Self Help – Cognitive-Behavioural Therapy (CBT)

Learning about Anxiety: Psychoeducation

An important first step in overcoming a psychological problem is to learn more about it, otherwise known as “psychoeducation.”

Learning about your problem can give you the comfort of knowing that you’re not alone and that others have found helpful strategies to overcome it. You may even find it helpful for family members and friends to learn more about your problem as well. Some people find that just having a better understanding of their problems is a huge step towards recovery.

For example, an individual suffering from frequent panic attacks would begin by learning what a panic attack is (see Panic Disorder). In learning about panic, one would discover that although a panic attack is an uncomfortable experience, it’s temporary and not dangerous.

A CBT therapist is able to provide helpful information on your particular problem, but you can also find information on your own through reputable sources at bookstores and on the Internet.

Psychoeducation is a vital first step, but it’s important to remember that this is only one part of a complete treatment plan.

Relaxation Strategies

Learning how to relax your body can be a helpful part of therapy. Muscle tension and shallow breathing are both linked to stress and anxiety (and sometimes depression). So, it’s important to become aware of these bodily sensations and to regularly practice exercises to help you learn to relax.

Two strategies often used in CBT are Calm Breathing, which involves consciously slowing down the breath, and Progressive Muscle Relaxation, which involves systematically tensing and relaxing different muscle groups. As with any other skill, the more these relaxation strategies are practiced, the more effectively and quickly they will work. Other helpful relaxation strategies include listening to calm music, meditation, yoga and massage.

It’s important to realize, however, that the goal of relaxation is not to avoid or eliminate anxiety (because anxiety is not dangerous), but to make it a little easier to ride out these feelings.

Realistic Thinking

Effectively managing negative emotions involves identifying negative thinking and replacing it with realistic and balanced thinking. Because our thoughts have a big impact on the way we feel, changing our unhelpful thoughts to realistic or helpful ones is a key to feeling better. “Realistic thinking” means looking at yourself, others, and the world in a balanced and fair way, without being overly negative or positive. For example:

Steps to Realistic Thinking

Know what you’re thinking or telling yourself. Most of us are not used to paying attention to the way we think, even though we are constantly affected by our thoughts. Paying attention to your thoughts (or self-talk) can help you keep track of the kind of thoughts you typically have.

Once you’re more aware of your thoughts, try to identify the thoughts that make you feel bad, and determine if they’re problematic thoughts that need to be challenged. For example, if you feel sad thinking about your grandmother who’s been battling cancer, this thought doesn’t need to be challenged because it’s absolutely normal to feel sad when thinking about a loved one suffering. But, if you feel sad after a friend cancels your lunch plans and you begin to think there’s obviously something seriously wrong with you and no one likes you, this is problematic because this thought is extreme and not based on reality.

Pay attention to the shift in your emotion, no matter how small. When you notice yourself getting more upset or distressed, ask yourself, “What am I telling myself right now?” or “What is making me feel upset?”

When you’re accustomed to identifying thoughts that lead to negative emotions, start to examine these thoughts to see if they’re unrealistic and unhelpful. One of the first things to do is to see if you’ve fallen into Thinking Traps (e.g., catastrophizing or overestimating danger), which are overly negative ways of seeing things. You can also ask yourself a range of questions to challenge your negative thoughts (see Challenge Negative Thinking), such as “What is the evidence that this thought is true?” and “Am I confusing a possibility with a probability? It may be possible, but is it likely?”

Finally, after challenging a negative thought and evaluating it more objectively, try to come up with an alternative thought that is more balanced and realistic. Doing this can help lower your distress. In addition to coming up with realistic statements, try to come up with some quick and easy-to-remember coping statements (e.g., “This has happened before and I know how to handle it”) and positive self-statements (e.g., “It takes courage to face the things that scare me”).

It can also be particularly helpful to write down your realistic thoughts or helpful coping statements on an index card or piece of paper. Then, keep this coping card with you to help remind you of these statements when you are feeling too distressed to think clearly.

Facing Fears: Exposure

It’s normal to want to avoid the things you fear because this reduces your anxiety in the short term. For example, if you’re afraid of small, enclosed places like elevators, taking the stairs instead will make you less anxious. However, avoidance prevents you from learning that the things you fear aren’t as dangerous as you think. So, in this case, taking the stairs prevents you from learning that nothing bad happens when you do take the elevator.

In CBT, the process of facing fears is called exposure – and it’s the most important step in learning to effectively manage your anxiety. Exposure involves gradually and repeatedly entering feared situations until you feel less anxious. You start with situations that only cause you a little bit of anxiety, and you work your way up to facing things that cause you a greater deal of anxiety (See Facing Fears: Exposure).

The first step involves making a list of the situations, places or objects that you fear. For example, if you’re afraid of spiders and want to overcome this fear so you can enjoy camping with friends, the list may include: looking at pictures of spiders, watching videos of spiders, observing a spider in an aquarium, and standing across the room from someone holding a spider. Once you have a list, order it from the least scary to the scariest.

Starting with the situation that causes you the least anxiety, repeatedly take part in that activity or face that situation (e.g., looking at pictures of spiders) until you start to feel less anxious doing it. Once you can face that specific situation many different times without experiencing much anxiety, you’re ready to move on to the next step on your list.

CBT stresses the importance of facing fears on a regular basis. The more you practice, the faster your fears will fade! Having successes and feeling good about your progress is a powerful motivator to keep going.

How to Prevent a Relapse

Managing your problem effectively is a lot like exercise – you need to “keep in shape” and make practicing the helpful skills a daily habit. However, sometimes people slip back into old habits, lose the improvements they’ve made and have a relapse. A relapse is a complete return to all of your old ways of thinking and behaving before you learned new strategies for managing your problem. While it’s normal for people to experience lapses (a brief return to old habits) during times of stress, low mood or fatigue, a relapse certainly does not have to take place. Here are some tips on how to prevent lapses and relapses:

Keep practicing your CBT skills! This is the best way to prevent a relapse. If you’re practicing regularly, you’ll be in good shape to handle whatever situations you’re faced with.

Tip: Make a schedule for yourself of what skills you’re going to work on every week.

Know when you are more vulnerable to having a lapse (e.g., during times of stress or change), and you’ll be less likely to have one. It also helps to make a list of warning signs (e.g., more anxious thoughts, frequent arguments with loved ones) that tell you your anxiety might be increasing. Once you know what your warning signs or “red flags” are, you can then make an action plan to cope with them. This might involve, for example, practicing some CBT skills like calm breathing or challenging your negative thinking.

Remember that, like everyone else on earth, you are a work in progress! A good way to prevent future lapses is to continue working on new challenges. You’re less likely to slide back into old habits if you’re continually working on new and different ways of overcoming your anxiety.

If you have had a lapse, try to figure out what situation led you to it. This can help you make a plan to cope with difficult situations in the future. Keep in mind that it’s normal to occasionally have lapses and that you can learn a lot from them.

How you think about your lapse has a huge impact on your later behaviour. If you think that you’re a failure and have undone all your hard work, you’re more likely to stop trying and end up relapsing. Instead, it’s important to keep in mind that it’s impossible to unlearn all the skills and go back to square one (i.e., having anxiety and not knowing how to handle it) because you do know how to handle your anxiety. If you have a lapse, you can get back on track. It’s like riding a bike: once you know how to ride one, you don’t forget it! You might become a bit rusty, but it won’t be long until you’re as good as before.

Remember that lapses are normal and can be overcome. Don’t beat yourself up or call yourself names like “idiot” or “loser,” because this doesn’t help. Be kind to yourself, and realize that we all make mistakes sometimes!

Finally, make sure to reward yourself for all the hard work you’re doing. A reward might be going out for a nice meal or buying yourself a little treat. Managing anxiety is not always easy or fun, and you deserve a reward for your hard work!