CBT for Anxiety: How It Works & Examples

How Does CBT Treat Anxiety?

CBT treats anxiety by helping people make changes to the way they think and behave when they feel anxious. CBT aims to help people interrupt and change the worried thoughts that feed into anxiety, while also helping to reduce avoidant behaviors. Together, these changes help reduce anxiety without the use of medication, and lessen the impact of anxiety day-to-day.^2,4,5

CBT treatment is usually provided in hour-long therapy sessions, where a therapist helps you learn skills to manage your symptoms and develop healthy habits.

How Is CBT for Anxiety Different From Other Forms of Therapy?

Most people have an image of therapy that involves a patient lying on a couch and talking about their childhood. The therapist asks them “how do you feel about that?” such as in psychodynamic or psychoanalytic therapy. CBT for anxiety stands apart from other therapy for anxiety because it’s short-term, focuses on the present instead of the past, and you’ll practice what you learn outside of sessions.

What Anxiety Disorders Can CBT Treat?

CBT is effective in treating several types of anxiety disorders.^2,4 In fact, CBT is the most common choice for anxiety treatment as no other therapy has as much research supporting its effectiveness.

CBT is effective in treating anxiety disorders like:

• Generalized anxiety disorder
• Panic disorder
• Specific phobias
• Social anxiety disorder
• Noise sensitivity anxiety

CBT is also used to treat other disorders which have anxiety as a common symptom like obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).

10 Common CBT Techniques for Anxiety

CBT techniques for anxiety focus on teaching skills that help you replace your negative thoughts and behavior patterns with other, more helpful patterns. Not every technique works for everyone, so you may need to try several until you find one that works for you. We’ve included a free CBT for anxiety worksheet to help you get started.

Here are ten common CBT techniques used to treat anxiety symptoms:^2,4,5,8

1. Reframing Thoughts

Reframing, or cognitive restructuring, is a skill that involves interrupting an unhelpful thought and then trying to rethink it in a more helpful way. For example, a person could reframe an anxious thought about an upcoming doctor’s appointment by thinking about the ways it could benefit their health.

Reframing can help people adjust their thoughts in ways that reduce anxiety and lead to more effective responses. Reframing works by helping to introduce more rational thinking patterns during times when a person’s thinking has become overly emotional.^1,6,9

2. Anxiety Psychoeducation

CBT provides a level of psychoeducation to help you understand your particular anxiety disorder, how symptoms form, how they are maintained, and the proposed course of action. This phase of treatment could take a few minutes during your first session, or expand to cover a few sessions, depending on the complexity of the situation and your level of understanding about your anxiety.

3. Pattern Tracking

Pattern tracking is used to help recognize negative thought patterns and behaviors. When you can recognize the pattern, you can take steps to reduce symptoms and improve functioning by changing those thoughts and behavior patterns.^7,9,10

CBT pattern tracking exercises might include keeping a log to track your:^1,9

• Thoughts: What thoughts do you have throughout the day? What thoughts do you have during times of stress or anxiety (e.g.,  any “what-if” thoughts that increase anxiety)
• Emotions: Tracking the experience and the intensity of these emotions (e.g., slight nervousness vs complete panic)
• Behaviors: Tracking behaviors and responses when anxious, and any consequences or rewards these behaviors lead to (e.g.,  noticing avoidance relieves short term anxiety but increases long term anxiety)
• External or internal circumstances that cause specific thoughts, feelings, and responses (e.g.,  anxiety triggered by certain social situations or when thinking about the unknown)

4. Thought Stopping

When you have developed an awareness of your thought and behavior patterns, your CBT therapist may begin to teach specific skills to interrupt and replace some of those patterns. Thought stopping is a skill that involves using a verbal or visual mental command when experiencing unhelpful thoughts. This may be the word “Stop” or “No,” or imagining an image of a stop sign when a person begins replaying an embarrassing moment or worrying about something that hasn’t happened yet.⁹

5. Challenging Thoughts

Challenging thoughts involves testing the accuracy of a thought through rational processes like listing evidence that the thought is true or untrue, or considering other viable explanations. Challenging anxious thoughts can reduce anxiety and also reduce irrational and impulsive decisions during times of stress or worry.

For instance, listing the evidence for and against a certain belief or assumption is a common CBT method of challenging irrational thoughts. This skill can help people recognize when their thoughts might be distorted because of their anxiety, instead of automatically believing they are true.^6,9

6. Exposure Tasks

Because anxious people tend to avoid situations that make them anxious, exposure tasks are often recommended to limit avoidance, reduce anxiety, and build confidence. Exposure tasks involve gradually facing feared situations and building up to more intensely feared and avoided situations.^6,9

For example, a person afraid of public speaking might start by practicing a speech in front of one or two friends and progress to speaking to a small group at work. CBT therapists also teach clients relaxation skills (like deep breathing or muscle relaxation) to prepare for these exposures. Exposures work by helping people gain confidence in their ability to face their fears, while also developing the skills to better manage their anxiety.¹⁰

7. Problem Solving

In problem solving exercises, a therapist will encourage you to think through your options and evaluate the potential short- and long-term consequences of each scenario. Because many anxiety-driven behaviors are focused only on finding short-term relief, problem solving skills are needed to help you learn to make better decisions.

For instance, canceling plans might be tempting for someone with social anxiety because it would mean avoiding an uncomfortable situation, but it can lead to isolation, depression, and even more social anxiety in the long run. Using a problem solving approach could identify these consequences ahead of time, helping a person avoid making a poor choice in the moment.

8. Behavioral Activation

Anxiety tends to make people less active. People may think that doing less and avoiding their problems lowers anxiety, but it actually increases symptoms. Therefore, a therapist will encourage you to go places, do things, and engage with others to lessen the impact of anxiety.

9. Relaxation Skills

Exposure and behavioral activation activities will induce higher levels of anxiety in the short-term. Learning and using relaxing anxiety exercises can help to cushion the impact of anxiety and decrease symptoms sooner and more efficiently.

10. Journaling

Your therapist might ask you to journal your thoughts, feelings, and behaviors. The process can help you understand yourself and your experience, and it can also help the therapist better understand your point-of-view. Using anxiety journaling prompts can be a great way to start tracking your symptoms and understand what may be the underlying triggers associated with your anxiety symptoms.

Examples of How CBT Reduces Anxious Thoughts

CBT describes anxious thoughts as “thought distortions” or “negative automatic thoughts.” Examples of thought distortions might include things like “worst-case scenario” or “what if…” thoughts that many people ruminate on when they feel anxious.^2,4,5,6,7 Here’s how CBT interventions can help reduce common anxious thought patterns:^8,9

Magnification

Magnification is overfocusing or giving too much attention to an unimportant detail, or to something that is unlikely to happen.

• Example of magnification: Focusing on one small mistake you made in an hour long presentation.
• CBT intervention for magnification: Zooming out to focus on the big picture, or to notice other, positive parts of the presentation, which can help to reframe negative thoughts about the presentation.

Fortune Telling

Fortune telling is making predictions about the future without having sufficient information or evidence.

• Example of fortune telling: Believing that a blind date will be painfully awkward or uncomfortable without knowing or meeting the person.
• CBT intervention for fortune telling: Imagining positive outcomes or interactions for the date or use mindfulness to bring your attention to the present, instead of focusing on the future.

Mind Reading

Mind reading includes thoughts that assume knowledge about what another person thinks or feels, or what their motives were for a certain choice.

• Example of mind reading: Believing that a friend didn’t call you back because they are mad at you and don’t want to be friends anymore.
• CBT intervention for mind reading: Considering alternative, less personal, reasons for why they didn’t return your call (i.e. they were busy, forgot, etc.)

Comparisons

Comparisons involve unhelpful comparisons a person makes between themselves and others that make them feel more insecure, inadequate or anxious.

• Example of comparisons: Comparing yourself at work to someone who has been doing the job for five years longer, and feeling like a failure as a result.
• CBT intervention for comparison: Imagining a stop sign in your mind when you catch yourself making unhelpful comparisons, and working to refocus your attention to other thoughts when this happens.

Emotional Reasoning

Emotional reasoning is the tendency to believe something is true or will be true simply because of an emotion a person has.

• Example of emotional reasoning: Becoming convinced that a meeting will go poorly simply because you are dreading it.
• CBT intervention for emotional reasoning: Monitoring and tracking your anxious thoughts by writing them down in a log, which will help you become more aware of this distortion.

Filtering

Filtering occurs when a person discounts and ignores certain information that doesn’t fit with other thoughts, beliefs, or feelings.

• Example of filtering: Believing that others don’t like you and discounting the many friends and family members that love you, and also the people you’ve had positive interactions with.
• CBT intervention for filtering: Listing all of the “evidence” that supports the belief that people don’t like you, as well as the evidence that conflicts with this belief can help you challenge irrational thoughts and beliefs.

Examples of How CBT Reduces Problematic Behaviors

CBT therapists also help people identify behavior patterns that may be causing anxiety or making their problems worse. Problematic behaviors are identified by evaluating both the short and long-term consequences of a given behavior. Often, problem behaviors reduce anxiety in the short-term (by providing immediate relief) but increase it in the long-term, while also creating other unwanted consequences.

Here are some CBT interventions for reducing problematic behavior patterns:

Avoidance

Avoidance coping, or avoiding situations, places, or things that trigger anxiety, can offer short-term relief for anxiety, but tends to make symptoms worse in the long-term. CBT can be quite helpful for social anxiety and social phobias.

• Example of avoidance behaviors: Canceling plans with friends because of feeling anxious or insecure about rejection.
• CBT intervention for avoidance: CBT often uses exposure therapy to encourage anxious people to gradually face their fears, while also teaching them relaxation skills to manage their anxiety.

Control

Anxious people sometimes resort to controlling strategies to manage their anxiety and help them feel more secure when uncertain.

• Example of control behaviors: Needing to follow a rigid routine or schedule when stressed or anxious in order to feel more in control and less anxious.
• CBT intervention for control: a CBT therapist might encourage a person to change their routine or schedule in small ways as a form of exposure therapy. Over time, this can help them feel more confident in their ability to adapt to change.

Distraction

Distraction involves doing or focusing on things in order to avoid anxious thoughts or feelings.

• Example of distraction: Needing to keep the TV or radio on in the background to avoid the anxious thoughts that pop up during quiet times.
• CBT intervention for distraction: CBT teaches alternative skills that can be used instead of distraction, including skills to help them interrupt, challenge, and change anxious thoughts into ones that help them feel calmer.

Projection

Projection involves redirecting anxiety or other emotions outward to another person or situation.

• Example of projection: Snapping at your partner because of feeling anxious and on-edge about a big project at work.
• CBT interventions for projection: CBT would encourage a person to identify the real trigger or cause of the emotions, and to deal with this head-on by examining the specific thoughts and fears feeding into the anxiety. A CBT therapist might also help the person challenge these thoughts or come up with actionable steps they can take to successfully complete the project.

Procrastination

Procrastination involves delaying or putting off a task because of anxiety.

• Example of procrastination: Waiting until the night before a big project is due before starting on it.
• CBT interventions for procrastination: A CBT therapist might help a person identify procrastination patterns, when and where they are most likely to show up, and how to resist urges to procrastinate. For example, a person might be encouraged to break the task up into smaller parts that are easier to complete, instead of doing the whole task at once.

Types of CBT for Anxiety Disorders

Depending on the specific type of anxiety disorder a person has and the symptoms they experience, a slightly different form of CBT treatment may be recommended. Some forms of CBT have broken off to become their own distinct therapies but remain connected to the “family” of CBT treatments, like ERP for OCD or TF-CBT for post-traumatic stress disorder. These subtypes of CBT have been thoroughly researched and found effective for specific types of anxiety disorders.¹

Exposure Therapy for Anxiety

Exposure therapy is a type of CBT therapy for anxiety used to help people reduce avoidant behavior. It involves weekly therapy sessions that usually last 1-2 hours for a total of 9-12 sessions. Exposure therapy is most used with specific phobias (fears) or in situations where avoidance related to anxiety has become problematic.^1,9

As a part of this treatment, therapists first help clients learn relaxation skills. These might include anxiety breathing exercises or mindfulness for anxiety.

Next, therapy would involve exposing the client to some of the triggers that cause mild anxiety, gradually working up to triggers that cause high levels of anxiety. The exposure can happen in real-life (in-vivo exposure), in a person’s imagination (imaginal exposure), or in computer simulations (through virtual reality exposure).

Over time, people become desensitized to their triggers and experience less anxiety when confronted with them. They also develop better coping skills for anxiety that help them stay calm during times when they do experience anxiety.⁹

Because exposure therapy involves facing feared situations, some people do not complete treatment. Those who do, however, usually experience a significant reduction in symptoms.^2,4,6,7

Exposure & Response Prevention for OCD

Exposure and response prevention (ERP) is a specific type of CBT treatment used to treat obsessive-compulsive disorder (OCD). This treatment involves helping people learn skills to experience their obsessions (exposure) without engaging in repetitive compulsions (response prevention). Because compulsions are used by people with OCD to reduce anxious thoughts and feelings, this therapy involves teaching new ways to manage their anxiety.

Similar to exposure therapy, individuals receiving ERP will develop a fear hierarchy to denote low, moderate, and high-level fears. Over the course of several sessions, the person will gradually work their way up to facing high-level fears, developing skills along the way that promote coping. ERP treatment has been researched and found to be one of the most effective methods of treating OCD. It typically consists of weekly sessions lasting 1-2 hours for about 12 weeks.^2,4,6,10

Trauma-Focused CBT

Trauma-focused CBT (TF-CBT) is one of the most effective therapy methods for helping children and teens with post-traumatic stress disorder.^2,4,6 This treatment involves individual, parent, and family therapy sessions and provides a structured approach to helping resolve trauma symptoms.

TF-CBT is delivered over 8-25 sessions, usually offered on a weekly basis. Individual sessions are targeted towards changing unhelpful thoughts (like self-blame) the child may have about the traumatic event and working to find a more helpful framework. Parent sessions are typically focused on helping the parent work through their own reactions so they can support their child, and combined sessions focus on encouraging the parent to model this support.

Early treatment involves a lot of education and skills training, teaching children anxiety coping skills to deal more effectively with difficult thoughts and feelings that traumatic memories trigger. The child or teen works to develop a detailed account of the traumatic memory which is reviewed several times in sessions with the therapist, and later with the caregiver. This trauma narrative helps children process, work through, and heal from the traumatic event.

How Effective Is CBT for Anxiety?

CBT is highly effective in treating anxiety disorders, providing results in as little as 8 sessions. It has decades of research providing evidence that it works.^6,7

Recent research on the effectiveness of CBT for anxiety found:^2,4,6,7

• CBT is considered the leading treatment for anxiety disorders because it has the most evidence to support it works to reduce symptoms in people with generalized anxiety disorder (GAD), panic disorder, specific phobias, and social anxiety disorder.
• CBT for obsessive compulsive disorder (OCD) is effective, especially when exposure and response prevention (a specific kind of CBT) is used.
• CBT for post-traumatic stress disorder (PTSD) has proven to reduce symptoms, especially trauma-focused CBT for children and teens who are experiencing PTSD symptoms.
• CBT for depression and other mood disorders helps challenge depressive thinking patterns and change a person’s feelings to improve their thoughts and behaviors.

Whether you try CBT or another form of anxiety treatment, it’s important to reach out for help when needed. While less than 40% of people with anxiety disorders seek treatment, those who do often experience a significant reduction of their symptoms in as few as eight sessions.³

What Are CBT Sessions Like?

CBT sessions focus on teaching people skills to interrupt and change negative or problematic thoughts and behaviors that feed into mental health problems. Cognitive behavioral therapists use structured sessions to teach specific CBT skills and concepts and encourage the client to apply what they learn in between sessions.^1,2,4

A lot of the session will be spent discussing the thoughts, feelings, and behaviors during the last week and their impact on the present. Part of the session will focus on planning CBT interventions to be used during the coming week.

First CBT Session

The first CBT sessions can cover a lot of details. The CBT therapist will try to learn as much relevant information as possible to gain a thorough understanding of the client, their symptoms, and their goals. They will also outline the expectations of treatment and a proposed course of treatment. All initial therapy sessions should have a discussion about confidentiality, consent, and relevant policies.

Coming Up With a CBT Treatment Plan for Anxiety

You and your therapist will work together to create a CBT treatment plan based on your symptoms and goals. Some therapists will create in-depth written documents and others will simply have a conversation about the plan.

The anxiety treatment plan should include realistic goals with a tentative time frame of completion. It should be modifiable and referred to frequently in sessions.

How to Find CBT Treatment for Anxiety

If you have insurance, a good starting place is asking them to provide you a list of CBT specialists that are in-network. Health insurance will often cover at least part of CBT treatment, either in-person or virtual. There are several online therapy platforms for anxiety available. Online-Therapy.com is an excellent choice that focuses primarily on CBT treatment.

A local therapist directory can also be a good resource for finding CBT therapists near you for in-person or virtual sessions. Most directories have search filters that allow you to narrow your search to therapists who have experience in CBT and treating anxiety.

CBT Exercises for Anxiety to Try at Home

While you should always reach out to a professional if your anxiety interferes with your daily functioning, there are some CBT exercises you can do at home that could be helpful to some people with anxiety. These include activities and skills that focus on becoming more aware of thoughts, feelings, and behaviors, and making changes when those patterns are contributing to anxiety.

Here are some CBT techniques for anxiety that you could try at home:⁹

Become Aware of Your Anxious Thoughts

Make a list of the thoughts that feed your anxiety, the thoughts making it grow bigger and stronger. Become more aware of these thoughts and what situations tend to trigger them. You might use a CBT app or a journal to record these patterns throughout the day, such as the Bloom app.

Evaluate Your Behaviors

Make a list of things that change about your behavior during times when you are anxious and evaluate each, considering whether it is helpful or unhelpful. Remember to consider both the short-term and long-term effects each behavior has. You can also use this model to help you make decisions, thinking through the potential consequences of each option.

Use Positive Affirmations

Write positive affirmations on post-it notes and strategically place them around your home or office. These could be small mantras or phrases that remind you to breathe, take a break, or prompt you to name one thing you are looking forward to.

Talk to Yourself Like a Friend

Self-criticism is a pattern found in many mental health issues, including anxiety. Often, people speak to themselves in ways they would never speak to anyone else. Combat this negative self-talk by talking to yourself in the same way you would talk to an anxious friend during times when your anxiety spikes.

Try an Opposite Action

Because behaviors, thoughts, and feelings are all connected, acting bravely or confidently during times when you are anxious can sometimes make a big difference. This technique is sometimes called “opposite action” and can be used to counteract difficult feelings through behaviors that seem opposite to what you would normally do when you feel this way. For instance, when you feel like self-isolating, finding a way to connect with others (e.g., volunteer work or taking a walk with a friend) may help shift your mood.

CBT Apps for Anxiety

Since CBT offers great results for people dealing with anxiety, many apps have incorporated cbt techniques. You can use CBT apps like Sanvello, Happify or Wysa to help you practice CBT skills and techniques between sessions.