Stress and Anxiety

How Can CBT help with Stress and Anxiety?

Like most of us, you probably feel anxious or "stressed" in various areas of your life. In our fast-paced, competitive culture, these feelings are normal. In fact, some of the most high-achieving people report the highest levels of stress and anxiety!

However, these feelings can reach a point where they begin to interfere with work, sleep, and relationship patterns. Learning to manage stress and anxiety is an important skill.

When I work with clients on stress-management and anxiety-reduction efforts, I first try to make one thing clear: Anxiety is a normal response to challenges. People who are taking risks, trying new things in their lives, and growing in new ways will often feel anxious. Anxiety is a sign of growth. We all experience it in varying degrees.

Having said that, there are many approaches from the cognitive-behavioral therapy tradition that can help to reduce anxiety and manage stress in our lives. As with the treatment of depression, I often begin my work with clients by introducing what I call the "TEA cycle."

The TEA Cycle for Anxiety and Stress

The idea behind the TEA cycle is that our Thoughts, Emotions, and Actions (T-E-A) can form an upward or downward spiral.

Stressful and anxious thoughts can contribute to anxious emotions and lead to anxiety-perpetuating actions (including avoidance, a common behavioral response to anxiety).

This cycle can spin on itself over and over, creating a downward spiral. The anxiety-based thoughts, emotions, and actions reinforce each other, and keep each other in place.

In holistic cognitive therapy, we address all three elements of this cycle. We make changes to thoughts, emotions, and actions.

Interestingly, cognitive therapists have found some commonalities among people who are prone to high levels of stress and anxiety. These people often have:

  • Thoughts that involve perfectionism, high internal standards, and often a significant amount of self-criticism.
  • Emotions that include worry about results, impatience with self or others, and a sense of threat or pressure.
  • Actions that include self-sacrifice, overwork, avoidance or procrastination, and a tendency to take a great deal of personal responsibility for results.

Of course, each person is unique and everyone's TEA cycle is different. However, these are some elements that often show up in an anxiety/stress-oriented TEA cycle.

In cognitive therapy, we work on changing many of these elements. We shift perfectionistic, self-critical beliefs to self-accepting, self-supportive beliefs. We move the "balance-of-credit" for problems from overly personal responsiblity to shared responsibility. We identify catastrophizing thought patterns and replace them with more realistic thougth patterns.

We also emotionally face some of the "worst-case scenarios" and develop a "felt-sense" that we can handle even these scenarios. We develop new, self-soothing emotional patterns through relaxation and guided meditation practices. We begin to cultivate greater feelings of self-acceptance.

Behaviorally, we work to develop new self-caring actions. We identify actions that aren't self-respectful, and strategize about how to replace them with self-respectful new actions. We build a holistic plan for stress/anxiety-reducing behaviors such as enjoyable daily exercise and social connection. We also work on specific issues that need to be addressed, such as work conflicts and relationship problems.

The goal is to move the old anxious/stressed TEA cycle into a peaceful, self-respectful, self-accepting new cycle. The downward spiral can then change to an upward one.

More "Specific" Forms of Anxiety

Although everyone deals with anxiety and stress at times, other people experience more specific forms of anxiety.

The DSM, which is a book that psychotherapists often use to classify clinical issues, lists several specific forms that anxiety can take. These experiences are actually quite common; approximately 25% of people will fit the criteria for one of these types of anxiety at some point in their lives.

I have split descriptions of these onto separate pages. If you'd like information on any of these forms of anxiety, please click on the following:

  • Specific Phobias: most of us have these to some degree. From spiders to flying, these are specific things or situations that trigger feelings of anxiety or panic.
  • Worry and Generalized Anxiety: people who feel that they are "addicted to worry" may also experience insomnia, tension, and other symptoms.
  • Social and Performance Anxiety: this includes everything from public speaking anxiety to severe shyness. It is an extremely common form of anxiety.
  • Panic Attacks: these are intense experiences of fear and adrenaline that may seem to come "out of the blue." They may even occur in the middle of sleep.
  • Obsessive-Compulsive Disorder: people with OCD develop obsessive thought patterns or compulsive behavioral patterns as a response to anxiety. (This is now classified in a new Obsessive-Compulsive and Related Disorders section in the DSM-V.)