CBT & Exposure Therapy for Anxiety Disorders

Cognitive-behavioral therapy (CBT) is a research-backed treatment for both children and adults with anxiety disorders.

CBT involves learning how thoughts, behaviors, and emotions are linked:

For example, Little Timmy is afraid of dogs. When he sees a pitbull across the street, he thinks, "It's going to bite me!" and he feels anxious and hides behind his mother. To get over his fear of dogs, he could get more exposure them, which would result in changes to his thoughts ("Oh, they don't always bite!"), behaviors (avoiding avoidance of dogs), and emotions (happiness instead of fear).

Exposure therapy is a type of CBT that involves gradually facing one's fears in order to tackle unhelpful anxiety. Exposure therapy is the best psychology treatment for anxiety disorders. Gaining exposure to the fear trigger helps someone to challenge unhelpful thoughts and behaviors. This is how they get back into life and keep the fear from disrupting school/work, family/home life, their social life, health, or other important areas of functioning. Read my previous post for more detail.

Little Timmy might engage in exposure therapy by confronting videos of dogs, walking by a dog park, and petting small, medium, and large dogs until he is able to do things again like go to friends' houses, ride in the elevator, and go to the park.

The DSM-5 [what we use to diagnose] categorizes seven different anxiety disorders:

• Separation Anxiety Disorder: fear of being away from one's caregivers

• Selective Mutism: not speaking at all in certain situations/settings (e.g., school)

• Specific Phobia: fear of animals, heights, needles/blood, public speaking, etc.

• Social Anxiety Disorder: fear of being rejected by others

• Panic Disorder: fear of having a panic attack [sudden onset of intense fear along with physical sensations]

• Agoraphobia: fear of leaving the house or going in public

• Generalized Anxiety Disorder: catastrophic thinking for many anxiety triggers

Exposure therapy can be applied to each of these disorders. The common theme is learning that anxiety is normal and manageable, approaching the feared object or situation is not dangerous, and gaining confidence by continuing to approach anxiety triggers until they do not lead to avoidance of important life activities.

Anxiety disorders can absolutely wreck someone's life, leaving them shaky, unable to engage in day-to-day activities and hobbies, lashing out at loved ones, and more. Exposure therapy/CBT can be life-changing, as it teaches someone to gain back control of their emotional world. For children, parents are involved in the process and learn how to model approach toward anxiety triggers and manage their own anxiety about their child.

My favorite thing is teaching people that exposures do not have to be torture! If you confront your fear of singing karaoke, you might find yourself actually having fun! Exposures are challenging but sometimes the activities are enjoyable in themselves or someone can achieve a real sense of pride and accomplishment by facing their fears. As a therapist, I'm there with my patient every step of the way, cheering them on and building their confidence in doing hard things.