Today we are going to see how to use the CBT Anxiety thought record worksheet to manage your anxiety and panic effectively.
What are CBT worksheets?
CBT worksheets are a form of self-help techniques that have to be done by writing different things on the sheets which help to evaluate causes of your emotional stress and self-defeating behaviors which maintain anxiety in your life.
What is CBT?
CBT is a short form for Cognitive Behavioral Therapy which was developed by Dr. Aaron Beck and his colleagues in the 50’s and 60’s. It aims to resolve mental problems by reducing emotional stress caused by person’s irrational thinking patterns.
CBT effectively reduces the frequency and intensity of the negative, irrational and self-defeating thoughts, intrusive thoughts, views and behaviors which consequently reduces emotional stress and thus the problem begins to resolve.
You might be wondering to what extent it can help you. How effective is CBT self-therapy practice?
It has been proven through numerous studies that Cognitive Behavior Therapy is the gold standard treatment for all forms of anxiety. This fact has been documented by many leading researchers and doctors in this field. See: What are the principles of CBT?
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In the earlier articles, we discussed the causes of anxiety and panic attacks. But the problem is that you interpret anxiety symptoms in a different way that disturbs you.
Anxiety and panic might have a host of different causes but the maintenance factors are usually the thoughts, views, and behaviors related to anxiety.
The panic cycle demonstrated how anxiety is maintained in life and how it is fueled by our own thoughts and views about it.
The summary of what we learned is: Panic is fueled if we fear it and try to avoid or run away from it. It subsides if we accept and endure it and let it pass without any resistance.
It is pretty clear that our thought and views are the first things which we have to address.
This worksheet makes you pinpoint the views you hold about your own anxiety and dread, and then it makes you analyze whether the way you are thinking is reducing your fear or increasing it.
It makes you think and identify the truth about your fears. With that, you can identify the root cause of your problem and decide whether your thinking is working for you or against you. This CBT worksheet will help you get over the dread of future panic attacks.
This Anxiety CBT Thought Record sheet demonstrated here is from get.gg and is shared here with prior permission.
A Guide to 6 Step Anxiety Thought Record Worksheet:
Imagine that you were in a marketplace, shopping in a crowded area.
While shopping you suddenly had the initial symptoms of anxiety- Dizziness/Lightheadedness.
With that, other symptoms of anxiety also emerged and now you are slowly going towards higher arousal and a racing heart.
We will see how can you use Anxiety Thought Record Worksheet to reduce the intensity of anxiety in a situation like this.
1 The first column in the sheet is “Situation.”
Here you have to write the situations which often trigger anxiety or panic attack. You might be aware of the fact that you get anxious in particular conditions or surroundings.
Talking about your anxiety, for example, having chest pain, feeling shortness of breath or suffocation, feeling tingling in the body, getting dizzy are the symptoms of your panic attacks.
There has to be some preconscious thought process related to the situations that initiate these symptoms in your body.
We have to figure out what are the situations that provoke worry, concern, and anxiety or simply resistance to any particular thing in your daily life.
These have to be the situations you find uncomfortable and the ones you try to avoid.
So, these are simply the situations which make you anxious and panicky.
The questions you can ask yourself are:
- What happened?
- Who with?
Examples of Situations:
- Being in a certain closed place like a theater or an auditorium.
- Witnessing a bad news like accident or death or destruction.
- Having some minor health problems (which you are catastrophizing).
- Getting the initial sensations of anxiety. (This can also be called as a situation).
- Having automatic negative thoughts. They can be thoughts of death, public performance, inevitable challenges, one’s future etc.
2The second column reads “Emotions or Moods” and rating of their intensity from 0% to 100%
You have identified a situation which provokes anxiety and you are pretty sure that is the thing which is bugging you.
This is the column where you have to enter your emotions corresponding to panicky situation or condition and rate their intensity from 0 to 100.
These have to be the emotions you get immediately as a direct result of the situation you identified as anxious or panicky.
The emotions can be:
- Fear, feeling dread, apprehension, nervousness, impending doom.
- Angry, mad, fed up, irritated, frustrated.
- Hopeless, discouraged.
- Feeling stuck, pessimistic.
Looking with a wider perspective we can also say that it is your mood. Because we want to consider your overall emotional state during anxiety and panic attacks. The percentage number give has to be your mood, which includes the emotions.
3The third column reads, “Physical Sensations and Reactions”
You are in a certain situation and you are having intrusive disturbing thoughts. There are always some bodily sensations corresponding to these situations and thoughts. You are an anxiety sufferer and you are definitely aware of the fact that it produces these sensations within a minimal time.
With sensations, there come reactions. Actually, the reactions which occur begin automatically like a deep-rooted habit and you don’t notice that you are reacting (behaving) in certain ways.
This reaction of yours contribute to your discomfort and the discomfort increases your anxiety. This part of anxiety and panic is described in the panic cycle.
In this column, physical sensations are the main thing which has to be listed. They can be,
- Feeling Butterflies in the stomach.
- Chest pain.
- Sweating and hot flushes.
- Tingling in the body.
- Shortness of breath or feeling suffocation. Etc.
Now the main thing to understand is that you react to each of this sensation in a habitual pattern. The reaction is like a reflex action which is happening without your conscious decision.
For a fraction of the time you are not aware that you are resisting these sensations. Later on, you might be noticing that but the resistance reflex is always there in the beginning moments of anxiety.
So, the reactions, that is, the behaviors have to be,
- Avoiding a certain place.
- Trying to escape the situation.
- Walking slowly.
- Getting more alert.
- Praying to get relief.
4The next column is “Unhelpful thoughts or images”
Now, you have pinpointed the situation, your emotions, and mood in that situation and the corresponding sensations and reactions to the situation and feelings.
Here, you will have to think and list the unhelpful thoughts you keep in your mind during this situation. They are the thoughts that you feel are rationally unhelpful.
For example, if you are having lightheadedness in the column as a sensation and as a response to it you are thinking that “It is a sign that you are about to faint” as the reaction, you have to check the evidence for it.
You can look back and try to remember the times when you actually fainted during an anxiety attack. I guess you haven’t and you cannot remember a single such incidence. Because the reality is anxiety does not cause fainting.
So, your reaction, that is the fear of fainting can be listed under unhelpful thoughts and imageries as it is not helpful at all.
The image which you create in your mind- you collapsing on the ground because of anxiety, is not based on the reality.
Therefore, it can be listed under Unhelpful thoughts and Images.
No doubt the fear is very real in experience, but it is irrational. It is like the same as we get scared while watching a horror movie in a movie theater.
The fear is very real, but the cause of it is just a depiction of a fearful thing, not an actual dangerous situation.
If we feared only dangerous situations, we would not get scared by horror movies and horror story books. Because horror movies and storybooks are not life threating things. Isn’t it?
5The next column reads, “Alternative/Realistic thought. More Balanced Perspective”
Now that you have realized that the thoughts that you harbor in your mind are not based on the reality. They are just based on just how it feels. When they are tested for proof it turns out that they are not at all true!!!
So now, you have got a choice to think alternatively, realistically and in a balanced perspective which will help you reduce your distress.
Taking the example above you can write that “I have never fainted during panic before. Even all the anxiety experts say that it is highly impossible to faint in anxiety. I can believe them as all of them together cannot lie about that. They say what science says.”
The questions you can ask yourself:
- What would someone else say about this situation?
- What is the bigger picture?
- Is there another way to look at it?
- What advice would I give to someone else in this situation?
So, this way you identify the difference between your anxious thinking and the reality of anxiety.
6The last column asks, What I did / What I could do / Defusing technique /What’s the best response? Re-rate Emotion 0-100%.
By the time you arrive on this step, you realize that you were behaving in a way that increased your anxiety instead of curbing it.
Consequently, you decide to change your responses and later you noted them down in the “Sensations and Reactions” column.
For example, the reactions you chose were:
- You sat on a nearby bench instead of escaping from the market.
- You tried to relax and focused on slow and steady breathing.
- You focused on the positive thoughts instead of negative thoughts.
- You chose not to overthink.
So this time as yo behave differently, you learn something new which you haven’t done for a long time. You can see that the fear and discomfort has gone down from 90% to 40%.
What did you learn:
- You can endure the anxiety and panic attack symptoms.
- Anxiety and panic are temporary conditions and that they pass as you relax.
- When you decide not to overthink anxiety usually does not intensify.
- A way to eliminate intrusive thoughts in anxiety and panic attacks.
- Anxiety and panic are not dangerous as you were thinking.
The reactions which were responsible for your learning required:
- Daring/courage to face anxiety.
- Belief in the paradoxical method to relieve anxiety.
- A belief that it anxiety or panic is not permanent.
The habit which you gradually begin to break is:
Thinking catastrophically during anxiety and panic.
It will be difficult at first because you have been so habitual to react in those ways that it was like you were hard-wired to react in those ways.
So it will take time and effort.
The change may take some time to show.
The success of this exercise depends on the practical actions you take to change your thinking during your anxious episodes. Mere writing the sheet does not produce the desired result.
Mere writing the sheet does not produce the desired result.
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