Cognitive Behavioral Therapy (CBT) And Anxiety
by Dr. Carlo Carandang, MD
Does CBT Work For Anxiety?
What Is CBT?
CBT, or cognitive behavioural therapy, is a form of psychotherapy. Psychotherapy is talk therapy where you discuss your problems with a therapist, also known as a counsellor. Mental health therapists include social workers, psychologists, and psychiatrists. There are various forms of psychotherapy for anxiety disorders, including cognitive behavioral therapy (CBT) and insight oriented depth psychotherapy (psychodynamic psychotherapy). CBT involves addressing your cognitions and thoughts which lead to anxiety, and also addresses how your behaviors contribute to anxiety.1
CBT is an approach to correcting dysfunctional emotions, irrational thoughts (cognitions), and maladaptive behaviors. CBT helps you by identifying the thoughts, associated feelings, and behaviors that, as a self-perpetuating system, habitually lead to problems. The emphasis with CBT is to identify irrational thoughts and maladaptive behaviors, and to change them, thereby disrupting this negative, vicious cycle. The priority with CBT is not to uncover any ultimate root causes for what created the dysfunction; it is simply to fix it. In fact, the standard approach to CBT is essentially that after a negative system of thought, feelings, and behavior is established, its ultimate origin becomes largely irrelevant, because whatever triggered it is now less relevant than the faulty solutions that the individual imposed on him or herself. Where so-called insight oriented depth psychotherapeutic methods might only indirectly connect to present symptoms and distress by building bridges from historic traumas or disappointments, CBT cuts to the quick and asks what is not working today, and then seeks to design immediate remedies.1
Does CBT Work?
CBT is effective for anxiety, and is considered a first-line treatment for anxiety disorders. In fact, CBT is supported by higher-level evidence than any other type of psychotherapy for anxiety disorders.2 Psychodynamic psychotherapy is recommended as second-line treatment for anxiety disorders.1
A recent meta-analysis looked at comparing the efficacy of psychotherapy and pharmacotherapy for anxiety disorders.3 There was no difference in effect when comparing psychotherapy and pharmacotherapy for panic disorder and social phobia. However, psychotherapy was significantly more effective than pharmacotherapy in obsessive compulsive disorder (OCD). From this meta-analysis, psychotherapy and pharmacotherapy have equal effects for several anxiety disorders, but not true for all anxiety disorders, especially not for OCD. Also, non-directive counseling was less efficacious than other psychotherapies, and tricyclic antidepressants were less efficacious than other pharmacotherapies. There are also indications that psychotherapy has sustained long term effects, while pharmacotherapy effects do not last when the medication is discontinued.3
Of all the psychotherapies, CBT has the most evidence from studies as being effective for anxiety disorders.2
CBT can cause some worsening of anxiety symptoms when first starting it, as CBT involves confronting your fears. If this side effect of initial worsening anxiety with CBT is not tolerable, then you can go to your doctor and asked to be prescribed a medication on a short term basis to deal with this treatment-emergent side effect.
Overall, psychotherapy and pharmacotherapy are equal in effects for anxiety disorders, but they differ on side effects, lasting positive effects, and possibly cost. For side effect profile and lasting positive effects, psychotherapy has the advantage over pharmacotherapy. Therefore, psychotherapy is first-line treatment for anxiety disorders, and pharmacotherapy is only for non-response to psychotherapy, or for severe anxiety symptoms. Of all the different forms of psychotherapy, CBT has the most studies showing effectiveness for anxiety disorders. Psychodynamic psychotherapy is recommended as second-line treatment.
For people who have anxiety and who are not able to see a therapist for CBT, then CBT-guided self-help is an effective alternative.4 If you have anxiety and prefer a more convenient, more practical, and cheaper alternative to CBT delivered by a therapist, then you should consider CBT-guided self-help treatment with Anxiety Protocol. Also, as an adjunct to Anxiety Protocol, you can consider a natural supplement for anxiety, such as Kalmpro. CBT obtained from self-help with Anxiety Protocol, and adjunctive treatment with Kalmpro can provide a predictable, consistent, and complete treatment for anxiety.
- “Chapter 11 – Psychotherapy for Anxiety Disorders.” Anxiety Protocol. Carandang C. 2014. Healthy Mind Research Corporation.
- The diagnosis of and treatment recommendations for anxiety disorders. Bandelow B, Lichte T, Rudolf S, Wiltink J, E Beutel M. Dtsch Arztebl Int. 2014 Jul 7;111(27-28):473-80.
- The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis of direct comparisons. Cuijpers P, Sijbrandij M, Koole SL, Andersson G, Beekman AT, Reynolds CF 3rd. World Psychiatry. 2013 Jun;12(2):137-48.
- Media-delivered cognitive behavioural therapy and behavioural therapy (self-help) for anxiety disorders in adults. Mayo-Wilson E, Montgomery P. Cochrane Database Syst Rev. 2013 Sep 9;9:CD005330.