Cognitive Training
The cognitive component of CBT is focused on the specific thoughts that accompany anxiety. The central premise of cognitive work is that it is a person's interpretations of a feared situation rather than the situation itself that determine the degree of anxiety experienced. Individuals are taught to notice the specific "anxious thoughts" that they are having, and to write them down. For example, a person worried about his health might write "I have no energy lately. What if I have cancer?" This task of thought monitoring alone often results in reduced anxiety. Looking at their thoughts on paper allows the person to experience some "distance" between themselves and the thoughts, making the thoughts less compelling. The next step in cognitive training is to evaluate the thoughts to determine whether or not they include distortions or logical errors. People with excessive anxiety often engage in a number of characteristic types of distorted thinking. Two examples include overestimation of probability and catastrophizing.
Overestimating the probability that things will go wrong or that something bad will happen may be the most common thinking error associated with anxiety. For example, you might believe that it is very likely that your home will be burglarized if you forget to lock your door, even though there is a very low crime rate in your neighborhood. Similarly, many people who worry about flying believe that it is quite likely that the plane they are flying on will crash, even though they may be more likely to win the lottery than to be killed in a plane crash.
"Catastrophizing" is a term used by cognitive therapists to describe the anxious person's tendency to anticipate extreme outcomes or to view unfortunate events as "catastrophic" and beyond their ability to cope. An example would be the traveler who thinks "If I miss my connecting flight, I don't know what I'll do!"
Cognitive therapists teach their clients to counter these distorted thoughts. In the case of overestimated probability, the thought is viewed as a hypothesis rather than as a fact. Clients learn to "challenge" the thought by reviewing all of the available evidence to determine whether or not the thought is supported by the facts. Alternative interpretations of the facts are explored. When individuals are catastrophizing, they are asked to imagine the "worst case scenario" regarding their fears, and then to evaluate exactly how bad this would actually be, and how they might be able to cope with such an event. In addition, clients are encouraged to come up with a list of any other possible outcomes besides the "worst case scenario."
Many people mistakenly view the goal of cognitive therapy as coming to see a negative event as positive or neutral. Rather, cognitive therapy is about seeing events realistically. The goal is to change the pattern of thinking from "This event will probably happen and it will be awful! I will be devastated, and my life will never be the same!" to "This event, while unlikely to occur, would be very unpleasant. However, it would be manageable, and its effects would be time limited." While cognitive training has been shown to be helpful to many people suffering from anxiety problems, many people find it difficult to change their thoughts, even when they recognize that they are distorted or irrational. The findings of several studies of cognitive training have suggested that much of the benefit of this approach may lie in the process of recording and observing thoughts, thereby obtaining a degree of "distance" between thinker and thought, rather than from actually changing thoughts using cognitive techniques. Obtaining this "distance", rather than struggling to change thoughts is the focus of acceptance and commitment therapy and the LLAMP approach.