By Christopher Mogan, Charles H. Elliott, Laura L. Smith

Central to the anxiety management program called Cognitive Behavioural Model (CBT) is the personal appraisal made of every moment, every interaction and every experience that we encounter in our day-to-day living — past and present. When we experience rejection or deprivation, the CBT model predicts a depressive reaction; when we experience threat, danger, doubt or uncertainty, the CBT predicts a response of anxiety.

As our sense of frustration reaches breaking point, the CBT model predicts a response of anger. When we feel that we have let ourselves down, let our family down or gone against our principles, the CBT model predicts a response of guilt and shame.

This model shows a cycle of thinking, feeling and activity interaction that becomes dysfunctional when our appraisals are distorted by unclear thinking, unregulated emotion and impulsive actions. On the other hand, there is a clear adaptive function for anxiety that keeps us alert and aware of risks or pitfalls, and this role for anxiety is a normal productive way for humans to survive and thrive.

When anxiety is triggered too easily, lasts for a long time, reaches high levels of intensity and interferes with our effective thinking and acting, this type of anxiety is problem anxiety. When a person develops over-sensitivity to anxiety, their appraisals will result in being caught up in the emotional trap of problem anxiety that can take various forms ranging from incessant worrying to disabling panic attacks.

Problem anxiety is intrusive, recurrent, confusing and undermining. Our basic response to problem anxiety is avoidance, escape or freezing in the face of it.

This CBT model seeks to provide strategic adaptive responses to problem anxiety:

  1. Think clearly.

    An anxious person is encouraged to think clearly and to put things in perspective. They’re encouraged to manage their feelings more effectively, not by avoiding or escaping at the first sign of anxiety but by learning to be ‘in touch’ without being overwhelmed by these feelings and knowing the feelings will pass.

  2. Develop skills.

    Skills are taught to help them to be effective in the face of anxiety. The key is to change your relationship with worry, doubt, fear and threat responses by using common sense, acceptance and mindfulness-based coping skills.

  3. Implement Exposure and Response Prevention (ERP).

    This is a key strategy in this working model for anxiety. ERP is a method of gradually facing anxiety triggers, learning to sit with the resulting anxiety feelings until they pass over time and with repeated presentations. Implementing ERP results in a process called habituation, which means to lower the experienced anxiety over successive presentations.

  4. Use a self-help technique.

    ERP is a self-help technique that needs to be clearly understood and consistently applied. It’s a thoroughly researched strategy, soundly based in theory and practice, and supported by consistent findings in research studies.

  5. Combine coached exposures.

    The best results are obtained by using a combination of coached exposures (helped by another) and un-coached exposures (self-administered). The evidence is clear that exposure and response prevention delivered in a graded, repeated, intense and prolonged manner results in a marked reduction, even complete reversal, of anxiety symptoms.