Can Cognitive Behaviour Therapy Help Anxiety?

While I believe that Cognitive Behaviour Therapy (CBT) does not go deep enough in unravelling anxiety and getting to the root cause, it can be a very good starting point for many.

So in this article, I want to help you identify some of your repetitive thoughts and beliefs, so you can catch them and avoid the overwhelm and anxiety that is often associated with them.

I have also included links throughout this article to additional tools and workbooks that you can use alongside CBT.

 

We will look at some basic techniques that you can use on your own to begin to respond to and modify these thoughts. We do this by looking at the facts, or “evidence,” to see a situation in a more realistic way.

“The ancestor of every action is a thought.”

~Ralph Waldo Emerson

Cognitive behaviour is just a term used to describe how our thoughts influence our feelings and emotions, which determine our behaviour and our actions.

As anxiety is an emotion, understanding our thoughts can help to modify our anxious feelings and behaviour.

Our thoughts, feelings/emotions, behaviour are all interconnected, and when we are feeling anxious, it can lead to physical sensations such as increased heart rate, rapid and shallow breathing, overheating or sweating and trembling legs and muscle aches.

Likewise, we may feel a physical sensation, such as noticing we are getting hot and sweaty, and then start to scan our bodies for evidence that we are anxious. This will negatively impact how we think and we may start to think "I am going to have a panic attack". This would then influence our behaviour further, and we may wish to get out of the situation we are in fast.

This all happens so quickly, we have to make a conscious effort to catch ourselves and question what exactly is going on for us.

 

Understanding Anxiety

So let's start by really understanding what Anxiety is. It is characterised by feelings of fear, worry, nervousness and overwhelm.

Anxiety is an evolutionary response to danger. Your parents experienced it, as did their parents, and their parents before them. It goes back to a time even before human existence. 

Have you ever been away and seen a lizard? As soon as it sees you, it feels threatened and freezes (part of the fight, flight, and freeze anxiety response). If you stand still, the lizard thinks the danger has passed, and it then runs away. The flight response. 

The anxiety centre of our brain is called the amygdala, and this forms part of the reptilian brain. 

And then mammals. We have all seen a rabbit or deer freeze in the headlights of an oncoming car. What about a tiger chasing a herd of zebra? When the tiger starts to approach the herd, they will sense danger and scatter due to the flight anxiety response. 

Once one Zebra has been caught, the rest of the herd know that the danger has passed, and while their heart rate may be slightly elevated for a short period, they return to grazing again. 

This is anxiety in its simplest form. It is there to serve us and keep us safe. In fact, we would not have survived as a species without it. 

How Is Anxiety Different for Humans?

In both the above scenarios, anxiety is caused by a potential predator. And the fear smoke alarm reacted just when it should.

The difference with humans is that our smoke alarm can be activated by

• our inboxes
• a traffic jam
• a friend taking too long to reply to a text
• our work
• our colleagues
• our partner
• our kids
• elderly parents

The list is actually endless. 

It gets worse. We have the ability to dwell on the past and ruminate on something over and over and over again. And we have the ability to think about our future, to surround ourselves with what if? We can create fear and panic about something that has not yet even happened.

There is more bad news. We all have a negativity bias, which means that we focus far more on the negatives than the positives. We needed to know where the tiger hid out. We didn't need to know what it was like to go skipping through a meadow of pretty flowers. 

This wasn't a design fault in our brain, this is nature's way of keeping us alive and hypervigilant. We want our anxiety radar to be alerting us if there is actual danger out there. It is protecting us, and it is a good thing. However, when we are anxious stuck in traffic or triggered by a colleague, our negativity bias increases our anxiety as we are constantly looking to justify the way we are feeing.

It can become a downward spiral. Negative thoughts can cause anxiety, and when we are anxious, we are more likely to have these negative thoughts and cognitive distortions, and assume the worst-case scenario. Use the Cognitive Distortions Worksheet to help with this.

 

 

Numbing Anxiety

No one enjoys feeling anxious, so many people choose to numb their feelings with behaviours that may offer them temporary relief, but over time, these negative coping strategies may exacerbate anxiety and lead to other problems. 

• Substance Abuse: This includes alcohol, drugs (both legal and illegal) and even excessive caffeine or nicotine
• Overworking: Excessive work can serve as a distraction from anxiety, but it can lead to burnout and other health problems
• Binge Eating or Restricting: These behaviours can be used to cope with difficult emotions, but they can lead to eating disorders and other health issues 
• Compulsive Behaviours: This includes excessive cleaning, gambling, shopping, or even excessive exercise
• Social Isolation: Avoiding social interactions can be a way to avoid potential anxiety triggers, but it can also lead to loneliness and depression
• Self-Harm: This includes any behaviour that causes physical harm to oneself, like cutting or burning
• Rumination: Continuously dwelling on negative thoughts and feelings can worsen anxiety
• Hyperfocusing on Distractions: This could involve spending excessive time on social media, video games, Netflix or other forms of so called entertainment
• Avoiding Anxiety-Provoking Situations: This can create a cycle of procrastination and avoidance, where anxiety increases over time

Anxiety does not mean you are broken, it means your nervous system needs a reset as you are stuck in a fear response.

Is Anxiety Natural?

Yes, anxiety is perfectly natural when we are in fearful situations, however, it can be debilitating when we are feeling anxious on a regular or constant basis.

When we are fearful of fear itself, this can lead to prolonged anxiety, known as Generalised Anxiety Disorder (GAD) and is also associated with Panic Attacks.

When we can recognise, understand and modify our anxious thoughts, we are able to better cope with everyday stresses and anxiety.

How does Cognitive Behaviour Therapy Work?

The aim of cognitive behaviour therapy is to gather evidence and uncover facts about something that has happened in our past, is happening to us right now, or we are predicting will happen in our future.

Examining the Evidence

A trained Anxiety Therapist knows the right questions to ask, so you can better understand a situation.

Questions you can ask yourself include:

1.  What is the likelihood that this anxiety inducing event will actually happen?
2.  If this event were to happen, what is the worse case scenario?
3.  What would I do if that was to happen? How would I handle it?
4.  Is there any other explanation to account for what could happen?
5.  Do I, with 100% certainty, know all of the facts about this situation?

It may seem strange to focus on the worst case scenario; however, we are often not specific about what makes us anxious. We focus on a concept and a feeling instead. Once we have identified the worst case, we can talk through the best solution to the challenge. 

There is always more than one explanation to account for what could happen, so this is where we look at alternatives. 

And in most cases, we do not know all the facts with 100% certainty, so this means that the anxiety inducing event can not be predicted as we thought.

Having that conversation helps to understand that even if you cant control the situation, you still have influence over it. You can down load our Circle of Control and Influence Workbook to try this yourself by clicking on the link or image.

It is important that we notice both the positive and negative scenarios in this case. We are not burying how we feel in the sand but instead acknowledging how we feel and meeting that feeling with ease. In this way, we have the opportunity to examine how we would cope in a worst-case scenario and look at alternative outcomes.

The more you can think about alternative positive outcomes, the more you train your brain to understand that you would be able to cope, and the initial thought is no longer as scary as it initially appeared to be.

Neurons that fire together wire together.

Science has proved, without a shadow of a doubt, that we all have the capacity to change the way our brains work. This is a term known as neuroplasticity.

When we adjust our thoughts, we are actually creating new neural pathways in our brains!

Whilst one new thought will not completely change your life overnight, repeatedly practising different types of thought patterns can actually rewire our brain, making new, more realistic, and helpful patterns of thought more natural.

Just like going to the gym to build up our physical health, we need consistent practice and repetition to keep the brain functioning optimally.

I often explain it to my clients like this. Your current way of thinking is like the M25 and your thoughts are the cars travelling on it. There is constant traffic day and night.

We are creating a footpath with a new way of thinking, and slowly, we will start diverting the traffic from the M25 to the footpath. As the footpath becomes better known, other cars follow, and before we know it, the footpath is an established new route, and the M25 is no longer the preferred path.

 

Practice Makes Permanent

Most people think that practice makes perfect, however, I disagree. Practice makes permanent. After all, if we are practising the wrong thing, it will never be perfect, it just becomes more of the same.

By consistently examining our thoughts, beliefs and behaviours, we can learn to make better choices about situations that impact us.

When we discover that a thought is not entirely true, we can choose to refocus our attention, calm our instinctive fight and flight response, and reduce our anxiety.

An alternative approach would be to understand the new evidence and facts, and proactively come up with a solution that can be more empowering and effective.

Finally, if there is nothing that can be done to change a situation, we can work to accept this and let go of our attempts to control.

The Circle of Concern, Control and Influence Workbook can also help us here, as even when we believe something is totally outside of our control, we can often influence the outcome.

Aligning our Thoughts, Beliefs and Behaviours

Whilst understanding and acknowledging our thoughts is one tool in overcoming anxiety, we also need to be aware of our beliefs and behaviours.

It is often easier to recognise a behaviour or a physical sensation, before we become conscious of our thoughts.

A question you can ask yourself is “What Am I Avoiding Right Now?

For example, if we continue to avoid meetings and speaking up in front of others, the anxiety is very likely to still be there when we actually have to do this, regardless of how we think.

This is because we have not proved to ourselves that we are capable of doing the thing we are avoiding.

Therefore, we need to work towards overcoming our fears. We can do this using Exposure Therapy to confront the things we are trying to avoid. This is done using small baby steps to ensure it is not too overwhelming and anxiety inducing. You can find out more about Exposure Therapy in the workbook here.

Client Case Study

A client of mine, we will call him Bob, continued to have many negative thoughts about speaking in meetings or interviews. His current contract was coming to an end and he was worried that his fear and anxiety would prevent him from interviewing and getting a new job.

As such, he was avoiding calls from recruiters, and this was leaving him feeling guilty and ashamed that he would not be able to support his family, and understandably increasing his anxiety further.

By this stage, he was also avoiding friends and neighbours, and his confidence was at rock bottom.

He had been in a meeting a few months earlier, and the CEO had turned up unexpectedly. Bob was asked a question. He froze, was unable to speak up and had to walk out of the meeting, shaking and sweating. He was mortified and believed that he was no longer capable of doing his job. He believed that everyone in his office saw him as a failure. 

Bob then avoided attending meetings at all costs.

He would procrastinate, and his fears prevented him from properly preparing for future meetings. Instead, his entire focus was on panicking and freezing again. Unsurprisingly, that is exactly what happened when he was forced to attend another meeting.

Where Is The Evidence?

Bob predicted that everyone witnessed his voice shake and how he panicked, and therefore, they thought less of him. He believed his colleagues no longer felt he was capable of doing his job, and therefore he was going to lose his job.

He avoided conversations with anyone outside of his immediate family, for fear of making a fool of himself. He was certain the same thing would happen again. He couldn’t help himself. He was unable to ever attend a meeting again as he was too anxious.

The next meeting he had after the CEO walked in was a zoom call with me, so we could discuss working together. He had a large Whisky to “help” him through our conversation ... despite our call being at 9am.

By the time he contacted me, the situation was dire. He needed to start interviewing again, and he had no option but to take action if he was going to be able to continue to pay his mortgage.

Over a couple of sessions, we looked for evidence of what he was telling me and the language he was using.

I wanted to know if he had asked any of his colleagues about that specific day. He told me his trusted colleague hadn’t noticed his voice break and assumed he had to leave the meeting abruptly because something came up. He was taken aback when my client told him he had panicked.

Bob only imagined and predicted what he thought others saw, heard and felt during that meeting, and he was too busy creating a worst-case scenario, instead of acknowledging what was real.

I asked my client if anyone else has sought out his opinion since. “Yes they had” he explained, “but only because no one else knows the project in as much detail”.

So my client is still the expert in his area, and colleagues are still valuing what he has to say. Initially, my client would respond with “Yes, but …… ” and come up with a justification in his own mind why this didn’t count.

Despite his contract being scheduled to end two weeks after the meeting with the CEO, he felt he had failed when the contract ended. The reality is that his contract was ending regardless, so how can he label himself as a failure?

Once he was able to see that his thoughts were not real, using one of the strategies that I teach, we then used the Exposure Ladder alongside more intense techniques, to help him build his self belief back up and reverse the snow ball effect of perceived fear and failure.

So to overcome this, we broke the challenges he was facing into small manageable steps, and over the next couple of months, he was able to prove to himself that he was capable.

It is important to congratulate yourself on each small step and practice it multiple times until you feel truly comfortable, before moving on up the ladder.

The “Snowball Effect”

The snowball effect ( also known as fuelling the fire) occurs when we have a negative thought, which results in avoidant or protective behaviours. Over time, the thought gets bigger and bigger, and more distorted, until it becomes all consuming.

This is when our thoughts and beliefs can make our anxiety worse and even cause more problems. In my client's case, he stopped socialising with friends and neighbours, which he had previously enjoyed, and felt alone and isolated.

Having a Balanced View of Our Thoughts

When we look at our thoughts realistically and can question our initial thoughts, we can start to see them for what they are. Thoughts only.

When we are able to modify these negative thoughts, we stop them from triggering our anxiety and prevent them from avoiding things that are important to us.

Types of Negative Thoughts (Cognitive Distortions).

It is helpful to be aware of some of the kinds of negative thoughts that many people with anxiety experience.

Cognitive distortions are thoughts that are heavily influenced by emotions and may not be consistent with the facts of a situation. As we are able to identify our distorted thoughts, we notice patterns in our thinking and are better able to catch ourselves when we notice an anxiety inducing thought. You can download our list of Cognitive Distortions here.

Black and White Thinking / All Or Nothing Thinking:

Learning to see shades of grey is immensely useful and we can appreciate that there is a middle ground.

“I always get anxious when driving.” Recognising that you only sometimes get anxious when driving can be a relief, as there are also times when you don’t feel so anxious.

Overgeneralisation:

Seeing a pattern based on a single event, or being overly broad in the conclusions we draw, can blind us to the reality of the situation.

“Nothing good ever happens to me.” Ask yourself, “Nothing? Really?” and you will generally find evidence that this thought pattern is not valid.

Mental Filter:

When we only pay attention to certain types of evidence and don't register the bigger picture. We may choose to pick out the negative detail, dwell on it exclusively and ignore any positives.

“The traffic jam ruined my entire day”, even though you may have also enjoyed a phone call from a good friend and caught up with the kids over dinner.

Disqualifying the Positives:

By discounting or rejecting the good things that happen to us, we can feel anxious even when we achieve something great. We may believe something positive was pure luck alone and do not give ourselves the credit we deserve.

“The A* I received in Maths was a fluke, so it doesn’t count”.

Yes, it still counts!

Jumping to Conclusions/Mindreading:

When we believe we can guess what someone else is thinking or feeling, when they may not be thinking that at all.

We feel hurt if someone ignores us or doesn’t return a call when the reality is most likely that they didn’t see us or are tied up with something else at that precise moment. It is most likely nothing to do with us at all!

Fortune Telling:

When we think we can predict the future, as a result of something that has influenced our past.

If we didn’t get the last three jobs we applied for, we can start “predicting” that we won't get the next few jobs we apply for either, and we may give up trying. The reality is that no one gets accepted for every job, and eventually, if we keep putting ourselves out there, we will be successful.

Magnification and Minimisation:

This is when we magnify the importance of errors as evidence of the truth.

“I took the wrong turn and it was an absolute disaster,” or we minimise a compliment we receive because we think it is undeserved or the person paying the compliment didn’t really mean it. We may tell ourselves they were just being nice!

Notice we don’t normally apply the same logic if we receive perceived negative feedback!

Labelling and Mislabelling:

We may label ourselves as "terrible" at something such as public speaking, based on an incident that happened many many years ago, and avoid speaking in front of an audience from there on, or we may take one particular situation, such as burning the toast, and label ourselves based on that situation alone.

"I am such an idiot". No, the reality is you just burnt the toast, that does not make you an idiot!

I personally believe this is one of the most damaging of all. The majority of my clients come to me believing they are an "anxious person". No, they are someone who sometimes feels anxiety, alongside other emotions. When we label ourselves, our bodies look for evidence that we are right. 

Choose your label wisely. 

Catastrophising:   

This is when we think of events as catastrophes instead of acknowledging the reality of the situation.

Your boss asks you to come to her office. You then assume she is going to fire you, resulting in you not being able to afford the mortgage, the house will be repossessed, your partner will leave and take the kids and you will spend the rest of your life alone. The reality was that she had a simple question about a report you had completed!

Should and Must Statements:

Using critical words like “should” and “must” can put a lot of pressure on us and make us feel guilty, or like we have already failed before we have started.

"I should clean the car this Sunday" when really we have no desire to clean the car and would rather have a day with our family. Could you make a conscious decision instead, to prioritise your family? This takes away the guilt immediately!

Beliefs Around Our Own Ability

If we believe that anxiety itself is dangerous, we may predict that we will lose control, not be able to cope, have a heart attack or pass out, when anxiety symptoms get more extreme. This results in us being anxious about anxiety and can lead to increased panic attacks.

We may believe we cannot tolerate discomfort, pain or negative events, and will question our ability to cope with future events because of the anxiety, believing “If I can’t tolerate this, what will happen if something really bad happens?”. This belief can evolve into General as well as Health Anxiety Disorders or even Death Anxiety.

While it is true that anxiety and worry are there to protect us, we may start believing that “if we don’t worry about XYZ, then ABC may actually happen.” This thinking results in Obsessive Compulsive behaviours (OCD).

We may have negative thoughts and beliefs about ourselves, others and the world. Most of our beliefs are created before the age of seven. These beliefs are most likely to have been handed down to us from our parents, rather than created by us.

I was led to believe “The world is a really dangerous place and terrible things can happen." These types of statements can make us feel more anxious, especially around other people and can lead to Social Anxiety Disorder.

We all have some patterns of negative thinking, depending on our experience, but sometimes these patterns can get out of control.

Self Awareness is Key

Being aware of our thoughts is the first step in overcoming them. Once we are aware, we can start to question their validity.

You can use the Anxious Thoughts Diary to assist you, by recording the initial thought as a statement, avoiding “what if’s” and questions.

So, if the thought is “What if I lose my job?” it is more impactful if you state “I will lose my job.” 

When we are feeling anxious, it is common to have a thought that leads to a more disturbing thought, which then leads to an even more disturbing thought, and so on.

Make a note of the date and situation that is triggering you. How are you feeling right now and what is the automatic thought?

What evidence do you have to support or go against that thought? How can you revise that thought and feeling?

You can download the Anxious Thoughts Diary Workbook to help you with this by clicking on the image below. Full instructions are included.

If You Need Further Support

If you need further support to overcome your anxiety and the accompanying symptoms, a trained Anxiety Specialist can prescribe a personalised plan to help you understand the underlying cause of your anxiety, as well as help develop healthy coping strategies that are focused around your individual needs.

Taking care of your mental wellbeing is an essential part of your overall well-being. Left unresolved, anxiety can spiral out of control and have a significant impact on relationships, work, school and family life.

So if you want to take the next steps to have a happier life where your fears no longer hold you back, click the link below and book a free no obligation consultation call.

Click the button below to book a Free Consultation call

 

Additional Resources to Ease Anxiety

Read What Causes Anxiety? 

Read What Are The Different Types of Anxiety?

Read Can Mindfulness Help with Anxiety

Watch How to Feel Less Anxious

Watch How To Reduce Anxiety Immediately

Watch Breathing Techniques for Anxiety

Download Circle of Control and Influence worksheet

Download Cognitive Distortions worksheet

 

FAQs about CBT and Anxiety

What Is CBT And How Does It Work For Anxiety?

CBT, or Cognitive Behavioural Therapy, is a short-term therapeutic approach that helps people recognise and challenge negative patterns of thinking. For anxiety, it can sometimes be useful in identifying unhelpful thought loops and learning how to replace them with more balanced, realistic ones, however it doesn't tend to get to the root cause of anxiety

2. Does CBT Work For Everyone With Anxiety?

No. While CBT can be a helpful introduction to understanding anxiety for some people, others may find it too surface-level. Many of my clients benefit more from nervous system therapy, which supports long-term healing by going deeper into the root cause of their anxiety.

3. What Are The Limitations Of CBT For Anxiety?

CBT focuses primarily on changing thoughts, but it often overlooks the body’s nervous system response. For many of us, anxiety is felt physically with a racing heart, tight chest, breathlessness, and without calming the body, it’s difficult to truly shift anxious patterns. That’s why we combine CBT tools with nervous system support at Better Your Life.

4. How Can I Tell If My Thoughts Are Making My Anxiety Worse?

If your thoughts often spiral into worst-case scenarios, feel all-or-nothing, or keep you up at night, you’re likely caught in a loop of cognitive distortions. Becoming aware of these patterns is the first step to shifting them. Our Cognitive Distortions Worksheet can help.

5. What Are ‘Cognitive Distortions’?

Cognitive distortions are habitual ways of thinking that exaggerate negativity or filter out positives. Examples include catastrophising, mindreading, or black-and-white thinking. These patterns can fuel anxiety if we don’t learn to spot and question them.

6. Can CBT Help With Physical Symptoms Of Anxiety Like Shaking Or Nausea?

CBT can help reduce these symptoms over time by changing the thoughts that trigger them. However, if your anxiety feels stored in your body, techniques that calm the nervous system, like breathwork, somatic tools or nervous system therapy, may provide faster relief.

7. I’ve Tried CBT Before And It Didn’t Help. What Now?

You’re not alone. CBT is one of many tools, and it doesn’t work for everyone. That’s why we offer a more personalised approach that integrates deeper emotional work, body-based techniques, and a greater focus on your past experiences and triggers.

8. Can CBT Prevent Panic Attacks?

CBT may reduce the likelihood of panic attacks by helping you recognise early thought patterns that spiral into fear. But if your panic is rooted in unresolved trauma or chronic stress, you may need more than just thought-based strategies.

9. How Long Does It Take For CBT To Work On Anxiety?

Some people see improvements within 6 to 12 sessions, especially when combined with daily practice. But lasting change often requires deeper work. At Better Your Life, we believe in going beyond temporary fixes and helping you build long-term resilience.

10. Should I Try CBT Or Go Straight To Working With An Anxiety Specialist?

CBT can be a great starting point if you’re new to understanding anxiety. But if your symptoms feel stuck or keep returning, it may be time to explore a more comprehensive and individualised plan. A qualified anxiety specialist can help you identify what’s really going on and what approach will work best for you.