Manage anxiety with 3 steps in CBT

This article Manage anxiety with 3 steps in CBT is about how you can improve your life with effective strategies from CBT, Cognitive behavioral therapy. CBT is an effective treatment method, both for decreasing psychological symptoms and for developing your life in positive directions.

The content of this article Manage anxiety with 3 steps in CBT

This article explains 3 simple steps for managing anxiety by using CBT. You can start with these exercises already today and they will change you life in positive directions:

  • What is anxiety?
  • Viewing anxiety as a symptom – not a cause
  • Anxiety as a defense against unwanted thoughts and feellings
  • What is the difference between anxiety and fear?
  • How to manage acute anxiety
  • Manage anxiety with 3 steps in CBT – the important connection between anxiety and thoughts
  • 1. Step 1 in managing anxiety using CBT: Notice what is happening inside and outside of you
  • 2. Step 2 in managing anxiety using CBT: Be aware of your triggers, thoughts, feelings and responses
  • 3. Step 3 in managing anxiety using CBT: Create more adaptive responses
  • More information on how to manage anxiety
manage anxiety
Manage anxiety with 3 steps in CBT

What is anxiety?

Anxiety is:

  • the body’s natural response to stress.
  • diagnostic in different anxiety disorders.
  • experiencing unease and apprehension about what is to come. It involves a mix of feelings such as fear, sadness, anger and distress.
  • a fire alarm, signalling that something is happening that has to be dealt with.
  • one of the body’s most important response mechanisms to ensure our survival. Anxiety helps us survive by forcing us to pay attention to something disturbing in the surrounding. Anxiety consists of patterns of physiological arousal in the body that many can relate to.


Viewing anxiety as a symptom – not a cause

Another important view of anxiety in therapy is that anxiety, any kind, can be seen as a cover-up, a shield. In this view anxeity is a response to a trigger. This trigger creates thoughts and feelings that we have learnt are “forbidden”. They are forbidden in the sense that we have reasons for fearing that they will create severe negative consequences for us. One common consequence is fearing that our thoughts, feelings and related responses are not tolerable for important persons in our lives. Therefore, we fear to be punished and abandoned by them.

One concrete example of this is a child who has been taught never to display emotions, for example anger, sadness or fear, since that will be punished by the caretaker. Common punishments could be withdrawing support, comfort, interaction or sending the child off into isolation in his/her/their bedroom. Psychological and physical separation can be perceived as so devastating for a child. This is understandable since a child by nature and instinct is dependent on, and often wants to be close to, the caregiver.

Hence, a possible consequence of these forbidden reactions in the form of thoughts, feelings and behaviors is that they become supressed. They become unconciously buried and then lie hidden in the body. Instead, anxiety is produced when an event or situation triggers the forbidden thought, feeling and behvaior. In turn, this leads to the use of defense mechanisms such as denial or regression, which involves acting younger than one’s actual age. The defense mechanism then coexists with the psychological symptoms.


Anxiety as a defense against unwanted thoughts and feelings

A defense mechanism is a psychological strategy, a manner of thinking and behaving, that we unconsciously use. Most of us do not realize that we are using a defense mechanism in the moment. This is one of the key purposes of the defense mechanism: to unknowingly protect us from anxiety that arise from ‘unacceptable’ thoughts or feelings.

The aim of using a defense mechanism is to protect ourselves from uncomfortable anxiety or feelings. The anxiety or feeling arise when we, our Ego in Sigismund Freud’s terminology, fear being judged by important people, Freud’s Superego, or pressured by our biological drives, Freud’s concept of the Id.

Hence, anxiety, according to this view of the human mind, is a signal to the ego that the survival is in danger. According to Freud and followers, the ego instead uses unconscious defense mechanisms to avoid anxiety and make us feel better.

The defense mechanisms are not under our conscious control. They are one way of looking at how we distance ourselves from full awareness of our unpleasant thoughts, feelings and behaviors. The usage of them is both natural and normal. It is when more primitive defenses are used too frequently that anxiety disorders can develop.

Defense mechanisms are often learnt behaviors during childhood. We use them when we fear the consequences and reactions from our loved ones. Since it is about learnt behaviour, we can as adults get insights into this dynamic. This knowledge can free us from problematic psychological symptoms. We can also learn new, more adaptive defense mechanisms and behaviors. See more about defense mechanisms here:


What is the difference between anxiety and fear?

Some practioners within the field of psychology think fear and anxiety are versions of the same state, but many disagree. Fear is usually aimed at a specific stimuli and situation with specific bodily reations.

Hence, anxiety and fear are interrelated and overlap partially. For example, fear is a component aimed at a specific topic in many of the medical anxiety disorders such as panic attacks and fobias. Even if many of the sensations when experiencing anxiety or fear overlap, anxiety is not a feeling but a set of symptoms.


How to manage acute anxiety

Learning to manage anxiety and feelings is an important skill for better self-care and inner harmony. Important skills to develop in order to calm anxiety and feelings are practicing observing the body as well as changing focus to more compassion and self-compassion.

Here are some techniques you can try:

  1. Touch: caressing oneself or being touched by a loved one, such as cuddle up, keep warm, hugs etc.
  2. Calm breathing using the stomach – slowly breathing out longer than breathing in
  3. Relaxation exercises
  4. Identifying and observing feelings, which in itself is calming. This can be done by using mindfulness techniques,writing a diary, talking to close ones, but also through practicing acceptance and validation. The core themes to study is: what feelings do I feel right now? How strong are they individually? Where can I feel them in the body? What do they want me to do? What is wise to do considering the possible consequences?
  5. Visualization exercises, such as imagery, writing letters, role play etc.
  6. Practicing mindfulness: mindfulness exercises can expand the tolerance needed to be able to stay in unpleasant inner experiences such as anxiety, trauma and suppressed feelings. This can be done by developing an inner base of compassion, compassionately studying internal emotional turmoil as the pass by, like clouds in the sky, instead of getting caught up in pain and misery.

Manage anxiety with 3 steps in CBT – The important connection between anxiety and thoughts

These are the 3 steps you can use to manage anxiety in general by using CBT:

1. Step 1 in managing anxiety by using CBT: Notice what is happening inside and outside of you

A common first step in traditional CBT is to be aware of how you are doing. More precisely, your mental status at that moment, i.e. how you are feeling at a given time. If you want to improve your ability to be aware of this, you can try this exercise:

Try for one week to note down 3 times a day: morning, lunch, evening, what you are doing and how you rate your mental state, health and well-being on scale 1= worst possible state to 10= best possible state at that time.

If you notice that you are rating yourself under or around 5 for several days, consider seeking local professional help immediately.


2. Step 2 in managing anxiety by using CBT: Be aware of you triggers, thoughts, feelings and responses

The second step in traditional CBT is to be aware of your thoughts and related feelings impact how you feel as well as what situation that triggered them.

A trigger is something that happened or something somebody said or did. The trigger makes you react with thoughts and feelings that reinforce each other making you create a response. Common responses are: talk back, walk away, ruminate, withdraw, mourn, blame yourself, criticize yourself etc.

Go back to your diary over your activities and mental state under Step 1.

Look at the diary where you rate your mental state high (above 7) and low (below 5) respective on the scale 1 to 10. Try to see if you can understand what triggered how your were feeling by using this formula:

Trigger: This happened:

Thoughts: The situation made me think:

Feelings: The situation and thoughts made me feel:

Response: This made me react by:

Short term consequence: My reactions helped me by:

Long term censequence: Long-term, this pattern creates problems for me by:

In Step 3 below I will go through how you can use this information to improve your well-being.


3. Step 3 in managing anxiety by using CBT: Create more adaptive thoughts and responses

The third step in traditional CBT is about creating an alternative thought and response to your pattern in Step 2, which in turn will create other, more positive and less intense feelings as well as more healthy behavioral responses.

This is vitally important!

It is important since, in opposition to healthy sensory stimuli or feelings, thoughts are not per se true but they affect hugely how we are feeling. Normally we should trust our senses since they help us orient = survive in our daily life: “I have to step aside from that pole…” “There is a crossing…” “I am hungry…” “That car drove scaringly close…”

Thoughts are just constructions of the mind, i.e. one, but only one, possible explanation of many. They are not the truth but often an interpretation.

Hence, thoughts are not per se true, but just a version of the truth. If you really get this, it will most likely change your life! Learning to identify alternative thoughts can liberate you from the conviction that there is just one truth.

There are several ways of challenging your thoughts:

  • Consider if there are other possible explanations
  • Scrutinize the proofs supporting your thoughts. Are there any possible proofs against your beliefs, supporting a more positive interpretation
  • Practice shifting perspectives: Ask yourself – what would your best friend say as a possible alternative explanation/interpretation? If your child said the same negative/self-defeating thought, what would you reply?

The important thing is not whether you believe the alternative explanations. Just the fact that there are alternative perspectives can easen up the impact of painful thoughts.

When you realize that thoughts are just constructions and only one version or possibility of the truth and NOT the truth, you will most likely feel more free.


More information on how to manage anxiety

You will find more information and exercises about how to manage anxiety under the blog heading Anxiety & Mood:

Also, see these user-friendly medical research databases:

The world’s largest government funded medical library:

Johns Hopkins University:

Harvard University:

Oxford university: