CBT for Clients Experiencing Anxiety

In the last section, we discussed the key to recovery. We also introduced the "Healing Hurts" Technique.

In this section we will discuss watching worries come and go.  Regarding watching worries come and go, three techniques we will examine are tracking anxiety levels, journaling, and focusing on positive aspects of life. 

CBT Techniques for Controlling Anxiety

CBT Technique #1.  Tracking Anxiety Levels
First, let’s discuss tracking anxiety levels.  Would you agree that clients can take charge and feel more in control of their anxiety by simply recording how they feel?  Rob found that by tracking his anxiety levels, he could learn more about how his anxiety, sometimes in the form of panic attacks, affected him.  When I first mentioned tracking anxiety levels, Rob stated, "That’s crazy.  I’m anxious all the time.  There’s no let up."  I urged Rob to try. 

Rob tracked his anxiety levels for one week.  On a scale of one to ten, he rated the levels of anxiety he felt in the morning, the afternoon, and later in the evening.  At our next session, Rob stated, "It seemed like my anxiety was less in the morning, escalated during the afternoon, and then peaked later in the evening.  But I kept a daily average."  I looked over Rob’s daily averages which decreased by almost 2 within one week’s time.  Rob attributed this decrease to tracking anxiety levels.  Think of your Rob.  Could your client benefit from this technique?

CBT Technique #2. Journaling
Next, let’s discuss the common technique of journaling.  Clearly, you already have experience utilizing journaling as a therapeutic tool.  However, I felt that, regarding anxiety, a brief discussion of how I implement journaling in my practice may be productive.  Perhaps you could play this track so your client could hear how Rob benefited from journaling.  In the case study on this track, you might find Rob’s introduction to journaling useful for your client.  In one of his sessions, Rob stated, "It seems like my panic comes and goes.  Sometimes it’s there and sometimes it’s not, but there’s really no way to tell when or if panic is coming or going." 

How might you respond to Rob?  I stated, "Observing your anxiety in such a way is productive.  Observing anxiety serves several functions. 
First, monitoring forces you to be aware of your emotions. 
Second, you’ll see that your anxiety goes up and down throughout the day. 
Do you think recording how you feel as your level of panic or anxiety goes up and down might help you feel more in control over how you feel?"  Rob responded, "I guess so."

Here is one tactic Rob used with his journaling.  Rob stated, "I don’t really think journal writing should have rules.  It helps me when I write about anything, anywhere, and anytime."  Rob benefited from journaling in that he had an interest in writing about his feelings an the emotionally important events in his life.  Rob found that writing about past traumas brought him considerable relief.  Think of your client.  Could journaling benefit him or her?

CBT Technique #3. Focusing on Positive Aspects of Life
Once your client, like Rob, begins to identify the ebb and flow of anxiety through journaling exercises, perhaps the next step is focusing on positive aspects of life.  Rob began to use his journal to ponder the positive events and people in his life.  For example, Rob considered those who had extended kindness to him.  Rob also saw his education as a positive thing in his life.  Could having a home, food to eat, or ways to find pleasure help your Rob focus on positive aspects of life?

In this section we have discussed watching worries come and go.  Regarding watching worries come and go, three techniques we discussed were tracking anxiety levels, journaling, and focusing on positive aspects of life. 

- Cully, J. A. & Teten, A. L. (2008). A Therapist’s Guide to Brief Cognitive Behavioral Therapy. Department of Veterans Affairs South Central MIRECC, 44-57.
- Diefenbach, G. J., McCarthy-Larzelere, M. E., Williamson, D. A., Mathews, A., Manguno-Mire, G. M., & Bentz, B. G. (2001). Anxiety, depression, and the content of worries. Depression & Anxiety (1091-4269), 14(4), 247-250.  
Reviewed 2023

Peer-Reviewed Journal Article References:
Aviram, A., Westra, H. A., Constantino, M. J., & Antony, M. M. (2016). Responsive management of early resistance in cognitive–behavioral therapy for generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 84(9), 783–794.

Bélanger, L., Harvey, A. G., Fortier-Brochu, É., Beaulieu-Bonneau, S., Eidelman, P., Talbot, L., Ivers, H., Hein, K., Lamy, M., Soehner, A. M., Mérette, C., & Morin, C. M. (2016). Impact of comorbid anxiety and depressive disorders on treatment response to cognitive behavior therapy for insomnia. Journal of Consulting and Clinical Psychology, 84(8), 659–667.

El Alaoui, S., Hedman, E., Kaldo, V., Hesser, H., Kraepelien, M., Andersson, E., Rück, C., Andersson, G., Ljótsson, B., & Lindefors, N. (2015). Effectiveness of Internet-based cognitive–behavior therapy for social anxiety disorder in clinical psychiatry. Journal of Consulting and Clinical Psychology, 83(5), 902–914.

Gallagher, M. W., Phillips, C. A., D'Souza, J., Richardson, A., Long, L. J., Boswell, J. F., Farchione, T. J., & Barlow, D. H. (2020). Trajectories of change in well-being during cognitive behavioral therapies for anxiety disorders: Quantifying the impact and covariation with improvements in anxiety. Psychotherapy, 57(3), 379–390.

Öst, L.-G., Enebrink, P., Finnes, A., Ghaderi, A., Havnen, A., Kvale, G., Salomonsson, S., & Wergeland, G. J. (2023). Cognitive behavior therapy for adult anxiety disorders in routine clinical care: A systematic review and meta-analysis. Clinical Psychology: Science and Practice, 30(3), 272–290.

Shafiei, M., Rezaei, F., & Sadeghi, M. (2021). The role of childhood traumas, interpersonal problems, and contrast avoidance model in development of the generalized anxiety disorder: A structural equation modeling. Psychological Trauma: Theory, Research, Practice, and Policy.

Spaderna, H., Hoffman, J. M., Hellwig, S., & Brandenburg, V. M. (2020). Fear of physical activity, anxiety, and depression: Barriers to physical activity in outpatients with heart failure? European Journal of Health Psychology, 27(1), 3–13.

Wadsworth, L. P., Potluri, S., Schreck, M., & Hernandez-Vallant, A. (2020). Measurement and impacts of intersectionality on obsessive-compulsive disorder symptoms across intensive treatment. American Journal of Orthopsychiatry, 90(4), 445–457.

Online Continuing Education QUESTION 6
What are CBT techniques your client can use to feel more in control of anxiety? To select and enter your answer go to CE Test..