Discover What Really Works For Anxiety

Discover What Really Works For Anxiety

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How to Use CBT for Anxiety: 12 CBT Techniques You Can Use Right Now (With Worksheets)

Article Summary:

Discover how to use CBT for anxiety with 12 profoundly effective CBT techniques and CBT worksheets provided to help you manage anxiety and overcome negative thinking...

Cognitive Behavioral Therapy (CBT) is an increasingly popular form of therapy used to treat many types of mental and emotional issues, including; anxiety, panic attacks, OCD, and depression.

The use of CBT for anxiety has increased over the past two decades.

It is now recommended by the American Psychiatric Association, the American Psychological Association, and the British Health Service for treating and managing anxiety.

CBT is often regarded as "the gold standard" for anxiety therapy.

Whether or not CBT is the "best" form of therapy for anxiety is debatable, but studies have proven CBT's effectiveness compared to medication and other forms of treatment.

What impresses me the most about CBT is how quickly it can work, even in those with limited success using other strategies to manage their anxiety

Measurable improvements have been shown in people with different types of anxiety over a few short weeks, compared to months or years, as with many forms of traditional talk therapy or psychoanalysis.

One of the major reasons CBT often works so quickly is that it focuses on how thoughts and behaviors play themselves out now instead of spending months or years digging into childhood and past pain.

CBT is well known for its direct, concrete, and practical techniques.

These techniques and exercises are used with CBT worksheets to track and record progress and to record and challenge negative thoughts and beliefs.

This article will discuss 12 of the most effective CBT techniques available.

We have also provided worksheets you can download and use in conjunction with the techniques.

So let's get started!

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A Quick Introduction to Cognitive Behavioral Therapy (CBT)

CBT operates under the tenet that thoughts affect feelings, which in turn affects behaviors, which can affect thoughts, and on and on.

A vicious cycle.

You feel how you think, and your behaviors are directly related to your thoughts and feelings.

Many people assume the cycle only goes in one direction: thoughts>>>feelings>>>behaviors

Any area can begin the cycle, but it's always your thinking – your thoughts, interpretations, and beliefs – that begins the anxiety cycle/process

How you feel can influence your thoughts, which can affect your behaviors.

For example, You feel nervous, so you think, "I'm feeling nervous; something terrible is bound to happen, "and then you behave in a way to reduce or avoid the anxiety (i.e., avoidance, compulsive behaviors, distraction, etc.)

Regardless of how it may initially look, your thinking caused the problem.

In the example above, by thinking/believing – because you feel nervous something terrible will happen – you have kick-started the anxiety response and the resulting behaviors.

Your behaviors can also influence and affect your thoughts or your feelings.

For example, You slip up and have a few beers while trying to stop drinking, and the next day, you think, "I'm such a fuck up; I'll never get over this." As a result, you feel anxious, depressed, and guilty.

Yet again, your thoughts (your interpretation of what happened) primarily cause your negative feelings.

You may be thinking, "But it was the behavior, the drinking, that caused anxiety, depression, and guilt. "

But this isn't true.

What if your behavior was the same, you slipped up and drank again, but instead of thinking, "I'm such a fuck up, I'll never get over this," you think, "That was a mistake; I promised myself I wouldn't drink. I will take more decisive action from here on out; I'll start by throwing out all the alcohol in the house. "

Do you think your feelings would be the same?


But they would be less intense and harmful.

Besides that, if you were to go back in time and look closely, your thoughts before drinking would have directly influenced your drinking in the first place (i.e., your behavior).

"Thoughts" include conscious thoughts, thinking processes, interpretations, and deeply held beliefs.

"Feelings" can be in awareness and felt, or they can be unconscious and repressed, desperately seeking expression.

"Behaviors" can be consciously acted out (deliberate) or may seem out of control (compulsive).

CBT focuses on developing personal strategies to challenge and change negative thoughts and beliefs, creating a healthier emotional response to life's challenges, and taking action to eliminate unhelpful (or unhealthy) behaviors and habits.

CBT & Trauma

For many people, unresolved trauma and underlying traumatic memories are the primary cause of much of the anxiety they are experiencing.

Trauma can cause a person to avoid certain people, places, or things that could reignite the trauma response.

Very often, even the most subtle of triggers (a particular smell, a sound, or the way someone looks or talks) can trigger feelings of intense anxiety, fear, and loss of internal control.

While we highly recommend CBT for working with thought patterns and beliefs that are causing anxiety in daily life, CBT would not be our first choice for therapy if you are dealing with deep trauma.

Our first recommendation would be to seek out a competent therapist that can provide a safe environment for you to explore traumatic memories and emotions that are often held in the body and the unconscious mind.

Cognitive therapies like CBT, which primarily work with surface-level thoughts, will often not provide sufficient depth to unearth and integrate these trauma-based experiences.

Our first choices for trauma work would be EMDR and Internal Family Systems (IFS), along with working with a therapist trained in handling trauma.

Body-based or somatic therapies such as Yoga and Somatic Experiencing can be powerful approaches for releasing the body's stuck/held energy of trauma.

In future articles, we will dive deeper into trauma and its relationship to anxiety.

You can also check out our article on Psychological Causes of Anxiety, where we briefly discuss trauma and anxiety and repressed and suppressed emotions.

Cognitive Distortions

One of CBT's primary strategies is to challenge and change unhelpful, unrealistic, illogical, or just plain harmful thoughts, interpretations, beliefs, and attitudes.

These can be thoughts, attitudes, and beliefs about yourself, others, or the world.

These unhelpful and illogical thoughts and beliefs are known as cognitive distortions.

Cognitive distortions are errors in your thinking and your thought processes.

By changing how you think, you can change how you feel.

Below is a guide we created with the 10 major cognitive distortions in Cognitive Behavioral Therapy.

When filling out your thought log (which you can download further down), use the cognitive distortions list below to determine which distortions are present in the negative thoughts you wrote down.

The 10 Major Cognitive Distortions​

The Cognitive Distortions list we provided is an essential reference for recording the distortions in your negative thinking in your Thought Log and the CBT techniques we will discuss below.

If you'd like to download this list for your reference, click the button below...

CBT Worksheets for Anxiety

At the heart of CBT, and one of the strategies that truly sets it apart from other forms of therapy, is the focus on tracking, journaling, and recording during treatment.

This process is typically done using CBT worksheets assigned by the therapist to track daily thoughts and levels of anxiety, to directly challenge negative thoughts, to record worries, or for any number of different purposes.

You can also purchase CBT workbooks, such as "The Anxiety & Worry Workbook" by David Clark and Aaron Beck (the founder of cognitive therapy), that provide blank CBT worksheets for anxiety.

CBT relies heavily on tracking and recording to track what works and work out particular thought patterns or beliefs.

Writing it down makes it all so much easier.

Worksheets also provide a visual representation of what is going on in your mind and concrete recorded information you can look back on and say, "I've really improved my life" or "Looks like I still need to get over that particular fear."

There are dozens of CBT worksheets for anxiety, fear, worry, panic, and exposure.

We have provided three primary worksheets for you to download and use.

The worksheets are in PDF format.

Simply download the PDF, print it, and fill it in according to the technique you are doing.

There is something more powerful about writing things down on paper than typing on a computer or phone.

Feel free to download as many copies as you need and use them alongside the CBT techniques discussed below.

The Thought Log (based on David Burn's "Daily Mood Log")

The Thought Log is one of the primary worksheets in CBT.

There are different types of thought logs, some basic and some more complex.

The one we created and provided for download is based on Dr. David Burns's "Daily Mood Log."

Its purpose is to allow you to record and challenge your negative thoughts and beliefs.

cbt thought log worksheet

How to fill out The Thought Log worksheet:

  • 1. Write down your negative thought or belief
  • 2. Write down how much you believe the negative thought
  • 3. Determine which cognitive distortions apply to your negative thought
  • 4. Write a positive thought to challenge and disprove the negative thought
  • 5. Write down how much you believe the positive thought
  • 6. Write down your new belief in the negative thought after coming up with the positive thought or using a technique

You are done if your belief in the negative thought is reduced to 0%. If not, continue with a new positive thought or technique. Continue until your belief in the negative thought is 0%

Example Worksheet & Instructions:

Cost-Benefit Analysis Worksheet

The Cost-Benefit Analysis Worksheet is used to help change beliefs, attitudes, and behaviors by clearly stating the advantages and disadvantages.

No matter how bad your particular issue may seem, you always receive some type of advantage (benefit) from holding onto a specific belief, attitude, behavior, or habit.

This is almost always the case - whether you can admit it to yourself or not.

There are also obvious and not-so-obvious disadvantages.

When you compare what something is costing you versus what benefits you are receiving, it can significantly help you to make a choice and make the necessary changes.

cost benefit analysis worksheet

How to fill out the Cost-Benefit Analysis worksheet

Using this worksheet is pretty straightforward. If you'd like to see an example of how to fill it out, check out the Cost-Benefit Analysis Technique below…

Fear Hierarchy Worksheet

The Fear Hierarchy Worksheet is used primarily with Exposure Therapy.

It is used for Classical Exposure and Gradual Exposure in particular.

This worksheet allows you to list and lay out the different steps and levels of the particular fear you are working on so that you can approach exposure one level at a time.

For example, if the fear you are working on is shopping in a crowded mall alone, Level 1 may be to simply ride to the mall with a support person without actually going inside. While level 10 would be to shop on your own on a Saturday afternoon.

fear hierarchy worksheet

How to fill out the Fear Hierarchy worksheet

If you want to see a complete example, check out Exposure below....

CBT Cognitive Approaches to Anxiety

There are many CBT techniques for managing anxiety - far too many to list every one you could use in a single article.

We have chosen twelve of the most effective and divided them between cognitive approaches (which we will discuss here), behavioral or exposure approaches (which we will discuss next), and finally, uncovering repressed emotions.

Some CBT techniques work better for certain types of anxiety or focus areas than others.

Cognitive approaches are techniques that you can use to uncover, challenge, or change thoughts and beliefs, typically using pen and paper or one of the worksheets provided

For example, the first technique, the "Downward Arrow Technique," is used to uncover limiting beliefs.

The semantic technique further below focuses on changing the language and labels used - which can change the tone in which you speak to yourself.

We recommend trying different techniques until you find one that is effective.

You can also try mixing and matching techniques until you can bring the belief in a negative thought down to zero or replace a belief with something more empowering.

If one technique doesn't work for you, try a different one!

We highly recommend downloading and using the worksheets with the CBT exercises.

It will make the process much more effective (and easier).

(Several of the CBT techniques listed below were borrowed from or inspired by Dr. David Burns's book "When Panic Attacks." An excellent book that uses CBT exercises for anxiety. We highly recommend it)

The Downward Arrow Technique

When you have negative or recurring negative thoughts or imagine a particularly frightening scenario, there is often a deeper held belief or beliefs behind the thought or scenario.

For example, suppose you have the recurring fear of being judged incompetent by others.

In that case, you may ask yourself why you have this fear, but more particularly, why does it bother you so much if someone did you judge you as incompetent?

What does it mean?

The Downward Arrow Technique is a popular CBT technique for this very purpose. This inquiry can reveal the "why" behind the limiting, negative thought or scenario. By asking "why?" and digging a little deeper, you can uncover the underlying beliefs and fears.

In fact, it's one of our overall favorite techniques from any form of therapy.

It's also relatively simple to do and cuts to the core of the matter quickly and clearly.

How to Use: The Downward Arrow Technique

  • 1. Write down a negative thought using the Thought Log (download above) or blank paper. It could be a negative thought/belief about yourself, another person, or an upcoming situation
  • 2. Next, ask yourself, "If that is true, what would it mean to me? Why would it be bad/upsetting? "
  • 3. Draw an arrow underneath the first thought, pointing down and fill in your next thought based on the questions you just asked yourself
  • 4. Ask yourself the questions again and draw a downward arrow underneath, listing the new thought
  • 5. Write down how much you believe the positive thought
  • 6. Keep going like this until you get to the deep core beliefs around your original negative thought


The What-If Technique

People with anxiety tend to have vivid imaginations, which they often put to negative aims, i.e., imagining terrible, frightening, anxiety-producing fantasies and scenarios.

But they rarely uncover the fantasy at the core of the fear around a particular situation.

And, just as important, they rarely ask themselves the odds that this fear and anxiety-producing fantasy would occur in real life.

The What-If Technique works similarly to the Downward Arrow Technique, but instead of uncovering self-defeating beliefs, you discover a fantasy or imagined scenario/experience triggering your anxiety

The What-If Technique can uncover beliefs and hidden emotions as you pinpoint the deeper underlying fantasy.

As a result of doing the What-If Technique, you can see just how illogical, unlikely, or just plain silly the majority of your anxiety-producing fantasies can be.

Once the core fantasy is uncovered, you need to ask yourself:

"How realistic is this fantasy?" "Is it based on reality?" How likely is it to occur?"

And if the fantasy is realistic and could actually occur, you need to ask:

"Could I live with it if it did?"

The What-If technique is one of our favorite CBT techniques and is highly effective.

How to Use: The What-If Technique

  • 1. Using the Thought Log (download above), or a blank piece of paper, write down an adverse scenario you imagine happening or a recurring fantasy you have that causes you anxiety
  • 2. After you have written it down, ask yourself, "What if this happens?" "Then what?" "What happens next?"
  • 3. Draw an arrow underneath your first response and write your new response under it (based on the questions you just asked yourself)
  • 4. Now ask yourself, "And if that happens, what then?" Draw an arrow down and write your subsequent response
  • 5. Continue doing this until you uncover the actual core fantasy that is causing you anxiety and fear
  • 6. Once uncovered, ask yourself:
  • 7. How realistic is the fantasy?
  • 8. Is it based on reality?
  • 9. How likely is it to occur?
  • 10. Finally, if it is 100% realistic and likely to happen: could you live with it?

The Double Standard Technique

A common issue with any type of anxiety is how you talk to yourself or react to situations in your life, especially ones that didn't turn out how you wanted or expected.

I'm willing to guess that you often treat yourself worse than you ever would a friend (or even most strangers, for that matter).

I bet you talk to yourself in ways you would never speak to a close friend or loved one.

The Double Standard Technique is a compassion-based technique aimed at correcting this double standard in how you treat yourself. The goal is to treat everyone, including yourself, with the same level of compassion and fairness.

Instead of instantly beating yourself up over a mistake or failure, you learn to approach the situation with the same understanding you would if it happened to a close friend or loved one.

This CBT exercise can help reveal how mean and uncaring you can be to yourself and how you often make your situations worse by beating up on yourself.

It can also show us just how distorted your thinking can be.

Once you can see how your negative thoughts sound coming from a friend or loved one, it can help to change your perspective and develop greater self-compassion.

Developing greater self-compassion can not only help with issues from the past but can help change how you treat yourself in the future.

So instead of beating yourself up for being anxious about something, you can talk to yourself with more compassion and patience.

How to Use: The Double Standard Technique

The Double Standard Technique can be done in 1 of 2 ways:

Alone using the Thought Log (download above)


With someone else doing a role-playing exercise

On your own:

  • 1. To do this exercise on your own, use the Thought Log or a blank piece of paper
  • 2. Now write a self-defeating thought or a thought where you have beaten yourself up over something that has happened. For example, "I'm such a total screw-up" or "I really messed things up again like I always do."
  • 3. After you have written the thought down, ask yourself, "What would I say to a close friend or loved one if they were telling themselves this or had a similar issue?"
  • 4. As you come up with a response you would give if it were someone close to you, turn that response around so it is about yourself and write the response in the positive thoughts column
  • 5. Continue until you get a change in perspective, and the negative thought or response loses its charge and is no longer believed

With someone else (role-playing):

If you have someone to practice this technique with, you can try doing a role-playing dialogue

  • 1. Write down a copy of your negative, self-defeating thoughts around a particular situation
  • 2. Give the person your list of thoughts and ask them to play a clone of you using the negative thoughts you have listed
  • 3. Now create a dialogue where the person states your problem and the thoughts you have around it as their own
  • 4. You respond in an understanding way as you would with a close friend
  • 5. Write down the positive/empowering thoughts you come up with in response to your friend's negative self-talk (so you are essentially responding to your own negative thoughts)

Cost-Benefit Analysis

Every way of thinking, feeling, and behaving has advantages and disadvantages, including negative ones that we want to change.

But most people rarely take the time to look at what a particular habit or attitude is costing them or what they gain from behaving in a certain way.

For example, there are clear disadvantages to having the attitude "I am a weak person," but what does a person gain by having this attitude?

If they were to do a Cost-Benefit Analysis, they might discover that they get to feel sorry for themselves or avoid things that make them uncomfortable or that they don't feel "up to doing."

A Cost-Benefit Analysis can help you to clearly state and compare the advantages of a particular habit, attitude, or belief to the disadvantages

In most cases, when you lay things out using a cost-benefit comparison, you get to see exactly what it costs you to think or behave in a certain way and uncover benefits you may not have been aware of before.

Cost-Benefit Analysis is a staple CBT exercise and is highly effective.

We recommend using it for any attitude or behavior you want to change.

How to Use: Cost-Benefit Analysis

  • 1. Use the Cost-Benefit Analysis sheet (download above) or a blank piece of paper with a line down the center
  • 2. At the top, write down the particular belief, attitude, or behavior (habit) you want to work on or change
  • 3. Now write down the advantages of the specific belief, attitude, or behavior on the left and the disadvantages on the right
  • 4. When you have written down everything you can think of, decide based on your answers whether this particular thing is costing you more or benefiting you more
  • 5. You can write a score for each and choose the one with the higher score or make a final decision after reviewing what you have written
  • 6. When you clearly see that something is a significant disadvantage in your life, it makes it much easier to change



If you are quick to beat yourself up, blame and shame, or use harsh words toward yourself, such as "failure" or "loser," when things don't go as planned or you encounter problems in life, reattribution can be an effective method.

You can use Reattribution to challenge automatic assumptions and self-blame around experiences in your life and take a more precise look at all the factors contributing to the problem

Instead of beating yourself up over something that happened, you can stop the blame game and look at the situation from a more realistic and holistic point of view.

In most cases, many different factors are involved where blaming yourself isn't entirely accurate or healthy.

If an unfavorable outcome results from your actions, you can focus on making it right or learning from your mistakes.

Either way, blame, and shame don't solve anything.

Using Reattribution, we can eliminate self-blame and the resulting guilt and anxiety.

You can look at the situation from a more clear point of view, take responsibility for what you do, and learn from your mistakes to make better choices in the future.

How to Use: Reattribution

  • 1. Think of a situation in your life that you feel was a mistake or failure and that you still blame yourself for
  • 2. Using a piece of paper right down this situation and everything you blame yourself for and how it was a mistake/failure
  • 3. Now begin to look at this from a more realistic perspective
  • 4. Write down the situation using truth based on all of the factors involved in the situation
  • 5. Take responsibility for your part and only your part, and learn from it
  • 6. (Do not simply move all of the blame to someone else unless this is truly the case - try to consider every factor involved)


Semantic Techniques

Two of the major cognitive distortions in CBT, Shoulds, and Labeling, are particularly common in anxiety.

People who struggle with anxiety often tell themselves they should or shouldn't behave or feel a certain way.

They also apply shoulds to others.

"The world should be fair" or "He shouldn't act like that. "

With labels: many of us habitually label ourselves based on a flawed perception, experience, or mistake.

You might label yourself as "stupid" because you forgot to do something or label another person as a "bitch” from one interaction with them at the store.

In either case, you are discounting every other quality of yourself or others and overgeneralizing – creating a label based on limited or inaccurate evidence.

Semantic Techniques work to correct the distortions involved in Should Statements and Labeling by changing your language. You become clearer on the terms you use and more realistic instead of overgeneralizing.

There are several different types of Semantic Techniques in CBT.

Below we'll look at one way to change your language to help with Shoulds and Labeling and reduce much of the charge behind hurtful statements often used towards ourselves and others.

How To Use: Semantic Techniques

  • 1. To begin, notice an obvious should (or shouldn't) statement in your life right now. Notice the labels you use based on the success or failure of this should
  • 2. Write down exactly how you are saying it in your mind
  • 3. Now find the should statement in what you have written down (it may not always expressly state "should" but will be the part that puts unnecessary pressure on you or others)
  • 4. Now find the label(s) you have used for yourself or others if the situation doesn't happen in the way you think it should
  • 5. Once you have a clear idea of the should and the label, reframe the situation by substituting the word should or implying should, for a preference or in less absolute terms
  • 6. Now look at the label used and clarify the term. Be specific, don't overgeneralize, and use kinder language with yourself. Or remove the label altogether.
  • 7. See the example below for help


CBT Exposure & Behavioral Approaches to Anxiety

With the techniques above, we focused on cognitive approaches, which deal primarily with thoughts and beliefs.

This section will focus on behavioral approaches, which seek to identify and change unwanted behaviors and responses.

This work is primarily done using exposure in varying forms.

With this approach, you will move away from a strictly thought-based system and begin facing your fears and phobias head-on

Thoughts and beliefs are the primary drivers behind fears and phobias and the pattern of avoidance.

Rather than challenging these thoughts and beliefs with other thoughts, you will challenge these fears in reality, where you will likely see that most (if not all) of your fears were unwarranted, untrue, or at the very least, inaccurate.

An understanding partner or therapist can be beneficial with exposure-based approaches.

Whether or not you have someone with whom you can work, getting out there and exposing yourself to the situations and environments that cause anxiety is the essential part.


What you resist persists and becomes stronger.

When you avoid things you believe to be threatening, you solidify and strengthen the fear and the belief.

The more things you believe to be threatening and the more you avoid, the stronger the fear and the smaller your world becomes.

Exposure is the direct antidote to fears and avoidance behaviors - you expose yourself to what is feared until you cure yourself of the fear

Exposure is a powerful CBT technique that also stands on its own as Exposure Therapy.

Exposure is also used in other forms of therapy.

There are different forms and approaches to Exposure Therapy:

  • Gradual Exposure: you approach the feared experience little by little, starting with the least frightening
  • Flooding: you jump into the fear head-on and let the anxiety ignite to the extreme until it burns itself out, and you come through the other side cured of the fear
  • Cognitive Exposure: you expose yourself to the fear by imagining it in great detail no matter how terrible (this is often used for experiences you can't expose yourself to in real life)
  • Interpersonal Exposure: commonly used for social anxiety, shyness, and social phobias (the Smile and Say Hello technique above is an example of this)

Exposure is a central strategy in CBT, and it is also a deep topic that can be extremely helpful for anxiety and overcoming fears and phobias.

We have an article in the works on exposure where we will go much more in-depth on the topic than we can here.

How to Use: the Fear Hierarchy Worksheet

The Fear Hierarchy Worksheet can be used for Gradual Exposure to a primary fearful situation.

When you use the worksheet, you break the fearful situation down into different levels (or steps) of approach and expose yourself to one level at a time.

You start with the easiest, or least fearful, Level 1, to the most frightening, Level 10, or whatever number the last level may be.

See the example below to get a better idea.


The Experimental Technique

Most people (especially those struggling with anxiety) walk around with negative thoughts, beliefs, and fears in their minds but never stop to question whether or not they are true.

They may hold these thoughts and beliefs to be true even without any proof in reality.

With the Experimental Technique, you will take definite action to validate or dispute a negative thought, limiting belief, or fear by testing the thought or belief directly in real life

For example: let's say that you believe you must be dressed nicely, have your hair done, and otherwise look perfect before you can leave the house to go anywhere.

Otherwise, people will notice and see you as a slob, or they will see you as dirty or unattractive.

You deeply fear their imagined criticism.

Now, you've believed this for as long as you can remember and have never left the house without your appearance immaculate.

This belief/fear has caused you to arrive late to events or meetings with others, it has caused deep anxiety about how others see you, and you've become overly self-conscious about your appearance.

Using the Experimental Technique, you would devise various "experiments" you could try to either prove or disprove the underlying fear-based belief, i.e., if I don't look nice whenever I leave the house, people will notice and judge me as a slob or dirty.

For the experiment, let's say you decide to wake up in the morning and leave the house as you are, without any preparation.

Wild hair, pajamas, and sleep still in your eyes.

You get in the car and drive to the store.

As you go about your day, you realize very few people even notice you, let alone make comments or stare.

You get a few brief looks from people surprised to see someone in their pajamas, but otherwise, nothing terrible happens.

Here you have essentially disproven your fear-based belief…

The Experimental Technique is highly effective for anxiety, panic attacks, and fear-based thoughts and beliefs.

It can remove limitations you've placed on yourself quickly as you discover that what you feared was false.

How to Use: The Experimental Technique

  • 1. Decide on a limiting belief, fear, or negative thought that you want to test
  • 2. Come up with a few creative ways to experiment with this belief, fear, or thought
  • 3. Try out one or several different experiments (acted out in reality) to prove the thought or beliefs validity
  • 4. If necessary, keep experimenting until you have demonstrated (with certainty) that it is accurate or inaccurate, true or false


See the decription above for a good example of how to use this process

Smile and Say Hello

Shyness is common with anxiety, especially for those with social anxiety and phobias.

If you struggle with social anxiety and shyness, you may feel self-conscious, like everyone is judging you in public places, or you may believe people are "cold" or are downright rude or even assholes.

The practice of smiling and saying hello to people as you go about your day is a simple but surprisingly effective strategy for breaking this spell of shyness and self-consciousness

It also allows you to open yourself to others as they are in the present moment rather than how you imagine them to be.

The more you use this practice, the more likely you will see that most people are friendlier than you may have thought.

This technique can change your beliefs about others to a surprising degree and make you naturally more friendly in the process.

As simple as the strategy is, it can be profoundly effective for shyness and social anxiety.

Smiling and greeting others can also benefit those around you.

Most people enjoy being acknowledged.

A friendly face and a greeting can quickly brighten someone's day or lift their mood.

Simply smiling and saying hello to others may seem harmless or like a pretty weak strategy to some, but if you suffer from social anxiety or you are particularly shy, this otherwise "harmless" strategy may seem pretty intimidating.

If this is the case for you, you will likely find this strategy extremely beneficial if you keep practicing.

Note: If you notice that during this practice, some people do not smile back or return the greeting, do not take it to heart, and remember that the other person's response is not the point of this approach. It's also worth keeping in mind that many people in different places, like certain cities, have grown accustomed to focusing on their routine and ignoring the rest; it doesn't necessarily mean they are being rude.

How to Use: The Smile and Say Hello Technique

  • 1. Commit to smiling and saying hello to 5 strangers each day, starting today
  • 2. If you are overly shy or nervous, start with strangers that you find to be the most non-threatening
  • 3. Once you can do this, begin to include every type of person you encounter, not just those you find non-threatening
  • 4. Begin to increase the number of people you smile and say hello to until you are doing this with nearly everyone you meet
  • 5. Continue practicing each day until it feels entirely natural for you; you may find that you continue to smile and say hello to strangers simply for the joy of interacting with others

Using this Practice to Find Love and Dating

This practice can also be customized if you are single and looking for a partner.

If you are shy or anxious around others (especially people you find attractive), you may have trouble approaching or starting conversations

  • 1. You can practice Smiling and Saying Hello as described above to become comfortable with simple interactions with others.
  • 2. Then begin smiling and saying hello to people you find attractive or would like to get to know better. The goal isn't to necessarily get a date but to simply practice.
  • 3. Over time you will become comfortable speaking to people you find attractive and move into conversations. By smiling and saying hello, you may find the other person engaging you if they are interested.

Response Prevention

Compulsive rituals, urges, and behaviors are often performed by those with obsessive/compulsive types of anxiety, such as OCD.

These behaviors can be seen as a way to control or prevent anxiety responses caused by perceived or imagined threats - even if the behaviors seem illogical or pointless to an outside observer.

For example: let's say you have a deep fear of someone breaking into your house in the middle of the night; you may perform the compulsive ritual of repeatedly checking that every window and door is locked before going to bed. If you don't perform this ritual, you may worry or feel unsafe until you do.

Compulsive urges and rituals can vary in intensity and how much they interfere with a person's life.

In the example above, a relatively mild urge would be to double-check that the doors are locked before heading upstairs to bed each night.

An extreme version of this would be checking every door and window multiple times, possibly even getting up in the middle of the night to check again.

Response prevention is an effective CBT technique often combined with Exposure to help eliminate a compulsive ritual/behavior

Stopping a compulsive behavior can ignite feelings of anxiety, much like quitting an addictive substance.

If you continue not giving in to the compulsive behaviors, the urges will disappear in time.

Response Prevention combined with Exposure therapy, a competent therapist, and medication may be beneficial for severe compulsions.

How to Use: Response Prevention

There are no step-by-step directions for this technique.

You simply recognize a ritual or repetitive behavior that you do when anxious or that you do to prevent feelings of anxiety and fear.

Then you make a committed effort to stop performing the ritual or behavior.

Whenever you feel the urge, you refuse to give in.

While not easy, the compulsive urges will often disappear over time as the behaviors are no longer performed.

This technique is often combined with Exposure Therapy, where the patient is exposed to the phobia or anxiety-producing situation and then practices Response Prevention by not performing the compulsive behavior.

For example, someone with a dirt or germ phobia may be asked to rummage in a trash can and not immediately wash their hands.

(Please note: moderate and severe forms of OCD often need more than just techniques and exposure. A competent therapist and medication can be incredibly beneficial for these issues)

Confronting Judgment & Criticism

Self-judgment and self-criticism are unfortunately all too common with anxiety.

Many people with anxiety struggle with insecurity and feeling self-conscious.

They might imagine that others are highly critical of their appearance or how they carry themselves.

They project judgment and criticism onto those around them (they see it coming from the outside), or they may be well aware that they are the ones harshly criticizing themselves.

In either case, they are their own worst critics and often judge themselves to the point of insecurity, low self-esteem, anxiety, self-doubt, or even helplessness.

There comes the point when one must stand up to judgment and criticism, whether toward oneself or imagine it is how others think about them.

The Confronting Judgement and Criticism Technique is a CBT technique I created by combining several traditional methods, including Cognitive Exposure techniques and role-playing

For this CBT exercise, you imagine a person that personifies all of the worst judgments and criticisms about yourself and then face them as they express these negative judgments to you.

Most people have a general archetype or persona for the type of person they fear, whether it's an actual type of person or an imagined one with a combination of different traits from different people.

The most effective way to use this approach is with a partner - you can explain the archetype to your partner and have them embody the character.

This is an extremely powerful way to use this technique, but if you prefer to do this work on your own, you can use pen and paper as a replacement for a partner.

How to Use: Confronting Judgment & Criticism

You can use this technique on your own or with another person

On your own:

  • 1. Write down a few negative thoughts, beliefs, and criticisms you have about yourself or what you believe others have about you using the Thought Log (download above).
  • 2. Now come up with a few positive thoughts in response to each.
  • 3. Make sure they are thoughts you believe in and can easily counter, dismiss, or use to prove the negative thought to be false or inaccurate.
  • 4. Now imagine this archetypal hostile person in front of you; they represent all of the negative judgments you came up with
  • 5. Work out a written dialogue between you and this person as they tell you all the nasty negative things they see wrong with you and respond to their criticisms
  • 6. Keep going until this person (your negative judgments against yourself) are neutralized

With another person:

Using this technique with another person works the same as above, except instead of imaging a person and writing down the dialogue, you have your friend play the part of the negative person expressing all of your negative thoughts while you play the role of yourself.

  • 1. Write down a few negative thoughts, beliefs, and criticisms you have about yourself or what you believe others have about you using the Thought Log (download above).
  • 2. Now come up with a few positive thoughts in response to each.
  • 3. Make sure they are thoughts you believe in and can easily counter, dismiss, or use to prove the negative thought to be false or inaccurate.
  • 4. Now imagine this archetypal hostile person in front of you; they represent all of the negative judgments you came up with
  • 5. Work out a written dialogue between you and this person as they tell you all the nasty negative things they see wrong with you and respond to their criticisms
  • 6. Keep going until this person (your negative judgments against yourself) are neutralized

Uncovering Hidden Feelings & Emotions

A common theme among people with anxiety is that they tend to avoid confrontation - either with others or with themselves.

They don't want to "rock the boat" or hurt people's feelings, and they regularly avoid (or suppress) uncomfortable feelings and emotions that they label as "bad" or "unacceptable."

In other words, people with anxiety strive to come across as "nice."

Or want to be seen as nice by others.

Keeping up this "nice" appearance is often done at the expense of their emotions, expressing how they feel, or standing up for themselves.

This was definitely the case for me.

In fact, getting over being seen as a "nice guy" was one of the major transformations I made in my life.

Not because being nice is bad but because it wasn't entirely sincere.

Underneath the nice facade, I was angry; I was hurt, and I was unsatisfied.

Being nice at the expense of my genuine emotions caused a lot of the anxiety I had in my life.

Once I worked on this and brought my true feelings to light, I felt much better; I felt more authentic and better able to face life.

Anxiety caused by trying to keep up a false facade of niceness (or any other inauthentic facade) is a common issue for many.

Uncovering and releasing or integrating suppressed emotions is likely this list's most powerful and effective strategy

Whether or not you can relate to keeping up the niceness facade - nearly everyone has feelings or emotions they stuff down, ignore, and run from.

If you're suffering from anxiety, I'm willing to bet this is the case for you too.

Uncovering hidden feelings and emotions that are causing pain, anxiety, or depression isn't an approach created around CBT.

Most forms of psychotherapy focus on uncovering hidden emotions (typically suppressed or repressed) so they can be brought to conscious awareness.

Once these emotions are brought to conscious awareness, they can be released or integrated, and you can move on with your life.

A Note on Trauma:

Unresolved trauma can be a major cause of suppressed and repressed emotions. If you are dealing with trauma, trying to do this work on your own by uncovering traumatic memories and emotions can do more harm than good. A good therapist's expertise and safe holding environment can make all the difference in the world. If trauma is an issue for you, I highly recommend reaching out to someone for help before trying this work on your own.

The Hidden Emotion Technique

The Hidden Emotion Technique comes from Dr. David Burns's Book "When Panic Attacks."

There is a difference between Dr. Burns' Hidden Emotion Technique, which is closely aligned with CBT, and the way that other forms of therapy use this process.

With the Hidden Emotion Technique, Dr. Burns believes the hidden emotion is related to something clear and present in our lives right now, not necessarily something buried in the past or some infantile unconscious urge, which is the common focus of other forms of therapy like Psychoanalysis.

It is what we are doing in our lives in the present that matters, not digging up the past.

Very often, the hidden emotion is related to one of the major areas of life:

  • Work: Do you enjoy your job? Is it satisfying? Do you feel appreciated?
  • Relationships: Do you have satisfying relationships? Do you feel loved? Do you have close friends? If you have a partner, do you feel they are right for you?
  • Health: Is your health good, or are you constantly ill and frustrated? If you are ill, do you feel it is unfair that you have to deal with it while others are healthy?
  • Free time and personal time (or lack thereof): Do you have time to do things you like to do (hobbies)? Do you have time to yourself, or are you always busy or preoccupied?
  • Overall personal freedom and satisfaction: Are you doing what you want to do in life? Is your life satisfying?

It's typically not hard to see what area is of concern; most people just choose not to face it.

Instead, they take their dissatisfaction and other emotions and sweep them under the rug to avoid confrontation, upsetting others, or being seen as anything other than nice.

As a result of not facing and accepting what they feel, they "forget" what they were initially upset about and instead experience anxiety, panic attacks, obsessive thoughts, behaviors, etc

Before we jump into how to do the Hidden Emotion Technique, I want to say one more thing.

The point of this exercise is not to go from a nice person that suppresses their emotions to a raging asshole that tells everyone how they feel without any filter.

The point is to be honest with yourself, to uncover the emotion so you can express it and stop feeling anxious as a result.

The goal is to become more authentic and make the necessary changes in your life instead of ignoring problems or areas where you are dissatisfied.

If you'd like to learn more about suppressing and repressing emotions, check out our article: Psychological Causes of Anxiety

How to Use: The Hidden Emotion Technique

There is no actual step-by-step method for uncovering hidden emotions. Instead, the two steps below point out two stages of the process.

The first stage is to uncover the hidden emotion. Depending on how deeply you are resisting the feeling will determine how difficult this can be. This process is also not linear, rational, or planned. This is more of a felt experience. Often it helps to drop down from the mind and into the body and begin to notice what you are feeling right now.

The second stage is expressing the feeling or emotion so it can be felt and released, allowing you a make changes in your life and move forward. Again this can be easy or difficult depending on your level of resistance and the severity/strength of the emotion. The more fully you can accept and feel it and let go; the more complete will be the release and ability to move on.

  • 1. Uncover the Hidden Emotion: the first step is to find out what is truly bothering you, this can be difficult, or it can be easy depending on how truthful you are with yourself and how willing you are to face the problem; remember to look at the key areas in your life mentioned above (work, relationships, health, etc.)
  • 2. Accept, Feel, Integrate & Change: once you've uncovered the hidden emotion (the underlying problem causing your anxiety), you will have to feel/integrate the feelings and then take action where necessary; this a step where many people make a mistake; they might uncover the feeling, feel it and then stop there; if a certain behavior or pattern of resistance is the cause of the hidden emotion the underlying problem may not be fixed until you take action to change both internally and externally where necessary; otherwise the feelings will come back, and if you ignore the emotions, the anxiety will come back; so accept the feelings and make the change

Final Thoughts

There are two critical elements to making these CBT techniques work for anxiety.

They are Commitment and Action.

Commit to challenging your limiting thoughts, beliefs, feelings, fears, and behaviors.

And take the necessary action.

Completing the work, doing the exercises, and facing your fears.

Feel the anxiety and do it anyway.

It may be uncomfortable and even downright scary, but it is necessary to overcome anxiety.

There's a reason those who take action and do the work provided by their CBT therapist see great results, while those who resist, refuse, and make excuses do not.

Find the right techniques for you in the list of methods above and do the work.

I promise if you commit yourself, you will see results!

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