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For general anxiety disorder, symptoms can last longer than normal compared to non-patients in the same or similar situations. Some of these symptoms are brought on by automatic negative thoughts or false assumptions. Cognitive therapy examines these thoughts and tries to restructure them. For example, if a patient was told he had to give a 30-second public speech for his job in two weeks, he might automatically think about not remembering his speech, stumbling over his words, becoming embarrassed and getting fired.
Cognitive restructuring involves openly discussing these thoughts, addressing the feelings associated with them, and then focusing on positive outcomes and history. Patients, for instance, might learn to think of times when speeches were successful or consider the benefits that would result, such as confidence building and career enhancement. Practicing this technique helps reduce symptoms of anxiety. -
Anxiety disorders involving phobias and panic attacks can also benefit from cognitive restructuring. Often, desensitization through gradual exposure to the thing that frightens the patient is the best way to begin making progress. For instance, an individual who wants to overcome a fear of crowds may have to rate on a scale of 1 to 10 the level of anxiety he has when he thinks about being in a crowd, with 10 being the worst. The patient then describes the feelings associated with those thoughts.
The first therapist-guided exposure might be a trip to a strip mall parking lot during lunchtime. Before entering the food court, the therapist would ask the patient to rate his anxiety on the 1-to-10 scale again. He would then go to the entry area of the food court with the patient and ask for another rating and description of feelings. The therapist might ask the patient to remain in one spot for up to five minutes and intermittently ask for an assessment of his anxiety level. The idea is to continue the exposure until his anxiety drops to a manageable level.
