Anxiety & Exposure: Facing Your Fear


What’s the take-home message? Cognitive Behaviour Therapy provides tools to modify thoughts and behaviours, which in turn diminishes anxiety and and lifts mood.

Cognitive Behavior Therapy (CBT) is an approach to psychotherapy that focuses on the thoughts (cognitions) you have and the actions (behavior) you engage in.

The underlying notion is that thoughts, feelings, and behaviors are all connected to one another. So, changes in one of these elements are likely to lead to changes in the other two. In CBT, we typically target thoughts and behaviour in order to help people feel less anxious or depressed, and to promote well-being.

Unfortunately, things happen in life which are beyond our control. The good news, though, is that we can develop some control over our reactions to life events.

These reactions occur in our thoughts, emotions, and actions. We now know that the way we interpret or think about what is happening has a big impact on how we feel about things. For example, if you couldn’t find your iPod, you might have two different thoughts:

  1. “It’s been stolen,” or
  2. “I must have left it at the gym”.

Thinking it’s been stolen would lead to different feelings (e.g., anger, fear) than thinking you had forgotten it somewhere (e.g., annoyance, worry).

These different thoughts/beliefs would also lead to different courses of action. Thinking your iPod has been stolen, you might look to see what else is missing, you might suspect people at the gym and treat them badly, and so on.

Alternatively, if you thought you’d left your iPod at the gym, you might call the gym to see if anyone has found it, you might go back there to look yourself, and so on. If we are able to manage the way we react to situations more effectively, then we will be more likely to diminish the impact of unnecessary worrying and discouraging thoughts.

Some reactions come to us so automatically that we take them for granted and believe them without question.

One of the ways CBT helps is by questioning (challenging) automatic thoughts that are not accurate or helpful. If you said hello to a neighbour but he did not answer back, you might think “He doesn’t like me”. That could be true, however, in CBT we encourage consideration of alternatives.

So, what other possibilities are there for why he did not respond? Perhaps he is hard of hearing or was distracted. If you believed those statements, you might feel better and be more inclined to say hello again in the future.

Changing how we think changes how we feel and what we do.

Another way CBT helps is by purposefully changing your behavior. If you are feeling down, you may not have the energy or desire to see friends. However, if you force yourself to go out with a friend, you may enjoy yourself and feel better. Changing what we do changes what we think and how we feel.

These CBT principles are often applied to anxiety disorders. Anxiety is a feeling of intense fear or nervousness. Let’s see how CBT might address excessive anxiety. Say you were afraid of dogs. You went over to your friend’s house and lo and behold there’s a dog barking at you. Anxious? Yes. Now, what might you be thinking that is leading you to feel this way? You might think “This dog is going to bite me” or “This dog is dangerous.”

Let’s say, you believed those thoughts; how would you act? Chances are you would leave the house or request that your friend lock up the dog for the duration of your visit. Once safely away from the dog, you would feel relieved. The conclusion you would likely come to is that avoiding the dog makes you feel better. While this is true, being afraid of dogs might have a negative impact on your life (e.g., your friend with the dog might not want to have you over again).

What would have happened had you stayed in the room with the dog (assuming your friend has reassured you it is a friendly dog who has never attacked or hurt anyone before)? Would your feeling of anxiety increase steadily until you fainted? Unlikely. Anxiety doesn’t work that way. The truth is, your anxiety would likely go away given enough time and exposure to the dog. Avoidance perpetuates anxiety.

That means that you will keep the anxiety going by never testing the theory that your anxiety would come down and you would feel better if you just stayed with whatever you were afraid of (in this case, the dog).

The same principles apply to other fears, such as giving a presentation, being in large crowds, and many more. So, what is the take-home message?

Thoughts and actions can be changed and in doing so, can reduce feelings of sadness and anxiety.


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