How to Use CBT for Anxiety: 12 CBT Techniques You Can Use Right Now (With Worksheets)
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Cognitive Behavioral Therapy (CBT), is an increasingly popular form of therapy used for the treatment of many types of mental and emotional issues including; anxiety, panic attacks, OCD and depression.
The use of CBT for anxiety has increased over the past 2 decades and is now recommended by the American Psychiatric Association, the American Psychological Association and the British Health Service for treating and managing anxiety.
CBT is often regarded as “the gold standard” for anxiety therapy.
Whether or not CBT is the “best” form of therapy for anxiety is obviously debatable, but studies have proven CBT's effectiveness in comparison to medication and other forms of therapy.
What impresses me the most about CBT is how quickly it can work, even in those who have had limited success using other strategies to manage their anxiety.
Measurable improvements have been shown in people with different types of anxiety over the course of a few short weeks, compared to months or years, as is the case with many forms of traditional talk therapy or psychoanalysis.
One of the major reasons CBT often works so quickly is the fact that it focuses on how our thoughts and behaviors play themselves out in our lives now instead of spending months or years digging into our childhood and past pain.
CBT is well known for it's direct, concrete and effective techniques.
These techniques and exercises are used with CBT worksheets to track and record our progress and to record and challenge our negative thoughts and beliefs.
In this article, we will discuss 12 of the most effective CBT techniques available.
We have also provided worksheets you can download and use in conjunction with the techniques.
So let's get started!
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A Quick Introduction to Cognitive Behavioral Therapy: CBT
CBT operates under the tenet that our thoughts affect our feelings, which in turn affects our behaviors, which can affect our thoughts, and on and on.
A vicious cycle.
We feel the way we think and our behaviors are directly related to how we think and feel.
Many people assume the cycle only goes in one direction: thoughts>>>feelings>>>behaviors
Any area can begin the cycle, but it's always our thinking – our thoughts, interpretations and beliefs – that causes anxiety.
How we feel can influence our thoughts, which can affect our behaviors.
For example: You feel nervous so you think “I'm feeling nervous, something terrible is bound to happen“, and then you behave in a way to reduce or avoid the anxiety (ie. avoidance, compulsive behaviors, distraction, etc.)
Regardless how it may initially look, it's our thinking that caused the problem.
In the example above, by thinking/believing – because you feel nervous something terrible will happen – you have essentially kick started the anxiety response and the resulting behaviors.
Our behaviors can also influence and affect our thoughts or our feelings.
For example: You slip up and have a few beers when you are trying to stop drinking, the next day you think “I'm such a fuck up, I'll never get over this.” As a result you feel anxious, depressed and guilty.
Yet again our thoughts (our interpretation of what happened) come into play as the primary cause of our negative feelings.
You may be thinking, “but it was the behavior, the drinking, that caused the feelings of anxiety, depression and guilt.“
But this isn't true.
What if your behavior was the same, you slipped up and drank again, but instead of thinking “I'm such a fuck up, I'll never get over this,” you think, “That was a mistake, I promised myself I wouldn't drink. I'm going to take stronger action from here on out, I'll start by throwing out all the alcohol in the house.“
Do you think your feelings would be the same?
Maybe…
But I guarantee they wouldn't be anywhere near as intense, as negative or as long lasting.
Besides that, if we were to go back in time and look closely, our thoughts prior to drinking, directly influenced or led to our drinking in the first place (ie. our behavior).
“Thoughts” include not only our conscious thoughts but our thinking processes, our interpretations of ourselves and events and our deeply held beliefs.
“Feelings” can be in our awareness and felt fully or they can be unconscious and repressed, desperately seeking expression
“Behaviors” can be consciously acted out (deliberate) or may seem out of our control (compulsive).
CBT focuses on developing personal strategies to challenge and change our negative thoughts and beliefs, creating a healthier emotional response to life's challenges and taking action to eliminate unhelpful (or unhealthy) behaviors and habits.
Cognitive Distortions
One of CBT's primary strategies is challenging and changing unhelpful, unrealistic, illogical, or just plain harmful – thoughts, interpretations, beliefs and attitudes.
These can be towards ourselves, towards others, or towards the world at large.
These unhelpful and illogical thoughts and beliefs are known as cognitive distortions.
Cognitive distortions are essentially “errors” in our thinking and our thought processes.
By changing how we think, we change how we feel.
Below is a guide we created with the 10 major cognitive distortions in Cognitive Behavioral Therapy.
When filling out your thought log (which you can download further down), use the cognitive distortions list below to determine which distortions are present in the negative thoughts you wrote down
The 10 Major Cognitive Distortions
The Cognitive Distortions list we have provided is an essential reference for recording the distortions in your negative thinking in your Thought Log and with the CBT techniques we will discuss below.
If you'd like to download this list for your personal reference, simply click the report.
CBT Worksheets for Anxiety
At the heart of CBT and one of the things that truly sets it apart is the amount of tracking, journaling and recording during therapy.
This is normally done using CBT worksheets assigned by the therapist to track our daily thoughts and levels of anxiety, to directly challenge our negative thoughts, to record our worries or for any number of different purposes.
There are also CBT workbooks you can purchase such as the “The Anxiety & Worry Workbook” by David Clark and Aaron Beck (the founder of cognitive therapy), that provide blank CBT worksheets for anxiety.
CBT relies heavily on tracking and recording so that we can keep track of what works as well as work out particular thought patterns or beliefs.
Writing it down makes it all so much easier.
Trying to do it all in our heads or relying on our memory often doesn't work out very well.
Worksheets also provide a visual representation of what is going on in our minds as well as concrete recorded information we can look back on and say “I've really improved my life” or “Looks like I still need to get over that particular fear.”
There are dozens of different CBT worksheets for anxiety, fear, worry, panic, exposure, etc.
We have provided 3 primary worksheets for you to download and use.
The worksheets are in PDF format.
Simply download the PDF, print, and fill in according to the technique you are doing.
There is something much more powerful about actually writing stuff down on paper vs typing on a computer or phone.
Feel free to download as many copies as you need and use them alongside the CBT techniques we will be discussing below.
The Thought Log (based on David Burns "Daily Mood Log")
The Thought Log is one of the primary worksheets in CBT.
There are different types of thought logs, some basic, some more complex.
The one we created and are providing for download is based on Dr. David Burns “Daily Mood Log.”
It's purpose is to allow us to record and challenge our negative thoughts and beliefs.
It's pretty straightforward to fill out, although the red boxes and arrows I used below make it look a lot more complicated than it is.
- Write down your negative thought or belief
- Write down how much you believe the negative thought
- Determine which cognitive distortions apply to your negative thought
- Write a positive thought to challenge and disprove the negative thought
- Write down how much you believe the positive thought
- Write down your new belief in the negative thought after coming up with the positive thought or using a technique
Cost-Benefit Analysis Worksheet
The Cost-Benefit Analysis Worksheet is used to help us change beliefs, attitudes and behaviors by clearly stating the advantages and disadvantages.
No matter how bad our particular issue may seem, there are always advantages (benefits) we are getting out of holding onto to the particular belief, attitude or behavior (habit).
Whether we care to admit it to ourselves or not….
There are also obvious and not so obvious disadvantages.
When we clearly compare what something is costing us versus what benefits we are receiving, it can greatly help us to make a choice and make the necessary changes.
Using this worksheet is pretty straightforward.
If you'd like to see an example of how to fill it out, check out the Cost-Benefit Analysis Technique below…
Fear Hierarchy Worksheet
The Fear Hierarchy Worksheet is used primarily with Exposure Therapy. It is used for Classical Exposure and Gradual Exposure in particular.
It is used to list and layout the different steps and levels to the particular fear we are working on, so that we can approach exposure one level at a time.
For example, if the fear we are working on is shopping in a crowded mall on our own, Level 1 may be to simply ride to the mall with a support person, without actually going inside. While level 10 would be to shop on our own on a Saturday afternoon.
If you want to see a full example, check out Exposure below.
CBT Techniques for Anxiety
There are many different CBT techniques for managing anxiety.
Far too many to list every single technique in a single article.
So we have chosen 12 of the most effective that cover just about every type of anxiety, issue, overall goal or purpose.
Some CBT techniques work better for certain types of anxiety, or areas of focus, than others.
For example; the first technique, the “Downward Arrow Technique” is used to uncover limiting beliefs. The technique “Smile and Hello” is primarily used for social anxiety and social phobia. Etc.
We recommend trying different techniques until you find one that is effective or mix and match techniques until you're able to bring the belief in a negative thought down to zero or replace a belief with something more empowering.
If one technique doesn't work for you, try a different one!
We highly recommend downloading and using the worksheets provided above with the CBT exercises.
It will make the process much more effective (and easier).
(Several of the CBT techniques listed below were borrowed from or inspired by Dr. David Burns's book “When Panic Attacks.” An excellent book that uses CBT exercises for anxiety. We highly recommend it)
The Downward Arrow Technique
When we have a negative thought or recurring negative thoughts, or we imagine a particularly frightening scenario, there is often a deeper held belief or beliefs behind the thought or scenario.
For example; if you have the recurring fear of being judged as incompetent by others, you may ask yourself why you have this fear but more particularly, why does it bother you so much if someone did you judge you as incompetent, what does it mean?
This is uncovering the “why” behind the limiting, negative thought or scenario.
This is how you uncover the deeper beliefs. Why something bothers you in the first place and the meaning you place on it.
The Downward Arrow Technique is a popular CBT technique for this very purpose. With this technique, we can uncover the deeper beliefs behind negative thoughts and fears.
And it's very effective.
In fact, it's one of our overall favorite techniques, from any form of therapy.
It's also relatively simple to do and cuts to the core of the matter quickly and clearly.
How to Use: The Downward Arrow Technique
- Using the Thought Log (download above), or a blank piece of paper, simply write down a negative thought. It could be a negative thought/belief about yourself, another person, or an upcoming situation
- Next ask yourself “If that is true, what would it mean to me? Why would it be bad/upsetting?“
- Draw an arrow underneath of the first thought pointing down and fill in your next thought based on the questions you just asked yourself
- Ask yourself the questions again and draw a downward arrow underneath listing the new thought
- Keep going like this until you get to the deep core beliefs around your original negative thought
Example
The What-If Technique
Those of us with anxiety tend to have vivid imaginations, which we often put to negative aims, ie. imagining terrible, frightening, anxiety-producing fantasies and scenarios.
But we rarely uncover the exact fantasy that is at the core of our fear around a particular situation.
And, just as important, we rarely ask ourselves the odds that this fear and anxiety-producing fantasy would ever actually occur in real life.
The What-If Technique works in a similar way to the Downward Arrow Technique, but instead of uncovering the self-defeating beliefs, we uncover a fantasy or imagined scenario/experience that is triggering our anxiety and/or frightening us.
The What-If Technique can also uncover beliefs and hidden emotions during the process, as we pinpoint the deeper underlying fantasy.
As a result of doing the What-If Technique, we can see just how illogical, unlikely or just plain silly, the majority of our anxiety-producing fantasies can be.
Once the core fantasy is uncovered we need to ask ourselves:
“How realistic is this fantasy?” “Is it based in reality?” How likely is it to actually occur?”
And if the fantasy is realistic and is something that could actually occur we need to ask, “Could I live with it if it did?”
This is one of our favorite CBT techniques overall, and extremely effective.
How to Use: The What-If Technique
- Using the Thought Log (download above), or a blank piece of paper, simply write down a negative scenario you imagine happening or a recurring fantasy you have that causes you anxiety
- After you have written it down, ask yourself “What if this actually happens?” “Then what?” “What happens next?”
- Draw an arrow underneath your first response and write your new response under it (based on the questions you just asked yourself)
- Now ask yourself “And if that happens, what then?” Draw an arrow down and write your next response
- Continue doing this until you uncover the actual core fantasy that is causing you anxiety and fear
- Once uncovered, ask yourself….
- How realistic is the fantasy?
- Is it based in reality?
- How likely it is to occur?
- Finally if it is 100% realistic and likely to happen, could you live with it?
The Double Standard Technique
A common issue with any type of anxiety is the way we talk to ourselves or react to situations in our lives, especially ones that didn't turn out the way we wanted or expected.
We quite often treat ourselves worse than we ever would a friend (or even most strangers for that matter).
I'm willing to bet you talk to yourself in ways that you would never talk to a close friend or loved one.
The Double Standard Technique is a compassion-based technique aimed at correcting this double standard in the way we treat ourselves.
The goal is to treat everyone, including ourselves, with the same level of compassion and fairness.
Instead of instantly beating ourselves up over a mistake or failure, we learn to approach the situation with the same understanding we would if it happened to a close friend or loved one.
This CBT exercise can help reveal not only how mean and uncaring we can be to ourselves, but how we often make our situations worse by beating up on ourselves.
It can also show us just how distorted our thinking can be.
Once we can really see how our negative thoughts sound coming from a friend or loved one, it can help to change our perspective so that we develop greater self compassion.
This works not only towards a particular issue in the past, but helps to change the way we treat ourselves going forward.
So instead of beating ourselves up for being anxious about something, we can talk to ourselves with more compassion and patience.
How to Use: The Double Standard Technique
The Double Standard Technique can be done in 1 of 2 ways.
Alone using the Thought Log (download above)
or
With someone else doing a role-playing exercise
On your own:
- To do it on your own use the Thought Log, or a blank piece of paper
- Now write a self-defeating thought or a thought where you have beaten yourself up over something that has happened. For example “I'm such a total screw-up” or “I really messed things up again, like I always do”
- After you have written the thought down, ask yourself “What would I say to a close friend or loved one if they were telling themselves this or had a similar issue?”
- As you come up with a response you would give if it were someone close to you, turn that response around so it is about yourself and write the response in the positive thoughts column
- Continue until you get a change in perspective and the negative thought or response loses it's charge and/or is no longer believed
With someone else (role-playing):
If you have someone to practice this technique with you can try doing a role-playing dialogue
- Write down a copy of your negative, self-defeating thoughts around a particular situation
- Give the person your list of thoughts and ask them to play a clone of you with the same exact problem using the negative thoughts you have listed
- Now you create a dialogue where the person states your problem and the thoughts you have around it as their own
- You respond in an understanding way as you would with a close friend
- Write down the positive/empowering thoughts you come up with in response to your friend's negative self-talk (so you are essentially responding to your own negative thoughts)
Cost-Benefit Analysis
Every way of thinking, feeling and behaving has its own advantages and disadvantages.
This includes negative ones that we want to change.
But we rarely take the time to look at what a particular habit or attitude is costing us or what we gain from behaving in a certain way.
For example; there are clear disadvantages to having the attitude “I am a weak person” but what do we gain by having this attitude?
If we do a Cost-Benefit Analysis we may discover that we get to feel sorry for ourselves, or we get to avoid things that make us uncomfortable or that we don't feel “up to doing.”
A Cost-Benefit Analysis can help us to clearly state and compare the advantages of a particular habit, attitude or belief to the disadvantages.
In most cases when we lay things out using a cost-benefit comparison we get to see exactly what it is costing us to think or behave in a certain way and uncover benefits we may not have been aware of before.
Cost-Benefit Analysis is a staple CBT exercise and highly effective.
We recommend using it for any attitude or behavior you want to change.
How to Use: Cost-Benefit Analysis
- Use the Cost-Benefit Analysis sheet (download above), or a blank piece of paper with a line down the center
- At the top, write down the particular belief, attitude or behavior (habit), you want to work on or change
- Now write down the advantages of the particular belief, attitude or behavior on the left and the disadvantages on the right
- When you have written down everything you can think of, decide based on your answers whether this particular thing is costing you more or benefiting you more
- You can write a score for each and choose the one with the higher score or simply make a final decision after reviewing what you have written
- When you clearly see that something is a major disadvantage in your life, it makes it much easier to change
Example
The Experimental Technique
We often walk around with many negative thoughts, beliefs and fears in our minds and we never stop to question whether or not they are true.
We may hold these thoughts and beliefs to be true even without any proof in reality.
With the Experimental Technique, we take definite action to validate or dispute a negative thought, limiting belief, or fear by testing the thought or belief directly in real life.
For example: let's say that you believe you must be dressed nicely, have your hair done and otherwise look perfect before you leave the house to go somewhere, otherwise people will notice and see you as a slob, or they will see as dirty or unattractive.
You deeply fear their imagined criticism.
Now, you've believed this for as long as you can remember and have never left the house without your appearance immaculate.
This belief/fear has caused you to be late going places, anxiety about how others see you and you've become overly self-conscious about your appearance.
Using the Experimental Technique you would come up with various “experiments” you could try to either prove or disprove the underlying fear based belief, ie. if I don't look nice whenever I leave the house, people will notice and judge me to be a slob or dirty.
For the experiment, let's say you decide to wake up in the morning and leave the house as you are, without any preparation. Wild hair, pajamas, and sleep still in your eyes.
You get in the car and drive to the store. As you go about your day you begin to realize very few people even notice you, let alone make comments or stare.
You get a few brief looks by a few people surprised to see someone in their pajamas, but otherwise, nothing terrible happens.
Here you have essentially disproven your fear based belief…
The Experimental Technique is extremely effective for anxiety, panic attacks and fear-based thoughts and beliefs.
It can remove limitations we've placed on ourselves quickly as we discover that the thing we feared was false all along.
How to Use: The Experimental Technique
- Decide on a limiting belief, fear or negative thought that you want to test
- Come up with a few creative ways to experiment with this belief, fear or thought
- Try out one or a few different experiments to prove the thought or beliefs validity
- Keep experimenting until you feel you have proven (with certainty) that it is true or that it is false.
Example
See above…
Response Prevention
Compulsive rituals, urges and behaviors are often performed by those of us with compulsive types of anxiety such as OCD.
These behaviors can be seen as a way to control or prevent anxiety responses caused by perceived or imagined threats. Even if the behaviors themselves seem illogical or pointless to an outside observer.
For example; let's say you have a deep fear of someone breaking into our house in the middle of the night, you may perform the compulsive ritual of repeatedly checking that every window and door is locked before going to bed. If you don't perform this ritual you may worry or feel unsafe until you do.
Compulsive urges and rituals can vary in intensity and the amount that they interfere with our lives.
In the example above, a relatively mild urge would simply be to double-check that the doors are locked before heading upstairs to bed each night.
In its severe form, you may check every door and window multiple times, possibly even getting up in the middle of the night to check again.
Response prevention is an effective CBT technique often used in combination with Exposure to help eliminate a compulsive ritual/behavior.
Stopping a compulsive behavior can ignite feelings of anxiety, much in the same vein as quitting an addictive substance.
If you continue to not give in to the compulsive behaviors, the urges will disappear in time.
For severe compulsions; Response Prevention combined with Exposure therapy and a competent therapist may be beneficial.
How to Use: Response Prevention
There's really no step-by-step directions for this technique.
You simply recognize a ritual or repetitive behavior that you do when anxious or to prevent feelings of anxiety and fear. Then you make a committed effort to stop performing the ritual or behavior.
Whenever you feel the urge you refuse to give in.
While not easy, the compulsive urges will go away over time as the behaviors are no longer performed.
This technique is often combined with Exposure Therapy, where the patient is exposed to the phobia or anxiety-producing situation and then practices Response Prevention by not performing the compulsive behavior.
For example, someone with a dirt or germ phobia may be asked to rummage around in a trash can and then not immediately wash their hands.
(Medication and/or therapy may be recommended for severe cases of compulsions and OCD)
Example
See above…
Smile and Say Hello
Shyness is common with anxiety. This especially true for those of us with social anxiety and social phobias.
When we are in public places we may feel self-conscious like everyone is judging us or we may believe people are “cold” or that people are downright rude or assholes.
The practice of smiling and saying hello to people as you go about your day is a simple but surprisingly effective strategy for breaking this spell of shyness and self-consciousness.
It also allows us to open ourselves to others as they truly are in the present moment, rather than what we imagine them to be.
The more you use this practice the more you are likely to see that most people are actually friendlier than you may have thought.
It can change your beliefs about others to a surprising degree.
It can also make you naturally more sociable in the process.
For as simple as the strategy is, it can be profoundly effective for shyness and social anxiety.
Smiling and greeting others can also benefit those around you.
Most people enjoy being acknowledged. A friendly face and a greeting can be enough to quickly brighten someone's day or lift their mood.
Simply smiling and saying hello to others may seem harmless or like a pretty weak strategy to some, but if you suffer from social anxiety or you are a particularly shy person, this otherwise “harmless” strategy may seem pretty intimidating.
If this is the case for you, you will likely find this strategy to be extremely beneficial if you keep practicing.
Note: This strategy may not be as effective in crowded cities where people tend to stick to themselves and focus on where they are going next (ie. New York City). If you live in a city like this don't take it to heart if some people do not smile back or return the greeting, many people in inner cities have simply grown accustomed to focusing on their routine and ignoring the rest, it doesn't necessarily mean they are rude.
How to Use: The Smile and Say Hello Technique
- Make a commitment to smile and say hello to 5 strangers each day, starting today
- If you are overly shy or nervous, start with strangers that you find to be the most non-threatening
- Once you can do this move up to 10 strangers each day and include every type of person, not just those you find non-threatening
- Continue practicing each day until it feels completely natural to you, you may find that you naturally continue to smile and say hello to strangers simply for the joy of interacting with others
Using this Practice to Find Love and Dating
This practice can also be customized for those who are single and looking for a partner. If you are shy or anxious around others (especially people you find attractive) you probably have trouble approaching or starting conversations.
- You can practice Smiling and Saying Hello as described above to become comfortable with simple interactions with others.
- Then begin smiling and saying hello to people you find attractive. The goal isn't to necessarily get a date but to simply practice.
- Over time you will become comfortable speaking to people you find attractive and move into conversations. By smiling and saying hello you may find the other person engaging you if they are interested.
Either way, just practice this simple technique and you'll be surprised at the improvements you can see in your interactions with others.
Many friendships, love affairs and intimate relationships started from a simple smile and one word “Hello.”
Exposure
What we resist persists and becomes stronger. When we avoid things we believe to be threatening we solidify the fear and the belief and make it stronger.
The more things we believe to be threatening and the more we avoid, the stronger the fear and the smaller our world becomes.
Exposure is the direct antidote to fears and avoidance behaviors. We expose ourselves to the thing that is feared until we cure ourselves of the fear.
Exposure is a powerful CBT technique but also stands on its own as Exposure Therapy. It's also used in other forms of therapy.
There are different forms and approaches to Exposure Therapy:
- Gradual Exposure: we approach the feared experience little by little, starting with the least frightening
- Flooding: we jump into the fear head-on and let the anxiety ignite to the extreme until it burns itself out and we come through the other side cured of the fear
- Cognitive Exposure: we expose ourselves to the fear by imagining it in great detail no matter how terrible (this is often used for experiences we can't expose ourselves to in real life)
- Interpersonal Exposure: commonly used for social anxiety, shyness and social phobias (the Smile and Say Hello technique above is an example of this)
Although Exposure is a central strategy in CBT it is a deep topic. Instead of just briefly discussing it here, we have a complete article on the topic in the works.
How to Use: the Fear Hierarchy Worksheet
The Fear Hierarchy Worksheet can be used for Gradual Exposure to a primary fearful situation.
When we use the worksheet, we break the fearful situation down into different levels (or steps) of approach and expose ourselves to one level at a time.
We start with the easiest, or least fearful, Level 1, to the most fearful, Level 10 or whatever number the last level may be.
See the example below to get a better idea.
Example
Semantic Techniques
Two of the major cognitive distortions in CBT, Shoulds and Labeling, are particularly common in anxiety.
We often tell ourselves that we should or shouldn't behave or feel a certain way.
We also apply shoulds to others. Such as, “the world should be fair” or “he shouldn't act like that.“
With Labels, we are often quick to label ourselves based on a flawed perception, experience or mistake.
We may label ourselves as “stupid” because we forgot to do something or label another person as a “bitch” from one interaction with them at the store.
In either case, we are discounting every other quality of ourselves or others and overgeneralizing – creating a label based on limited evidence.
Semantic Techniques work to correct the distortions involved in Should Statements and Labeling by changing our language. We become more clear on the terms we use and specific instead of overgeneralizing.
There are several different types of Semantic Techniques in CBT.
Below we'll look at one way to change your language to help with Shoulds and Labeling and reduce much of the charge behind hurtful statements we often use towards ourselves and others.
How To Use: Semantic Techniques
- To begin, notice an obvious should (or shouldn't) statement in your life right now. Notice the labels you use based on the success or failure of this should
- Write down exactly how you are saying it in your mind
- Now find the should statement in what you have written down (it may not always expressly state “should” but will be the part that puts unnecessary pressure on you or on others)
- Now find the label(s) you have used for yourself or others if the situation doesn't happen in the way you think it should
- Once you have a clear idea on the should and the label reframe the situation by substituting the word should or the implying should, for a preference or in less absolute terms
- Now look at the label used and clarify the term. Be specific, don't overgeneralize and use kinder language with yourself. Or simply remove the label completely.
- This isn't easy to explain step by step, although it's not as complicated as it sounds, it's more of a process of reframing statements as a whole
- See the example below for help
Example
Confronting Judgment & Criticism
Self-judgment and self-criticism are unfortunately all too common with nearly all types of anxiety.
We may feel insecure or self-conscious. We may imagine that others are highly critical of our appearance or the way that we carry ourselves.
We might project judgment and criticism onto those around us (we see it coming from the outside) or we may be well aware that we are the ones harshly criticizing ourselves.
In either case, we are our own worst critic and often judge ourselves to the point of insecurity, low self-esteem, anxiety and self-doubt or even helplessness.
There comes a point where we need to stand up to judgment and criticism, whether we see it in ourselves or we imagine it is the way others think about us.
The Confronting Judgement and Criticism Technique is a CBT technique I created by combining several traditional techniques; including Cognitive Exposure techniques and role-playing.
For this CBT exercise, you imagine a person that personifies all of the worst judgments and criticisms about yourself and then face them as they express these negative judgments to you.
Most of us have a general archetype or persona for the type of person we fear, whether it's a real type of person or an imagined one with a combination of different traits from different people.
Use this archetype as you dialogue in your head or on paper. Or you can explain the archetype to your partner if your using the technique with someone else and have them embody the character for greater affect with the technique.
How to Use: Confronting Judgment & Criticism
This technique can be done on your own or with another person.
On your own
- Write down a few negative thoughts, beliefs and criticisms you have about yourself or you believe others have about you using the Thought Log (download above).
- Now come up with a few positive thoughts in response to each.
- Make sure they are thoughts that you believe in and can easily counter, dismiss and/or that you can use to prove the negative thought to be false or inaccurate.
- Now imagine this archetypal mean person that represents all of the negative judgments you came up with
- Work out a written dialogue between you and this person as they tell you all the nasty negative things they see wrong with you and respond to their criticisms
- Keep going until this person (your negative judgments against yourself) are neutralized
With another person
This works the same as above except instead of imaging a person and writing down the dialogue, you have your friend play the part of the negative person expressing all of your negative thoughts, while you play the part of yourself
- Have them say out loud your negative judgments using “you” statements; “you're no good,” “you're weak,” “no one really loves you” etc.
- Respond to each negative judgment with your own positive statements
- Be sure to use “I” statements; “I have many good qualities,” “It's foolish to say I'm weak, I've overcome much in my life and I'm still standing.” etc.
- Keep going until the negative statements just seem ridiculous or illogical based on your responses to them
- If you're having trouble, try swapping roles, where you play the part of the negative thoughts and your partner plays your positive ones
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Reattribution
When there are problems in our lives or things don't go as planned we are often quick to beat ourselves up, take full blame or see ourselves as a “failure” or “loser.”
Using Reattribution we challenge our automatic assumptions and self-blame regarding events in our lives and take a clearer look at all of the factors that contributed to the problem.
Instead of beating ourselves up or tearing ourselves apart over something that happened we stop the blame game and look at the situation from a more realistic and holistic point of view.
If a situation was actually entirely our fault we focus on either making it right or learning from our mistakes.
In most cases, there are many different factors involved in situations that blaming ourselves entirely just isn't accurate.
Either way, blame doesn't solve anything. Using Reattribution we can eliminate self-blame and the resulting guilt and anxiety. We can look at the situation from a clearer point of view, take responsibility for the things we did, and learn from our mistakes so we can make better choices in the future.
How to Use: Reattribution
- Think of a situation in your life that you feel was a failure and that you still blame yourself for
- Using a piece of paper right down this situation and everything you blame yourself for and how the situation was a failure
- Now begin to look at this from a more realistic perspective
- Write down the situation using truth, based on all of the factors involved in the situation
- Take responsibility for your part and learn from it
- (Do not simply move all of the blame to someone else, consider every factor involved)
Example
Hidden Emotion Technique (Uncovering Suppressed Emotions)
There is a common theme among those of us with anxiety and that is, we tend to avoid confrontation, we don't want to “rock the boat” or hurt peoples feelings and we regularly avoid (or suppress) uncomfortable feelings and emotions that we label “bad” or “unacceptable.”
Anger is big one here.
In other words, people with anxiety tend to be “nice.”
Or constantly strive to be seen as nice by others.
Often at the expense of our own emotions, expressing how we feel or standing up for ourselves.
I would say this is the case for 99.9% of all those who suffer from anxiety.
This was definitely the case for me. In fact, getting over being seen as a “nice guy” was one of the major transformations I made in my life.
Not because being nice is bad, but because it wasn't entirely sincere. Underneath the nice facade, I was angry, I was hurt, I was unsatisfied.
Being nice at the expense of my true emotions caused the vast majority of the anxiety I had in my life. Once I worked on this and brought my true feelings to light, I felt much better, I felt more authentic and felt better able to face life.
This has been the case for many, many others.
In fact, I believe this to be the most powerful and effective strategy on this list. Because nearly everyone has feelings or emotions they stuff down, they ignore and they run from.
If you're suffering from anxiety I'm willing to bet anything that this is the case for you too.
The Hidden Emotion Technique comes from Dr. David Burns Book “When Panic Attacks.”
But uncovering hidden feelings and emotions that are causing us pain, anxiety, or depression isn't exclusive to CBT. Far from it.
Most forms of Psychotherapy focus on uncovering hidden emotions (typically referred to as suppressed or repressed emotions) so they can be brought to conscious awareness and expressed. Then they can be released and we can move on with our lives.
There is major difference between Dr. Burns' Hidden Emotion Technique, which is closely aligned with CBT, and the way that other forms of therapy use this process.
With the Hidden Emotion Technique, Dr. Burns believes the hidden emotion is related to something clear and present in our lives right now, not necessarily something buried in our past or some infantile unconscious urge, which is the common focus of other forms of therapy like Psychoanalysis.
Essentially it is what we are doing in our lives in the present that matters not digging up the past.
Very often the hidden emotion is related to one the major areas of life
- Work: Do you enjoy your job? Is it satisfying? Do you feel appreciated?
- Relationships: Do you have satisfying relationships? Do you feel loved? Do you have close friends? If you have a partner, do you feel they are the right one for you?
- Health: Is your health good or are you constantly ill and frustrated? If you are ill do you feel it is unfair that you have to deal with it while others are healthy?
- Free time and personal time (or lack thereof): Do you have time to do things you like to do (hobbies)? Do you have time to yourself or are you always busy or preoccupied?
- Overall personal freedom and satisfaction: Are you doing what you want to do in life? Is your life satisfying?
It's typically not hard to see what area is bothering us, we just choose not to face it.
Instead, we choose to take our dissatisfaction and other emotions and sweep them under the rug to avoid confrontation, or upsetting others, or to avoid being seen as anything other than nice.
As a result, we forget/ignore what we were originally upset about and instead experience anxiety, panic attacks, obsessive thoughts and behaviors, etc.
Before we jump into how to do the Hidden Emotion Technique I want to say one more thing.
The point of this exercise is not to go from a nice person that suppresses their emotions to a raging asshole that tells everyone how they feel without any filter.
The point is, to be honest with ourselves, to uncover the emotion so we can express it and stop feeling anxious as a result. The goal is to become more authentic and make the necessary changes in our lives, instead of ignoring problems or areas where we are dissatisfied.
If you'd like to learn more about suppressing and repressing emotions, check out our article: Psychological Causes of Anxiety
How to Use: The Hidden Emotion Technique
- Uncover the Hidden Emotion: the first step is to find out what is truly bothering you, this can be difficult or it can be easy depending on how truthful you are with yourself and how willing you are to face the problem; remember to look at the key areas in your life mentioned above (work, relationships, health, etc.)
- Express the Feeling and Make the Change: once you've uncovered the hidden emotion (the underlying problem causing your anxiety), you will have to express the feelings and do something about the problem; this a step where many people make a mistake; they uncover the feeling, feel it and feel better and then stop there; the underlying problem isn't fixed, it's still there; you have to make the necessary change otherwise the feelings will come back, and if you ignore the feelings, the anxiety will come back; so express the feelings and make the change
Final Thoughts
There are 2 key elements to making these CBT techniques work for anxiety.
They are: Commitment and Action.
Commitment to facing and challenging your limiting thoughts, beliefs, feelings, fears and behaviors.
And taking the necessary action. Completing the work, doing the exercises and facing your fears.
Feel the anxiety and do it anyway. It may be uncomfortable and even downright scary, but it is necessary to overcoming anxiety.
There's a reason those who take action and do the work provided by their CBT therapist see great results, while those who resist, refuse and make excuses do not.
Find the techniques that are right for you in the list of techniques above and do the work.
I promise if you commit yourself, you will see results!
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