The Workhorse of Anxiety Treatments

The psychological treatment of choice for anxiety is called Cognitive Behaviour Therapy or CBT. It is a type of talking therapy that is based on the belief that negative emotional states such as depression, anxiety and anger are often started or worsened by habits of thought and behaviour. For example, we become anxious or more anxious when we think about ourselves and the world around us, and act in ways that suggest the potential for some danger or harm. Anxiety is a feeling of apprehension, fear, nervousness, or dread, accompanied by restlessness or muscle tension. It is part of the natural process of preparing ourselves emotionally and physically for various kinds of challenging and sometimes threatening situations, using what is known as the “fight and flight” response.

Anxiety is generally considered to be an anxiety disorder when three conditions are met. The first, is experiencing a state of anxious preparedness that is excessive or unwarranted by the current circumstances. The second, is that this state of anxious preparedness causes us significant distress and/or impairs our ability to function in significant areas of our life, such as in our job or day-to-day social interactions. The third condition, is that we resort to extreme and sometimes desperate measures as a means of regaining control of the situation. For example, we may react to a panic attack by abandoning our shopping cart in a grocery store line-up and running out of the store, or we may cope with worries by self-medicating ourselves with alcohol.

An anxiety disorder is therefore a kind of “false alarm” to situations that are objectively not dangerous. We respond as if we were facing some sort of peril, when we are in fact quite safe. The role of CBT in helping people with anxiety is to tone down the otherwise overwhelming problem of false alarms by dividing the problem up into three parts. The first part is about the physical sensations associated with being tense and “on edge”. The second part concerns the mistaken information we have about our false alarms, and our tendency to engage in two main types of thinking errors. The third part stems from our tendency to respond to false alarms as if they were real, by fleeing, fighting or freezing.

CBT addresses each of the physical, thinking and behavioural parts with a set of time honoured, research-proven treatment techniques. I will be covering all three sets of techniques in the next five articles (refer to the Links section of, beginning with managing the physical sensations in an article entitled “Getting Rid of Those Heeby Jeebies”. While these six articles are not meant as a substitute for the dozen sessions generally required by a cognitive behavioural therapist to teach these techniques in a clinic, they will at least give you a start on addressing your fears. If in the meantime, you or someone you care about might benefit from CBT, check out some of our program offerings at

John R. Cook, Ph.D.