What is Anxiety?
In the English language, we typically use the word Fear to describe our immediate emotional reaction to present danger or threat, whereas Anxiety tends to refer to the more persistent physiological and cognitive (or thinking) response associated with the anticipation of threat, particularly when this remains uncertain. Of course, as human beings, we are all more-or-less familiar with the urge to avoid, escape, or attend to the perceived threat, as a natural response to the uncomfortable bodily sensations associated with this survival mechanism.
What maintains Anxiety?
Anxiety is a normal human experience. However, when Anxiety intensifies and becomes more persistent, it can be debilitating and interfere with our lives in so many ways, causing significant distress. In CBT we work together with individuals to develop a shared understanding of the underlying beliefs and thoughts that are maintaining a person’s anxiety. This will look quite different for individuals, although there may be common themes depending on the nature of someone’s difficulties, such fears of social judgement in Social Anxiety, or the sense of current threat arising from the meanings attributed to traumatic events, in PTSD.
We all have our own set of beliefs about ourselves and the world around us, which tend to be completely understandable in the context of our experiences. Or at least, the meaning that we have attributed to those experiences. The challenge in CBT is to identify the specific factors that could prevent such beliefs from being tested, updated, or contextualised with other evidence or information. For example, a spider-phobic individual is unlikely to have witnessed how quickly a spider scurries away if you try to touch it (rather than up your arm) because the intensity of their fear would have prevented them from pursuing such encounters. Similarly, the breathlessness they might experience on exposure would likely persuade any of us that we could suffocate, yet by taking deep breaths or avoiding the experience altogether, one could never be confident that this would not in fact occur.
In practice, there are multiple factors that can maintain anxiety, ranging from commonly understood behaviours like Avoidance or Safety-Seeking Behaviours such as those described above, to more discrete cognitive (or thinking) processes such as where we focus our attention, the internal dialogue that we can get stuck in, or the way in which we experience intrusive memories or images.
So, how can CBT help with this?
A key aim of CBT is to collaboratively identify changes to break the vicious cycles of Anxiety, through a wide range of evidence-based techniques. This might involve designing a series of Behavioural Experiments to test your beliefs, finding ways to gather new information, re-processing distressing images, or discussion techniques, all in the pursuit of developing alternative perspectives that help you to break free from persistent anxiety.
