As a therapist, the reason I like cognitive-behavioral therapy (CBT) is because with the multitude of tools available to a therapist, there is almost always a solution to a given problem. Granted, the solution may not always be easy, but at least CBT offers concrete possibilities. I always tell my clients not to worry about failing with any particular method because even if a method doesn't work it can give us more information about what might be helpful. This article describes 50 different CBT methods to help learn how to manage panic and anxiety.
If you have read my previous articles describing CBT suggestions such as Happy Habits: 50 Suggestions or Stress: 50 Suggestions you will find one important difference regarding this list for panic and anxiety. For happiness, depression, or stress, the order of using the different suggestions is not as critical. However, this list of CBT tools for anxiety is presented in a general order presenting the initial tools to learn through the more advanced tools to learn. The purpose is to provide more of a training procedure as some of the advanced tools require proficiency with the earlier training methods.
However, the tools do not have to be used in the exact order they are presented, nor or all the methods appropriate for every person or situation. Therefore, it is best to have a therapist help determine which methods may be most useful in your circumstances and to help guide you. In addition, if you require the more advanced techniques (some people may not because the initial methods may be effective), it is particularly important to have therapeutic assistance. Techniques such as exposure therapy can be quite intense and, if done inaccurately, can have the opposite of the desired effect and cause increased anxiety (this will be discussed in more depth in the section about exposures).
In addition, with panic and anxiety it is always recommended to have a full medical examination to rule out physical conditions that can mimic anxiety or increase anxiety (thyroid conditions, asthma, high blood pressure, etc). However, the purpose of the medical examination is not for treatment of the anxiety disorder but for treatment of any physical conditions that could be present and impacting anxiety.
I say this because many times physicians want to immediately prescribe medication when they hear complaints of anxiety. Yet, research clearly shows that CBT is as effective as medication if not superior for certain conditions (Anderson et al., 2012). And CBT does not have the serious side-effects and possible long-term consequences of medication. Therefore, it seems sensible to pursue a path that is less likely to do harm and just as likely to help.
In addition, ruling out medical conditions can aid with the cognitive methods of challenging irrational thinking. For instance, if you have had a medical examination ruling out heart disease you are much more likely to believe the statement “These feelings are not a sign of heart disease. This is just anxiety which is a normal condition of the body and can't hurt me.”
The following 50 CBT tools for panic and anxiety are divided into several categories explained in greater detail at the beginning of each section: general skills, initial relaxation training, initial cognitive restructuring, advanced mindfulness training, advanced cognitive restructuring, and exposure treatment. The best approach to the following methods is to start with the initial tools, learn them well, and then continue with the more advanced tools.
Although you may choose to learn some of the initial skills concurrently such as learning relaxation while learning about cognitive restructuring, it is best to pursue the more advanced skills after you have mastered the initial skills.
Engaging in a program to learn to control panic and anxiety requires effort. Although some aspects may be immediately rewarding because anxiety reduces or because a method might be pleasant (such as relaxation), to truly manage anxiety you need to make changes in your thinking and lifestyle. When people make lifestyle changes such as exercise or weight loss, they erroneously believe that the reward of the change will be enough.
Unfortunately, that is not true most of the time. Although most change is rewarding in the long-term it does not provide much immediate reward or at least not comparable to the amount of effort required. Without immediate reward people are more likely to quit their attempts to change their lifestyle because making changes can be uncomfortable. Therefore, if you want to manage anxiety not just for the moment but for the future you need to start by developing a reward system.
First, identify various rewards. Make a list of things that are rewarding to you. This list will vary from person to person but it can include activities you enjoy, foods that you like, buying yourself something, etc. It can also include reward from other people (if they agree) such as a massage from your spouse or going to a movie with a friend.
Once you have made this list, reward yourself frequently! Don't withhold reward because something you tried didn't work. Reward yourself for trying! You can even reward yourself for making your list of rewards. The idea of reward is to help motivate you . The task of changing your thinking and lifestyle is difficult enough so don't be stingy with the reward.
By the way, just giving yourself reward can be a change in thinking for many people with anxiety. Often, people think “I SHOULD just do this because it is good for me. Feeling better should be enough reward.” So when you give yourself a reward for making the attempt to change then you ARE changing the perfectionistic demands or “shoulds” that tend to increase anxiety. Read more: page 2
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