How CBT for Anxiety can Backfire
Updated: Feb 11
CBT for Anxiety
Cognitive Behavioural Therapy (CBT) is a therapy approach which is commonly used to support individuals with anxiety. CBT provides a useful framework for understanding anxiety difficulties and can help individuals to see what factors are potentially keeping their anxiety going along with how to make changes in order to alleviate anxiety.
CBT Anxiety Vicious Cycle
Let’s see this in action a little. When we notice ourselves feeling anxious, CBT suggests it is helpful for us to identify our associated thoughts, behaviours (or actions) and physical sensations (or bodily symptoms) as well as to work out the interaction between these four aspects. To help identify your thoughts, behaviours and physical sensations when you’re feeling anxious, you can ask yourself the following questions to help:
· Thoughts: What just ran through my mind? What am I saying to myself in this situation? What’s the worst thing about what I am facing? What do I fear will happen?
· Behaviours: What have I got the urge to do in this situation where I am feeling anxious? What did I just do?
· Physical Sensations: What do I feel in my body? Where do I feel it?
If one of these four aspects is unpleasant, negative or unhelpful, it has a knock on negative effect on the other areas where the four aspects are inter-connected. This can lead to a vicious anxiety cycle where we can feel stuck. In CBT, you can be introduced to various tools and concepts which make good changes to each of these four aspects which then breaks down such vicious cycles.
Thought challenging, or ‘cognitive restructuring’ (which is the more fancy term that is used!), is the CBT tool which targets the thoughts part of the anxiety cycle. Thought challenging involves identifying worrying thoughts and, rather than accepting these as facts and letting them dictate what we do, to instead, question and challenge them. The aim is to replace the initial worrying thoughts with more balanced, accurate and helpful thoughts. This, in turn, will help alleviate anxiety, its associated unpleasant physical sensations and will lead to more fruitful behaviours.
When and Why can Thought Challenging Backfire?!
The thought challenging tool has a great amount of research to support its effectiveness for alleviating anxiety and our clinical experience further supports this notion. However, there are some individuals who struggle to implement thought challenging and find it of limited use. Some can even find that it further fuels their worries, which is the opposite of what it is intended to do! So what’s happening here? People who can sometimes face this problem are those who have a tendency to ruminate, i.e. they go round and round in circles with their thoughts and/or they replay things over and over in their minds. People who ruminate tend to already frequently analyse their and others’ thoughts, behaviours as well as overly analyse situations. Employing thought challenging can serve to feed into this analytical thinking which can keep individuals stuck in their heads thus leading to further rumination and heightened anxiety.
Some argue that another mechanism through which thought challenging can potentially backfire is that by challenging troublesome thoughts, this only gives them more ‘air-time’ when they have enough of that already! Challenging thoughts can give our brains the message that these troublesome thoughts are significant which can lead them to gain greater power. If this happens, we can experience these troublesome thoughts more frequently in the future and they can hit us harder each time they pop up into our minds.
How to Address These Pitfalls of Thought Challenging
The way in which thought challenging can backfire, especially for those who have a tendency to ruminate, may make you think that thought challenging should be avoided. But don’t be put off! We can all benefit from calming our thinking down, from trying to think in more balanced ways and to try to see situations as less threatening than they actually are. Thought challenging can still be helpful with a few tweaks, even for those who have a tendency to ruminate. Here are some tips to minimise the likelihood of thought challenging backfiring:
· Be boundaried with the amount of time you give to challenging your thoughts. Perhaps even time yourself, give yourself 20 minutes maximum
· Write out the thought challenging process rather than just doing it all in your mind. Give yourself a limited amount of space to write this out, once you fill in this space, stop it there
· After you have challenged your thoughts, move your attention on by distracting yourself. If you find your mind is still on the troublesome thoughts and you are ruminating once more, try to engage in your distracting activity mindfully i.e. slow down your actions, do one thing at a time, bring your attention to the present moment by focusing on the details in your different senses (what you can see, smell, touch, hear and maybe taste if you’re eating!). If your mind wanders onto troublesome thinking again, just acknowledge your mind has wandered, remind yourself it’s not fruitful to ruminate and return your attention back onto the here and now
· The troublesome thoughts we experience are often recurring, we experience the same or similar ones again and again. If recurring thoughts enter your mind and you have challenged these before, you do not need to go through the whole thought challenging process again. Perhaps go back to what you have previously written when you have challenged the thoughts before. Or simply say to yourself, “I know this is just a thought rather than reality, it’s just my brain trying to over-protect me” and attempt to move your attention on
· If emotions are very high, our thoughts can be strong and harder to relax. Therefore, if you are struggling to relax your thoughts by using thought challenging, try bringing down your anxiety first through your behavior e.g. have a bath, go for a walk, talk to someone, wash your face in cold water, listen to relaxing music, do some exercise. Once your emotions come down you may then find it easier to challenge your thoughts
· If you find that despite your best efforts, thought challenging is proving too difficult and it is potentially further fuelling your ruminating, you may benefit from an alternative method to manage troublesome thoughts called defusion. This is a strategy from a therapy approach called Acceptance and Commitment Therapy (ACT) that you may wish to learn more about. There is an excellent self-help booked called ‘The Happiness Trap’ by Russ Harris which is based upon ACT and describes what defusion and how to implement it
If you are seeking therapy for anxiety please reach out via email: firstname.lastname@example.org or kindly complete the webform. I offer therapy in-person in St Albans/Hertfordshire and online.