What are the cognitive-behavioral techniques for treating anxiety?

Review of the forms of cognitive-behavioral intervention for patients with anxiety disorders.

The prevalence of anxiety disorders in the world population is very high. Some studies consider them to be the most prevalent mental disorders, and others the second most prevalent. Cognitive-behavioral techniques for anxiety are among the most widely used for this are among the most widely used for this type of disorders.

In this article we will know the five most frequent anxiety disorders, their basic characteristics and which specific cognitive-behavioral techniques are used for each of them, mentioning their components and usual psychological strategies.

Cognitive-behavioral techniques for anxiety.

The anxiety disorders are one of the most frequent mental disorders. in the population worldwide.

These can be of different types, ranging from the presence of generalized anxiety in everyday life (generalized anxiety disorder or GAD), to the presence of panic attacks (panic disorder) and the constant fear of having them and not being able to get help (agoraphobia), or the irrational fear of a specific stimulus, object or situation (specific phobia). Phobia of social situations (social phobia) is also considered an anxiety disorder.

As we can see, there are a wide variety of anxiety disorders. The treatments used for them also varyThere are pharmacological (anxiolytics, antidepressants...) and, of course, psychological options. The most frequently used psychological treatments are, together with relaxation techniques, cognitive-behavioral techniques for anxiety.

Let's see what kind of cognitive-behavioral psychological techniques we can use for each type of disorder:

1. Panic disorder

Panic disorder, categorized as such in the DSM-5 (Diagnostic Manual of Mental Disorders), is characterized by the presence of unexpected and recurrent panic attacks (2 or more). (2 or more). In addition, the person feels a continuous preoccupation for suffering them again, or for the consequences of the same ones.

Cognitive-behavioral techniques for anxiety used in the case of this disorder include two classically known therapies: Barlow's panic control treatment and Clark's cognitive therapy:

1.1. Barlow's panic control treatment.

This treatment includes a prominent educational component. In terms of its characteristics, the treatment includes systematized exposure to interoceptive sensations. (sensations coming from the internal organs of the body), similar to those produced in a panic attack.

The treatment also includes the cognitive restructuring technique, which aims to modify the patient's erroneous beliefs about panic and anxiety. Finally, it includes breathing and/or relaxation training, as well as homework. It is worth mentioning that the breathing and/or relaxation techniques it employs have not been shown to be effective as an isolated component.

Ultimately, the cognitive-behavioral techniques for anxiety that Barlow proposes in his therapy emphasize exposure to perceptual sensations (and in fact it is the (and in fact this is the feature that differentiates it from Clark's cognitive therapy).

1.2. Clark's cognitive therapy

Clark's cognitive therapy, also called cognitive therapy program, instead emphasizes the cognitive component. This therapy focuses on working on the patient's catastrophic cognitions, such as "I won't be able to breathe", or "I will drown".such as "I won't be able to breathe", or "I will drown". It also includes the patient's testing of his or her catastrophic interpretations and replacing them with more realistic ones.

On the other hand, it also includes the induction of feared sensations, through "experiments" such as the focusing of attention, with the aim of showing the possible causes of the patient's sensations.

Finally, in Clark's cognitive-behavioral techniques for anxiety, the therapist recommends the patient to abandon safety behaviors (e.g. "always go with someone"). (as for example "to go always accompanied", "to take amulets", etc.), with the purpose that he disconfirms the negative predictions of the consequences of the symptoms that he has.

2. Agoraphobia

Agoraphobia is an anxiety disorder characterized by fear of being in public places or in situations where it is difficult to receive help in case of a panic attack or "escape". Thus, the fear appears in public places, not open, as it is popularly thought..

Cognitive-behavioral techniques for anxiety used in the case of agoraphobia include cognitive behavioral therapy (CBT), which in turn, usually includes the following components: anxiety and panic education (psychoeducation), controlled breathing, cognitive restructuring, live self-exposure, interoceptive exposure and recordings.

Its effectiveness may decrease if the time spent on live exposure is reduced.. This type of therapy usually produces fewer dropouts and fewer relapses in panic attacks than isolated live exposure techniques.

3. Specific phobias

Specific phobias are characterized by excessive and irrational fear of "harmless" stimuli, objects or situations, or that would not have to cause such levels of fear and anxiety. For example would be the phobia of flying, phobia of insects, snakes, clowns, darkness, etc.

In this case, the cognitive-behavioral techniques for anxiety that are used include some treatments, such as Ellis' Rational Emotive Therapy (ERT), Meichembaum's Stress Inoculation Training and Goldfried's Systematic Rational Therapy.

This type of therapy (CBT) for the specific phobia aims at exposure to the phobic stimulus with as little anticipatory anxiety as possible, together with more adaptive attributions to the phobic stimulus.This type of therapy (CBT) for specific phobia aims at exposure to the phobic stimulus with the least possible anticipatory anxiety, together with more adaptive and realistic attributions of the patient's reactions.

4. Social phobia

Social phobia, as we have already mentioned above, involves excessive anxiety in social situations that involve exposure to others, interaction with other people, being at parties, initiating conversations, presenting a work in public, etc.The social phobia is a social phobia, an interaction with other people, being at parties, starting conversations, presenting a work in public, etc.

Cognitive-behavioral techniques for anxiety used for social phobia include classic cognitive-behavioral therapy (usually combined with the use of antidepressants).

In this therapy, cognitive techniques are applied together with exposure (a key element) to social situations. This is done both in therapeutic sessions and in homework assignments.

4.1 Goals of CBT for social phobia

The objectives of CBT in social phobia include: eliminating the patient's negative expectations regarding control over his or her behavior, suppressing recurrent thoughts about feared consequences, andThese include changing the focus on the physical symptoms of anxiety and curbing the tendency to set such perfectionistic goals.

They also include eliminating the tendency to belittle accomplishments, and finally, creating the need to be active and focus on what one can do.

5. GAD (Generalized Anxiety Disorder)

GAD involves a chronic, non-specific worry that appears in multiple situations of daily life.. A kind of "free-floating anxiety" appears. This anxiety disorder is the second most prevalent anxiety disorder in the general population.

Cognitive-behavioral techniques for anxiety used for GAD in particular are techniques considered effective, and include some of the following components: psychoeducation, problem-solving techniques, questioning whether worries are dangerous and the usefulness of worries, imaginative exposure to worst fears, applied relaxation, and maintenance of achievement and relapse prevention.

Specific treatments of cognitive-behavioral cut that we can find for GAD are: the Brown & col. treatment, the Barlow treatment, the Dugas treatment and the Wells treatment.

Bibliographical references:

• Belloch, A., Sandín, B., Ramos, F. (2010). Manual of Psychopathology. Volume II. Madrid: McGraw-Hill.
• Clark, D., Beck, A. T. (2012). Cognitive therapy for anxiety disorders. Bilbao: DDB.
• Ministerio de Sanidad y Consumo (2008). Clinical Practice Guideline for the management of patients with anxiety disorders in Primary Care. Barcelona: Catalan Agency for Health Technology Assessment and Research.
• Pérez, M., Fernández, J.R., Fernández, C., Amigo, I. (2010). Guide to effective psychological treatments I: Adults. Madrid: Pirámide.