Best CBT Techniques for Anxiety (With Examples)

Cognitive Behavioral Therapy (CBT) offers practical, effective, evidence-based strategies to help clients manage anxiety by addressing the cognitive, emotional, and behavioral elements that contribute to it. The following are evidence-based, impactful CBT techniques that therapists should consider when working with anxious clients.

Cognitive Restructuring (Challenging Negative Thoughts)

This core CBT technique enables clients to recognize and change automatic, distorted thought patterns that contribute to anxiety and stress. By actively questioning and reframing problematic thoughts, clients learn to shift from rigid, unhelpful beliefs to more balanced, constructive perspectives, reducing emotional distress and enhancing coping skills.

Cognitive restructuring directs clients to follow these steps:

1. Identify the Thought: Pinpoint the specific thought causing distress. For example, a client may think, “I’ll embarrass myself when I present at the conference.”

2. Examine the Evidence: Gather factual evidence for and against the negative thought. The therapist might ask, “Have you succeeded in similar situations before?” or “Have others offered feedback about your presentation skills?” Clients frequently realize that their fears are not based on facts but rather on automatic, anxious responses.

3. Generate Alternative Thoughts: Encourage clients to create balanced and realistic thoughts. For instance, they might replace “I’ll fail at this presentation!” with “I’m prepared, and I’ve successfully presented in the past,” which reduces the emotional charge of the original thought and supports a more realistic perspective.

Example: Challenging Fear of Failure

Sergio thinks, “I’ll fail at this presentation. I know I will embarrass myself in front of hundreds of people!”

With cognitive restructuring, the therapist helps Sergio:

• Identify the thought causing anxiety.

• Gather evidence by discussing past presentations where the client managed well, possibly receiving positive feedback.

• Generate alternative thoughts such as “I’ve prepared for this, and I’ve successfully managed similar challenges before,” reducing the immediate anxiety response.

Sergio uses the “Thought Record” worksheet to record:

• Anxiety-inducing situations (e.g., upcoming presentation)

• Automatic negative thoughts (e.g., “I’ll embarrass myself!”)

• Alternative, balanced thoughts (e.g., “I’m well-prepared and have done this before”)

Using the “Thought Record” tool daily increases resilience by training Sergio to spot and reframe automatic negative thoughts as they arise, leading to more adaptive emotional responses over time (Beck, 2011; Leahy, 2017).

Studies have shown that consistently challenging and reframing negative thoughts can reduce cognitive distortions, enhance emotional well-being, and decrease symptoms of anxiety (Hofmann et al., 2012). Practicing this technique daily helps solidify new, balanced thinking patterns, making it easier for clients to approach anxiety-inducing situations with greater confidence and less distress.

Behavioral Experiments

By engaging in structured, real-world activities, clients test and challenge the beliefs and assumptions driving their fears and gain a new understanding of how their predictions differ from actual outcomes. An experiential approach helps clients change their beliefs through lived experiences, making the changes more impactful and long-lasting.

By engaging in low-stakes, controlled interactions, clients experience the difference between their anticipated and actual outcomes, which often reveals their fears are exaggerated or unfounded. Over time, behavioral experiments reduce anxiety, encourage adaptive behaviors, and reinforce new beliefs based on evidence rather than assumptions (Wells, 1997; Bennett-Levy et al., 2004).

Example: Testing Social Anxiety Assumptions

Sue has social anxiety, as she fears others will judge her harshly in social settings. A simple behavioral experiment might involve Sue initiating a short conversation with a cashier.

The therapist would guide Sue in:

1. Predicting the Outcome: Before initiating the conversation, Sue makes a specific prediction, such as, “The cashier will think I’m awkward.”

2. Engaging in the Experiment: Sue completed the action by speaking briefly with the cashier.

3. Debriefing and Reflecting: The therapist and Sue discuss what actually happened versus the initial prediction. Sue discovered the cashier reacted neutrally, challenging Sue’s belief about being judged.

This process illustrates the discrepancy between feared and real outcomes, reinforcing that clients' social fears may not be as accurate or pervasive as they initially thought.

Therapists can collaborate with clients to develop a graded hierarchy of situations based on anxiety levels, starting with low-stakes experiments and gradually progressing to more challenging ones. This hierarchy helps clients feel safe while testing beliefs, which reduces the chance of overwhelming them. For instance, a social anxiety hierarchy might begin with:

• Smiling at a stranger.
• Making small talk with a cashier.
• Introducing oneself to a group of people.

Each experiment is reviewed for learning rather than “success,” helping clients appreciate the effort and insight gained regardless of the outcome (Rachman, 2012). Debriefing each experiment allows clients to reflect on their achievements, adjust future goals, and reshape their beliefs.

Behavioral experiments have shown effectiveness in treating a range of anxiety disorders, especially social anxiety and obsessive-compulsive disorder.

Exposure Therapy

This structured approach helps clients systematically confront feared situations, allowing them to desensitize to anxiety triggers through repeated, controlled exposure. By gradually facing the source of their anxiety in a safe environment, clients learn that they can manage and reduce their anxiety responses.

Example: Public Speaking Anxiety

Freddie experiences severe anxiety about public speaking. Together with his therapist, Freddie develops a gradual exposure plan.

1. Reading Aloud Alone. Freddie starts by reading a short passage out loud to himself. This initial step allows him to get used to hearing his voice project, addressing his baseline anxiety about speaking out loud.

2. Reading Aloud to a Friend: Once Freddie feels comfortable reading alone, he practices reading a passage to a trusted friend. This step introduces a minor social element while keeping the environment supportive.

3. Recording Himself Speaking: Freddie records himself delivering a short talk on his phone, listens to it afterward, and reflects on how he sounds. This helps him get comfortable with how others might perceive his voice and delivery.

4. Speaking to a Small Group of Family or Close Friends: Next, Freddie practices giving a short presentation to a small, familiar group. This increases the challenge slightly, helping him build confidence and manage his anxiety in a safe, supportive setting.

5. Presenting to Colleagues in a Low-Stakes Meeting: When Freddie feels more comfortable, he schedules a brief presentation in a low-stakes setting at work, such as an informal team meeting. He keeps the presentation short, focusing on reducing his anxiety and accepting the experience without pressure to be perfect.

6. Gradually Increasing Audience Size and Presentation Duration: Freddie progresses to more formal presentations with larger groups, gradually building up to high-stakes situations, such as delivering a full presentation to a large audience at a conference.

Therapist Tips

• Teach clients relaxation strategies, like deep breathing, grounding exercises, or progressive muscle relaxation, to use before and during each exposure step. Practicing these techniques helps him manage physical anxiety symptoms.

• Encourage clients to celebrate each milestone. Recognizing progress, even small steps, helps reinforce the client’s commitment to the process.

• Remind clients that setbacks are a natural part of exposure therapy. Anxiety may spike, especially at new stages, but each exposure gradually diminishes the anxiety response.

• Encourage clients to keep journals of their experiences, noting how they felt during and after each exposure. Reflecting on their progress can help them see how far they’ve come, building their confidence.

Mindfulness-Based Cognitive Therapy (MBCT)

Mindfulness helps clients detach from anxious thoughts, reducing reactivity by focusing on the present rather than getting caught up in fears of the future or ruminations about the past.

Example: Client with Generalized Anxiety Disorder (GAD)

Freda struggles with GAD, which causes her to feel persistent and overwhelming anxiety about many aspects of her daily life. During therapy sessions, her anxious thoughts often become overwhelming, making it hard for her to focus on the present moment. To help Freda regain control and shift her focus away from anxious thoughts, her therapist introduced a grounding exercise called the “5-4-3-2-1” technique.

Step-by-Step Guide to the “5-4-3-2-1” Grounding Exercise

1. Five Things She Can See: Freda is asked to look around the room and identify five things she can see. This could include noticing a painting on the wall, her therapist’s notebook, the color of the rug, the texture of the couch, and a plant in the corner. This visual focus helps to anchor her in her surroundings.

2. Four Things She Can Touch: Next, Freda is encouraged to identify four things she can physically touch. She might touch the soft fabric of her sweater, run her fingers over the smooth leather of the chair, feel the warmth of her coffee cup, and press her feet firmly against the floor. By engaging her sense of touch, Freda reconnects with her physical space.

3. Three Things She Can Hear: Freda then closes her eyes and listens for three sounds in her environment. She may hear the hum of the air conditioner, the ticking of the clock, and the faint sound of cars passing outside. Focusing on sounds outside her body helps draw her attention away from her internal anxious thoughts.

4. Two Things She Can Smell: Freda is asked to identify two scents. She may smell her lavender-scented hand lotion or the aroma of her herbal tea. Engaging her sense of smell is grounding, as it connects her to calming sensory details.

5. One Thing She Can Taste: Finally, Freda takes a small sip of her tea, noticing the warmth and flavor as it touches her tongue. This taste sensation completes the exercise, bringing her full awareness of her immediate sensory experience.

Freda uses this technique both in and outside of therapy sessions. It’s especially helpful when she feels overwhelmed in daily situations, like walking to the bus stop or shopping at the grocery store. Freda takes a calming breath between each step to create a natural rhythm and allow time for her senses to reset.

Through consistent practice, Freda learns to rely on the “5-4-3-2-1” exercise as a go-to technique for interrupting anxious thought spirals. This exercise allows her to reorient to her environment and feel more present and grounded. This technique helps Freda gradually manage her GAD symptoms more effectively, building her confidence in handling everyday challenges.

Note: Mindfulness takes time and consistency to become effective. To make mindfulness accessible, suggest brief daily practices, like focusing on breathing or tuning into the senses. Encourage clients to track their progress and discuss their experiences.

Visualization and Guided Imagery

Visualization leverages the power of imagination to create a calm mental space or prepare for anxiety-inducing events, reducing anxiety through mental rehearsal.

Example: Social Anxiety

Clyde feels intense anxiety when he’s invited to parties, especially when he doesn’t know most of the people attending. He worries about making small talk, fearing that he might embarrass himself or come off as awkward. This social anxiety builds up days before an event, leaving him feeling restless and overly self-conscious, sometimes even causing him to avoid these gatherings altogether. To help Clyde face these situations more confidently, his therapist introduces techniques that allow him to mentally prepare and practice feeling at ease in social situations.

1. Creating a Positive Social Scenario

• Clyde’s therapist guides him to close his eyes, take a few calming breaths, and imagine himself at a gathering where he feels comfortable and confident. Clyde imagines arriving at a cozy get-together, seeing friendly faces, and feeling calm.

• To make the visualization vivid, the therapist encourages Clyde to focus on what he can see, hear, feel, and even smell. Clyde pictures himself warmly greeted by a host, hears light conversation in the background, feels the comforting weight of a drink in his hand, and smells the scent of food being served.

2. Practicing Positive Interactions

• Clyde imagines introducing himself to someone new and chatting naturally about shared interests. He envisions himself listening attentively, smiling, and contributing to the conversation with confidence.

• Clyde’s therapist guides him to visualize moments where he might not know what to say right away and calmly laugh it off or ask a question, practicing a relaxed response. This helps Clyde feel prepared for these situations if they arise.

3. Developing a Pre-Event Ritual

• Clyde’s therapist encourages him to repeat this visualization exercise before an upcoming event, focusing on calming his mind and visualizing a positive experience. This pre-event ritual helps him approach the situation with less anxiety and more self-assurance.

• Clyde uses visualization regularly, not just before parties. Practicing often helps reinforce feelings of calm and confidence. After visualizing, the therapist guides Clyde to take a deep breath and feel gratitude for the positive interaction he just imagined, reinforcing a sense of accomplishment. The therapist reminds Clyde to practice self-compassion, accepting that anxiety may still arise but that he can manage it. Through consistent practice, Clyde builds confidence at parties, feeling more grounded and able to approach events without paralyzing anxiety.

Thought-Stopping

This tool allows clients to interrupt and defuse spiraling anxious thoughts, helping them regain control over their thinking patterns (Clark & Beck, 2010).

Example: Obsessive-Compulsive Disorder (OCD)

Cece struggles with OCD and often finds herself caught in repetitive, distressing thoughts about contamination. She worries excessively about germs, leading to compulsive handwashing. These spiraling thoughts consume her focus, making it challenging for her to function. To help Cece interrupt and defuse these spiraling thoughts, her therapist introduces her to the Thought-Stopping Technique, which encourages her to control her thinking patterns.

1. Using “Stop” to Interrupt the Thought Cycle

• Each time Cece notices herself starting to spiral with a thought like, “I touched something contaminated, and now I’m going to get sick!” she practices firmly saying “Stop!” either out loud or in her mind. This interruption serves as a mental signal that she can choose to break the cycle of anxious thoughts.

• If the thought returns, Cece repeats the “Stop!” command, reinforcing her ability to pause and redirect her thinking.

2. Following Up with Grounding and Affirmation

• After saying “Stop,” Cece shifts her focus to a grounding activity, such as pressing her feet into the floor and feeling its firmness or focusing on her breath by counting her inhales and exhales. This grounding technique helps Cece refocus on her body and the present moment, creating space from her obsessive thoughts.

• Cece’s therapist encourages her to follow up with a calming phrase, such as “I am in control,” “I am safe,” or “I don’t need to act on this thought.” These affirmations reassure her, helping her detach from the thought’s intensity.

3. Building a Personalized List of Affirmations

• Cece works with her therapist to create a list of affirmations tailored to her specific anxieties. Examples include: “This is just a thought, not a fact,” “I am okay in this moment,” or “I am stronger than my anxiety.” With affirmations ready, Cece can quickly reinforce a calming response after each thought-stopping instance.

4. Setting Small, Manageable Goals

• Cece’s therapist encourages her to practice thought-stopping in various settings, starting in low-stress situations like home. Once she feels comfortable, she practices it when encountering slightly more challenging scenarios, such as visiting a friend’s house.

Cece uses the thought-stopping technique every time she feels an anxious thought begin to spiral. Regular practice helps reinforce the technique's effectiveness. Cece keeps a journal of her successes with thought-stopping and any remaining challenges. Reflecting on her progress can help her see improvement, building her confidence. The therapist reminds Cece that detaching from obsessive thoughts takes time and effort, and it’s normal for difficult days to happen. Acknowledging her effort and progress, however small, can make the process feel more manageable. By practicing the thought-stopping technique regularly, Cece can gain a stronger sense of control over her thoughts, gradually lessening the grip of her OCD symptoms on her daily life. This technique empowers her to respond to her anxiety with calm and control.

Self-Monitoring and Journaling

Clients build awareness of their anxiety patterns and triggers when they self-monitor, offering insights that support growth and treatment progression.

Example: Client That Constantly Worries

Carlos struggles with persistent worries that often interfere with his daily life. He ruminates about work, relationships, and health, leaving him tense and exhausted. To help Carlos better understand and manage his worries, his therapist introduces the practice of keeping a Worry Journal.

1. Daily Logging

• Carlos’s therapist asks him to record his worries in his journal for 5-10 minutes at the end of each day. He writes down situations that triggered his anxiety, the specific thoughts that arose, and any physical sensations (like a racing heart or muscle tension).

• Carlos might record worries like, “I’m afraid I won’t meet my project deadline” or “I keep thinking I have cancer.” Over time, these entries will help Carlos and his therapist identify recurring themes in his anxieties.

2. Reviewing Patterns Together

• In sessions, Carlos and his therapist review his worry log to identify patterns. They notice that Carlos’s worries often revolve around uncertainty at work and health-related concerns.

• With these insights, the therapist and Carlos develop coping strategies designed for his main worry themes, such as practicing problem-solving skills for work-related anxieties and using grounding exercises to address health-related fears.

3. Tracking Progress and Building Self-Compassion

• Carlos’s therapist emphasizes that the journal isn’t for self-criticism but a tool for reflection and growth. They review entries to note any reduction in worry intensity or improvement in coping skills.

• By observing his progress, Carlos can see that he’s making strides in managing his worries and developing a more compassionate view of himself and his efforts.

• Carlos sets a reminder to journal at the same time each day to build a routine. His therapist reminds him that anxiety may fluctuate and that experiencing more worries on some days is natural. The journal helps him understand these fluctuations without judgment. Carlos notes the instances in which he successfully manages his anxiety, reinforcing his ability to handle challenging situations. Through consistent journaling, Carlos gains insight into his worry patterns, allowing him and his therapist to develop targeted coping strategies that increase his ability to manage his anxiety.

Conclusion

CBT offers a powerful toolkit for managing anxiety, with techniques that address both the cognitive and behavioral aspects. By introducing clients to CBT techniques, therapists can help them build lasting resilience. Clients will respond differently to these techniques, so flexibility and a personalized approach are vital.

References

Beck, J. S. (2011). Cognitive Behavior Therapy: Basics and Beyond (2nd ed.). The Guilford Press.

Bennett-Levy, J., Butler, G., Fennell, M., Hackmann, A., Mueller, M., & Westbrook, D. (2004). Oxford Guide to Behavioural Experiments in Cognitive Therapy. Oxford University Press.

Clark, D. M. (2001). A Cognitive Perspective on Social Phobia. In International Handbook of Social Anxiety (pp. 405–430). Wiley.

Clark, D. A., & Beck, A. T. (2010). Cognitive Therapy of Anxiety Disorders: Science and Practice. The Guilford Press.

Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive Therapy and Research, 36(5), 427–440.

Leahy, R. L. (2017). The Worry Cure: Seven Steps to Stop Worry from Stopping You. Harmony.

Wells, A. (1997). Cognitive Therapy of Anxiety Disorders: A Practice Manual and Conceptual Guide. Wiley.