If you’ve done any research into anxiety or panic disorders then you will doubtlessly have come across the term CBT, but what does that actually mean? CBT stands for Cognitive Behavioural Therapy – the cognitive side deals with our thoughts and beliefs about our personal triggers (no two people are the same) and the behavioural bit refers to the physical way that our symptoms manifest themselves.

So starting out on CBT:

First of all, you need to make sure that your therapist knows what they’re doing.  It’s always worth asking if you can record the sessions on your phone or a dictaphone. You might not take everything in straight away, so having a recording will help you go back over what you missed, (but refusing doesn’t make them a bad therapist, of course).  You are also entitled to ask a few questions, these might include:

• How do you set goals?
• How many clients have you had with similar circumstances to your own and when was the last time they worked with someone similar to yourself. 
• How long are the sessions?
• What kind of homework/reading will you receive?

Now let us start with the behavioural side of things because it was developed first. Behavioural therapy is almost always what’s called ERP; Exposure and Response Prevention. In ERP we must expose ourselves to the anxiety and allow for it to fall naturally without avoiding or abating it. Sounds easy, doesn’t it? Take a deep breath and don’t worry, someone who has a phobia of snakes is not going to have a boa constrictor wrapped around their neck during the first session.

Let’s look at an example that you’ll all have experienced at some time in your life – jumping into a cold swimming pool. The water feels freezing and you want to stop and shiver, but by moving around and thinking about something else the water starts to feel warmer.

With your therapist, you will determine a hierarchy of fearful situations. For example, someone who has a spider phobia would perhaps start by looking at pictures of them in a book to progressing to having a real one in the same room.  It doesn’t happen overnight but with support and determination, it can happen.

The other side of CBT is the cognitive (thoughts). Everybody has intrusive thoughts – everyone has imagined throwing themselves under a train impulsively, everyone has done a spontaneous U-turn on their way out in order to check that they have turned the oven off, but it is what you do with this thought that counts (pun not intended).

With anxiety and panic attacks, these thoughts are not everyday worries or horrible images in your mind, they are associated with the misguided belief that we are somehow able to stop harm from occurring, that we have the power to control these events. By ascribing such power to meaningless thoughts, we try too hard to stop the “bad thing” from happening – this is where the cognitive side comes from.

Different techniques are used in cognitive therapy. A favourite is the downward arrow, which is a way of working through your automatic thoughts to find the irrational beliefs or schemas at the base. A lot of the time, these core beliefs are not obvious to us – so it’s a case of asking the same question again and again until you get to the bottom of it: “What does that mean about me?” or “what does that imply?”. Another technique you might find helpful to do is the Theory A/Theory B technique, especially in panic attacks. This works by setting two theories – the belief that you have and an alternative interpretation. So for example you might feel that you are dying and the opposite theory would be that you were having a panic attack, so whilst it can cause palpitations, you are actually totally safe.

So there you go – a quick guide to CBT. Time and time again it has been found to be the most effective treatment of anxiety disorders and hopefully, this will help you to make sure that you are accessing the best therapy.