Specifically, heightened anxiety and fear prompt individuals to avoid experiences, events, and thoughts that they believe will lead to catastrophic outcomes. Exposure techniques rely on learning theory to explain how prolonged fear is maintained over time. There are several behavioral strategies in CBT for anxiety disorders, yet the central behavioral strategy is exposure therapy. Some combination of cognitive restructuring and behavioral experiments are often implemented in CBT across all anxiety disorders. For example, if a patient believes that he/she/they is romantically undesirable and that asking someone on a date will cause the other person to react with disgust and disdain, then the patient would be encouraged to test this belief by asking someone on a date. Behavioral experiments involve encouraging patients to empirically test maladaptive beliefs to determine whether there is evidence supporting extreme thinking. Similarly, behavioral experiments can be used to facilitate cognitive change. And, it’s not a forgone conclusion that even if I lose my job, I will never find another one for the rest of my life.”). Through identification of thinking traps, cognitive restructuring can be used to promote more balanced thinking, encouraging patients to consider alternative interpretations of circumstances that are more helpful and less biased by anxiety (e.g., “Maybe thinking the chance of losing my job is 100% is overestimating the likelihood that it will actually happen. For example, “black-and-white thinking” describes the interpretation of circumstances as either all good or all bad, without recognition of interpretations between these two extremes, and “overgeneralization” describes the making of sweeping judgments on the basis of limited experiences). These cognitive traps are patterns of biased thinking that contribute to overly negative appraisals. ![]() Cognitive restructuring promotes more adaptive and realistic interpretations of events by identifying the presence of thinking traps. The objective of cognitive interventions is to facilitate more adaptive thinking through cognitive restructuring and behavioral experiments. Anxiety disorders are associated with negatively biased cognitive distortions (e.g., “I think it’s 100% likely I will lose my job, and no one will ever hire me again”). In brief, CBT holds that one’s emotional experience is dictated by one’s interpretation of the events and circumstances surrounding that experience ( 2, 3). One of the primary CBT strategies is cognitive intervention. Although there are several CBT interventions for different types of anxiety, some common techniques and treatment goals form the basis of the CBT philosophy. When each of these three components interact and mutually reinforce one another, distressing and impairing levels of anxiety can be maintained over time. ![]() A cognitive-behavioral conceptualization of anxiety disorders includes identification of dysfunctional thinking patterns, distressing feelings or physiological experiences, and unproductive behaviors. CBT sessions often occur weekly for a limited period (e.g., 12–16 weeks), and a small number of booster sessions are sometimes offered subsequently to reinforce independent use of skills. CBT differs from other therapeutic orientations in that it is highly structured and often manualized. At its core, CBT refers to a family of interventions and techniques that promote more adaptive thinking and behaviors in an effort to ameliorate distressing emotional experiences ( 2). One of the most well-researched and efficacious treatments for anxiety disorders is cognitive-behavioral therapy (CBT). Anxiety disorders are among the most prevalent of mental disorders and are associated with high societal burden ( 1).
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