A Mass General psychologist explains how cognitive behavioral therapy can help patients cope with anxiety.

Most people will experience anxiety — especially during major life changes, like starting a new job or preparing for a wedding.

But when anxiety interferes with a person’s ability to work, care for their family or find joy in activities they once found fun, it might be beneficial to talk to a doctor or therapist, says Susan Sprich, PhD, a psychologist at Massachusetts General Hospital.

Susan Sprich, PhD
Susan Sprich, PhD

Anxiety disorders are characterized by worry that can create physical symptoms such as a racing heart and loss of sleep. Such disorders are also characterized by cognitive symptoms such as negative thoughts and difficulty concentrating, and behavioral symptoms, such as leaving or avoiding uncomfortable situations.

One in Ten Diagnosed

One in ten American adults will be diagnosed with an anxiety disorder. Women are twice as likely as men to have them. And research has shown the tendency to have such a disorder can run in families. “Often anxiety disorders will develop in childhood and can persist through adulthood, if they are not treated,” says Dr. Sprich, director of Mass General’s Cognitive Behavioral Therapy Program for adults.

The good news is that anxiety disorders are treatable. The two most successful treatments are medication and cognitive behavioral therapy. Dr. Sprich says this therapy is a good option for people who want to learn coping skills to help them manage their anxiety.

Types of Anxiety:

  • Panic disorder — intense symptoms, often when a person feels trapped
  • Social anxiety — concern about negative reactions of others (public speaking, meeting new people)
  • Phobia — anxiety about specific situations (heights, flying)
  • PTSD — (post traumatic stress disorder) anxiety following a traumatic situation
  • GAD — generalized anxiety/excessive worrying

Cognitive behavioral therapy is a form of psychotherapy that makes patients aware of their negative thoughts and helps change their behavior. Dr. Sprich works with her patients to develop strategies to counteract their negative thoughts.

Dr. Sprich says, for instance, that a person with social anxiety might dread receiving a party invitation, fearing that if she attended the party no one would talk to her. Dr. Sprich tells her patients: “Thoughts are just thoughts. Thoughts are not facts. If you accept your negative thoughts as being accurate, it’s going to lead to a behavior, such as avoiding the party.”

Of course, not all anxiety is bad. For example, anxiety can motivate a student to study for a final exam. But when testing time comes, too much anxiety can get in the way of concentration and become an obstacle, Dr. Sprich explains.

The emotion can also physically affect the body causing the hands to tremble and making breathing difficult.

Understanding Your Thoughts

Learning how to counteract negative thoughts takes work, Dr. Sprich says, but generally such therapy is a short-term treatment and can be accomplished in 12 to 20 visits. Patients often leave sessions with homework to expose themselves to situations that make them anxious, like going to the party (if a patient has social anxiety disorder) or patting a dog (if a patient has a phobia of dogs).

“Thoughts are just thoughts. Thoughts are not facts.”

Many of her patients go through the sessions and find they have the tools they need to manage their anxiety. Then, when another big life change occurs, they can return for a booster session, if desired.

Some cognitive behavioral therapy programs incorporate mindfulness, which has gained a lot of attention recently. Mindfulness is the practice of bringing one’s attention to the present moment in a nonjudgmental fashion. It can include practices like meditation and yoga.

“The goal really isn’t to completely eliminate anxiety,” Dr. Sprich says. “It’s about coming up with ways to coach yourself to cope with it more effectively.”

How to Counteract Anxiety

Dr. Sprich tells her patients to pause when they begin to feel anxious. She tells them to take a deep breath and ask the following questions:

  • What is making you anxious?
  • Is this thought realistic?
  • Is this thought helpful?
  • What is the worst thing that can happen?
  • If that happens, can I cope with it?
  • What would you say to a friend in this situation?

Dr. Sprich says the act of going through the questions helps patients learn how to recognize when they are having negative thoughts and come up with more realistic and effective coping statements. By doing this, they can reduce their anxiety.

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