Cognitive restructuring is one of the main components of cognitive behavioral therapy (CBT) for anxiety. The previous post provided a brief overview of cognitive restructuring in CBT. Now we’re going to look at how to use cognitive restructuring to manage anxiety.
We’ll examine some common types of negative thoughts and worries associated with anxiety. And then learn how to modify these thoughts with cognitive restructuring in ways that reduce our anxiety and make us less anxious.
CBT for Anxiety and Cognitive Restructuring
One of the basic premises of cognitive behavioral therapy is that our thoughts have a powerful influence on our moods and how we feel. If we can change our thoughts – change the way we’re thinking about situations or circumstances we find ourselves in – then we can change the way we feel. So if we’re feeling anxious and having a lot of anxious thoughts, if we can change or modify the nature of these thoughts to make them less anxious, then our levels of anxiety will decrease. In cognitive behavioral therapy, we change or modify our thoughts with a technique called cognitive restructuring. In this video, we’re going to learn how to use cognitive restructuring to modify our anxious thoughts in ways that help make us less anxious.
When we have anxious thoughts, we tend to overestimate the likelihood that something bad will happen and overestimate how bad things will be, and underestimate our abilities to cope with bad things if they do occur. Sometimes it’s just one of these, and sometimes it’s two or all three.
My boss wants to meet with me this afternoon. She must be disappointed with my work. I’m probably gonna get fired, and then I’m never gonna be able to find a new job.
My partner was supposed to be home an hour ago. They’re not answering my texts. Something must have happened to them. What if they were in an accident? What if they’re really hurt?
I have to go to Sam’s birthday thing this weekend. It’s going to be really uncomfortable. I’m not going to know anyone there. I’m not going to have anything to say to anyone. Everyone’s going to think I’m some kind of weirdo. I’m just going to embarrass myself.
Oh no, what’s this feeling in my chest? What if there’s something wrong with me? I’m having a heart attack. I’m starting to have trouble breathing. I think I’m dying.
When we have these types of thoughts, they make us anxious. If we’re already feeling anxious, we tend to have more of these thoughts, which make us even more anxious, leading to even more anxious thoughts that increase our anxiety, creating a vicious cycle. The more anxious we are, the more anxious thoughts we have, and the more anxious thoughts we have, the more anxious we feel, and so on. But if we’re able to change our thoughts with cognitive restructuring to make them less anxious, then we reverse this cycle. As our thoughts become less anxious, our levels of anxiety begin to decrease, which leads to us having fewer anxious thoughts, which reduces our anxiety even more, and so on.
When we have these types of thoughts, they make us anxious. If we’re already feeling anxious, we tend to have more of these thoughts, which make us even more anxious, leading to even more anxious thoughts that increase our anxiety, creating a vicious cycle. The more anxious we are, the more anxious thoughts we have, and the more anxious thoughts we have, the more anxious we feel, and so on.
But if we’re able to change our thoughts with cognitive restructuring to make them less anxious, then we reverse this cycle. As our thoughts become less anxious…
So, how does cognitive restructuring work? How do we change these thoughts to make them less anxious? We can’t just change our thoughts because we decide we want to. If we try to do this and engage in some sort of positive thinking, for example, if we’re having the thought, “This is going to be terrible,” and we tell ourselves, “No, you can’t think that, it’s making you anxious, you need to change that thought to ‘This is going to be great’ or even ‘Everything’s going to be fine,” the problem is we don’t believe that this is going to be great or that everything is going to be fine.
And since we don’t really believe these thoughts, they’re not going to affect the way we feel, they’re not going to make us any less anxious. If anything, this type of positive thinking only makes us feel worse because we’re trying to force ourselves to believe things that we don’t really think are true. So the key to cognitive restructuring is to replace or modify our existing thoughts with thoughts that are less anxiety-provoking but that we can believe. Let’s learn how to do this.
So, first, we start with a thought we’re having that’s associated with our anxiety. Then we’re going to assess how accurate that thought is. We want to see how well that thought fits the facts of the situations or circumstances we find ourselves in that we’re feeling anxious about. And then if we discover that our thought isn’t that accurate, it doesn’t fit the facts that well, then we change that thought to make it more accurate so that it fits the facts better.
And instead of just trying to come up with a new thought off the top of our heads to replace this anxious thought with, there are a series of questions we can use as prompts to help us come up with new less anxious thoughts or ways of looking at things. You can pause the video and read over them now if you like, or you can download a copy of these questions from my website from the link in the description. But we’re also going to go through them now with some examples. And it can help to actually write down our answers because that gets us out of our heads a bit, and sometimes it’s easier to see things from a different perspective when we’re looking at them on paper rather than trying to sort it all out in our heads.
So, we have a presentation coming up that we’re feeling anxious about. So we ask ourselves, what’s going through my mind? What am I thinking? I hate speaking in front of people. I’m no good at it. It’s going to be terrible. And what am I worrying will happen? I’m going to embarrass myself and let people down. What am I predicting will happen? I’m not going to be prepared enough, and I’m going to forget what I want to say. And then what’s the worst-case scenario? I’ll completely freeze and make a fool of myself, and people will think I’m stupid, my boss will be disappointed, and it’s going to hurt my career.
What evidence do I have that this worst-case scenario will come true? I’m always uncomfortable when I speak in public. I never do as well as I think I should.
What evidence do I have that the worst-case scenario may not come true? Even if it hasn’t always been perfect, it’s always gone okay when I’ve given a presentation, and I’ve always managed to get through it. How likely is it that the worst-case scenario will come true? It’s not very likely.
If the worst-case scenario did happen, what could I do to help me cope with it? If I start to freeze and figure out what I’m supposed to say, I can drink some water to help calm myself down and gather myself, and then I can start reading off my notes for a bit until I get back on track. What are some other possible scenarios, other outcomes, other ways things might turn out? It could go fine, and no one will notice that I’m nervous, and I might stumble a bit, but I’ll get through it. And what’s the most likely thing to happen? Well, I’ll be nervous beforehand, and when I first start speaking, but once I’ve been going for a while, I’ll settle down, and I’ll do okay, even if it’s not perfect.
So if that most likely case scenario were to happen, how could I cope? Well, there’s not much to cope with, and that actually isn’t so bad.
Have I ever been in a similar situation? How did that turn out? How was I able to cope then? Well, I always feel really nervous when I know I’m going to have to do a presentation. I never feel like I’m prepared enough, and I usually make a few mistakes or forget something, but nothing bad has ever really happened, and I’ve always gotten through it.
And what have I learned from past situations that can help me deal with what I’m going through now? Well, I’ll be uncomfortable when I first start talking, but then I’ll calm down, and things will go okay. Even though I never feel prepared, I usually prepare really well, and so if I get stuck, I can always refer to my notes until I get back on track.
What advice would I give to a friend or loved one who is in a similar situation, or what advice might a friend or loved one give to me? Just prepare as much as you can and know that you’re probably going to be nervous at first, but a lot of people get nervous speaking in front of people. If you stumble over a few words or speak too fast or forget something, people will understand, and once you start talking, you’ll start to feel less anxious, and it’ll probably go okay. And you’ve never completely messed up a presentation in the past, so there’s no reason to think you will now.
So is there another way of thinking about the situation that’s more accurate or fits the facts better? I’ll probably be really nervous at first and feel unprepared, but once I start talking and settle into the presentation, I’ll start feeling less anxious, and the presentation is going to be fine.
We started off thinking, “This presentation is going to go terribly. I’m really going to mess it up,” and this perspective causes us a lot of anxiety. But then after some cognitive restructuring, we’re able to come up with a way of looking at things that’s more accurate and fits the facts better and helps us feel less anxious.
We don’t have to use all of these questions, just whichever ones seem most relevant or helpful for the situation. So let’s look at a couple more examples.
I’m feeling anxious about going to my friend’s birthday party on the weekend. What am I worrying will happen? Well, that I won’t know anyone there. What am I predicting will happen? I’ll be too uncomfortable to talk to anyone, and the worst-case scenario is I’ll just stand in a corner by myself looking stupid, or I’ll try talking to people, but I won’t have anything to say, and I’ll just embarrass myself.
And how likely is this worst-case scenario? Well, I probably won’t embarrass myself, but there’s a good chance I spend a lot of time avoiding people I don’t know, just staring at my phone.
And what evidence do I have that this worst-case scenario will come true? Well, when I’m around a group of people I don’t know, I’m usually very uncomfortable and quiet and keep to myself.
And what evidence do I have that it won’t come true? Well, I usually find at least one person I know that I can talk to, and even if I don’t, there’s usually someone friendly who comes over and starts talking to me.
And that’s also the most likely scenario. I’ll know someone there, but even if I don’t, someone will start talking to me, and as long as they’re outgoing enough, I usually don’t have a problem holding up my end of the conversation. And then once I’ve talked to one person, I start feeling less anxious, and I start enjoying myself.
And if the worst-case scenario does come true, how could I cope? Well, I can stick around for a while feeling uncomfortable and then go home, and at least Sam will know that I showed up, and that’ll mean a lot to them.
We started off thinking, “I’m not going to know anyone. I’m not going to have anything to say to anyone. I’m just going to look stupid or embarrass myself,” which causes us a lot of anxiety. But then after some cognitive restructuring, we end up with a more accurate perspective that fits the facts better, something like, “I felt this way about going to parties before and still had a good time, but I might be uncomfortable and not have much to say to anyone, and if that happens, I can just go home,” and this new perspective and new way of thinking about the situation reduce the amount of anxiety we’re experiencing.
Or finally, I notice an uncomfortable feeling in my chest, and I start worrying. I think I’m having a heart attack. The worst-case scenario is I’m having a heart attack, and I’m about to die. And obviously, as soon as we start thinking about this worst-case scenario, it causes us a lot of anxiety. But how likely is that worst-case scenario? Well, I’m pretty young, and I’ve never had any problems with my heart before, so it’s probably very unlikely that I’m having a heart attack.
What evidence do I have that the worst-case scenario will come true? Well, I feel horrible right now, and I’m not sure why my heart is pounding like this.
So what are some other possible scenarios? It feels like a heart attack because my anxiety has set off the fight-or-flight response, and that’s caused my heart to start racing, and it’s probably just a panic attack.
What have I learned from past situations like this? Well, I’ve had a lot of panic attacks in the past, and they often feel like a heart attack at first, but they always turn out to be just a panic attack.
And if this most likely scenario is true, what can I do to help me cope with it? If I can slow down my breathing, I’m usually able to prevent a full-blown panic attack, but even if I can’t, once the panic attack passes, I’m going to be okay.
So I’m not having a heart attack, I’m having a panic attack, and I have some tools that can help me cope with it, and even if they don’t work, I know that once the panic attack passes, I’m going to be okay.
So with the help of some cognitive restructuring, we’re able to change our initial thought that’s causing us so much anxiety, “I’m having a heart attack and I’m gonna die,” to a new, more accurate thought, “This is a panic attack and it feels really scary and uncomfortable, but it’s not gonna kill me and I’m gonna be okay once it passes,” and this new way of looking at things reduces our anxiety, which also makes it less likely that things do escalate into a full-blown panic attack.
So in each of these examples, we took our initial thoughts about a situation that were causing us a lot of anxiety and modified them with cognitive restructuring into a more accurate way of looking at things that reduces our anxiety.
Cognitive restructuring is important in CBT because it helps us change how we’re thinking. And in CBT, changing our thoughts is one of the main ways we change how we feel. If we’re able to modify our worries and anxious thoughts in order to:
- more accurately estimate a situation’s level of threat and danger
- consider outcomes other than the worst case scenario
- feel more confident in our abilities to cope with negative outcomes
then we’ll start to reduce our anxiety.
The questions in the Cognitive Restructuring for Anxiety Worksheet [download PDF] or [download Word] can help with cognitive restructuring of worries and anxious thoughts.
Next we’ll learn how to complete a worry record. The worry record is a thought record that’s been modified to focus on worries, and guides us through the process of cognitive restructuring for anxiety. If you have any questions or comments, please leave them on the YouTube video page.