How Does Cognitive Behavioural Therapy (CBT) Help Anxiety and Addiction Recovery?

Anxiety is an important part of the human condition that exists for a reason. Everybody should feel worried sometimes, for doing so keeps us out of trouble and kicks us into survival gear when things get dangerous. Cognitive Behaviour Therapy is one of the main tools to fight anxiety disorders during addiction treatment.

 

There is a vast difference between the fleeting anxieties of a neurotypical brain and the consuming, constant fears of a person diagnosed with Generalised Anxiety Disorder (GAD). Anxiety in this context is by definition detrimental to the life and well-being of the person feeling anxious.

 

Feelings of anxiety may override their ability to perform basic tasks and interactions, burdening their jobs, relationships, and personal life. Even in situations where the individual explicitly wants to step out and take healthy risks, anxiety will prevail.  Sometimes, people find unhealthy ways to deal with these uncomfortable feelings and turn to mind-altering substances, which can have devastating consequences. After realising that debilitating anxiety is not only happening to you but manifesting in a chronic pattern and causing harmful behaviours, it is natural to start wondering if and how it is treatable.

 

Among the most tried-and-true treatments for GAD is the near-ubiquitous form of talk therapy, cognitive behavioural therapy (CBT),  which helps people find healthy coping strategies for anxiety without turning to substance use. Other solutions include depression and stress counselling with qualified personnel, such as David Goodlad.

Generalised Anxiety Disorder (GAD)

Anxiety disorders, taken together, have an estimated 18% prevalence rate at any given moment, and a nearly 29% prevalence when projected over our lifetimes as a population. The most common of the five most common anxiety and panic disorders, GAD is estimated to affect no less than 5%, or 1 in 20, of the UK’s adults. Approximately 20% of people who suffer with GAD also report having an alcohol use disorder.

 

The numbers do remain estimates – it’s all too easy to live with anxiety but dismiss symptoms as a requisite response to the stresses of modern life, and it should come as no surprise that the past two years of worldwide COVID-19 pandemic has only worsened the situation, coinciding with and almost certainly precipitating a global 25% uptick in the diagnosis of depression and anxiety disorders. Research found that alcohol consumption increased during the pandemic.

 

Symptoms

What makes GAD unique among other anxiety disorders is its core characteristic of uncontrollable worry. Rather than being triggered by a specific event, GAD brings along feelings of worry that complicate interactions and burden individuals before, after, and during related situations that crop up throughout their normal lives.

 

Typical symptoms of GAD include:

 

• Feelings of worry
• Difficulty focusing
• Difficulty sleeping
• Shakiness
• Dizziness

 

At the same time, many people who have been living with generalised anxiety for some time begin to develop telltale coping skills that are visible to others including avoidance and hyper- control.

Treatment

One piece of good news about GAD is that in most cases, this mental health condition is eminently treatable; it doesn’t have to result in picking up a drink or a drug. A range of talk therapies and medications exist for anxiety, and while every individual’s treatment needs to be adjusted to their case, for the majority of people psychotherapy alone can reduce symptoms quickly and effectively.  According to the American Psychiatric Association, talk therapy reduces or eliminates symptoms in most clients in a matter of months, and for many, significant changes start to come into effect after just a few sessions.

 

There are many treatment modalities on the market for GAD, but don’t let that overwhelm you. The list of non-pharmaceutical interventions for GAD with the strongest history of evidence for significant improvement is reasonably short. These are:

 

• Cognitive Behavioural Therapy
• Guided Self-help
• Applied Relaxation

 

Depending on the individual’s care and treatment preferences, medication may also be prescribed as a part of a treatment program for GAD, including:

 

• SSRIs,
• Beta-blockers,

 

Cognitive Behavioural Therapy

First developed in the 1960s by psychiatrist Aaron Beck, CBT is unique among psychotherapies in that it is pragmatic (read: solutions-focused), highly structured, focused on present problems, collaborative, and client-centred.

 

CBT techniques helps clients challenge and cope with negative or anxious thought patterns. It intentionally gives clients space to approach problems they are facing through the lens of their own voices and perceptions and then helps them to break down and make sense of these thoughts and feelings as they come. Studies have found that the benefits elicited by CBT for the reduction of symptoms may be more extensive and long-lasting than those of medications.

What it Is

In short, CBT focuses on the thoughts and beliefs that drive anxious feelings and actions, giving clients the tools they need to identify and stop negative thought cycles in their tracks before they can take control. When a client poses problems, CBT breaks them down into five interconnected areas:

 

1. Situations
2. Thoughts
3. Emotions
4. Physical sensations
5. Actions

 

Each aspect of a ‘problem’ is understood as holding a unique relationship to the other four. This framework asserts that when thoughts about specific situations go unchecked, they precipitate particular sets of emotions and physical responses, and lock us into a particular set of protective actions that may not be good for our health in the long term.

Identifying Anxious Thought Patterns

CBT has its own language for describing the thought cycles that produce anxious feelings of behaviour, calling these patterns ‘negative automatic thoughts’ or ‘thought distortions’. Through CBT, clients learn to identify these negative automatic thoughts as they arise, and replace them with more positive thought patterns that protect their agency and ultimately reduce anxiety.

 

The list of anxious thought patterns is extensive, but in many clients, these thoughts boil down to the following:

 

• Comparisons: An anxious client may be overwhelmed with insecurities that stem from comparing themselves to others in unfair or unhelpful ways.

 

• Emotional reasoning: It is surprisingly commonplace to allow our emotions about a situation to guide what we believe is true about that situation. An example of emotional reasoning would be to believe that a public speaking event will go badly due to feelings of dread.

 

• Filtering: When we dismiss evidence that does not confirm a preconceived belief, emotion, or thought about a situation, we are ‘filtering’. Anxious filtering blinds our potential to see the potential positive outcomes of our actions and keeps us in a fearful state where only the dark side of things is visible.

 

• Fortune telling: When a client’s extrapolations about the future consequences of present situations start to get out of control and lack sufficient information to ground them, it’s called fortune-telling.

 

• Magnification: ‘Mountains out of molehills’ is hyperfocus on small details that did or could go wrong in particular situations. Magnified hiccups don’t truly affect the big picture, so learning to zoom out can ‘reframe’ this negative thought pattern and keep mistakes in healthy perspective.

 

• Mind reading: A mind reader may not realise it at first, but they assume to know too much about what motivates the people around them. They may misinterpret colleagues, friends, loved ones, and even strangers’ beliefs and intentions as personal and negative without real evidence.

Identifying Anxious Behaviours

CBT works on building coping skills in clients so that they can build a more positive outlook by fostering the practice of healthier actions and vice versa. Taking a look at anxious behaviours, and how they produce certain outcomes, is therefore the crucial second pillar of CBT.

 

• Avoidance: No one likes becoming frozen with fear or dread, so avoiding situations that seem to cause these feelings is one of the most common behaviours produced by GAD. This is a learned coping skill for anxiety, but by keeping people with anxiety in the dark about their resilience to challenges, it often makes symptoms worse over time.

 

• Control: Exhibiting an extreme degree of control over one’s life is another coping behaviour that helps clients with anxiety feel safe and secure in the moment but tends to worsen symptoms over time. Control helps us avoid, but it also keeps us away from ever experiencing the potential positive consequences of taking risks that make us feel anxious.

 

• Distraction: If anxious thoughts tend to come up in specific situations, many people create distraction routines to preempt their symptoms before they arise. Distraction is often not that good for us. Think of heavy substance or alcohol use in a social situation that makes us insecure, or constantly keeping screens and content input turned on around the house to distract from anxious thoughts alone.

 

• Projection: When we’re amid intense negative emotions, our brains often want to find other people or situations to blame. Redirecting anxious feelings and identifying external people as the cause of our anxiety rather than looking within at our unhelpful thought patterns are common manifestations of projection.

 

• Procrastination: Anxiety can sometimes lead to us being held in place, and putting off our tasks into the eleventh hour finally shakes us into action. However, this behaviour often feeds back into the negative experiences that make us procrastinate in the first place. If flights and airports make a person anxious, and because of that they tend to put off printing paperwork, packing, and checking in until the last moment, they are very likely to develop more stressful experiences to confirm their anxiety.

How CBT Can Help Addiction

Anxious thoughts and behaviours are common, but once they have been identified by the client and their therapist, what comes next? What are the steps that you can expect when ‘replacing negative thought patterns’?

 

CBT offers a solutions-oriented approach that aims to stop and replace problematic thoughts and behavioural patterns with more healthy ones that help clients achieve their goals. Ultimately, this helps people remain sober by arming them with healthier alternatives to manage their anxiety symptoms.

 

 

Typical CBT techniques that are employed in response to anxious thoughts and feelings are:

 

1. Challenging thoughts: When a thought or feeling is screaming for attention, but we don’t know how grounded it is in reality, we can challenge it. Thoughts can be ‘tested’ with rational processes by considering evidence and following that through to the more likely outcomes.

 

1. Exposure: Slowly working up towards facing situations that cause the greatest degree of fear can help us face the reality of the things that make us anxious. Often, these situations are not as bad as they seem.

 

1. Pattern tracking: Keeping a record of anxious thoughts and emotions builds up clients’ self-knowledge of where they need intervention, and what situations they already do well in.

 

1. Reframing: This refers to the process of flipping an anxiety around. There is often a more helpful way to think about even very scary situations, reducing anxiety, and keeping clients on track to make positive decisions.

 

1. Thought stopping: This technique describes the practice of halting negative thought patterns with clear, often habituated interruptive thoughts. In practice, this can be as simple as firmly thinking or saying ‘no’ when the signs of an identified anxious thought pattern occur.

 

Evidence for CBT as Anxiety Treatment

CBT is one of the most well-evidenced tools that mental health research has offered us in treating anxiety. Endorsed by the APA, SAMHSA, NHS, and many more government health agencies, CBT is the gold standard and often the quickest and most long-lasting treatment available for GAD. Decades of research have come out between the time when it was developed and present-day suggest an approximate consensus that CBT doesn’t just work, but it also works best for most clients. Meta-analysis of decades of studies across the world include that of:

 

• Otte (2011), who pooled data from 11 smaller meta-analyses all of which investigated the effects of CBT on various anxiety disorders in control trials and naturalistic therapeutic settings. For CBT’s effect on GAD, they calculated an average pre- to post-treatment effect size of 0.92 – a statistics term that indicates strong, consistent, and significant difference between the symptoms of individuals before and after treatment.

 

• James et al (2020) whose meta-analysis of CBT’s treatment efficacy for childhood symptoms of anxiety pooled data from 87 studies and nearly 6,000 participants found that it is highly effective in relieving treating childhood anxiety disorders calculated by the remission of anxiety diagnosis relative to waitlist (49.4% and 17.8% respectively).

 

• Van Dis et al (2019) whose meta-analysis of 69 trials pooling 4119 clients with GAD found that even at a 1-year follow-up, clients’ mood gains from CBT reverted in only 0-14% of cases.

When to Get Help

If there’s one positive trend in the public relationship to mental health and addiction that’s been seen in the past decade, it is the solidifying normalisation and demystification of therapy’s benefits even for people who aren’t experiencing severe mental health symptoms. With that in mind, we advocate for accessing therapy as a preventative measure and as a facet of a holistic mental health care regimen.

 

However, if anxiety and anxious symptoms are dictating what you feel you can and cannot do and you find yourself reaching for a drink or a drug to cope, know that CBT and other effective, evidence-based treatment modalities are easily accessible throughout the UK and online. With time and commitment, it is possible to start living a life directed more by hope than fear.