In this set of two articles I will summarize some of the different therapy and treatment approaches that are available for helping people to reduce their anxiety and stress levels. In this article we will mostly focus on cognitive and behavioural therapies for anxiety.
THERAPY AS USUAL
Many therapists primarily focus on either empathic understanding of their clients, or on helping their client’s to gain insight into where their patterns come from in their history. Many therapists combine empathy and insight in their sessions. While empathy and insight are probably important elements of all effective therapy, when they are used on their own they may not be enough to help clients to achieve their goals, and at worst could turn into a recipe for endless therapy.
The cognitive and behavioural therapies that I will review in this article were developed out of a frustration with the limited benefits that most people get out of talk therapy, instead wanting to give practical solutions to clients’ struggles. In contrast to the focus on empathy and insight that happens with most therapists, from a cognitive and behavioural therapy perspective, therapy is a process of education where the client learns about the power of their habitual unconscious thoughts and actions, and learns alternative ways to think and act that pragmatically address their identified problems and goals.
COGNITIVE THERAPY FOR ANXIETY TREATMENT
Cognitive therapy believes that anxiety and other symptoms are caused by irrational and/or unhealthy thoughts. Treatment sessions focus on helping to bring insight into what these negative thought processes are, how they negatively impact the person, and then work to develop alternative healthy and realistic thoughts for the person to consciously practise so they feel better.
To see this therapy in action, let’s use the example of a client suffering from social anxiety. They mostly stay to themselves, avoid social situations, do not feel comfortable sharing openly about themselves, and avoid interpersonal conflict. However they are suffering from depression, severe isolation, and they cannot form satisfying long term relationships.
A cognitive therapist would help the client to examine their thoughts and beliefs on the issue. They might discover that the client has such thoughts as: “People don’t like me”, and “If I share something personal or vulnerable, people will judge me”, “I cannot speak up or assert myself”, and even worse, “I’m not lovable.” The cognitive therapist would encourage the client to challenge these unrealistic thoughts, and instead consciously focus on healthy realistic thoughts such as “Some people will like me, some people will not like me”, “It’s important for me to share personal or vulnerable things to the right people”, “I can learn to speak up for myself”, and “Some people will love me”.
After going through this process in session, the client would then practise this in their daily life. They would identify when the old unhealthy and unrealistic thoughts occur, challenge the truth of those thoughts, and consciously bring in their newly identified healthy thoughts. Though the repetition of this process the cognitive therapist would hope to see these different thoughts and beliefs decreasing their social anxiety and increasing their social behaviour.
Key Takeaways of Cognitive Therapy for Anxiety Treatment:
- based on the assumption that our thoughts create our feelings.
- develops alternative healthy and realistic thoughts that decrease anxiety.
- the client consciously practises this in their daily lives until it becomes an automatic habit.
BEHAVIOURAL & EXPOSURE THERAPY FOR ANXIETY TREATMENT
Behavioural therapy is about the observable actions and things we do. One of the basic skills taught in behavioural therapy for anxiety is diaphragmatic breathing. Deep slow breaths into our belly area reliably helps reduce anxiety and relax the body.
Another key component of behavioural therapy is “exposure therapy”. When we are anxious about something, we tend to avoid it. All of us are drawn to comfort, and with many things in our lives we unconsciously turn away from what is uncomfortable and challenging and instead move towards what is familiar and easy. But the problem is that when we avoid something, our anxiety about it gets worse, which then fuels greater avoidance. In this way, when anxiety is paired with avoidance it becomes a vicious circle that is hard to escape.
From a behavioural therapy perspective it is normal to feel anxiety about what is unfamiliar to us. However if we are able to break the pattern of avoidance and instead face the fears and challenges in our lives, we will inevitably become less and less anxious about them. So the starting point in exposure therapy is to help the client to identify the people, places, actions, and activities that they feel anxious about. After these are identified, they will create a step by step action plan that helps them to progressively address these and overcome their fears. Just as when you are teaching a person who cannot swim you do not throw them in the deep end right away, so too the behavioural therapist breaks the larger goal down into smaller doable steps. The person needs to start out with just dipping their toes in the water, before progressing to the next doable step. It is through mastering each of these smaller micro-goals, that the client gains confidence in their ability to create the changes they want in their life.
So let’s go back to our above example with a client who has social anxiety problems. The behavioural therapist’s first step would likely be to teach diaphragmatic breathing to the client, and for the client to practise this until it became a habit. Then exposure therapy would identify the social situations that the client normally avoids and instead have them start progressively exposing themselves to them. As the client was in these situations, important behaviours like sharing personal information about themselves or speaking up assertively would be progressively practised.
Key Takeaways of Behavioural & Exposure Therapy for Anxiety Treatment:
- diaphragmatic breathing is taught and then practised by the client until it becomes a habitual coping strategy
- avoidance of anxiety triggers makes anxiety worse. We need to face our fears to overcome them. This is the essence of exposure therapy.
- a list of the people, places, actions, and activities that the client avoids would be identified, with special attention on the avoidance behaviours that fuel the client’s symptoms.
- a step by step action plan would be created for the client to progressively expose themselves to the things they avoid.
- as the client summons the courage to face their triggers, they not only become less anxious about them, but they also develop increased confidence in themselves. This growing sense of mastery and self-confidence further fuels their motivation to expose themselves to progressively more challenging situations.
COGNITIVE BEHAVIOURAL THERAPY FOR ANXIETY TREATMENT
Cognitive Behavioural Therapy is the integration of the 2 above approaches, and is a very common approach that therapists use for Anxiety Treatment. So in this integrated approach, the client would be challenging their old unrealistic thoughts and beliefs, consciously focusing on their realistic beliefs about assertiveness, practise diaphragmatic breathing when their anxiety gets too high, and exposing themselves to progressively more challenging situations.
TOP-DOWN vs BOTTOM UP APPROACHES TO ANXIETY TREATMENT
There can be a lot of practical value in CBT, but sometimes clients feel chronic anxiety despite their best efforts as a client. CBT emphasizes the power of our conscious mind to change our unconscious patterns and physiological symptoms such as anxiety and stress. This is referred to as a “Top Down” therapy approach that relies on the power of our conscious mind to change our unconscious patterns.
While some clients benefit greatly from top down therapy approaches like CBT, for others their anxiety symptoms continue despite their best efforts. In response to the significant number of people with anxiety who do not achieve their goals through CBT, clinicians and researchers have developed other treatment models. These newer approaches to anxiety treatment focus on a “Bottom Up” approach that sees anxiety as being driven by deeper physiological causes that must be the focus of therapy. We will review 2 highly effective “Bottom Up” approaches – Somatic Therapy and Neurofeedback – in part 2 to this article.
BRAIN SHIFT ANXIETY & STRESS TREATMENTS
VANCOUVER, BC, CANADA
At BrainShift we integrate multiple different treatment approaches to get the best results in effectively lowering your anxiety, stress, trauma/PTSD, and other symptoms. If you live in or near Vancouver, BC, Canada, and want to move your life to the next level, contact us for more information about how we can help you.