NewAccess is a free and confidential service that provides support in the form of a coach. The program includes six free sessions tailored to your individual needs. NewAccess coaching is only available in some areas nationally. Instead it focuses on encouraging activities that are rewarding, pleasant or give a sense of satisfaction, in an effort to reverse the patterns of avoidance and worry that make anxiety worse.
Behaviour therapy for anxiety relies mainly on a treatment called 'graded exposure'. There are a number of different approaches to exposure therapy, but they're all based on exposing you to the specific things that make you anxious. This experience helps you cope with fearful situations rather than avoiding or escaping them, as well as putting your worry about the situation into perspective.
Most e-therapies teach you to identify and change patterns of thinking and behaviour that might be preventing you from overcoming your anxiety. You work through the program by yourself, and although e-therapies can be used with or without help from a professional, most involve some form of support from a therapist. If you'd like to explore what's on offer and what might work for you, the Australian Government's Head to Health website has a library of online programs.
Sign up below for regular emails filled with information, advice and support for you or your loved ones. You are currently: Home The facts Anxiety Treatments for anxiety Psychological treatments for anxiety. To help with this, your therapist may ask you to keep a diary or write down your thought and behaviour patterns. You and your therapist will analyse your thoughts, feelings and behaviours to work out if they're unrealistic or unhelpful and to determine the effect they have on each other and on you.
Your therapist will be able to help you work out how to change unhelpful thoughts and behaviours. After working out what you can change, your therapist will ask you to practise these changes in your daily life. This may involve:. At each session, you'll discuss with your therapist how you've got on with putting the changes into practice and what it felt like.
Your therapist will be able to make other suggestions to help you. Confronting fears and anxieties can be very difficult. Your therapist will not ask you to do things you do not want to do and will only work at a pace you're comfortable with. During your sessions, your therapist will check you're comfortable with the progress you're making. One of the biggest benefits of CBT is that after your course has finished, you can continue to apply the principles learned to your daily life.
This should make it less likely that your symptoms will return. A number of interactive online tools are now available that allow you to benefit from CBT with minimal or no contact with a therapist. You can see a selection of mental health apps and tools in the NHS apps library. Some people prefer using a computer rather than talking to a therapist about their private feelings. However, you may still benefit from occasional meetings or phone calls with a therapist to guide you and monitor your progress.
Read more about self-help therapies. Page last reviewed: 16 July Next review due: 16 July How it works - Cognitive behavioural therapy CBT. In CBT, problems are broken down into 5 main areas: situations thoughts emotions physical feelings actions CBT is based on the concept of these 5 areas being interconnected and affecting each other. How CBT is different CBT differs from many other psychotherapies because it's: pragmatic — it helps identify specific problems and tries to solve them highly structured — rather than talking freely about your life, you and your therapist discuss specific problems and set goals for you to achieve focused on current problems — it's mainly concerned with how you think and act now rather than attempting to resolve past issues collaborative — your therapist will not tell you what to do; they'll work with you to find solutions to your current difficulties Stopping negative thought cycles There are helpful and unhelpful ways of reacting to a situation, often determined by how you think about them.
In vivo exposure is commonly used for social anxiety disorder eg, participating in social situations without using avoidance or safety behaviors.
Exposure with or without cognitive therapy has been shown to be effective in reducing social anxiety symptoms. However, compared with each other in the same study, cognitive therapy performed better than exposure plus applied relaxation.
In addition, meta-analytic results demonstrated that both cognitive and exposure therapy performed better than applied relaxation or waitlist control in treating social anxiety disorder patients. In vivo exposure is considered the treatment of choice for specific phobia. In vivo exposure may involve flooding exposure to the most intense feared stimulus or graduai exposure systematic exposure of gradually increasing intensity.
Meta-analytical studies have shown that in vivo exposure therapy is highly effective for specific phobias compared with no treatment, placebo treatment, and non-exposure-based active therapy conditions. Cognitive therapy is another widely used method for treating anxiety disorders.
Cognitive therapy is based on Beck's tri-part model of emotion which proposes that thoughts, feelings, and behaviors are interrelated. Aceording to this theory, changing maladaptive thoughts is proposed to alter the patienfs maladaptive affect and behavior. Cognitive therapy targets distorted thoughts using a number of techniques such as identifying inaccu rate thinking, examining the evidence for and against automatic thoughts, challenging and changing maladaptive thoughts, altering problematic behaviors, and relating to other people in more adaptive ways.
Psychoeducation about the tri-part model of emotion, the different forms of distorted thinking eg, all-or-nothing thinking, jumping to conclusions, disqualifying the positive, etc , and cognitive restructuring is an integral part of cognitive therapy.
Homework is typically assigned to give patients opportunities to practice these skills in their daily life, allowing them to gain mastery of the techniques so they will be able to apply what they have learned after treatment has ended. In treating anxiety disorders, cognitive therapy is most often used in conjunction with behavioral techniques, which may include exposure exercises.
Cognitive therapy is typically time-limited to about 20 sessions or less, and is problem-focused on the issues the patient identifies as of primary concern. The use of cognitive techniques in treating anxiety disorders is widely implemented. Yet the research on the efficacy and effectiveness of cognitive techniques alone for anxiety disorders has shown variable results. For example, a study comparing transdiagnostic CBT therapy with relaxation training in anxiety disorder patients found both treatments to be equally beneficial, although relaxation training was associated with a higher dropout rate.
Many of the treatment protocols investigated in treatment outeome studies combine both exposure and cognitive therapy techniques, making conclusions about the relative contributions of each method difficult to disentangle. Several cognitive therapy techniques have been proposed for treating PTSD.
For example, cognitive processing therapy CPT for PTSD postulates that erroneous beliefs about the causes and consequences of the traumatic event prevent the patient from processing the emotions surrounding the trauma memory.
Patients then learn to identify their thoughts and feelings with the goal of understanding the interconnected relationship between them. The majority of the subsequent sessions are used to challenge the patients stuck points using Socratic questioning gently challenging the accuracy of the patienfs thoughts to draw out alternative and more balanced ways of thinking. Other forms of cognitive therapy for PTSD may include imaginal and in vivo exposures cognitive therapy for PTSD 39 or may not include any exposure exercises.
Furthermore, cognitive therapy CT for PTSD has also been shown to be more effective than wait-list, self-monitoring, or self-help booklet control groups. Other studies have found similar outcomes for cognitive therapy alone compared with imaginal exposure. Cognitive therapy protocols for OCD often involve identifying and altering distorted cognitive beliefs about the significance of intrusive thoughts eg, intrusive thoughts mean the patient is a bad person.
For example, a cognitive therapy protocol tested by McLean and colleagues begins with psychoeducation about OCD symptoms and an introduction to the treatment rationale. Patients are then taught to recognize the different types of distorted appraisals including overimportance of thoughts, overestimation of danger, inflation of responsibility, overestimation of the consequences of danger, overestimation of the consequences of responsibility, and need for certainty-control-perfectionism.
Therefore, it is difficult to determine the relative contributions of the cognitive aspects of these treatments from these behavioral experiments. Interoceptive exposure for panic disorder is often combined with cognitive skills such as learning that physical sensations are not necessarily always harmful and learning to reappraise the meaning of physical symptoms instead of catastrophizing. Furthermore, another study found that applied relaxation, exposure, and cognitive therapy were ail about equally effective in treating patients with panic disorder with agoraphobia.
GAD treatment also involves a significant cognitive aspect such as using cognitive techniques to reduce excessive worrying. For example, Craske and Barlow's GAD treatment manual teaches patients to learn to change patterns of thinking that lead to anxiety, challenge thoughts that overestimate risk, and identify and change catastrophic thinking.
The results of a meta-analysis suggested that cognitive-behavioral therapy showed better long-term outcomes than applied relaxation in GAD patients. Additionally, although Dugas and colleagues found that CBT treatment which included both cognitive therapy and exposure was generally comparable to relaxation in treating GAD, the authors noted that when compared with a waitlist control group, cognitive therapy plus exposure was superior to applied relaxation.
Conversely, other research suggests that relaxation is equally effective as cognitive therapy in terms of symptom improvement in patients with GAD at post-treatment and at follow-up. Cognitive techniques are routinely used in treating social anxiety disorder to help the patient identify and change cognitive factors that maintain social anxiety.
In terms of effectiveness, a meta-analysis found individual CBT to be effective in treating social anxiety compared with a waitlist control. Although exposure therapy is considered the most effective therapy for specific phobias, exposure can be supplemented with cognitive restructuring strategies as well.
For example, one study found that one session of cognitive therapy was equally effective as one session of exposure therapy for small animal phobia; in addition, cognitive therapy was viewed by participants as less intrusive in this study.
The results of this review demonstrate the effieacy and effectiveness of using CBT methods to treat anxiety disorders as well as revealing areas in need of additional research.
Exposure and cognitive methods represent the most frequently implemented and widely studied CBT techniques. Exposure methods in particular are often thought of as the first fine of treatment for many anxiety disorders.
The effectiveness of exposure remains relatively unchallenged for some anxiety disorders such as specific phobias and OCD. However, despite research showing the superior benefits of exposure techniques compared with no treatment, the collective research has not consistently shown that exposure techniques are significantly better than cognitive therapy. For example, we previously discussed the finding by Powers and colleagues that PE was not found to be significantly different than eye-movement desensitization and reprocessing EMDR , cognitive therapy CT , or stress inoculation training SIT.
Additionally, many cognitive treatments for OCD incorporate behavioral experiments, a form of exposure. There are a disproportionately larger number of studies investigating exposure therapy than cognitive treatments in OCD patients, suggesting that further research is needed in this area before conclusions can be drawn about the effectiveness of cognitive therapy for OCD. Complexities arise in attempting to disentangle these results due to the frequent overlap in techniques used in many of these therapies.
For example, PE for PTSD patients is primarily based on exposure but also includes processing of the imaginal exposure where the patient discusses their perceptions and feelings associated with the traumatic memory, introducing a cognitive element to the treatment although no formai cognitive techniques are used. Likewise, although CPT for PTSD focuses on the cognitive beliefs about the causes and consequences related to the trauma, a component of CPT involves writing a detailed account of the traumatic event and reading it to the therapist, thereby engaging the patient in exposure in addition to cognitive therapy.
The overlap in techniques between CBT therapies may explain why different active therapies do not necessarily resuit in superior outeomes. If exposure and cognitive therapies tap into separate but equally efficacious therapeutic mechanisms, then the combination of therapies might be expected to show superior results.
Additional studies examining cognitive therapy alone are needed to adequately compare exposure and cognitive techniques. In summary, the research on CBT in anxiety disorders supports the efficacy and effectiveness of these methods, with most of the current research demonstrating the usefulness of providing exposure therapy in the treatment of anxiety disorders.
However, these results may change as additional research is conducted on cognitive therapy alone and cognitive therapy combined with exposure. At the same time, the repeated finding of equal or near-equal effectiveness across CBT therapies suggests that the commonalities underlying these treatments may be more important than any specific differences between the techniques.
Studies aimed at identifying these commonalities have been sparse, and represent an important but relatively underdeveloped area of clinical treatment research. In addition to determining what treatments work, it is equally important to understand which patients are most likely to benefit from a given treatment or from given components.
Studies aimed at identifying predictors of beneficial treatment outeome are invaluable in determining what factors and patient characteristics are most likely to lead to improvements.
Research supports the notion that anxiety disorder patients share common psychological and biological vulnerabilities, suggesting that effective treatments for anxiety are tapping into these shared mechanisms. Future directions in treatment research would benefit from a better understanding of the common mechanisms underlying effective CBT treatments. National Center for Biotechnology Information , U. Journal List Dialogues Clin Neurosci v. Dialogues Clin Neurosci. Antonia N. Edna B.
Foa , PhD Edna B. Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract A large amount of research has accumulated on the efficacy and effectiveness of cognitive-behavioral therapy CBT for anxiety disorders including posttraumatic stress disorder, obsessive-compulsive disorder, panic disorder, generalized anxiety disorder, social anxiety disorder, and specific phobia.
Keywords: cognitive-behavioral therapy , exposure , anxiety disorder , post-traumatic stress disorder , obsessive-compulsive disorder , panic disorder , generalized anxiety disorder , social anxiety disorder , specific phobia.
Introduction Cognitive behavioral therapy CBT has been shown to be effective for a wide variety of mental health disorders, 1 including anxiety disorders. Exposure therapy Exposure-based techniques are some of the most commonly used CBT methods used in treating anxiety disorders.
Post-traumatic stress disorder PTSD is often treated with prolonged exposure therapy PE which incorporates both imaginal and in vivo exposures. Panic disorder As mentioned previously, a hallmark of exposure therapy for panic disorder involves interoceptive exposure eg, increasing heart rate by running or hyperventilating which is aimed at disconfirming the idea that physical sensations will lead to harmful events such as a heart attack or embarrassing oneself in public.
Generalized anxiety disorder GAD treatment can include both imaginal exposure eg, imagining the worst-case scenario associated with their worries and less frequently, in vivo exposures. Social anxiety disorder In vivo exposure is commonly used for social anxiety disorder eg, participating in social situations without using avoidance or safety behaviors.
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