A pattern of excessive worry that makes normal functioning difficult. It may include phobia, social anxiety, generalized anxiety or obsessive-compulsive disorder. Medications and psychotherapy combination have shown significant improvement in anxiety symptoms.
Everyone feels anxious now and then. It’s a normal emotion. For example, you may feel nervous when faced with a problem at work, before taking a test, or before making an important decision.
Anxiety disorders are different, though. They are a group of mental illnesses, and the distress they cause can keep you from carrying on with your life normally.
For people who have one, worry and fear are constant and overwhelming, and can be disabling. But with treatment, many people can manage those feelings and get back to a fulfilling life.
Types of Disorders
Anxiety disorder is an umbrella term that includes different conditions:
- Panic Disorder: You feel terror that strikes at random. During a panic attack, you may also sweat, have chest pain, and feel palpitations (unusually strong or irregular heartbeats). Sometimes you may feel like you’re choking or having a heart attack.
- Social Anxiety Disorder: Also called social phobia, this is when you feel overwhelming worry and self-consciousness about everyday social situations. You fixate about others judging you or on being embarrassed or ridiculed.
- Specific Phobias: You feel intense fear of a specific object or situation, such as heights or flying. The fear goes beyond what’s appropriate and may cause you to avoid ordinary situations.
- Generalized Anxiety Disorder: You feel excessive, unrealistic worry and tension with little or no reason.
All anxiety disorders share some general symptoms:
- Panic, fear, and uneasiness
- Sleep problems
- Not being able to stay calm and still
- Cold, sweaty, numb or tingling hands or feet
- Shortness of breath
- Heart palpitations
- Dry mouth
- Tense muscles
Thought challenging in CBT for anxiety
Thought challenging—also known as cognitive restructuring—is a process in which you challenge the negative thinking patterns that contribute to your anxiety, replacing them with more positive, realistic thoughts. This involves three steps:
- Identifying your negative thoughts. With anxiety disorders, situations are perceived as more dangerous than they really are. To someone with a germ phobia, for example, shaking another person’s hand can seem life threatening. Although you may easily see that this is an irrational fear, identifying your own irrational, scary thoughts can be very difficult. One strategy is to ask yourself what you were thinking when you started feeling anxious. Your therapist will help you with this step.
- Challenging your negative thoughts. In the second step, your therapist will teach you how to evaluate your anxiety-provoking thoughts. This involves questioning the evidence for your frightening thoughts, analyzing unhelpful beliefs, and testing out the reality of negative predictions. Strategies for challenging negative thoughts include conducting experiments, weighing the pros and cons of worrying or avoiding the thing you fear, and determining the realistic chances that what you’re anxious about will actually happen.
- Replacing negative thoughts with realistic thoughts. Once you’ve identified
the irrational predictions and negative distortions in your anxious thoughts, you can replace them with new thoughts that are more accurate and positive. Your therapist may also help you come up with realistic, calming statements you can say to yourself when you’re facing or anticipating a situation that normally sends your anxiety levels soaring.
To understand how thought challenging works in cognitive behavioral therapy, consider the following example: Maria won’t take the subway because she’s afraid she’ll pass out, and then everyone will think she’s crazy. Her therapist has asked her to write down her negative thoughts, identify the errors—or cognitive distortions—in her thinking, and come up with a more rational interpretation. The results are below.
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