CBT

Cognitive Behavioral Therapy (CBT) refers to widely recognized, effective psychological treatments for treating many psychological disorders and, more specifically, is very effective for anxiety disorder treatment. Firmly based on scientific evidence, CBT focuses on the ways that a person’s thoughts, emotions, and behaviors are connected and affect one another. The CBT therapist and the client work together with a mutual understanding that the therapist has theoretical and technical expertise, but the client is the expert on him- or herself. The therapist seeks to help the client discover that he/she is powerful and capable of choosing positive thoughts and behaviors.

(Adapted, by permission, from the Association of Behavioral and Cognitive Therapy website, 2017.)

Our thoughts influence our feelings and actions.

Brief CBT Self-Help for Anxiety, Panic, and Overworry

You might wish to try out CBT as self-help if you don’t feel able or ready yet to engage in therapy but are determined to do what you can to overcome disturbing anxiety and worry.  CBT is most effective and precise when executed through dialogue with a skilled therapist with expertise in CBT, but people often find they can benefit from self-help cognitive therapy and behavioral interventions (like focus on the breath) implemented as self-help. If you would like a taste of CBT perhaps you’d like to begin here.

For more information on CBT, or to make an appointment, call David Mellinger, MSW at 818-716-1695.

This brief self-help protocol is designed to help you reduce disturbing anxiety enough to feel free from its grip. Try to follow this protocol faithfully.

You’ll learn select procedures of decentering, cognitive reappraisal, and overcoming sticky thinking.  Decentering is a mindfulness- and acceptance-based CBT technique for enabling a person to “step outside of his or her anxious thoughts and feelings enough to see them as just coming and going, rather than getting carried away by them.”  (Goleman & Davidson, 2017, pp. 196-197).

Anxiety is both driven by disturbing, irrational thoughts and perpetuated by getting you caught up in these thoughts and anxious feelings.  Cognitive reappraisal techniques will help you notice, identify, and remedy errors in your thinking that contribute to your anxiety – like over-generalization (e.g., “I almost had heat stroke once, so I’m too afraid to go out whenever it’s very hot.”) and catastrophic thinking (e.g., “I keep getting headaches lately. What if I have brain cancer?”). The brief acceptance- and mindfulness-based CBT procedures will help untangle you from the sticky thinking and feelings that keep you caught up in a state of anxiety.

What Can Improve?  By following the protocol – acknowledging when you’ve become anxious and pressing the pause button on your upwardly spiraling anxiety – you may discover that nothing really bad is about to happen and expand your awareness of what’s actually going on. Brief, mindful breathing will help you settle your state of mind and abide in the here and now [Mellinger (2017), FTAW Anxiety Workshop].  Clearing the tangle of your anxiety-laden thoughts by taking these steps is like disconnecting the main power from an old house with seriously short-circuited wiring:  It opens a window of opportunity to rethink scary thoughts more clearly and less fearfully.  Then you can cope well enough and decide what’s best to do next. Here’s how you do it:

The “A.P.A. Protocol”

  • Acknowledge when you’re anxious, worried, or panicky.
  • Check your anxiety in the here and now.
  • Press the Pause Button.

Abide:  Stay with the disturbing feeling.

  • Engage in brief, mindful breathing.
  • Remedy distinct thinking errors.
  • Practice Resilience.

1. Acknowledge

First, acknowledge that you’re feeling worried or anxious. “Acknowledging” means “letting yourself know,” and knowledge is a powerful antidote to fear.

Whenever you’re feeling any form of disturbing anxiety – worry, self-blame, fear of an anxiety attack, a disheartening thought or feeling – simply acknowledge it with a quiet “mental” voice and label it with a simple label, such as “worrying myself sick”, “panic”, ‘’what-if’ thinking“, “dwelling”, or “beating myself up.”

2. Check your anxiety.
Now ask yourself whether there’s really anything to be afraid of right now. Answer either “yes” or “no”.If there seems to be no reason to fear, perhaps what you’ve already accomplished is good enough.If you find you’re still anxious or afraid, then move on to the next step. Try not to get caught up. No need to overthink it.

3. Pause

Next, press the “mental pause button”:

Pause whatever anxiety-driven story or imagining has been going through your mind and, for a few moments, suspend your catastrophic thinking or chaotic, panicky thoughts.  A useful visual aid is to look at two fingers that you hold up vertically, parallel to each other – replicating the “Pause Button” symbol in your electronic devices.

     This “therapeutic pause” enables you to put on hold the momentum of pressurized anxiety. Stop in your tracks, briefly explore your feelings, and allow the higher-functioning, executive portions of your brain to re-engage in making better sense of things.

4. Engage in Brief, Mindful Breathing

After pausing, as above, and intentionally interrupting the nonstop flow of your thoughts and behaviors, “stop for a few seconds, take three conscious breaths, and move on. . . [Perhaps say “in” to yourself in a quiet mental voice when you breathe in and “out” to yourself when you breathe out.]. Pause and allow this interlude to be a gap in whatever you’re doing.  Don’t make it into a project.” [adapted from Pema Chödrön (2009), Taking the Leap.]

The purpose of this brief practice is to create a momentary contrast between being completely self-absorbed and being awake and present.  Practice as often as possible, preferably numerous times a day.

mindful breathingPhoto credits: “Beach at Night with Moon and Stars” – Ko Li Pe, Thailand. Photo by Piith Hant, 16 April 2013

Brief, mindful breathing is the informal practice of concentration on the breath (COYB), a traditional practice often known as samatha (from the Sanskrit).  Formal practice of COYB is a cognitive and behavioral strategy for enhancing our capacity for helpful action to work with disturbing feelings.  It trains us to bring our attention to the here and now, steadies our minds, and enhances our awareness when entering or exiting emotionally charged situations.  I encourage you to consider formally practicing COYB, because it’s likely to enhance the effectiveness of your brief cognitive-behavioral therapy as self-help. Click here to learn the formal practice of Concentration on Your Breath.

5. Remedy Your Thinking Errors

Don’t believe everything you think:

Thoughts are not facts.

Below are four of the most frequent thinking errors that arise automatically during acute anxiety, panic, and disturbing worry, each with perspectives and remedies for modifying them and relieving your anxiety.  Why not study these errors and – as soon as you recognize they’re occurring – try out the remedies? You may find you have the power and skill to choose sensible thoughts over irrational, negative thoughts and gain the upper hand over anxiety.

Common Thinking Errors and Their Remedies

  1. Dwelling on false solutions to important problems – “If I were better looking, I’d attract someone, and I wouldn’t be alone.” The more we dwell, the more real a notion seems, regardless of whether it’s rational. In this example, the reality of the matter is far more bittersweet and nuanced: Neither beauty, handsomeness, nor cosmetic surgery can curtail aloneness.
  2. All or Nothing Thinking – “It’s all my fault” is a classic all-or-nothing statement that illustrates looking at things in absolute, black-and-white categories. Your performance was totally good or totally bad; if you are not perfect, then you are a failure. This thinking error does not recognize shades of gray, only black or white.  We always, or at least very often, share only a portion of both the blame and the credit with others.
  4. Remedy this error by honestly evaluating the negativity of your actions on a range from 0 to 100; recalling any              neutral and positive actions, and then taking a few moments to correct your perspective (from David D. Burns, The Feeling Good Handbook. New York: Penguin, 1989.)

     3. Catastrophizing – Catastrophizing is the essence of disturbing anxiety – potent, irrational thinking that arises           “automatically” when our vital concerns or values seem jeopardized. Catastrophic thinking can make us feel like            major upheavals or personal disasters are in the works and activate our instinctive “fight, flight, or freeze”                      reaction – despite the absence of solid evidence that a catastrophe actually will  Ask yourself earnestly “Where’s            the evidence?”

    4. Wild Ride in the Mental Time Machine – Much anxious disturbance involves irrational fear of future plans           and events. When we travel through time in our thoughts, it’s very easy to have wrong emotional reactions when           we aren’t in the Here and Now. Deliberately return yourself to the present. Breathe in, pay attention, breathe                 out, pay attention – gather yourself and experience this moment mindfully. For now, just acknowledge and                     accept what really is.  This isn’t a time to judge yourself.

6. Practice Resilience: Proceed in a Valued Direction

Resilience entails intentionally allowing yourself to bounce back from emotional distress. By doing so, you may discover that you feel safer, get your footing, and realize you can move forward.  Once you’ve acknowledged the anxiety, engaged in brief, mindful breathing, and remedied your anxiety-generated thinking errors, you may know that you’re back! – feeling good with yourself, ready to go ahead. The final step of this strategy is to form the intention to progress in a direction you care about or value, and then –

Proceed in a valued direction.

What would you like to do that would really matter right after you gain the upper hand over strong anxiety, worry, or panic? 

Consider actions you can take in accord with your values – steps that move you away from internal tension or the grip of chaotic feelings.  Make a list of the areas of life that you currently care about deeply or hold close to your heart; remind yourself of the important, valued areas; and decide what you wish to do more of right now, or what would be best to do next.

Has the practice you just completed reduced or relieved your disturbing anxiety?  Having just completed it, to what extent do you feel different, or “back to yourself”? Does this kind of treatment give you more hope of overcoming troubling anxiety, panic, or worry?

If this treatment seems to help, try to utilize it consistently – whenever you feel disturbingly anxious or notice familiar patterns of anxiety disorder – such as when you’re stirred up by intense worry, panicky feelings, or sudden shyness.  After you’ve finished working with yourself, take note or journal about helpful insights, new perspectives, or notably useful ways of coping that would be good to bear in mind.

For more information about CBT and anxiety therapy, or to set up an appointment, call me – David Mellinger, MSW – at 818-716-1695.

Reference List

Association of Behavioral and Cognitive Therapy website (www.abct.org), December 31, 2017.

David D. Burns (1989).  The Feeling Good Handbook. New York, NY:  Penguin Books.

Pema Chödrön (2009). Taking the Leap.  Boston, MA:  Shambala Publications.

David I. Mellinger (2017). Protocol of the FTAW (Fundamentals of Treatment of Anxiety Workshop).

David I. Mellinger & Steven Jay Lynn (2015).  Anxiety Smarts:  Cutting-Edge Strategies for Overcoming Anxiety and Worry.  Unpublished manuscript.