1. Cognitive Restructuring (Cognitive Reframing)
- Goal: Identify, challenge, and replace unhelpful thought patterns (e.g., catastrophizing, black-and-white thinking).
- Technique: Use thought records or Socratic questioning to test the truth and usefulness of anxious thoughts.
- Example: “What’s the worst that could happen? What’s the most likely outcome?”
2. Behavioral Experiments
- Goal: Test the validity of feared predictions through action.
- Technique: Plan and carry out experiments to confront fears (e.g., giving a presentation to see if people will judge you).
- Why it works: Helps disprove distorted beliefs and build new evidence-based thinking.
3. Exposure Therapy
- Goal: Reduce avoidance and desensitize to feared stimuli.
- Types:
- In vivo: Real-life exposure (e.g., riding an elevator)
- Imaginal: Visualizing feared events
- Interoceptive: Triggering physical symptoms (e.g., dizziness) to reduce fear of bodily sensations
- Why it works: Breaks the cycle of avoidance and reduces fear over time (habituation).
4. Psychoeducation
- Goal: Help clients understand how anxiety works (fight-flight-freeze response) and how CBT treats it.
- Technique: Provide simple models of anxiety, such as the CBT Triangle (thoughts–feelings–behaviors).
- Why it works: Reduces shame and builds a foundation for treatment.
5. Relaxation & Breathing Techniques
- Goal: Reduce physiological arousal that magnifies anxiety.
- Examples:
- Diaphragmatic breathing
- Progressive muscle relaxation (PMR)
- Grounding techniques
- Why it works: Helps restore parasympathetic nervous system balance.
6. Mindfulness & Present-Focused Awareness
- Goal: Reduce rumination and fear-based forecasting.
- Technique: Focus attention on the present moment using non-judgmental awareness.
- Why it works: Increases distress tolerance and emotional regulation.
7. Problem-Solving Training
- Goal: Build confidence and skill in managing real-life stressors.
- Technique: Identify the problem, generate solutions, weigh pros/cons, implement, and review.
- Why it works: Reduces helplessness and increases agency.
8. Thought Journaling
- Goal: Increase awareness of automatic thoughts and emotional patterns.
- Technique: Track situation → thought → emotion → behavior; look for patterns.
- Why it works: Helps differentiate between thoughts and facts.
9. Graded Exposure (Fear Hierarchy)
- Goal: Gradually face fears in a manageable way.
- Technique: List feared situations from least to most distressing (SUDS scale) and work through them systematically.
- Why it works: Builds mastery without overwhelming the nervous system.
10. Values-Based Action (borrowed from ACT but often integrated)
- Goal: Act according to one’s values rather than fear.
- Technique: Clarify core values and use them to guide behavior despite anxiety.
- Why it works: Encourages meaningful engagement with life, not just symptom reduction.