Generalized Anxiety Disorder Cognitive Behavioral Therapy

Efficacy/effectiveness Of Exposure For Anxiety Disorders

Exposure therapies for each anxiety disorder tend to take on similar forms, with differences emerging most often in the emphasis on the content of exposure, which is specific to the patienfs presenting concerns. Exposure therapies also differ in their relative emphasis on the different exposure techniques . The efficacy and effectiveness of exposure therapy has been well documented for anxiety disorders, and exposure therapy is considered the treatment of choice for many forms of pathological anxiety.

Try An Opposite Action

Because behaviors, thoughts, and feelings are all connected, acting bravely or confidently during times when you are anxious can sometimes make a big difference. This technique is sometimes called opposite action and can be used to counteract difficult feelings through behaviors that seem opposite to what you would normally do when you feel this way. For instance, when you feel like isolating, finding a way to connect with others may help shift your mood.

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Relaxation Breathing Training: Relaxation training is a cognitivebehavioraltherapyexercise designed to help people reduce physiological symptoms of anxiety, such as shortness of breath, rapid heart rate, dizziness, etc.

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CognitiveBehavioraltherapy is a fourth-generation behavioraltherapy that achieves behavior modification by altering cognitive functioning. It is one of the leading treatments for anxiety as it aims to reduce anxiety by remodeling the factors and thought processes that trigger anxiety and fears. 3 steps of CognitiveBehavioralTherapyForAnxiety. Exposure therapy involves starting with items and situations that cause anxiety, but anxiety that you feel able to tolerate. You need to stay in this situation for 1 to 2 hours or until the anxiety reduces for a prolonged period by a half. Your therapist will ask you to repeat this exposure exercise 3 times a day.

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Complementary Therapies For Anxiety Disorders

As you explore your anxiety disorder in therapy, you may also want to experiment with complementary therapies designed to bring your overall stress levels down and help you achieve emotional balance.

Exercise is a natural stress buster and anxiety reliever. Research shows that as little as 30 minutes of exercise three to five times a week can provide significant anxiety relief. To achieve the maximum benefit, aim for at least an hour of aerobic exercise on most days.

Relaxation techniques such as mindfulness meditation and progressive muscle relaxation, when practiced regularly, can reduce anxiety and increase feelings of emotional well-being.

Biofeedback uses sensors that measure specific physiological functionssuch as heart rate, breathing, and muscle tensionto teach you to recognize your bodys anxiety response and learn how to control it using relaxation techniques.

Hypnosis is sometimes used in combination with CBT for anxiety. While youre in a state of deep relaxation, the hypnotherapist uses different therapeutic techniques to help you face your fears and look at them in new ways.

What Is The Effectiveness Of Cbt For Anxiety

CBT is highly effective in treating anxiety disorders and has decades of research providing evidence that it works.5,6,7 It is an evidence-based practice endorsed by the Substance Abuse and Mental Health Services Association and by the American Psychiatric Association, two of the leading authorities on mental health and addiction treatment.

• CBT is considered the gold standard treatment for anxiety disorders because it has the most evidence to support it works to reduce symptoms in people with Generalized Anxiety Disorder , panic Disorder, Specific Phobias, and Social Anxiety Disorder
• CBT is also effective in treating Obsessive Compulsive Disorder , especially when Exposure and Response Prevention us used
• CBT has proven to reduce symptoms in people who struggle with Posttraumatic Stress Disorder , especially Trauma-Focused CBT for children and teens who are experiencing PTSD symptoms
• CBT is effective in treating other common disorders including depression and mood disorders and substance use disorders

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Cognitive Behavioral Therapy For Generalized Anxiety Disorder

Everyone has worry and anxiety sometimes, however, some people experience worry and anxiety almost all the time, and about almost everything. This condition is known as Generalized Anxiety Disorder and is characterized by chronic anxiety. This kind of anxiety can be incredibly exhausting and is distinct from the more acute anxiety one may experience around an isolated incident.

GAD is particularly distinguished by an uncontrollable worry about things that the average person would not give much thought to. Other distinguishing characteristics of GAD include:

• over-thinking things or events that have happened in the past or that may happen in the future

• difficulty setting aside worry and being present

• feelings of restlessness and nervousness

• physical symptoms such as nausea, sweating, and muscle tension

While the effects of GAD have the potential to disrupt ones quality of life , there are effective treatment options for those looking for relief. Cognitive Behavioral Therapy is one of them.

Final Recommendationswhen To Seek Help

If you experience occasional anxiety and worry, there is little need to be concerned. However, if you are experiencing anxiety and worry more days than not, if it is interfering with your ability to function, or if you are starting to feel depressed then it is strongly recommended that you seek out professional help. And the earlier the better, before you feel even worse.

Finding the right professional may feel intimidating, but there are mental healthcare practitioners across the country who are well trained to help individuals with GAD. Try an internet search for what you need in your location. For example, search for Psychotherapist in Brooklyn or Cognitive Behavior Therapy in New York. You can often then view the therapists website and do a preliminary screening to make sure the person you found will be a good fit for what you are looking for. Contact to schedule an appointment and be on the way to feeling better.

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Psychological Therapies For Gad

Given the high prevalence and considerable individual and societal burden of GAD, developing and disseminating efficient and effective interventions is essential. Receiving preferred treatment type impacts clients engagement and outcomes , and people with common mental health conditions, including GAD, exhibit a strong preference for psychological versus pharmacological treatments . Current guidelines recommend individual, face-to-face cognitive behavior therapy as the first-line treatment for moderate-severe GAD . CBT refers to a range of interventions that aim to modify maladaptive cognitive processes, which are proposed to maintain psychological disorders such as GAD . While CBT was initially developed in the context of depression , clinically useful GAD-specific CBT interventions have been developed and tested. A number of CBT protocols are recommended by NICE for use in the UK .

The Emotional And Behavioral Approach

The emotional and behavioral approach is generally favored. The therapist tries to teach relaxation in order to instruct how to create positive emotions, not to manage negative ones. There is a double effect as follows: the provision of a psychological tool to prepare for exposition exercises relaxation allows desensitization of anxiogenic situations and a balancing of the general mood by adding cognitive break times in thoughts and worries.

The behavioral dimension of CBT is the most important. Patients will be able to expose themselves to their own emotions and so will be able to learn how to fight maintaining factors and avoidance behaviors that perpetuate the disorder. The cognitive process that is sought is habituation. It is the acceptance of thoughts as normal and nonblocking that initiates cognitive work. An example of mental exposition is the instruction think the worst. This strategy allows a rapid and effective reduction in avoidance. Exposure to anxiety allows patients to remain in the presence of images related to their possible concerns , in order to encourage emotional habituation. Patients can learn to tolerate their fears, which will allow them to think less often and less intensely about their worries.

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Exposure Therapy / Systematic Desensitization

The basic idea of exposure therapy is to face your fears. When someone exposes themselves to the source of their anxieties and nothing bad happens, the anxiety lessens. This doesn’t mean that you should throw someone with a fear of spiders into a room of tarantulas and lock the door . Instead, you’ll gradually work your way up to the feared stimuli with the client in a process called systematic desensitization.

The first step of systematic desensitization is to create a fear hierarchy. Identify the anxiety you would like to address with your client, and then create a list of steps leading up to it with rankings of how anxiety-producing you think the situation would be. Here’s an example:

Now, before following through and exposing a client to these stimuli, they must learn relaxation techniques to learn during the process. These can include deep breathing, progressive muscle relaxation, or meditation. They’re described in detail in the next session of this guide.

Finally, the client will follow through with the fear hierarchy . The goal is for the client to be exposed to stimuli that are only moderately anxiety-producing while using relaxation skills to manage their response. Eventually, the client can move on to the more challenging situations that they identified in the fear hierarchy.

Example Of Exposure Therapy For Anxiety

Exposure therapy is a type of CBT therapy used to help people reduce avoidant behavior driven by anxiety. It involves weekly therapy sessions with a licensed professional. Sessions usually last 1-2 hours and occur weekly for a total of 9-12 sessions. Exposure therapy is most used with specific phobias or in situations where avoidance related to anxiety has become problematic.1,9

As a part of this treatment, therapists first help clients learn relaxation skills. These might include exercises like breathing or mindfulness or exercises that introduce calming thoughts.

Next, therapy would involve exposing the client to some of the triggers that cause mild anxiety, gradually working up to triggers that cause high levels of anxiety. The exposure can happen in real-life , in a persons imagination or in computer simulations .

Over time, clients become desensitized to their triggers and experience less anxiety when confronted with them. They also develop better coping skills that help them stay calm during times when they do experience anxiety.9

Because exposure therapy involves facing feared situations, some clients do not complete treatment. Those who do, however, usually experience a significant reduction in symptoms.2,4,6,7

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Example Of Exposure & Response Prevention For Ocd

Exposure and Response Prevention is a specific type of CBT treatment used to treat Obsessive-Compulsive Disorder . This treatment involves helping people learn skills to experience their obsessions without engaging in repetitive compulsions . Because compulsions are used by people with OCD to reduce anxious thoughts and feelings, this therapy involves teaching new ways to manage their anxiety. The client will also need to learn skills to resist the strong urges they will have to engage in the compulsive behavior.

Similar to exposure therapy, clients receiving ERP will develop a fear hierarchy to denote low, moderate, and high-level fears. Over the course of several sessions, the client will gradually work their way up to facing high-level fears, developing skills along the way that promote coping. This treatment has been researched and found to be one of the most effective methods of treating OCD. It typically consists of weekly sessions lasting 1-2 hours for about 12 weeks.2,4,6,10

Medical Treatments For Generalized Anxiety Disorder

The National Institute for Health and Care Excellence recommends that if you have GAD and choose drug treatment, you should be offered a selective serotonin reuptake inhibitor at first, or a serotonin-noradrenaline reuptake inhibitor if SSRIs are ineffective. The NICE guidelines recommend against offering benzodiazepines for the treatment of GAD except as a short-term measure during crises.

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Treating Anxiety Disorders With Therapy

Whether youre suffering from panic attacks, obsessive thoughts, unrelenting worries, or an incapacitating phobia, its important to know that you dont have to live with anxiety and fear. Treatment can help, and for many anxiety problems, therapy is often the most effective option. Thats because anxiety therapyunlike anxiety medicationtreats more than just the symptoms of the problem. Therapy can help you uncover the underlying causes of your worries and fears learn how to relax look at situations in new, less frightening ways and develop better coping and problem-solving skills. Therapy gives you the tools to overcome anxiety and teaches you how to use them.

Anxiety disorders differ considerably, so therapy should be tailored to your specific symptoms and diagnosis. If you have obsessive-compulsive disorder , for example, your treatment will be different from someone who needs help for anxiety attacks. The length of therapy will also depend on the type and severity of your anxiety disorder. However, many anxiety therapies are relatively short-term. According to the American Psychological Association, many people improve significantly within 8 to 10 therapy sessions.

Online vs. in-person therapy

However, not all online therapy is the same. Communicating via a messaging app, phone, or email, for example, is no substitute for live face-to-face interaction using video chat.

Read: Online Therapy: Is it Right for You?

Key Cognitive Processes Underlying Worry

Given that the central characteristic of GAD is uncontrollable worry, treatment needs to target key mechanisms that maintain worry. In keeping with treatment development for other disorders , research needs to first identify processes that differentiate GAD and general populations. Subsequently, studies should confirm that the identified mechanism has a causal role in maintaining key aspects of the disorder, i.e. worry in the case of GAD.

Based on Hirsch and Mathews theoretical model of pathological worry, three key candidate processes trigger and maintain bouts of worry: automatic emotional-processing biases that lead to intrusions of negative thoughts into awareness, and then continue to operate during worry and generate thoughts about more negative potential outcomes, use of a generalized verbal thinking style during worry that prevents positive resolution and increases the likelihood of further episodes of worry, and impaired intentional control of attention that impedes terminating an episode of worry and re-focusing onto the task at hand or other non-worry topics.

Automatic Emotional-Processing Bias Favoring Negative Information

GAD is characterized by streams of thinking on wide-ranging topics imbued with emotional ambiguity about negative outcomes. Individuals with GAD exhibit automatic emotional-processing biases favoring negative information.

Interpretation Bias

Attention Bias

Representation of Threats in Generalized Verbal Form

Defective Attentional Control

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Do I Have Generalized Anxiety Disorder

GAD should only be diagnosed by a mental health professional or a doctor. However, answering the screening questions below can give you an idea of whether you might find it helpful have a professional assessment.

• Deliberately exposing yourself to hypothetical event worry.

Outcome Literature On Basic Cognitive

The first controlled trial on psychotherapy for GAD appeared in 1984 . Since then, 16 such experimental evaluations have been reported . Prior reviews and meta-analyses concur that the evidence consistently supports the efficacy of traditional CBT. Indeed, CBT for GAD is listed as an empirically-supported treatment by the Task Force for the Dissemination and Promotion of Empirically Supported Treatments . The most recent meta-analysis of controlled trials was based on 13 investigations available at the time . This review builds upon that review with the addition of the three further experimental studies that have since appeared.

In terms of within-group effect sizes, CBT has generated the largest degree of improvement relative to other comparison conditions prior to posttherapy and follow-up . Conditions that have served as controls for nonspecific effects have generated smaller effect sizes . Component control conditions have shown effects that were slightly lower than those of nonspecific treatments . Four of the seven studies that included a waiting-list no-treatment condition and provided measures and data allowing effect-size calculations found virtually no change for these control conditions .

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Cbt Helps Reduce Anxious Thought Patterns

CBT describes anxious thoughts as thought distortions or negative automatic thoughts, which are believed to increase anxiety. These include worried worst-case scenario or what if thoughts that many people ruminate on when they feel anxious, and other negative thoughts a person has about themselves or their lives. With the help of CBT skills, it is possible to stop and change these thoughts into more positive, helpful thoughts that reduce anxiety.2,4,5,6,7

Here are some examples of how CBT can help to interrupt negative or distorted thoughts that feed into anxiety:8,9

Cognitive Restructuring Or Reframing

This involves taking a hard look at negative thought patterns. Perhaps you tend to:

• place too much importance on minor details

Thinking this way can affect what you do and, in some instances, can become a self-fulfilling prophecy.

Your therapist will ask about your thought processes in certain situations so you can identify negative patterns. Once youre aware of them, you can learn how to reframe those thoughts so that theyre more positive and productive.

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Cbt Exercises For Anxiety To Try At Home

While it is not possible to do CBT treatment on your own at home, there are some CBT exercises that could be helpful to some people with anxiety. These include activities and skills that focus on becoming more aware of thoughts, feelings, and behaviors, and making changes when those patterns are contributing to anxiety.

Here are five CBT techniques for anxiety that you could try at home:9