Written by Lauren Helm, M.A.
Our last blog discussed the ways in which anxiety manifests in our minds, bodies, and actions, and how depending on the context, anxiety may be an adaptive or problematic force in our lives. In excess, the symptoms of anxiety can be overwhelming and interfere with our quality of lives, and thus it is often a worthwhile use of our time to become well-versed in the “language” of anxiety. Namely, how does it appear, and why? Once I understand anxiety, what can I do about it? Our last blog focused primarily on the ways in which our cognitions, or thoughts, may serve to contribute to the increase or reduction of excessive and chronic anxiety. Cognitive distortions, or inaccurate thinking patterns, typically feed anxious feelings. They also may lead to avoidant behaviors, which perpetuate anxious thoughts and feelings. When the cycle of anxious thoughts, feelings, and behaviors occurs outside of our awareness, we can be left feeling baffled and as if our lives have begun to spiral out of our control. Two evidence-based treatments provide strategies for managing unhelpful thoughts.
Cognitive-behavioral therapy (CBT) identifies how certain types of thoughts or ways of thinking in response to perceived threats actually create more difficulty for us, and potentially lead to anxiety, stress, low mood, and other problems. Simply put, situations do not cause negative emotions; our perceptions of them do. . Some of the unhelpful or inaccurate patterns of thinking related to anxiety include catastrophic thinking, probability overestimation (overestimating the likelihood of a negative outcome), worry or rumination (i.e. brooding), filtering out the positive and only seeing the negative, jumping to conclusions, mind reading (thinking you know another person’s intent for acting in a certain way, when this may not be true), personalizing, and black and white thinking. CBT therapists help individuals to alleviate the consuming nature of anxiety by using various strategies. However, the various approaches that are used to deal with these types of “inaccurate” thinking patterns have historically served a common purpose: correct the “thinking errors” that create anxiety. Over time, CBT has evolved and has placed more emphasis on helping people to generate more flexible, adaptive thoughts and responses to their thoughts. Instead of merely trying to replace one problematic thought with a more helpful one, CBT can help an individual to generate more balanced and healthy thoughts, and more easily identify and non-reactively respond to problematic, anxiety-provoking thoughts. In other words, if you notice that you are thinking in inaccurate ways, it is likely best to recognize that it may not be helpful to act on this inaccurate thought, and better to generate a new, alternative way of thinking about the situation that helps you to successfully reach your goals. Instead of trying “not to think” a certain way (for example, not trying to suppress or shut out a problematic thought), the emphasis is on being able to create more thoughts that are based on a more balanced review of available information and are informed by your goals in a particular situation. Rigidity, or getting stuck in one narrow way of thinking, is usually what contributes to us further being consumed by anxious thinking and behaving. Thus, increasing cognitive and behavioral flexibility (working towards developing a wide range of thinking and responding) is encouraged.
Cognitive restructuring is a CBT intervention that helps individuals get “unstuck” from the “mind traps” that thinking errors create. Generally, what is required is (1) an awareness of or monitoring of thoughts regarding a particular situation, (2) challenging the thought (i.e. “Is this a realistic thought?” “Is it helpful?”), (3) exploring the evidence for or against the thought (i.e. What are the facts?), (4) identifying other possible alternative explanations and putting the thought in perspective, and (5) generating a balanced, more helpful thought from which to act on.
Acceptance and Commitment Therapy (ACT) guides individuals in becoming aware of not only their thoughts, but also their enmeshment, or fusion, with these thoughts. Cognitive fusionrefers to how much we believe our thoughts, and thereby grant them power and “reality” in our lives. We often forget that every thought filters how we see the world, and dramatically impacts our direct experiencing of life. Regardless of how “true” our thoughts may be, they are just thoughts. Thus, ACT therapists help individuals practice cognitive defusion, reducing of the entanglement with the thoughts. In other words, we learn how to become less attached to and controlled by our thoughts, because we learn how to see them for what they really are. We learn how to give them less power over us, and take back the power of “choosing” which thoughts we want to listen to (for example, being guided by a thought that supports us in acting in valued ways, as opposed to avoidant ways).
Additionally, ACT asserts that we have limited control over which thoughts or emotions we experience. The problem is less in the content of our thinking or feeling, and more in what we dowith these thoughts or emotions, or how we relate to them. In other words, we can change our relationship with our thoughts so that we can focus our energy on what is truly worthy and important to us, instead of using most of our energy on trying to simply manage or reduce unpleasant thinking.
In sum, awareness of our thinking patterns is often the first step, and changing how we approach our thoughts is the next step along the way of healing and wellness.
These two approaches may resonate differently for different people. Both CBT and ACT are evidence-based treatments for anxiety, and can help those who struggle with the reign of anxiety get back into living full and meaningful lives.
If you are interested in having assistance with unhelpful thinking patterns, our CSAM therapists are trained in both CBT and ACT. If you'd like to speak with a professional at the Center for Stress and Anxiety Management for help with anxiety, please click here.
Cognitive Distortions and Restructuring Handout:
Barlow, D. H. (2004). Anxiety and its disorders: The nature and treatment of anxiety and panic. Guilford press.
Behar, E., DiMarco, I. D., Hekler, E. B., Mohlman, J., & Staples, A. M. (2009). Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of Anxiety Disorders, 23(8), 1011-1023.
Beck, A. T., Emery, G., & Greenberg, R. L. (2005). Anxiety disorders and phobias: A cognitive perspective. Basic Books.
Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new acceptance and commitment therapy. New Harbinger Publications.
Sibrava, N. J., & Borkovec, T. D. (2006). The cognitive avoidance theory of worry. Worry and its psychological disorders: Theory, assessment and treatment, 239-256.
Tags: anxiety, cognitive behavioral thearpy, anxiety therapy san diego, fear, acceptance and commitment therapy, worry, ACT, stress and anxiety in san diego, psychologist in san diego,Cognitive Behavioral Therapy, CBT San Diego, Center for Stress and Anxiety Management, cognitive distortions, cognitive restructuring