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» Cognitive Therapy Approaches to Anxiety

Cognitive Therapy Approaches to Anxiety

Cognitive Therapy is one of a number of evidence-based treatment strategies I employ

Cognitive Therapy is one of the four strategies I work with, and which has a strong evidence base for helping patients decrease their anxiety. While its origins go back to the ancient Greek philosophers, it’s only since the 1950s that clinical psychology has come into its own (away from merely doing psychometric tests for psychiatrists) and forged new ways to help people be relieved from the burdens of anxiety and depression.

If you see a therapist who proposes to work with you applying Cognitive Therapy, at its core will be the idea that much of human suffering – when the basics of survival, shelter and physical well being have been met – is due to our own evaluations of our circumstances:  considering the past, assessing the present and when contemplating our future.

Cognitive Therapists help patients identify and challenge their often automatic thoughts and beliefs about these evaluations. These thoughts are often judgemental and produce swift action or inaction (a freeze response). A cognitive therapist will guide you how to drill down to uncover these automatic thoughts (such as, “The plane’s engines just reduced in power – we’re going down!” or “My heart’s beating so fast as I board the plane – maybe it’s a sign I shouldn’t be doing this flight”.)

Then they help you challenge their veracity, before reappraising them with more evidence-based alternatives, which, combined with appropriate behaviours, will see the automatic thoughts become less frequent or potent. These appropriate behaviours need to be a match for the new thinking, and a mismatch or incompatible with the automatic thoughts.

The challenging aspect is often described as helping patients sort fact from fiction, to become better personal scientists, and to dispense with thinking distortions which commenced in childhood (usually) whilst our brains were still developing and making connections. In terms of our brain evolution, I think it’s true to say we’re emotional creatures who happen to think.

The challenge is that it’s not always easy to uncover the thoughts producing the unpleasant and unnecessary emotional reactions. We seem to often be in a cloud of competing thoughts as this wonderful video from Sydney’s TEDx from 2013 shows:

How does Cognitive Therapy work?

Cognitive therapy posits that while it may be interesting to know how our thoughts about current or future events may have originated, simply making that connection rarely changes behaviour.

One must go out and do the behaviours which are consistent with our reappraisals. These should be inconsistent or indeed inhibiting of our previously held, but rarely examined, ideas and beliefs. This requires deliberate and frequent practice. There is mounting evidence that patients who work hard at practising their reappraisal homework each day do far better than those who only do so during their weekly session with their psychologist. It’s why I usually advise patients who wish to use apps to assist them, to select those apps which have automatic reminders built in to them. This is how you establish and nurture good thinking habits.


Every so often, patients ask me about hypnotherapy as a way to change old habits. Sincerely, I wish an hour in trance could change a patient’s twenty five years of well-practiced and entrenched behaviours, but so far, I’ve not found evidence that this is the case. I do hear occasionally of miraculous changes, however, but based only on anecdotal evidence.

Choosing Apps to assist Cognitive therapy

There are a number of good, approachable books with accompanying workbooks to assist and a number of apps for iPhones, iPads and Android-based devices I recommend to patients. Email me (les at lesposen.com) and I’ll forward you a list.

Here’s even more recent ideas for your consideration:

What I’ve learnt about applying Cognitive therapy for anxiety patients

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