HOW TO COPE WITH STRESS, ANXIETY AND PHOBIAS USING COGNITIVE-BEHAVIOR THERAPY
William L. Golden Ph.D.
If you are looking for proven techniques pertaining to how to cope with stress, anxiety and phobias this article can help you. According to the cognitive-behavioral model, situations do not automatically cause anxiety. Anxiety-producing thoughts lead to anxiety. Cognitive and behavioral techniques capable of modifying our thoughts and feelings provide the treatment for the various anxiety disorders
How to cope with stress, anxiety and phobias using Cognitive Therapy
Albert Ellis and Aaron Beck are the originators of cognitive therapy. The basic concept in cognitive therapy is that it is not just the event or situation that causes emotional upset. Our thoughts, attitudes and beliefs cause or contribute to disturbing emotions such as anxiety. In cognitive therapy, patients are taught to identify and change self-defeating thoughts.
Coping self-statements can be used to reduce anxiety. Coping self-statements are constructive thoughts which can be used to prepare you for stressful situations or when in stressful situations. Using imagery, you can mentally rehearse coping self-statements while imagining how you will cope with a stressful situation.
Logging helps you to identify your anxiety triggers and the negative thoughts that lead to anxiety. You can begin a log or diary to identify the situations in which you feel anxious, as well as those situations that you avoid. Also identify and monitor your anxiety-producing thoughts.
The Two-column Method
The two-column method is a self-help tool that you can learn to use on your own. Start by dividing a page in half. On one side of the page, list your anxiety-producing thoughts. On the other side of the page, constructive thoughts are listed. The goal is to generate a set of coping thoughts that can be used for reducing anxiety. Here is an example of the two-column method, as it was used for generating a set of coping thoughts for a patient receiving therapy for social anxiety:
| Coping Thoughts
|1) I’ll get rejected.||1) I’m jumping to conclusions. If I don’t try, I won’t succeed. So I might as well take a risk. I really have nothing to lose. If I keep trying, I will have some success.
|2) I’m a loser.
3) If I get rejected,
it will prove I’m a loser.
|2) I’m not a loser. I’m good at some things and not at others. Social skills are not one of my strengths, but I can learn and get better at it with practice.
3) Acceptance and rejection from other people does not determine my self-worth. I can accept myself and stop calling myself names like “loser.” I can feel good about trying.
Coping self-statements, developed through the two-column method, can be used during imagery for the purpose of anxiety reduction. For example, using the social anxiety example described above, I suggested the following while having the patient visualize going to a social situation and interacting with people:
“Now imagine that you are going to a social event. And as you enter, you are thinking, you really have nothing to lose. Rejection from other people does not determine your self-worth. So take a risk. If you keep trying, you will get better at socializing and will be more successful, and you can feel good about trying, no matter what the outcome. Now imagine talking to people, feeling more confident and more comfortable”
This imagery technique, in combination with social skills training and role-play, helped prepare the patient for social situations and interactions.
Cognitive-behavior Therapy Techniques
Cognitive and behavioral techniques can be combined. Cognitive-behavior Therapy, also known as CBT, includes the use of relaxation techniques, imagery and exposure therapy techniques. Exposure involves facing your fear in a systematic manner where you learn to master your fear. Relaxation techniques and coping self-statements can be used to reduce anxiety both during imagery and exposure therapy techniques.
The various relaxation techniques can be combined to create a procedure that is tailored to the needs and preferences of a given individual. Experiment and find out which ones work for you.
The breathing technique that I use with most of my patients is diaphragmatic breathing. You will know you are breathing diaphragmatically if your stomach rises as you inhale and flattens as you exhale. A good way of checking this out is by lying down on your back with a book or a box of tissues on your stomach. As you inhale make the book, or box of tissues, rise as you inhale and lower as you exhale. If possible, breathe in and out through your nose. Try to breathe at a rate of four seconds to inhale and four seconds to exhale. Only a few minutes of slow diaphragmatic breathing are needed to produce relaxation.
Imagining a pleasant relaxing scene is another relaxation technique. Pick one of you favorite places, maybe somewhere you went on vacation. It could be a beach, a park, a garden, a stream or brook. Use as many of your senses to imagine it. Imagine what you would see, hear, feel and smell. Imagine it as vividly as you can with as many details as possible.
If you are having trouble identifying an image, try this exercise. Experiment and see if you can respond to any of these questions:
Can you imagine walking along the beach? Can you imagine the warmth of the sun? Can you imagine seeing the waves? Can imagine the sound of the ocean? What do the waves sound like? Can you imagine the sound of seagulls?
Can you imagine a sunset? If you can imagine the sunset, what colors is it?
Can you imagine floating in warm water? Can you imagine drifting along? Can you feel light and buoyant?
Can you imagine walking in the woods during autumn? Can you picture the colors of the leaves? What colors can you picture? Can you imagine the sound of leaves crunching as you walk along the path?
Can you imagine sitting in a garden?
Can you imagine some flowers?
Can you imagine a particular flower? What color is it? How many petals does it have?
Can you imagine a butterfly in flight? What does it look like?
Progressive Muscle Relaxation
First find a comfortable position with your eyes closed. Let your breathing slow down, so you are breathing slow and easy. With each exhalation, you can start to let go, one muscle group at a time.
Starting with your toes, as you exhale, find a comfortable position for your toes, letting them spread apart in a comfortable position. Feel the relaxation spreading to your feet. With each exhalation, you can let go more and more. And with each exhalation, you can feel your toes and feet becoming more relaxed…
Feel the relaxation spreading. As you exhale let go of any tension and feel the relaxation spreading, more and more. Feel the relaxation spreading to your ankles…calf muscles…knees…and thighs.
And now, let your back go loose and limp, head and neck in a comfortable position. … And as you exhale let go of any tension and feel the relaxation spreading, more and more. You can feel the relaxation spreading up and down your back…all the way up to your shoulders and neck.
And as you continue to breathe slow and easy, you can feel the relaxation spreading to your arms and shoulders. Let your arms hang loose and limp and as you exhale feel the relaxation spreading down your arms… hands open, fingers apart. Feel the relaxation spreading down your arms, all the way down to your fingertips.
And now let your jaw hang slack, in a relaxed position, teeth slightly parted, and feel the relaxation spreading to your facial muscles…to your lips… cheeks… the muscles surrounding your eyes… your forehead…the relaxation spreading to all of your facial muscles.
Feel the relaxation spreading throughout your body, spreading to your stomach muscles… and to your chest…spreading and deepening… more and more…deeper and deeper, with each exhalation.
And to deepen the relaxation, you can imagine your relaxation image… using as many of your senses as possible, imagine your relaxation scene…Imagine what you would see…what you would hear…what you might smell…how you would feel.
And as you continue to enjoy your peaceful scene, and continue to breathe slow and easy, you can feel yourself becoming even more relaxed, calm and relaxed. Arms and legs, more relaxed.
The relaxation spreading and deepening… with each exhalation…Shoulders hanging comfortably…Back and neck, loose and limp….Jaw hanging slack…Facial muscles, smooth and relaxed…Stomach, calm and relaxed. All the muscles of your body relaxed…and your mind feeling calm and peaceful…As you continue to imagine your peaceful serene and continue to breathe slow and easy, you can feel yourself becoming more and more relaxed…feeling calm and very relaxed.
Treatment of Phobias
Systematic desensitization is an exposure therapy technique that was developed by Joseph Wolpe for the treatment of fears and phobias. This technique provides patients an opportunity to confront their fears in a gradual systematic manner, one step at a time. Relaxation techniques are used to reduce anxiety during exposure to the feared situations. The specific anxiety “triggers” are identified. An anxiety list is then constructed. The fear or phobia is broken down to specific anxiety-producing triggers, which are then rank ordered from least to most anxiety producing. Systematic desensitization can be done in imagination and/or in reality. Here is an example of an anxiety list that was used for a patient with a fear of flying:
2-Thinking about flying
3-Watching planes on TV
4- Watching planes landing and taking off
5- The night before the flight
6- Driving to the airport
7-Boarding the plane
8-Plane taxiing on the runway
9-Plane on runway waiting to take off
10-Hearing sounds of the plane
11-Airplane hatch closing
12-Seatbelt light goes on
In the above case, I had the patient imagine each item while in a relaxed state, only going onto a next step after the patient was able to imagine the prior step comfortably. This desensitization technique enabled the patient to fly successfully. Research has shown that desensitization is about 80 – 90 % successful in the treatment of phobias. Research has found that Cognitive-behavior therapy is the most effective psychological treatment for stress, anxiety and phobias.
Beck, A.T., & Emery, G. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books.
Chambless, D.L. & Ollendick, T.H. (2001). Empirically supported psychological interventions: Controversies and evidence. Annual Review of Psychology, 52, 685-716.
Dryden, W., & Golden W.L. (1986). Cognitive-Behavioral Approaches to Psychotherapy. London: Harper & Row.
Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Lyle Stuart.
Wolpe, J. (1958). Psychotherapy by reciprocal inhibition. Oxford: Pergamon Press.