CBT for Anxiety: Top Tips

Exposure and Response Prevention

Each avoidance/safety- seeking behaviour makes the problem worse! Show the patient that their fears are without foundation in reality. Set up a graded hierarchy and coach the patient up the ladder towards normal response via graded exposure.

Modify Fearful Cognitions

  1. Ask questions to identify irrational thoughts

2. Help patients scrutinise the thoughts and check out the evidence

Breathing Training

  1. Explain difference between anxiety driven vs normal breathing.

2. Instruct her on ways to slow down the breathing to normal

Positive Imagery

1. Help patient to find 2 to 5 calming, soothing scenarios. E.g. beach, countryside

2. Coach patient to relax into the imagery by frequent practice.

Behavioural Contracts

Develop contract with patient to carry out tasks to reduce anxiety.

Tips: written contract better than verbal; always be specific (no escape clause!); always check their homework!)

Coping Cards

Use 3x5" index cards to record:

Side 1: the problem

Side 2: bulleted points on how best to deal with the problem (Tip: aim for 3 – 6)


Show patient both "in vitro" and "in vivo" ways of facing and overcoming anxiety; be positive, affirming and challenging.

Relaxation Training

Teach patient how to systematically tense and relax different muscle groups. Tip: insist on regular practice… the goal is 0% tension!

Professor Jesse Wright, Louisville, Kentucky

Comments, Suggestions and Questions are always welcome. You can reach me on: jwright@iglou.com