DEAR MAYO CLINIC: I have been diagnosed with anxiety but really do not want to take medication for it. What does cognitive behavioral therapy involve? How effective is it in treating anxiety?
ANSWER: Although an anxiety disorder can be difficult to manage on your own, anxiety is a highly treatable condition. Cognitive behavioral therapy, or CBT, is an evidence-based psychotherapy that addresses the thoughts and behaviors that contribute to anxiety. Research has shown CBT often can be effective in treating anxiety, even when it is used without medication.
Feeling anxious occasionally is part of life. But an anxiety disorder is different. People with anxiety disorders have intense, excessive and persistent worry and fear about everyday situations. These feelings often are hard to control and are out of proportion to the actual danger a person is facing. For many people, an anxiety disorder can disrupt daily life and interfere with normal routines. For example, you may have a tendency to think about worst-case scenarios and worry that you will be unable to cope with them. As you do, your mood may become more anxious. You may then try to control your anxiety by engaging in avoidance behaviors, which may include repeatedly asking for reassurance from others that everything will be okay, or staying away from situations that make you anxious.
CBT is based on the principle that your thoughts, behaviors and feelings are all related to each other and have a significant influence on one another. That means certain types of thinking patterns and behaviors have an impact on anxiety.
CBT for anxiety is targeted to help you learn to manage anxious thinking by re-examining your worries, challenging your assumptions and using strategies to reduce the emotional impact of your thoughts. In addition, with CBT you learn ways to change your avoidance behaviors in order to reduce anxiety.
Learning to change avoidance behaviors through exposure therapy is the most important treatment principle in the management of anxiety. Gradual and repeated exposure to feared situations, uncomfortable physical sensations and unpleasant thoughts can be very effective in reducing your anxiety. With practice, you can become much less reactive to triggers for your anxiety, so you can tolerate those situations, sensations and thoughts much better over time.
Stress management and relaxation techniques may also be a part of anxiety treatment. But they typically are not the primary focus of CBT treatment for anxiety.
In CBT, you and your therapist collaborate as a team. The two of you talk about your goals for treatment. You then work together to decide how you can best develop the skills you need to achieve those goals. CBT sessions are structured so that you learn the skills in therapy and then practice them between therapy sessions. That way you have an opportunity to actually try out those skills and see how they work for you with the guidance of a therapist.
Research suggests that the majority of patients with anxiety benefit from CBT. These effects tend to be long-lasting, even from a relatively brief course of therapy that lasts about four to 12 sessions.
CBT providers are in both primary care and specialty clinics within larger heath care organizations. Others run individual private practices. Your primary health care provider would be a good person to talk to about a referral to a cognitive behavioral therapy provider in your community. When selecting a CBT provider, make sure to ask if he or she treats anxiety using exposure therapy.
The following organizations also offer CBT resources and provide information about how to find a qualified CBT specialist: Anxiety and Depression Association of America (www.adaa.org) and Association for Behavioral and Cognitive Therapies (www.abct.org). — Julia Craner, Ph.D., and Craig Sawchuk, Ph.D., L.P., Psychiatry & Psychology, Mayo Clinic, Rochester, Minn.