.
- Overgeneralization: When overgeneralizing, an individual may tend to make major decisions based on the occurrence of one or two events. For example, if a man fails in an interview he may conclude that he would “always” fail “every” interview and “never” succeed.
- The words “every”, “never” and “always” are often mentioned in overgeneralized statements. This kind of negative self-talk leads to poor self-esteem and high anxiety levels in an individual.
- Jumping to Conclusions: Jumping to conclusions refers to making a decision about someone or a situation without considering all the facts and evidence. For e.g. statements like “All men are unfaithful”, “She hates me because I am a good student” are examples of this distortion.
This kind of distortion, negatively impacts the individual’s relationships, causing him/her to be isolated from others. Also, the mental strain of judging situations and people tends to take a toll on one’s mind causing an individual to become more anxious and susceptible.
- Catastrophizing / Magnifying or Minimizing: Also known as the binocular trick, this distortion refers to an individual’s tendency to blow things out of proportion by expecting the worst to happen. For e.g. the individual may make a small mistake in their exams and conclude that they should quit school. The other extreme form of this distortion is minimizing one’s positive characteristics or overlooking another’s imperfections.
The best example that can be quoted for this situation is when an individual is in an abusive relationship. The abused tends to completely minimize their self-worth and overlook their abuser’s imperfections. This distortion leads to wrong decision making eventually leading to high anxiety levels.
- Personalization: Personalization occurs when an individual holds themselves unreasonably responsible for the occurrence of an unpleasant event. They may believe that it is either something they have done or have not done that has led to the happening of the event. For e.g. A woman may believe that she had an extremely bad day because she walked out of the front door instead of using the back door. This distortion causes an individual to get worked up about a lot of unrealistic things thereby increasing their levels of anxiety.
- Control Fallacies: Human beings like to have a sense of control over what is happening in their lives. Sometimes things happen in our life which is beyond our control. In this distortion, however an individual may have the mistaken belief that either he/she is solely in control of other’s happiness and sense of well-being. Or, that others are responsible and in control of their happiness.
The individual either burn themselves out with unrealistic efforts trying to make others happy or are filled with extreme resentment about others not doing enough to keep them happy. These unrealistic demands both from oneself and from others greatly enhance one’s anxiety levels.
- Fallacy of Change: The unrealistic belief that others should act in accordance to one’s wish and fancy is called the fallacy of change. This distortion is a source of unpleasantness both in the individual’s life as well as in the lives of the significant people around him/her.
- Fallacy of Fairness: Life is not fair at all times and what seems fair to one person may seem very unfair to the other. An individual suffering from this distortion may find it very hard to accept this fact. This, in turn, may cause feelings of resentment and despair, causing the individual to suffer from anxiety.
- Heaven’s reward fallacy: This fallacy refers to the distortion where an individual believes that all their sacrifice, self-denial and righteous actions are being watched by a higher power and will be rewarded for eventually. A sense of despair and unhappiness seeps in when the rewards don’t come thus making the person very anxious.
- Should or Should Not’s: This distortion is characterized by statements of “Should and Should not’s” which are internalized rules that govern the individual’s behavior. If the individual goes against them they are plagued with guilt and if others go against them the individual experiences annoyance and resentment. This irrational thinking is a great source of anxiety for the individual.
- Emotional Reasoning: This distortion causes the individual to believe that what he/she is feeling is the absolute truth. This irrational belief system causes them to experience increased feelings of anxiety and unworthiness. For e.g., If a woman feels ugly and disinteresting she may believe that she is truly unattractive and not worthy of being admired.
- Global Labelling/Mislabeling: This distortion is a form of false thinking wherein an individual has a tendency to exaggerate, generalize and label themselves, situations or other people without knowing the entire truth. This kind of thinking leads to a lot of prejudice, misunderstanding and can be a cause of unhappiness in the person’s life thus leading to a lot of anxiety.
- Always being Right: In this distortion the individual considers themselves to be always right. They can go to any extent to prove their point. This kind of thinking can be tiring and can be considered selfish and narcissistic. It causes a lot of mental strain on the individual as they are continually trying to prove themselves.
- Blaming: Anxiety builds up in an individual due to this distortion because they tend to believe that others are to blame for their unhappiness. They don’t feel the need to take responsibility for their happiness and suffer from discontentment.
Individuals suffering from the above-mentioned distortions consider their false beliefs to be real and the absolute truth of their lives. This causes them to suffer from anxiety and various other mental disorders.
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Cognitive behavioral therapy exercises for anxiety is an excellent method to help these individuals as the therapy uses positive self-talk, reasoning and the following mentioned techniques to help alter an individual’s distortions.
Therapy methods can be classified into the following types
- WRITING THERAPY
- Journaling: Journaling therapy is an important form of writing therapy. It requires the individual to honestly write down his/her thought processes, feelings and emotions. The individual has to describe why they are feeling a particular way and write a detailed description of the intensity of their thoughts and emotions. This therapy exercise helps the individual be aware of the sources and triggers of anxiety and identify ways they can cope with them.
- Pleasant Activity Scheduling: This writing activity can be done with/without the help of a therapist. This activity requires the client to write down at least one activity per day that they would engage in throughout the next week. Writing down these activities gives the individual a sense of accomplishment and brings about more positivity in their day.
- Situation Exposure Hierarchies: This therapeutic exercise requires an individual to write down situations that stress them out and increase their anxiety. The individual then is required to rate the level of distress (on a scale of 0-10) they feel with regards to each situation. Once the situations are rated, the individual is asked to rank them in accordance with their distress rating.
This gives the individual an idea about the issues they need to address first. This writing technique is used when an individual is unsure about what causes them so much anxiety.
- Writing down Self Statements: This writing therapy requires an individual to write down counteractive statements to the negative thoughts they think. This therapy helps the individual to overcome negative thought patterns with positive affirmations. For e.g. an individual who feels useless can think “I am an intelligent and creative being”.
- Alternative Action Formulation: This therapy technique is used by a therapist to guide their client through anxiety treatment and understand the rationality behind their thoughts. This therapy form is administered in the form of a worksheet wherein the client has to:
- Firstly, make a note of all their problems
- Identify the reasons why they and not others are prone to suffer from these problems
- Thirdly, make a note of the ways they can cope with these problems
- Then assess the long-term effectiveness of these coping strategies and
- Finally, the client is asked to note down alternative ways to follow through in case the coping strategies don’t work.
- Functional Analysis: Also, known as the ABC model, this worksheet helps the client identify negative behaviors that are ruining their life and come up with solutions to modify them. The worksheet is categorized under three headings-
- Antecedents: Under this heading, the client is required to make note of all the factors that led up to the “Behavior that requires to be changed”
- Behaviors: Under this heading, the client has to write down all the behaviors that needs to be changed and why they need to be changed.
- Consequences: Here the client has to write about the consequences of the questioned behavior and how it is affecting their life.
- Longitudinal Formation: This detailed worksheet addresses 5P’s- these are factors which are described below that help an individual get a good understanding of their core beliefs, thought patterns and present behavior. The client needs to accurately fill in the information under each factor
- Presenting: Events that lead to the undesired behavior
- Predisposing: All experiences from childhood that led to the behavior.
- Precipitating: Beliefs they have about this behavior
- Perpetuating: Internal rules they adhere to when thinking or behaving.
- Positives: The results whether positive or negative when they behave in accordance with their internal rules.
The client then has to continue to introspect and write down the following information
- Behavior and Feelings: The client is required to think of a situation that brings about negative thoughts and note down the behavior, feelings and physical reactions it brought out.
- Protective Factors: The client is then required to list down ways that can help them deal with their negative thoughts and behaviors.
- New Rules for Living: Finally, the client has to make a list of new rules for themselves that will help them break the cycle of negativity and lead a better life.
- Dysfunctional Thought Record: This worksheet is used by a therapist to help a client who suffers obsessively from negative thoughts. This worksheet is divided into seven columns where the client is required to write down the following:
- Date and time the thought arose
- The situation that led to it
- The thought that came up
- The emotional reaction that followed
- The client needs to identify their false belief and thoughts with a type of cognitive distortion (that has been described above).
- Write down alternative thoughts that can replace the irrational thoughts.
- And finally, the outcome of this exercise.
- Fact or Opinion: This worksheet is used by the therapist to help their client distinguish facts from their own beliefs. The therapist helps the client understand the difference by challenging the client’s beliefs against the truth. This worksheet consists of 16 statements that the client has to distinguish as fact or opinion.
- Cognitive restructuring: This worksheet based therapeutic technique helps an individual suffering from irrational thoughts, challenge and question their thoughts. The client is required to note down the “Thoughts to be questioned”, and write down evidence for and against these thoughts, the client then has to identify if these thoughts are facts or judgments.
Next, the client has to distinguish if it is an absolute truth or if there is an area of grey in between. Finally, the client has to decide if the thought is valid or if it is just an assumption. This therapeutic technique can also be done in the form of verbal exchange between the therapist and client also.
- EXPOSURE THERAPY
- Exposure and Response Prevention: In this therapy, the client is exposed to a certain situation that tends to trigger an obsessive behavior. The client is then encouraged to control themselves and not react to the situation and write about how they feel. This therapy is very useful for individuals suffering from Obsessive Compulsive Disorder.
- Interoceptive Exposure: This therapy technique involves exposing the client to feared bodily sensations similar to those experienced during panic and anxiety attacks. The fear of experiencing these symptoms causes the individual who suffers from them to become withdrawn and isolated. The reason this is done is to help the client overcome their fears and be better equipped when in a similar situation.
- Nightmare exposure and rescripting: This therapy technique is useful for those individuals who tend to suffer from recurrent nightmares. This therapy requires the client to discuss their nightmares and the negative emotions associated with it. The therapist then discusses alternative and positive images to accompany the dreaded emotions, thus reducing the fearfulness associated with the nightmares.
- Visualizing Therapy
- Play the script till the end: This therapeutic technique is used when an individual is suffering from crippling fear or extreme anxiety. The individual is asked to visualize or imagine the situation that causes them extreme anxiety and play it out in their heads from start to end. This helps the client understand that no matter what happens they will turn out to be fine. This constant visualization desensitizes them slowly to the negative emotions and helps them overcome their anxiety.
- Thought Records: This therapy technique according to Boyes, applies the use of logic to ward of unreasonable negative thoughts and replace them with more balanced and rational thoughts.
- Imagery Based Exposure: In this therapy technique the client is asked to call to mind a recent memory that produced strong negative emotions and analyze the situation. The client is asked to think about “what happened”, “what they felt”, “how they felt like reacting to the negativity” and label the various emotions they experienced. This is done repeatedly until the situation no longer has the power to trigger negative emotions.
- BEHAVIOR THERAPY
- Meditation: In this therapeutic technique the individual is guided to consciously, turn their attention from distracting thoughts and feelings and focus on the present moment. According to researchers, this therapy form is a great way to reduce anxiety.
- Deep Breathing: This therapy technique can be closely associated with mindful meditation wherein the client is asked to focus on taking deep and relaxed breaths. Focusing on one’s breathing helps take the attention away from one’s anxious thoughts, thus helping the individual experience a sense of calm and balance.
- Behavior Experiments: According to psychologist Boyes, behavior experiments are a therapeutic technique wherein the client actually tests the “what ifs” practically outside their thoughts. For e.g. A person who feels anxious to sing publicly can tell themselves “If I sing everyone will think I sound bad vs If I sing everyone will think I have a good voice.” By witnessing the outcome, the individual gets to understand the rationality of their thoughts.
The above mentioned cognitive behavioral therapy exercises for anxiety help a client achieve positive behavioral goals when practiced faithfully. Each session lasts about an hour and the treatment regimen varies anywhere from five to ten months.
Anxiety is not a disease but a mental condition which can be effectively resolved with the help of a therapist. If you find yourself suffering from the above-mentioned distortions do not hesitate to seek help.