CBT Solutions for Anxiety Clinic

The CBT Solutions for Anxiety Clinic is an evidence-based treatment program focused on providing effective, affordable, sustainable treatment for anxiety disorders. Our goal is to help our clients regain their vitality and confidence through learning how to overcome troubling symptoms of anxiety.

Learn to

- control your panicky feelings and worries
- face fears gradually and safely
- use relaxation strategies to feel more comfortable
- enjoy activities again
- go places you currently avoid
- feel confident in social situations
- have peace of mind

Anxiety is one of the most common reasons that people seek therapy. This is not surprising given that 19 million American adults will meet criteria for an anxiety disorder at some point in their lives (Narrow, Rae, & Regier, 1998). Interestingly, however, anxiety is also one of the most normal and necessary aspects of the human experience. Mild to moderate levels of anxiety may help you to accomplish your goals by motivating you to do things like study for exams or clean the house before guests arrive. Higher levels of anxiety may be a signal that you are in danger and need to act quickly, such as to avoid an auto accident. Anxiety can become problematic, however, when its severity outweighs the needs of the situation and leads to avoidance or other unhelpful behaviors. Common forms of anxiety include:

Social Anxiety - (More Info)
- Worries or concerns of embarrassment that lead to either avoiding or painfully enduring social situations such as public speaking, speaking in small groups, eating in public, using public restrooms, intimate interactions, etc.

Specific Phobia
- Anxiety and avoidance that interferes with daily life related to specific situations such as heights, water, reptiles, insects, spiders, blood, air travel, car travel, bridges, etc.

Posttraumatic Stress Disorder - (More Info)
- Anxiety related to recent or past events that were physically and/or emotionally traumatic. Posttraumatic anxiety may involve feeling as if the event is reoccurring emotionally, visually, or on a sensory level. These reactions are often triggered by current experiences that are reminders of some portion of the trauma. These symptoms lead to avoiding any of these triggers.

Obsessive Compulsive Disorder - (More Info)
- Intrusive thoughts about topics like disease, dirt, lack of order, sex, religion, or violence are met with repetitive behaviors that serve to reduce anxiety. The nature of these repetitive rituals varies widely and may be associated with the feared outcome directly (e.g., washing hands repeatedly after touching something unclean) or indirectly (e.g., stepping in and out of the door exactly 13 times to prevent disease in the family).

Generalized Anxiety Disorder - (More Info)
- Persistent tension and anxiety due to nearly constant worrying about many topics such as money, relationships, cleaning, children, school, etc. Relief from one worry is usually replaced by another worry.

Panic Disorder - (More Info)
- Repeated and sudden episodes of intense fear, apprehension, or terror usually accompanied by physical symptoms such as hyperventilation, racing heart, chest pain, lightheadedness, numbness in limbs, upset stomach, sudden bowel symptoms, or choking. Fears of going crazy or dying are common. When these panic attacks lead to significant avoidance, Agoraphobia may also develop.

Although anxiety disorders may be very distressing and debilitating, there are effective treatments available. Research on anxiety disorder treatment suggests that effective treatments include anti-anxiety medication, antidepressant medication, and certain types of psychotherapy (see http://www.nimh.nih.gov). Amongst the psychotherapies, cognitive behavioral therapy (CBT) has been shown to be particularly effective with anxiety disorders.

Cognitive behavior therapy (CBT) is an evidence-based psychotherapeutic intervention for anxiety disorders (Barlow, Raffa, & Cohen, 2002). Although the specific interventions for each of the conditions described above vary, there are basic components common to evidence-based CBT interventions for anxiety.

Anxiety is typically characterized by a combination of cognitive, physical, emotional, and behavioral components. Consider the following example. You are preparing to give a speech at work tomorrow and you think, "I am going to make a fool of myself" (cognitive). Then you notice your heart racing and your face turning red (physical) simultaneously with significantly increased anxiety (emotional). Then you think, "I am a disaster; there is no way I can go up there and face all those people!" (cognitive). This leads to more racing heart, flushing, and shortness of breath (physical). You respond to this by putting the speech away and calling your boss to say you are too sick to give the speech (behavioral). After making the call to your boss you immediately feel relieved that you won’t have to give the speech tomorrow. This relief is so compelling that avoidance is likely to be repeated in the future. Further, although the avoidance works temporarily, your anxiety doesn't completely disappear because you know that you will have to give the speech when you return! When this cycle leads to avoidance that impairs functioning, an anxiety disorder develops.

CBT for anxiety specifically targets this interactive cycle where it is most likely to be effective—with thinking (cognitive) and behavior. Although, physical and emotional components are integral to the experience of anxiety, they are difficult to affect directly. Anyone who has been told to just "feel less anxious" knows how hard it is to simply force emotional or physical states to change. In contrast, thinking and behavior can, with education and practice, be changed directly. To this end, CBT treatment for anxiety is a collaborative process between therapist and client and typically involves the following components:

Assessment

Interview
- Treatment begins with a thorough understanding of the presenting concerns. This assessment involves an initial intake interview to increase our knowledge of symptoms, history, and current functioning. This interview is then be followed up with an anxiety-specific interview entitled the Anxiety Disorders Interview Schedule (ADIS; Grisham, Brown, & Campbell, 2004) to further clarify specific anxiety concerns and interventions.

Questionnaires
- Brief questionnaires such as the Beck Anxiety Inventory (BAI; Beck & Steer, 1993) and the Outcome Questionnaire-45 (OQ-45; Vermeersch, Whipple, Lambert, Hawkins, Burchfield, & Okiishi, 2004) are used at intake and throughout treatment to establish a baseline and assess progress. These questionnaires are used to guide treatment and ensure that treatment is facilitating progress toward goals.

Education - Client/therapist collaboration is the centerpiece of CBT treatment success. Central to this collaboration is education. Throughout treatment, clients participate in education about factors that cause and maintain anxiety as well as rationales for all of the therapeutic interventions. Our clients also learn about the research on anxiety disorders and effective treatments.

Cognitive Interventions
- As discussed earlier, anxiety disorders are nearly always characterized by thoughts that over-estimate the danger or catastrophize the outcomes of feared situations. These thoughts are often the catalysts that spur problematic anxiety. Fortunately, self-defeating thinking can be addressed through:
- Increasing awareness of unhelpful thinking (e.g., "I am going to die of embarrassment.")
- Challenging negative predictions with strategies such as evaluating the evidence for a negative prediction (e.g., "What embarrassment have you survived in the past?") or identifying another outcome that is equally likely or more likely than the feared outcome (e.g., "I will be very uncomfortable if I am embarrassed, but I could tolerate being embarrassed")

Behavioral Interventions
- In the same way that avoidance is at the heart of maintenance of anxiety disorders, behavioral change is central to recovery. Yet, facing fear is not easy! Avoidance works well in the short-run; but, in the long run it erodes joy and life satisfaction. That is why the behavioral portion of CBT involves:
- Learning skills such as relaxation or meditation to reduce the physical sensations of anxiety
- Taking small collaboratively developed steps to facing fears, one small step at a time.

Homework
- CBT hinges on practice. Much like learning to play a musical instrument, therapy requires regular practice of skills outside the session. Each week, the client and therapist develop some tasks to generalize the skills being learned in therapy to the world outside of therapy.

Collaboration
- CBT is collaborative. Clients are experts on themselves; our therapists are experienced and knowledgeable in the interventions that can help you to reduce anxiety. Together, the client and therapist work together to find ways to appropriately apply CBT principles to each client’s specific anxiety and circumstances. Ultimately, our goal is that clients will become their own therapists.

References

Barlow, D. H., Raffa, S. D., & Cohen, E. M. (2002). Psychosocial treatments for panic disorders, phobias, and generalized anxiety disorder . In P. E. Nathan & J. M.Gorman (Eds). A guide to treatments that work (2nd ed; pp 301-335). New York, NY: Oxford University Press.

Beck, A. T., & Steer, R. A. (1993). Beck Anxiety Inventory manual. San Antonio, TX.: The Psychological Association.

Grisham, J. R., Brown, T. A., & Campbell, L. A. (2004). The Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV) . In M. J. Hilsenroth & D. L. Segal (Eds). Comprehensive handbook of psychological assessment, Vol. 2: Personality assessment. (pp. 163-177). Hoboken, NJ: John Wiley & Sons, Inc.

Narrow, W., E., Rae, D.S., & Regier, D.A., NIMH epidemiology note: Prevalence of anxiety disorder. One-year prevalence best estimates calculated from ECA and NCS data. Population estimates based on U.S. Census estimated residential population age 18 to 54 on July 1, 1998.

Vermeersch, D. A., Whipple, J. L., Lambert, M. J., Hawkins, E. J., Burchfield, C. M., & Okiishi, J. C. (2004). Outcome Questionnaire: Is It Sensitive to Changes in Counseling Center Clients? Journal of Counseling Psychology, 51, 38-49.